International Study of Asthma and Allergies in Childhood (ISAAC): rationale and methods

Maternal asthma during pregnancy and risks of allergy and asthma in progeny: A systematic review and meta-analysis

BACKGROUND

Clinical and preclinical evidence indicate that in utero maternal asthma exposure increases progeny asthma risk. Whether maternal asthma also increases the risks of progeny allergy is unclear.

OBJECTIVES

To synthesise the available evidence on the relationship between in utero exposure to maternal asthma and postnatal asthma, wheezing and allergic diseases (Prospero: CRD42020201538).

SEARCH STRATEGY

We systematically searched MEDLINE [PubMed], Embase [Ovid], Web of Science, Informit Health, the Cochrane Library, CINAHL [EBSCOhost], MedNar [Deep Web Technologies], ProQuest Theses and Dissertations, Scopus [Elsevier] and Trove, to the end of 2023.

SELECTION CRITERIA

Studies reporting asthma, wheeze and/or allergic disease in progeny of women with and without asthma or with asthma classified by control, exacerbation or severity.

DATA COLLECTION AND ANALYSIS

Double screening, selection, data extraction and quality assessment were performed, using Joanna Briggs Institute (JBI) scoring.

MAIN RESULTS

Of 134 non-overlapping studies, 127 were included in ≥1 meta-analysis. Maternal asthma ever was associated with greater risks of asthma (65 studies, risk ratio [95% confidence interval] 1.76 [1.57-1.96]), wheeze (35 studies, 1.59 [1.52-1.66]), food allergy (5 studies, 1.32 [1.23-1.40]), allergic rhinitis (7 studies, 1.18 [1.06-1.31]) and allergic dermatitis (14 studies, 1.17 [1.11-1.23]) ever in progeny. Asthma during the pregnancy, more severe, and uncontrolled maternal asthma were each associated with greater risks of progeny asthma.

CONCLUSIONS

Children of mothers with asthma are at increased risk for the development of allergic diseases. Whether improved maternal asthma control reduces risks of child allergy as well as asthma requires further investigation.

The severity of the first occurrence of bronchiolitis increased the risk of developing asthma symptoms

AIM

The relationship between bronchiolitis and asthma is complex. We assessed whether patients admitted to a paediatric intensive care unit (PICU) with bronchiolitis had a greater risk of developing asthma than patients admitted to a paediatric ward.

METHODS

We retrospectively included children under 1 year of age, who were hospitalised for bronchiolitis for the first time at the University Hospital of Caen, France, between 2010 and 2014. The children were divided into two groups: 89 were admitted to the paediatric ward and 89 were admitted to the PICU. We wanted to assess which group developed more asthma before 6 years of age. The Global Initiative for Asthma definition was used.

RESULTS

The median age of the 178 children (55% boys) was 32 (interquartile range 19-56) days. We found that 35% of the PICU group and 19% of the ward group had asthma at 6 years of age. The mean onset of symptoms was 3 years earlier in the PICU group than the ward group (p < 0.01). Both these findings were significant.

CONCLUSION

The severity of the first episode of bronchiolitis increased the risk of developing asthma symptoms. Regular follow-ups are suggested for infants admitted to PICUs for bronchiolitis.

Single-cell profiling demonstrates the combined effect of wheeze phenotype and infant viral infection on airway epithelial development

The development of the airway epithelium in asthma is unclear. We characterized nasal airway epithelial cell (NAEC) developmental phenotypes from children aged 2 to 3 years in an a priori designed nested birth cohort from four mutually exclusive groups of wheezers/nonwheezers and respiratory syncytial virus (RSV)-infected/uninfected in the first year of life. NAECs were differentiated, followed by single-cell RNA sequencing analysis and in vitro RSV infection. Gene expression of NAECs from children with a wheeze phenotype indicated abnormal differentiation and basal cell activation of developmental pathways, plasticity in precursor differentiation, delayed onset of maturation, increased diversity of RSV receptors, and blunted antiviral immune responses to in vitro RSV infection. The most marked changes in differentiation were observed in NAECs from children with both wheeze and RSV in the first year of life. Together, this suggests that airway epithelium in children with wheeze is developmentally reprogrammed and characterized by increased barrier permeability, decreased antiviral response, and altered RSV receptor expression.

Antenatal depressive and anxiety symptoms in early pregnancy and offspring allergic diseases during toddlerhood

BACKGROUND

While maternal psychological stress during mid-to-late pregnancy has been linked to offspring allergies, the impact of early pregnancy distress remains unclear. This study investigates the association between maternal depressive and anxiety symptoms in early pregnancy and allergic diseases in offspring.

METHODS

Based on a birth cohort of 5263 children, antenatal depressive and anxiety symptoms in early pregnancy were assessed via the Patient Health Questionnaire and Generalized Anxiety Disorder Questionnaire, respectively. Allergic outcomes, including asthma, atopic dermatitis (AD), and allergic rhinitis (AR), were evaluated via structured questionnaires. Relative risks (RRs) with 95% confidence intervals (CIs) were estimated via generalized linear models, whereas restricted cubic splines were used to explore linear and non-linear associations between maternal distress and allergic outcomes.

RESULTS

Maternal depressive symptoms in early pregnancy were associated with an increased risk of AD [adjusted RR (95% CI) = 1.15 (1.03-1.29)] and AR [1.52 (1.29-1.79)]. Maternal anxiety symptoms in early pregnancy were associated with increased risks of AD [1.11 (1.02-1.21), mild anxiety] and AR [1.33 (1.04-1.68), moderate to severe anxiety]. Dose‒response analyses revealed graded relationships between distress severity and allergic outcomes. In the joint analysis, comorbid depression and anxiety in early pregnancy were associated with an increased risk of AD [1.15 (1.05-1.26)] and AR [1.42 (1.23-1.63)]. Subgroup analysis revealed a greater risk of asthma for boys born to mothers with mild anxiety [1.95 (1.20-3.15)] but not for girls.

CONCLUSION

Maternal distress in early pregnancy is associated with an increased risk of allergic diseases in offspring during toddlerhood.

Worsening asthma at school is associated with poor psychosocial well-being

Objective

To study whether worsening asthma at school was related to generic health-related quality of life (HRQoL) and asthma-related impact and worry among 15-year-olds with current asthma in Sweden. In addition, we studied the association between worsening asthma at school at age 15 and the change in the degree to which asthma interfered with daily activities between ages 15 and 19 years.

Methods

Within the Obstructive Lung Disease in Northern Sweden (OLIN) studies, a cohort of schoolchildren has been followed from age 8 years until 19 years of age. In the current study, the sample included 266 adolescents with physician-diagnosed asthma, and either wheeze or use of asthma medication during the last 12 months at age 15 years.

Results

At age 15, HRQoL scores were lower among those who reported worsening asthma at school (standardised beta (β) =  -0.18, p = 0.003), they had more asthma-related worries (β =  -0.33, p < 0.001) and asthma impacted their life during activities more (β =  -0.46, p < 0.001) than those whose asthma did not worsen. Furthermore, the more adolescents reported that asthma worsened at school at age 15, the more it was associated with the increase in the degree to which asthma interfered with their activities between 15 and 19 years (β = 0.14, p = 0.038).

Conclusions

Worsening asthma at school was associated with lower generic health-related quality of life, higher asthma-related worry and impact on daily activities among teenagers with asthma.

A Greater Adherence to the Mediterranean Diet Supplemented with Extra Virgin Olive Oil and Nuts During Pregnancy Is Associated with Improved Offspring Health at Six Years of Age

Background/Objectives: Children's health may be influenced by maternal eating habits during pregnancy. A Mediterranean diet (MedDiet)-based pattern has been associated with benefits in infectious disease and allergies in children. Methods: From a total 2228 pregnant women evaluated between 2015 and 2017 in the St. Carlos cohort, 1292 women belonging to the intervention group (IG) undertook a MedDiet supplemented with extra virgin olive oil (EVOO) and nuts from early on in pregnancy. The control group (CG) consisted of 516 pregnant women who were advised to follow a fat-restricted MedDiet. The modified 12-point Mediterranean diet adherence screener (MEDAS) was applied. A total of 1808 (81.2%) children were analyzed at 6 years postpartum. All women from both groups received the same postpartum nutritional recommendations as the IG had during pregnancy. Results: Children from the IG showed lower rates of bronchiolitis and atopic eczema compared to the CG. Children whose mother's MEDAS score was ≥6 at 24-28 GW vs. MEDAS scores < 6 presented lower rates of bronchiolitis [222/695 (28.8%) vs. 441/1113 (39.6%); p = 0.022] and atopic eczema [311/695 (39.0%) vs. 564/1113 (50.7%); p = 0.039]. The offspring of mothers with MEDAS scores ≥ 8 (n = 176) vs. MEDAS scores ≤ 3 (n = 564) showed a lower relative risk (RR) (95% CI) for developing bronchiolitis [0.75 (0.58-0.97)] and atopic eczema [0.82 (0.69-0.98)], with both having a p < 0.001 trend. Conclusions: A higher adherence to a MedDiet supplemented with EVOO and nuts during pregnancy is associated with health benefits in offspring at 6 years of age.

Development of respiratory allergic diseases according to cow's milk protein allergy mechanisms

BACKGROUND

Cow's milk protein allergy (CMPA) is early life's most common food allergy. There is limited data on the development of respiratory allergies in childhood for infants with CMPA.

OBJECTIVE

This study aimed to evaluate the development of respiratory allergic diseases in childhood according to the mechanism of CMPA in patients with CMPA in the first two years of life.

METHODS

Patients who were diagnosed with CMPA in the first two years of life and were over five years old during the study period were included in the study. The sociodemographic, clinical, and laboratory data of patients were recorded, and the status of respiratory allergic disease development in patients was assessed using the ISAAC questionnaire.

RESULTS

A total of 301 patients were included in the study; 182 (60.5%) were male. Most of the patients had mixed-type (87;28.9%) and had non-IgE-mediated (n:87;28.9%) CMPA. Of CMPA cases, 27.9% developed doctor-diagnosed asthma and 31.2% developed doctor-diagnosed allergic rhinitis. Doctor-diagnosed asthma was observed mostly with IgE-mediated CMPA (n:30;37%), and doctor-diagnosed allergic rhinitis was observed mostly with non-IgE-mediated CMPA (n:32;36.8%), and these differences were not statistically significant (p = 0.094, p = 0.385). Also, maternal asthma increased the risk of doctor-diagnosed asthma, while parental consanguinity, allergic rhinitis in mother/sibling, and paternal eczema were risk factors for doctor-diagnosed allergic rhinitis.

CONCLUSION

In this study, 27.9% of patients with CMPA in the first two years of life developed doctor-diagnosed asthma, and 31.2% developed allergic rhinitis. There was no difference in the frequency of occurrence based on the mechanism of CMPA development.

Long-Term Pulmonary Sequelae 5-14 Years After Protracted Bacterial Bronchitis in Early Childhood

BACKGROUND

There is little information about long-term changes in pulmonary function tests (PFTs) many years after protracted bacterial bronchitis (PBB), the most common cause of chronic wet cough in early childhood.

METHODS

Of 200 consecutively recruited children with a previously proven diagnosis of PBB 62 (12.2 years, female 48%) were interviewed after 7.7 (5.4-14.7) years about their previous and current symptoms and pulmonary function tests (PFTs: spirometry, body plethysmography, nitrogen multi-breath washout, exhaled nitric oxide and nasal nitric oxide) were performed. Children with persistent symptoms were offered lung imaging.

RESULTS

11 (17.7%) patients suffered from chronic or recurring wet cough years after their first PBB episode. 15 (24.19%) had at least one abnormal spirometry parameter. FEV1 was abnormal in eight of 62 (12.9%), LCI 2.5% in seven of 56 (12.5%), FVC in 12 of 62 (19.35%) and FEV1/FVC in five of 62 (8.06%) cases. PFT did not differ between children with and without wet cough. Lung MRI/CT demonstrate in four of nine cases abnormalities of the bronchial walls, including one with incipient bronchiectasis.

CONCLUSION

After PBB in early childhood, a significant proportion of children suffer from respiratory symptoms many years later, some have an objectively reduced lung function and structural changes of the bronchial wall despite adequate initial therapy. Wet cough alone seems not to be a sensitive clinical predictor. Due to the retrospective study design, we cannot proof any causal relationship. However, to detect late bronchopulmonary sequelae, continuous follow-up of these children should become mandatory.

The Effect of Being Born Moderate to Late Preterm on Lung Function and Respiratory Morbidity at 9 to 10 Years of Age

Rationale: The effect of moderate to late preterm (MLP) birth (32-36 completed weeks' gestation) on childhood respiratory health is unclear. Objectives: To assess the effect of being born MLP, compared with being born at term (≥37 completed weeks' gestation), on lung function and respiratory morbidity at 9-10 years of age. Methods: A prospective cohort study was conducted among children born MLP or at term at the Royal Women's Hospital (Victoria, Australia). Participants completed pre and postbronchodilator spirometry, measurement of diffusing capacity of the lung for carbon monoxide, plethysmography, and multiple-breath washout at 9-10 years of age. Parents completed the ISAAC (International Study of Asthma and Allergies in Childhood) questionnaire. Mean differences in z-scores of lung function outcomes and risk ratio for ISAAC outcomes between those born MLP and those born at term were estimated using regression models with adjustment for potential confounding. Multiple imputation was used to handle missing data. Results: A total of 148 of 201 children born MLP and 120 of 201 term-born control subjects were assessed at 9-10 years. Compared with control subjects, children born MLP had lower mean z-scores for forced expiratory volume in 1 second (mean difference, -0.35 [95% confidence interval (CI), -0.61 to -0.08]), ratio of forced expiratory volume in 1 second to forced vital capacity (mean difference, -0.29 [95% CI, -0.58 to -0.01]), forced expiratory flow at 25-75% of forced vital capacity (-0.33 [95% CI, -0.62 to -0.04]), and diffusing capacity of the lung for carbon monoxide (-0.24 [95% CI, -0.45 to -0.03]). Participants born MLP had higher risk of experiencing asthma symptoms (risk ratio, 1.52 [95% CI, 1.08-2.14]). Conclusions: Children born MLP have lower lung function and increased risk of exhibiting asthma symptoms compared with term-born peers at 9-10 years. Such findings at the end of the first decade of life may portend adverse consequences for respiratory health in adulthood.

Evaluation of the frequency of allergic diseases in pediatric patients with juvenile idiopathic arthritis

Objective: Allergic diseases are characterized by a T-helper type 2 (Th2) dominant immune response, whereas juvenile idiopathic arthritis (JIA) is an autoimmune condition attributed to the Th1 pathway of CD4+ T cells. Reciprocal inhibition between the Th1 and Th2 responses is proposed to result in mutual exclusion of their polarized immune responses and associated diseases. This study aimed to ascertain the frequency of allergic diseases among children with JIA. Methods: The International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire was used to assess symptoms of allergic diseases in children with JIA and a control group of children with no known autoimmune diseases. The presence of current wheezing, allergic rhinitis and/or rhinoconjunctivitis symptoms, eczema symptoms, and food allergy symptoms were assessed based on affirmative answers. Results: The ISAAC questionnaire was administered to 101 children with JIA and 99 healthy controls. The median (interquartile range [IQR]) age was 12.64 years (8.83-15.83 years) in the JIA group and 11.99 years (6.65-14.90 years) in the control group. Children with JIA had lower rates of current wheezing (p = 0.003), current allergic rhinitis (p < 0.001), current rhinoconjunctivitis (p = 0.006), current atopic dermatitis (p < 0.001), and current food allergy (p = 0.005) symptoms. In addition, ever having had allergic rhinitis, wheezing, and atopic dermatitis were less common in the JIA group. In the multivariate logistic regression model, the absence of autoimmune disease in the patient and the presence of any allergic disease in the mother emerged as independent risk factors for current wheezing symptoms and current rhinoconjunctivitis and/or rhinitis. Conclusion: The results of this study demonstrated that the frequency of allergic diseases was lower in the presence of JIA, an autoimmune disease. This offers further evidence of mutual opposition between diseases that involve the Th1 and Th2 pathways, but there remains no consensus on this matter. More comprehensive studies that delve into the molecular foundations of these diseases are still needed to reach more definitive conclusions.

Lung function outcomes in adults born extremely preterm across three decades of advancing perinatal medicine

AIM

Advances in perinatal medicine from 1980 to 2000 improved survival in extremely preterm (EP) neonates. Long-term effects of these developments remain unclear, and we aimed to investigate potential cohort effects on adult lung function.

METHODS

Three 18-year-old population-based cohorts born at ≤28 weeks gestation or with birthweight ≤1000 g during 1982-85, 1991-92 and 1999-2000 and term-controls underwent spirometry, body plethysmography, and tests of lung diffusing capacity, bronchodilator reversibility, and airway hyperresponsiveness. We used Welch's t-tests to compare term- with EP-born as a group and split by bronchopulmonary dysplasia (BPD), and regression models to test group/cohort interactions.

RESULTS

In all EP-born cohorts, z-scores for FEV1, FEV1/FVC, FEF25%-75%, DLCO and KCO were reduced compared with term-born. For the 82-85, 91-92 and 99-00 cohorts, deficits for z-FEV1 and z-DLCO were 1.23 and 0.53; 0.68 and 0.92; and 0.51 and 0.57, respectively (p ≤0.01 for all). Cohort analyses showed stable lung function across the three cohorts overall, but improvements across cohorts for the BPD subgroups in z-FEV1, z-FEV1/FVC, and z-FEF25%-75%.

CONCLUSION

Adults born EP across three formative decades of neonatal care had stable lung function overall, with notable improvements in BPD subgroups across cohorts.

Questionnaire for Clinical Diagnosis of House Dust Mite's Allergy Approved by Delphi Consensus

Despite house dust mite (HDM)-allergy is the most frequent in the world, no standard questionnaire exists to help physicians in their clinical practice for screening patients with this possible diagnosis. The objective of this survey was to develop a questionnaire that could be used to identify patients with suspicion of HDM-allergy. The survey was conducted using the Delphi methodology. Nineteen international experts in allergology constituted the scientific board who established the items included in the first version of the questionnaire, defined the criteria of the selection for the next steps, and validated the final questionnaire and its interpretation. The initial version of the questionnaire included 15 items. For each item, five answers were suggested graduated by scores from "no importance" to "very high importance." The predefined conditions for the item selection after each round were a median score ≥ 7 and > 50% of responses according "high importance" and "very high importance." The electronic survey circulated within the Interasma Scientific Network platform. Eight questions based on the occurrence/worsening of symptoms induced by HDM-allergen exposure meet the survey criteria after the second and the third rounds and were included in the final questionnaire. Binomial answers for each question with 1 point accorded for "Yes" and none for "No" were suggested for the final version with a score ≥ 5 points associated with a high probability for HDM-allergy. By applying the Delphi process, we generated a brief questionnaire with binomial answers, easy to use in clinical practice for screening patients with HDM-allergy.

Effects of residential greenness during pregnancy on childhood asthma, rhinitis, eczema, and their comorbidity: findings from the French mother-child cohort Pélagie

Maternal exposure to residential greenness during pregnancy may influence childhood respiratory and allergic diseases development. Yet, evidence is limited and results are not consistent, furthermore most studies focus on urban areas. In a predominantly rural population, we aimed to assess the effect of maternal residential greenness during pregnancy on childhood asthma, rhinitis, eczema, and their comorbidity. We analyzed data from 1325 to 1119 participants in the 6- and 12-year follow-ups of the Pélagie mother-child cohort in Brittany, France. Ever asthma, rhinitis, and eczema were defined using validated questionnaires, and a multimorbidity phenotype was constructed. Greenness was assessed using the Normalized Difference Vegetation Index (NDVI) within a 300m buffer around the residential address. Adjusted logistic regressions per 0.1-unit increase in NDVI were performed, further stratifying by urban and rural areas. At inclusion, 78 % of mothers were non-smokers, 64 % lived in rural areas, and their average age was 30 ± 4 years; 50 % of children were boys. Median NDVI differed significantly between urban (0.45) and rural (0.57) areas (p=<0.0001). Asthma, rhinitis, and eczema prevalence were respectively around 10 %, 20 %, and 20 % at both follow-ups. Overall, the NDVI within 300m did not show significant associations at either follow-up, across the whole study population, except for eczema (0.87 (0.76-1.00), p=0.05), and the single-disease category of the multimorbidity phenotype (0.87, (0.76-0.99), p=0.03) at 6 years, where it showed protective associations. Our findings highlight the need for further research, particularly in rural populations, to clarify the relationship between prenatal residential greenness and childhood health outcomes.

Air pollution exposure, respiratory consequences, and perceptions among urban African children living in poor conditions - A case study in Abidjan, Côte d'Ivoire

Air pollution can severely impact child lung health but is often not considered a public health priority by policy-makers and population in low-and-middle income countries. We conducted an interdisciplinary mixed method study to assess exposure to air pollution and respiratory health on children aged 5-10 living in poorly condition in Yopougon, a district of Abidjan, Côte d'Ivoire, and to evaluate parent and child perceptions and knowledge of air pollution. We measured pollution exposure with indoor and outdoor PM10 and PM2.5 concentrations and questionnaires, assessed children's respiratory health with ISAAC questionnaire, clinical evaluation, spirometry or RINT, depending on their ability to perform a forced expiration, their perception of air pollution with a "Draw and express yourself" activity and that of parents with semi-structured interviews and questionnaires. We enrolled 124 children from 65 households, that used mixed cooking with gas and charcoal in settings with important environmental air pollution. Median 48-hour PM10 and PM2.5 concentrations were 126.7 (IQR: 82.7) and 60.8 (IQR: 50.7) μg/m3, indoor respectively, and 113.4 (IQR: 64.2) and 58.2 (IQR: 36.9) μg/m3, outdoor in courtyards. 21 (16.9%) children reported wheezing in the previous year, 65 (52.4%) reported dry cough at night, and 63 (72.4%) had lung function impairment on spirometry with 24 (27.6%) asthma, 19 (21.8%) non reversible obstruction and 20 (23.0%) restrictive pattern. Adults and children were able to identify visible sources of air pollution but largely ignored effects on health. Despite high exposure to air pollution with particulate matter concentrations significantly exceeding WHO recommendations, and a high prevalence of respiratory symptoms, lung function impairment and asthma, among children, children and adults, perception of air pollution as a health issue was very limited. Recommendations and awareness-raising for parents and children, starting at primary school, are needed to limit the exposure to air pollution and its respiratory consequences.

Associations of Infant Colic and Excessive Crying With Atopic Outcomes in Childhood and Adolescence

OBJECTIVE

To assess the extent to which risks of atopic and respiratory conditions throughout childhood and adolescence differ by history of (1) infant colic, characterized by apparent abdominal discomfort and unsoothable crying, (2) excessive crying without colic, or (3) neither condition.

STUDY DESIGN

Among 1249 children participating in the prospective, unselected Project Viva cohort, we examined associations of history of infant colic or excessive crying without colic with risks of eczema, allergic rhinitis, asthma, and respiratory infections, measured in toddlerhood, early childhood, mid-childhood, early adolescence, and mid-adolescence using multinomial logistic regression models.

RESULTS

The study sample was 50% female and 71% non-Hispanic White; 26% had colic and 9% excessive crying. Children with colic (vs no colic or excessive crying) had higher risk of eczema (relative risk ratio [RRR], 2.1; 95% CI, 1.2-3.8), allergic rhinitis (RRR, 1.6; 95% CI, 1.1-2.4), and asthma (RRR, 1.6; 95% CI,1.1-2.4) in mid-childhood, and a higher risk of respiratory infections in toddlerhood (RRR, 1.6; 95% CI, 1.2-2.2) and mid-adolescence (RRR, 2.1; 95% CI, 1.2, 3.7). The risk of 2-3 concurrent atopic conditions (eczema, allergic rhinitis, and/or asthma) was nearly twice that among the colic group (vs unaffected) at all life stages. The group with excessive crying without colic did not have increased risk of atopic and respiratory outcomes.

CONCLUSIONS

Colic characterized by unsoothable crying and parent perceptions of abdominal distress may be an early marker of atopic susceptibility.

Exposure to outdoor aerospora and associated respiratory health risks among adults in Potchefstroom, North-West province, South Africa

Background

Data on allergic rhinitis and respiratory health metrics are limited for South Africa, with grass pollen as a key outdoor aeroallergen. Exotic trees such as plane trees and ragweed produce highly allergenic pollen, dominating indigenous trees and weeds. Pollen allergy prevalence data is lacking in cities of North-West province such as Potchefstroom.

Objectives

This study aimed to (i) assess the prevalence of allergies to major aeroallergens, including Poaceae (grasses), Cupressus/Hesperocyparis (cypresses), Platanus (plane tree), Ulmus (elm), Quercus (oak), Betula (birch), Olea (olive), Artemisia (sagebrush), Amaranthus (amaranth), Plantago (plantain), Morus (mulberry), and Ambrosia (ragweed), along with fungal spores such as Alternaria, Cladosporium, and Penicillium/Aspergillus, and (ii) investigate the monthly incidence of major aeroallergens and reactivity levels in sensitized adults in Potchefstroom.

Methods

Skin prick tests (SPTs) were performed on 202 adults aged 18-64 years with confirmed allergic symptoms during a field campaign at North-West University (NWU)'s Potchefstroom campus. A test panel of grass, weed, tree, and fungal spore extracts previously identified via aerobiological monitoring was used. Symptom scores were recorded using ISAAC questionnaires; Spearman's statistical correlation between symptom frequency and monthly aeroallergen concentrations were analyzed.

Results

Among the participants, 184 (91%) exhibited positive SPT reactions: 104 (57%) are monosensitized to pollen, 45 (24%) to fungal spores, and 35 (19%) are polysensitized. Aeroallergen prevalence was higher in females (73%) than in males (27%). The most common pollen allergens were Cynodon dactylon (Bermuda grass) (85%), Zea mays (maize) (46%), Platanus spp. (plane tree) (35%), and Ulmus campestris (field elm) (33%). Among fungal spores, Alternaria was the most common (93%), followed by Cladosporium (27%). A significant and positive statistical correlation was found between allergic rhinitis symptoms and monthly pollen concentrations of Betula, Morus, Platanus, and Quercus.

Discussion & Conclusion

This pilot study linked aeroallergens detected in Potchefstroom with allergy profiles of local residents. The findings highlight the need for more comprehensive regional studies that integrate allergen testing with aerobiological data. Raising awareness and implementing health strategies are essential for managing allergic rhinitis in South Africa. More affordable and available SPTs kits, adapted to allergy prevalence in South Africa, are strongly suggested.

Self-reported Nickel Allergy among Schoolchildren: Trends in Prevalence, Risk Factors, and Atopic Comorbidity

Nickel allergy is common among children. The present study investigated prevalence trends of self-reported nickel allergy, risk factors, and atopic comorbidity among children. Eight-year-old children from Norrbotten County, Sweden, were recruited in 1996 (n = 3,430), 2006 (n = 2,585), and 2017 (n = 2,785). Self-reported nickel allergy decreased from 7.7% (2006) to 6.1% (2017; p = 0.024) and was significantly more common among girls. In 1996, only children with atopic dermatitis answered questions on nickel allergy. Among children with atopic dermatitis, no significant decrease was seen over the years 1996 to 2017. Ear piercing (odds ratio [OR] 1.93, 95% confidence interval [CI] 1.39-2.68 and OR 5.57, 95% CI 3.71-8.38) and female sex (OR 4.05, 95% CI 2.68-6.13 and OR 1.73, 95% CI 1.09-2.74) were risk factors for self-reported nickel allergy in 2006 and 2017, respectively. Self-reported nickel allergy was significantly more prevalent among children with atopic dermatitis than without in 2006 (12.3% vs 6.4%; p < 0.001) and 2017 (11.5% vs 5.1%; p < 0.001), and among children with allergic rhinitis in 2017 (8.6% vs 4.7%; p = 0.015). In conclusion, we found a decreasing prevalence of self-reported nickel allergy, but not among children with atopic dermatitis. Ear piercing and female sex were strongly associated with nickel allergy. Our findings also suggest that nickel allergy is associated with atopic dermatitis and allergic rhinitis.

How allergic conditions influence hygiene practices among adolescents: insights from a nationwide Youth Survey data

Effective handwashing is important for preventing exacerbation of allergic diseases, yet the relationship between allergic diseases in adolescents remains underexplored. Utilizing data from the Korea Youth Risk Behavior Survey (2009-2022), a nationwide study involving students aged 12-19, we analyzed the allergic condition, International Study of Asthma and Allergic Conditions (Never, Previous, Current), and their handwashing scores. We analyzed the trend of handwashing by allergic condition. And we conducted the ordinal logistic regression between allergic condition and handwashing, adjusted with gender, age, economic status, urbanization, smoking status, alcohol consumptions, surveyed year, and education on HW. A total of 3,258,610 adolescents were analyzed. We observed spikes in mean handwashing scores in 2009, 2013, 2015, and 2020, which corresponded with trends in allergic conditions. Adolescents with current asthma and allergic rhinitis had higher odds ratios (ORs) for better handwashing practices compared to those without these conditions. Conversely, those with current or previous atopic dermatitis had lower ORs compared to those without these conditions. In adolescent age, asthma and allergic rhinitis positively influence handwashing practices, while atopic dermatitis negatively influences handwashing practice, due to their comorbidities, highlighting the need for specialized handwashing guidelines that address the unique challenges of those with allergic diseases.

Advancing birth cohort studies using administrative and other research-independent data repositories: Opportunities and challenges

The birth cohort study design is an essential epidemiologic tool for investigating the developmental origins of health and disease. Birth cohorts have greatly improved the etiologic understanding of asthma and allergic diseases, setting the stage for advancements in translational interventions. Increasingly, investigators leverage data repositories that have been compiled and maintained independently of research investigations (administrative data) to establish large birth cohorts or to augment data generated through active participant interaction. In many cases, administrative data can greatly enhance the capacity of birth cohorts to achieve their scientific goals. However, investigators must be wary of common pitfalls and carefully consider whether administrative data are well suited to the scientific inquiry. This article reviews the strengths and challenges of using administrative data and the pragmatic solutions that have been developed to optimize their use in birth cohorts. As birth cohorts continue to play an important role in understanding the etiology of early-life disease, unleashing the power of administrative data will greatly assist in this scientific process.

Association of diurnal temperature range and childhood asthma: a population-based cross-sectional study in a Tropical City, China

BACKGROUND

Climate change has significantly impacted the diurnal temperature range (DTR), particularly in tropical regions of China, where DTR fluctuations are more frequent. While previous studies have primarily focused on the link between short-term DTR exposure and childhood asthma, there is limited information on the long-term effects from large-scale studies.

METHODS

In 2022, a cross-sectional survey involving 9,130 children aged 2-10 years was conducted using stratified cluster random sampling in tropical Sanya, Hainan Province, China. Data on demographics, and asthma symptoms were collected using the validated International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. Temperature, precipitation and Normalized Difference Vegetation Index (NDVI) were obtained from remote sensing satellite. A generalized linear model (GLM) was employed to analyze the association between DTR exposure and asthma, and stratified analyses were conducted based on environmental and lifestyle factors.

RESULTS

The prevalence of childhood asthma was 7.57%, with the annual average DTR ranging from 5.15℃ to 7.26℃. After adjusting for potential confounders, each 1℃ increase in DTR was associated with a 65.9% higher risk of asthma (95% CI: 1.058, 2.602). Stratified analyses indicated that the impact of DTR on asthma risk was stronger among children living in areas with higher temperatures, higher precipitation, lower vegetation coverage (measured by NDVI), as well as those who were not breastfed, exposed to passive smoking, or whose mothers had pets during pregnancy.

CONCLUSIONS

In Sanya, increased annual DTR was significantly associated with a higher odds of childhood asthma, and this effect was influenced by environmental and lifestyle factors. Therefore, public health strategies could mitigate childhood asthma risk associated with DTR through urban greening, advocating for breastfeeding, reducing secondhand smoke, and avoiding pet ownership during pregnancy.

Associations of prenatal organophosphate esters exposure with risk of eczema in early childhood, mediating role of gut microbiota

Few epidemiological evidence has focused on the impact of organophosphate esters (OPEs) and the risk of eczema, and underlying role of gut microbiota. Based on the Shanghai Maternal-Child Pairs Cohort, a nested case-control study including 332 eczema cases and 332 controls was conducted. Umbilical cord blood and stools were collected for OPEs detection and gut microbiota sequencing, separately. Eczema cases were identified using the International Study of Asthma and Allergies in Childhood core questionnaire and clinical diagnosis. The environmental risk score (ERS) for OPEs was developed to quantify OPEs burden. Conditional logistic regression models, multivariate analysis by linear models, negative-binomial hurdle regression, and mediation analysis were employed. Tris(2-butoxyethyl) phosphate (TBP), tris (2-butoxy ethyl) phosphate (TBEP), 2-ethylhexyl diphenyl phosphate (EHDPP), and tris(1,3-dichloro-2-propyl) phosphate (TDCPP) had detection rates > 50 %, with median concentrations ranged from 0.11 to 2.71 μg/L. TBP (OR = 1.12, 95 % CI: 1.01, 1.25), TDCPP (OR = 1.32, 95 % CI: 1.09, 1.59), and ERS (OR = 6.44, 95 % CI: 3.47, 11.94) were associated with elevated risk of eczema. OPEs exposure was correlated with increased alpha diversity and the abundance of several pathogenic bacteria, such as Klebsiella. Negative associations were observed between OPEs exposure and the abundances of Lachnospiraceae genera. Additionally, a positive correlation was identified between alpha diversity and the risk of eczema during childhood. Alpha diversity indices and Lachnospiraceae serve as significant mediators in this relationship. Results of this study indicate that prenatal exposure to OPEs is linked to an elevated risk of eczema and gut microbiota dysbiosis, potentially contributing to immunotoxicity of OPEs during early life.

Impact of RSV Prevention in Infancy on Prevalence of Asthma Among 9-14-Year-old Native American Children in the Southwest United States

BACKGROUND

The impact of respiratory syncytial virus (RSV) prevention on persistent childhood asthma is unknown. We revisited Native American children 9-14 years old who participated as infants in a phase III, randomized, placebo-controlled trial of an efficacious monoclonal antibody (motavizumab) for prevention of RSV to quantify asthma prevalence and investigate relationships between RSV prevention and subsequent asthma.

METHODS

Families that participated in the phase III RSV prevention trial were contacted. Following informed consent, data were collected by parental questionnaire and medical record review to assess respiratory health. Composite outcomes for asthma were defined using a combination of questionnaire and chart review data. Relative risk reductions (RRRs) for asthma-related outcomes were stratified by motavizumab and placebo recipients.

RESULTS

Of the 2127 original trial participants, 97% were eligible for enrollment in this follow-up study, of which 1773 (86%) were enrolled at a median age of 11 years (range: 9-14). The composite measure of asthma prevalence was 18.2% (95% confidence interval: 16.5, 20). The point estimate for persistent asthma was lower in motavizumab recipients [17.5% (15.4, 19.7)] compared with placebo recipients [19.7% (16.6, 23.1)], but this difference was not statistically significant [RRR: 11.1% (-9.1, 27.6)].

CONCLUSIONS

Asthma-related outcomes occurred less frequently among children who received motavizumab compared with placebo in infancy; however, these findings were not statistically significant, related to insufficient study power. The potential for reduction in asthma related to the prevention of RSV should be further evaluated in larger studies, especially given the elevated asthma prevalence observed in Native American children in this study.

Exposure Profiles for the Long-Term Use of Disinfectants and Cleaning Products and Asthma

BACKGROUND

Using disinfectants and cleaning products (DCPs) at home and work is known to influence both the onset and course of asthma, but most epidemiological studies did not consider the multiplicity and correlations of exposures to DCPs. We aimed to identify exposure profiles for the long-term weekly use of DCPs by latent class analysis (LCA) and assess their associations with asthma.

METHODS

LCA was conducted on data from 1143 young adults initially recruited in the German centers of Phase II of the International Study of Asthma and Allergies in Childhood (ISAAC) and followed up three times. In our LCA model, we included the use of cleaning sprays, disinfectant sprays, and nonspray disinfection methods, measured at ages 19-24 (first assessment) and 29-34 years (second assessment). Associations between identified exposure profiles and current as well as incident asthma/wheeze were evaluated by logistic regression.

RESULTS

We identified five long-term exposure profiles to DCPs (latent classes): no weekly use of DCPs (55% of participants), use in first assessment (7%), use in second assessment (18%), persistent use (8%), and persistent cleaning sprays use (12%). Compared to "no weekly use," being in the "persistent use" profile was associated with both current asthma (OR = 1.68, 95% CI = [0.48-5.88]) and current wheeze (OR = 1.71, 95% CI = [0.75-3.90]). For incident asthma/wheeze, interval estimates were very wide.

CONCLUSIONS

Our study identified five distinct long-term exposure profiles to DCPs. Among those, only a persistent weekly use of multiple DCPs over time seemed to have an adverse effect on asthma. However, large confidence intervals indicate considerable uncertainty.

The odds of developing asthma and wheeze among children and adolescents exposed to particulate matter: asystematic review and meta-analysis

BACKGROUND

Exposure to air pollution specifically particulate matter causes significant health risk to children which increases their susceptibility to respiratory diseases.

OBJECTIVES

This review aimed to pool the association between particulate matter exposure and childhood asthma and wheeze among children and adolescents.

METHODS

This review included observational study articles retrieved from electronic data bases such as PubMed, Google Scholar, Hinari, Science Direct, and Semantic Scholar from 1996 to June 17, 2024. Data were extracted and analyzed using Microsoft Excel 16 and STATA version 17, respectively. Joanna Briggs Institute evaluation criteria and I2 test statistics were used for quality and heterogeneity assessment, respectively.

RESULTS

Fourty seven studies with a total of 417,874 of children and adolescents met the inclusion criteria. The pooled odd ratio (OR) of the association between Particulate Matter with a diameter of 10 micrometers or less (PM10) and Particulate Matter with a diameter of 2.5 micrometers or less (PM2.5) with asthma were 1.04 (95% CI: 1.03-1.06, p < 0.001) with significant extreme heterogeneity (I² = 82.7%, p < 0.001) and 1.05 (95% CI 1.04-1.07, p < 0.001) with high heterogeneity (I² = 80.6%, p < 0.001) among the included studies, respectively. The overall pooled estimate indicates a statistically significant association between PM10 and wheeze, with OR of 1.06 (95% CI: 1.05, 1.07) and moderate heterogeneity among included studies (I²=57.5%, p < 0.007) where as more association was observed between PM2.5 and wheeze with OR of 1.15. (95% CI: 1.10, 1.20) with an (I² =72.8%, p < 0.001).

CONCLUSION

The findings of this systematic review and meta-analysis demonstrated a statistically significant association between exposure to both PM10 and PM2.5 and the occurrence of asthma and wheezing in children and adolescents. Both PM10 and PM2.5 are associated with increased odds of asthma and wheezing, with PM2.5 showing a stronger relationship. The significant levels of heterogeneity observed suggest variations across studies, which may be due to differences in study designs, exposure level and outcome measurement types. These findings indicate the need for strategies to reduce particle air pollution to mitigate its adverse effects on children's respiratory health.

Understanding Social Inequalities in Childhood Asthma: Quantifying the Mediating Role of Modifiable Early-Life Risk Factors in Seven European Birth Cohorts

BACKGROUND

Children growing up in disadvantaged socioeconomic circumstances (SECs) have an increased risk of asthma.

OBJECTIVE

To increase our understanding of the pathways to inequalities in asthma and potential targets for intervention by (1) examining how the social patterning of asthma and its early-life risk factors varies across countries and (2) quantifying the mediation of observed inequalities by early-life risk factors.

METHODS

We used data for 107,884 mother-child dyads from 7 European birth cohorts across 6 countries. Maternal education was the primary exposure measure of early-life SECs. The outcome was current asthma in childhood (3-12 years). Inequalities were examined using multivariable regression and random effects meta-analysis. The mediating effects of early-life risk factors (maternal smoking during pregnancy, adverse birth outcomes, and breastfeeding duration) were examined using counterfactual mediation analysis.

RESULTS

In meta-analysis, children of mothers with low/medium versus high education had a 17% (95% confidence interval: 8%-27%, I2 = 21.6%) increased risk of asthma. Cohort-specific risk ratios ranged between 1.07 (0.97-1.18, Danish National Birth Cohort, Denmark) and 1.61 (1.08-2.40, study on the pre- & early postnatal determinants of child health & development, France). The early-life risk factors were similarly socially patterned, but with greater heterogeneity across cohorts (I2 range = 66.2%-95.3%). The mediation analysis suggested that these factors play a relevant role in mediating observed inequalities (proportion mediated range: 0.08-0.72).

CONCLUSIONS

There was a consistent tendency for children from disadvantaged SECs to be at greater risk of asthma in the European cohorts examined. Our results suggest that early-life risk factors partially mediate these disparities and, therefore, that public health interventions in the perinatal period may help to address inequalities in asthma.

Socioecological factors linked to co-occurring early childhood sleep health disparities and developmental outcomes: protocol for the sleep in preschoolers cross-sectional study

INTRODUCTION

Sleep deficiencies, such as sleep disordered breathing (SDB) and insufficient sleep, are linked to adverse health outcomes. These sleep deficiencies are more common in racial and ethnic minoritised children and have significant negative impacts on neurobehavioural and social-emotional development. Non-Latine Black/African American children are 4-6 times more likely than non-Latine White children to experience both SDB and short sleep duration. Although SDB and insufficient sleep often co-occur in young children, there is a paucity of research considering the potential unique and additive impacts of SDB and insufficient sleep on child outcomes, as well as racial disparities in these outcomes, thus hindering comprehensive interventions. Our study objectives are to (1) examine racial disparities in the neurobehavioural and social-emotional impacts of early childhood SDB and/or insufficient sleep and (2) identify proximal and distal socioecological factors linked to these sleep disparities and outcomes.

METHODS AND ANALYSIS

A cross-sectional observational study comparing neurobehavioural (executive functioning, attention, vigilance) and social-emotional functioning (social skills, emotion regulation) in 400 dyads consisting of caregivers and their otherwise healthy Black and White 3-5 year-old children and divided into four groups: (A) preschoolers with SDB; (B) preschoolers with insufficient sleep; (C) preschoolers with both SDB and insufficient sleep and (D) matched controls. Child SDB, insufficient sleep, neurobehavioural skills and social-emotional functioning are measured using validated objective and subjective assessment tools, with a subset of caregivers completing qualitative interviews. Primary outcomes include individual differences in neurobehavioural and social-emotional functioning in these groups of Black and White preschoolers, and multilevel socioecological factors associated with variation in outcomes. Quantitative data will be analysed using descriptive analyses, linear regression and comparison of model coefficients. Qualitative data will be coded using thematic analysis and a joint display to stratify qualitative themes by child race and sleep deficiencies.

ETHICS AND DISSEMINATION

The study protocol has been approved by the institutional review board of the Children's Hospital of Philadelphia and the University of Oregon. Results will be disseminated through peer-reviewed publications and conferences.

Validation and reproducibility of the International Study of Asthma and Allergies in Childhood (ISAAC) Written Allergic Rhinitis Questionnaire for phone survey in children aged 6‒7 years

OBJECTIVE

To validate and assess the reproducibility of the ISAAC Written Allergic Rhinitis Questionnaire (WARQ) for children aged between 6 and 7 years by telephone contact.

METHODS

Observational study through interviews with guardians of children aged 6-7 years using the ISAAC Allergic Rhinitis (AR) module questionnaire in three different phases separated by 2 weeks each: telephone interviews in the first and third contacts and face-to-face interviews, with the same guardian of telephone interviews, in the second contact. Reproducibility was estimated using the Kappa index and validation using the sensitivity and specificity coefficients.

RESULTS

Data from 94 children (48 from the allergic rhinitis Control Group ‒ CG) were analyzed. Reproducibility showed perfect agreement (100%) for the question number 1 - Which refers to the symptoms of AR, ever: "Has your child ever had a problem with sneezing or a runny or a blocked nose when he/she did not have a cold or the flu?" and for the question number 2 - Which refers to current symptoms of AR: "In the past 12 months, has your child had a problem with sneezing or a runny or a blocked nose when he/she did not have a cold or the flu?" A strong agreement was also observed for the question number 3 (κ = 0.871) - it defines the presence of comorbidity of allergic rhinoconjuntivitis "In the past 12 months, has this nose problem been accompanied by itchy-watery eyes?" The validation showed high specificity (≥76.7%) and sensitivity (≥98%) for all questions, except for the ones related to seasonality and intensity of symptoms.

CONCLUSIONS

Our results showed that the ISAAC AR module questionnaire by telephone interviews has good reproducibility and high agreement with the clinical diagnosis of AR. It may be an appropriate alternative tool in epidemiological studies of childhood AR, especially in periods of social isolation, such as Coronavirus pandemic.

LEVEL OF EVIDENCE

Cohort Study.

LEVEL IV

Post-tuberculosis lung disease in children and adolescents: A scoping review of definitions, measuring tools, and research gaps

Tuberculosis (TB) survivors, especially children and adolescents, can develop chronic respiratory problems called post-tuberculosis lung disease (PTLD). We conducted a scoping review to identify the current knowledge gaps on PTLD definitions, measuring tools, and research specific to this age group. We searched MEDLINE, EMBASE, Global Health, CINAHL, and Web of Science for studies published between January 1, 2000, and March 1, 2024, and identified 16 studies. Our review found that no consistent definition of PTLD was used in the studies, and the measurement tools used varied widely. Moreover, there was a lack of research on children under five years old, who are disproportionately affected by TB. Also, symptom screening tools designed for adults were frequently used in these studies, raising concerns about their accuracy in detecting PTLD in children and adolescents. Several critical research gaps require attention to improve our understanding and treatment of PTLD. Firstly, the use of inconsistent definitions of PTLD across studies makes it challenging to compare research findings and gain a clear understanding of the condition. Therefore, we need to include an objective measurement of respiratory health, such as a comprehensive post-TB lung function assessment for children and adolescents. It is also crucial to determine the optimal timing and frequency of post-TB assessments for effective PTLD detection. Furthermore, we need more knowledge of the modifiable risk factors for PTLD. The scarcity of prospective studies makes it difficult to establish causality and track the long-term course of the disease in children and adolescents. Finally, current approaches to PTLD management often fail to consider patient-reported outcomes and strategies for social support. Addressing these research gaps in future studies can improve our understanding and management of paediatric PTLD, leading to better long-term health outcomes for this vulnerable population.

Maternal dietary flavonoid intake and child wheeze and asthma in the Conditions Affecting Neurocognitive Development and Learning in Early Childhood (CANDLE) cohort

BACKGROUND

Higher intakes of flavonoids have been associated with better lung function in adults. The aim of this study was to examine the associations between maternal prenatal intake of flavonoids and offspring asthma and wheeze.

METHODS

We conducted a prospective study of Black (62.8%) and White (37.2%) mother-child dyads (N = 906) enrolled in the CANDLE study. We estimated prenatal dietary flavonoid intake using the Block Food Frequency Questionnaire administered during the second trimester and subsequently linked to the United States Department of Agriculture's Provisional Flavonoid Addendum and Proanthocyanidin database. Our primary outcomes included parent report of child current wheeze and asthma (based on diagnosis, symptoms, and/or medication use) at approximately age 4 years. We used multivariable logistic regression to investigate associations between prenatal flavonoid intake and child respiratory outcomes.

RESULTS

Overall, 19.4% and 15.8% of children had current wheeze and asthma, respectively. The highest quartile of prenatal dietary total flavonoid was associated with lower odds of childhood respiratory outcomes, relative to the lowest quartile, for current wheeze (adjusted odds ratios (aOR) [95% confidence intervals (CI)]: 0.58 [0.35, 0.96]) and current asthma (aOR [95% CI]: 0.53 [0.31, 0.91]), respectively, although there was not a clear dose-response. We observed an inverse association between the prenatal intake of proanthocyanidin and offspring current asthma, but no associations for other flavonoid subclasses.

CONCLUSIONS

We report a novel finding that children of women with the highest compared to the lowest prenatal intake of total dietary flavonoids had lower odds of current wheeze and asthma at age 4 years.

Feasibility and efficacy of the forced oscillation technique in patients with lysosomal storage diseases

Lysosomal storage disorders (LSDs) are a diverse group of inborn errors of metabolism, which involves the storage of macromolecules within the lysosome due to the absence of or deficiency in lysosomal enzymes. In this condition, respiratory dysfunction is the common cause of morbidity and mortality. Thus, an objective measurement examination of pulmonary function, such as spirometry, is essential for the diagnosis and management of respiratory conditions. However, spirometry requires active patient involvement. Meanwhile, the forced oscillation technique (FOT) is performed during tidal breathing and is feasible in patients who cannot perform spirometry. Thus, the current study aimed to assess the feasibility and efficacy of FOT in assessing respiratory function among patients with LSD. This study was conducted at the outpatient department of Tawam Hospital, Al-Ain, the United Arab Emirates. Patients with confirmed LSD were included in the analysis. Information on respiratory history was obtained using a standardized respiratory questionnaire, and lung function was assessed using FOT. The main outcomes were respiratory resistance (Rrs5), reactance at 5 Hz (Xrs5), and area under the reactance curve (AX). In total, 35 patients with LSD were assessed. FOT was used to evaluate 16 (47%) patients. Of the patients who were successfully assessed using FOT, 10 presented with abnormal outcomes. Hence, there was an association between lung function assessed using FOT and spirometry results in these patients. FOT can help obtain lung function measurements in patients with LSD. In this study, the patients commonly presented with abnormal FOT outcomes.

Growth and respiratory status at 3 years of age after moderate preterm, late preterm and early term births: the Japan Environment and Children's Study

OBJECTIVE

To assess the association between gestational age at birth and the risk of growth failure and respiratory symptoms at 3 years of age.

DESIGN

Cohort study using the Japan Environment and Children's Study database.

PATIENTS

A total of 86 158 singleton infants born without physical abnormalities at 32-41 weeks of gestation were enrolled between January 2011 and March 2014.

MAIN OUTCOME MEASURES

Growth failure (weight <10th percentile and height <10th percentile) and respiratory symptoms (asthma and wheezing) at 3 years of age.

METHODS

Logistic regression analysis was used to evaluate the risk of growth failure and respiratory symptoms in the moderately preterm, late preterm and early term groups compared with the full-term group after adjusting for socioeconomic and perinatal factors. Multiple imputation was used to reduce the attrition bias related to missing data.

RESULTS

The respective adjusted ORs (95% CI) of growth failure and respiratory symptoms for the moderate preterm, late preterm and early term groups compared with the full-term group were as follows: weight <10th percentile, 2.29 (1.48-3.54), 1.43 (1.24-1.71) and 1.20 (1.12-1.28); height <10th percentile, 2.34 (1.59-3.45), 1.42 (1.25-1.60) and 1.15 (1.09-1.22); asthma, 1.63 (1.06-2.50), 1.21 (1.04-1.41) and 1.16 (1.09-1.23); and wheezing, 1.39 (1.02-1.90), 1.37 (1.25-1.51) and 1.11 (1.06-1.17).

CONCLUSION

Moderate preterm, late preterm and early term births were associated with a higher risk of growth failure and respiratory symptoms at 3 years of age than full-term births, with an inverse dose-response pattern.

The INGENIOUS project: towards understanding air pollution in homes

This paper provides an overview of the INGENIOUS (UnderstandING the sourcEs, traNsformations and fates of IndOor air pollUtantS) project, aiming to better understand air pollution in homes. Although our homes are the microenvironment in which we spend most of our time, we know relatively little about the sources, transformation processes and fates of indoor air pollutants, or our exposure to them. INGENIOUS aims to address this knowledge gap by delivering: an indoor emissions inventory for UK homes; comprehensive air pollutant measurements in 310 homes in Bradford using a combination of low cost-sensors and more advanced air quality instrumentation; an analysis of the impact of indoor air pollution on outdoor air quality and vice versa using mobile measurements; insight into future indoor air quality using detailed air pollution models; identification of indoor air pollutants that warrant further toxicological study; and better understanding of the barriers and facilitators for behaviour that drives improved indoor air quality. Median daily PM2.5 and CO2 concentrations varied from 7.8 μg m-3 and 666 ppm in the summer, to 16.4 μg m-3 and 857 ppm in the winter respectively in our sampled homes. Peak daily PM2.5 concentrations above 150 μg m-3 were frequently observed across all seasons, and were driven by cooking. Cooking activities also generated high concentrations of volatile organic compounds during emissions measurements, such as harmful aldehydes (up to ∼50 ppb), and alcohols (up to ∼600 ppb) from a chicken stir-fry. Our sampled homes displayed a wide variation in indoor pollutant concentrations, with a strong link to behaviour, including frequency and type of cooking activities, and use of ventilation.

Prevalence of aeroallergen sensitization in a polluted and industrialized area: a pilot study in South Africa's Vaal Triangle

This pioneering study evaluates the prevalence of aeroallergens reactivity among atopic populations living in the Vaal Triangle Airshed Priority Area (VTAPA), South Africa. A total of 138 volunteers (51 males and 87 females), of African, colored, white, and Asian ethnicity, and with a mean (range) age of 22 (18-56) years were participating in the study. The study was conducted on the North-West University (NWU) campus in Vanderbijlpark/VTAPA. The International Study of Asthma and Allergies in Childhood questionnaire was utilized for pre-screening to identify individuals with probable allergic dispositions. Subsequently, skin prick testing was conducted using commercial aeroallergen extracts for all confirmed participants with allergy symptoms. One hundred six participants were clinically diagnosed with pollen and fungal spore allergies. The highest allergy prevalence was attributed to Cynodon dactylon ((L.) Pers) (Bermuda grass) (41.5%), followed by Lolium perenne (L.) (ryegrass), grass mix, and Zea mays (L.) (maize) (31.1%), respectively. Moreover, among the tree allergens, Olea (L.) (olive tree) was the most prevalent allergen (20; 18.8%), followed by Platanus (L.) (plane tree) (18; 16.9%). Among the weeds, 16 (15.1%) participants were allergic to the weed mix (Artemisia (L.) (wormwood), Chenopodium (Link) (goosefoot), Salsola (L.) (saltwort), Plantago (L.) (plantain), and 11 (10.3%) to Ambrosia (L.) (ragweed)). Regarding the fungal spores, Alternaria (Fr.) (9; 8.5%) followed by Cladosporium (Link) (5; 4.7%) had the highest skin sensitivity. In this pilot study, our findings provide insights into the prevalence of allergic responses in the study population-underlining the strong impact of allergens of exotic plants-and contribute to the existing aerobiological data in South Africa.

West London Healthy Home and Environment (WellHome) Study: Protocol for a Community-Based Study Investigating Exposures Across the Indoor-Outdoor Air Pollution Continuum in Urban Communities

The relationship between indoor air quality and public health remains under-researched. WellHome is a transdisciplinary community-based study that will engage with residents to co-design feasible and acceptable research to quantify air pollution exposure in 100 homes in West London and examine its potential to exacerbate asthma symptoms in children. Sampling strategies such as using air quality monitors and passive samplers placed in kitchens, children's bedrooms, and living rooms, will be developed in collaboration with local ambassadors and participating households to measure multiple physical, chemical, microplastic, and biological contaminants. This will provide a comprehensive understanding of indoor air quality across the city's socio-economic gradient. Other data collected will include housing types and tenure, ventilation practices, occupant behaviours, time-activity, and airway symptoms. Epidemiological analysis will examine air pollution exposure impacts on children's respiratory health. The particulate mixture's relative hazard will be evaluated in toxicity studies based on source profiles and activity patterns of participants, focusing on asthma exacerbation related pathways. The study's findings will be communicated to participants through co-designed reports and inform evidence-based recommendations for reducing indoor air pollution in London and urban areas worldwide. By raising awareness and providing actionable insights, WellHome seeks to contribute to global efforts to improve the health and well-being of vulnerable communities.

Specific airway resistance according to early maternal vitamin D status during pregnancy in children aged 5 to 6 years old from the FEPED cohort (RESPIFEPED)

There are conflicting results on the association between maternal vitamin D concentrations during pregnancy and respiratory outcomes for their offspring. However, published studies have mainly focused on the second and third trimesters of pregnancy or on high-risk population. The main objective of this study was to evaluate the association between vitamin D plasma concentrations in the first trimester (T1) of pregnancy and effective specific airway resistance (sReff) for children aged 5 to 6. Secondary objectives were to evaluate this association in the third trimester (T3) and in cord blood as well as the association between vitamin D plasma concentration and interrupter resistance (Rint), bronchiolitis, asthma, and allergen sensitization at the same time points. This multicenter study included 140 children born from women enrolled in the FEPED cohort. Associations between sReff and maternal vitamin D plasma concentration at T1, T3 of pregnancy, and in cord blood were assessed. sReff was analyzed according to in-utero and postnatal exposure to tobacco smoke and the occurrence of an episode of bronchiolitis before 6 months of age. The impact of maternal vitamin D status on the secondary outcomes was similarly assessed. sReff values were not associated with the maternal vitamin D status at T1 and T3, nor asthma status or allergen sensitization.

CONCLUSION

In a cohort of young children, airway resistance and asthma were not associated with early vitamin D deficiency during pregnancy.

TRIAL REGISTRATION

This study is registered with the ClinicalTrials.gov identifier NCT03229317.

WHAT IS KNOWN

• There are conflicting results on the association between maternal vitamin D concentrations during pregnancy and respiratory outcomes for their offspring. However, published studies have mainly focused on the second and third trimesters of pregnancy or on high-risk population.

WHAT IS NEW

• In a cohort of 5- to 6-year-old children assessed prospectively, there was no significant difference in sReff or any other lung function measurements depending on maternal vitamin D status during the first trimester of pregnancy.

Screen time among kindergarten children in the Australian Capital Territory (including a comparison of First Nations and non-Indigenous children)

BACKGROUND

Australian First Nations children have poorer outcomes across a range of health measures. High levels of screen time are associated with a range of adverse health outcomes. Gaps remain in our knowledge on the association between screen time and health outcomes for different demographic groups, including First Nations children. We aimed to describe the screen time behaviours of First Nations and non-Indigenous kindergarten children in the Australian Capital Territory (ACT) and identify any associated disparities in key health outcomes.

METHODS

5,516 children participated in the cross-sectional population-based ACT Kindergarten Health Check (KHC) survey, including 146 First Nations children. The association between screen time of more than two hours per day and health outcomes (body mass index, respiratory health, development and wellbeing) was assessed for both First Nations and non-Indigenous cohorts using comparative statistics.

RESULTS

Non-Indigenous children who had an average of more than two hours of screen time per day were 1.5 (95% CI, 1.3-1.7) times more likely to be overweight/obese, 1.2 (95% CI, 1.0-1.4) times more likely to have had a wheeze/whistle in their chest in the 12 months before the KHC, 1.5 (95% CI, 1.3-1.7) times more likely to have developmental concerns and 1.5 (95% CI, 1.3-1.8) times more likely to have reduced wellbeing measures compared to non-Indigenous children with screen time of two hours or less per day. None of these associations were statistically significant amongst First Nations children.

CONCLUSIONS

Screen time of more than two hours per day is associated adverse health outcomes in non-Indigenous children, including overweight/obesity, respiratory problems, developmental concerns, and reduced wellbeing. Further analysis is required to enable a more robust assessment of the effect of screen time on health outcomes for First Nations children.

The Joint Association of Sleep Quality and Outdoor Activity with Asthma and Allergic Rhinitis in Children: A Cross-Sectional Study in Shanghai

Purpose

Aiming to investigate the combined association of sleep quality and outdoor activity with the risk of asthma and allergic rhinitis in children.

Patients and Methods

16,936 children from kindergartens and primary schools in 13 administrative districts of Shanghai, China were involved in the analyses. The Children's Sleep Habits Questionnaire (CSHQ) and the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire were respectively used to evaluate the sleep quality, allergic rhinitis and asthma. Multivariable logistic regression models were used to analyze the correlation of sleep quality, outdoor activities and their combination with children's asthma and allergic rhinitis.

Results

The overall prevalence of asthma and allergic rhinitis in our sampled children were 10.2% and 17.6%, respectively. Poor sleep quality (asthma: aOR, 1.45; 95% CI: 1.23 to 1.73; allergic rhinitis: aOR, 1.16; 95% CI: 1.03 to 1.31) and low outdoor activity (asthma: aOR, 1.30; 95% CI: 1.14 to 1.49, allergic rhinitis: aOR, 1.18; 95% CI: 1.07 to 1.32) were separately associated with higher risk of asthma and allergic rhinitis, and when the two were superimposed, an additive effect (asthma: aOR, 1.76; 95% CI: 1.30 to 2.39; allergic rhinitis: aOR, 1.46; 95% CI: 1.17 to 1.82) was revealed. These associations were independent of sleep duration, but being stronger in sleep sufficiency group. And after stratification by gender, premature birth and family history of allergy, similar associations were validated in general.

Conclusion

Poor sleep quality and low levels of outdoor activity, when combined, have a stronger association with asthma and allergic rhinitis than each factor independently, and this relationship is not influenced by sleep duration. Our findings highlight the need for public health interventions that simultaneously address multiple lifestyle factors to reduce the risk of allergic diseases.

Dietary exposure to mixtures of chemicals in the first year of life and allergic and respiratory diseases up to 8 years in the French EDEN mother-child cohort

Exposure to environmental chemicals has been associated with higher risk of childhood allergies. This study aimed to examine the association between infant's dietary exposure to mixtures of chemicals and allergic and respiratory multimorbidity in childhood. Dietary exposures were assessed at 8 and 12 months in 724 and 745 children of the EDEN cohort. Allergic and respiratory multimorbidity clusters were identified using latent class analyses. Associations between dietary exposure to mixtures of chemicals and allergic clusters were assessed by adjusted multinomial logistic regressions. At 8 months, higher exposure to a mixture of furans, trace elements, dioxins and PAHs was positively associated with the "asthma only" cluster, while moderate exposure to a mixture of PAHs, pesticides, PCBs and acrylamide was negatively associated with this cluster. A mixture of PCBs and BFRs was positively associated with the "multi-morbidity" cluster. Exposure to a mixture of pesticides and trace elements was positively associated with the "allergy without asthma" cluster. At 12-months, higher exposure to a mixture of trace elements and pesticides was positively associated with "multi-morbidity" cluster. The differences in findings between the two ages suggest the need for further studies to explore this critical window of chemical exposure and its impact on children's health.

Development and clinical assessment of a novel probiotic candy in the prevention of respiratory infections in asthmatic children

Objective

Asthma is the most common chronic disease among children. Upper respiratory infections are often the cause of asthma exacerbation. Studies suggested that spore-forming probiotics can reduce viral infections. This study aimed to determine the effect of spore-forming probiotic Bacillus candy on respiratory illnesses in asthmatic children.

Methods & materials

In this randomized trial, 69 children aged 7-11 years with mild intermittent asthma were randomized to receive probiotic candy (containing 1010 CFU probiotic Bacillus coagulans) or placebo candy, daily for 2 months. The primary outcome was the number of viral respiratory infections. Secondary outcomes included salbutamol metered-dose inhaler (MDI) use, oral corticosteroids, school absenteeism, emergency department visits and hospitalizations, and Pediatric Asthma Control Questionnaire (c-ACT).

Results

The frequency of symptomatic respiratory illnesses was significantly lower in the probiotic candy group compared to placebo in the first month (0.28 ± 0.45 vs. 0.51 ± 0.50, p = 0.054), the second month (0.08 ± 0.28 vs. 0.41 ± 0.49, p = 0.001) and the total study (0.37 ± 0.54 vs. 0.90 ± 0.73, 0.001). The percent of patients with prednisolone consumption in the probiotic group was lower than the control group (2.9% vs. 14.7%) but did not show a significant difference (p = 0.081) and no difference was seen in the rate of emergency department visits and hospitalization between the 2 groups (both p = 0.254). The use of salbutamol and school absenteeism in the probiotic group was significantly lower than in the control group (p = 0.040 and p = 0.046, respectively. There was no significant difference in the evaluated scores for asthma control (c-ACT) in both probiotic and placebo groups. After the intervention, the difference between the 2 groups has become significant (p < 0.05).

Conclusion

Adding spore-forming probiotic candy containing Bacillus coagulans to standard asthma treatments reduced symptomatic respiratory illnesses over two months. Further studies including longer treatment periods are needed before making recommendations for routine use.

The Impact of Stressful Childhood Life Events on Atopic Dermatitis Disease Activity and Severity

Atopic dermatitis (AD) is a prevalent condition associated with stress. However, epidemiological data on the impact of both common and severe childhood stressors are limited. This study aimed to evaluate the impact of stressful life events throughout early childhood on AD activity and severity. We conducted a longitudinal cohort study of 13,972 children aged 1-8.5 years from the Avon Longitudinal Study of Parents and Children. Responses to a standardized stressful life event scale were linked to repeated measures of annual AD period prevalence and severity. After adjusting for potential confounders, we found that for each SD increase in stressful life events, there was a small increased risk of concurrent AD activity (OR = 1.04, 95% confidence interval = 1.01-1.07), which was higher for moderate-to-severe AD (OR = 1.13, 95% confidence interval = 1.03-1.23) and for a cumulative measure of stressful events across childhood (OR = 1.11, 95% confidence interval = 1.07-1.16). The association was driven by common stressful life events which were perceived as more impactful to individual children such as starting a new school or having a new baby sibling, than severe adverse childhood events such as being separated from a parent or abused. These results may help provide anticipatory guidance to families.

Association of environmental pollutants with asthma and allergy, and the mediating role of oxidative stress and immune markers in adolescents

BACKGROUND

Asthma and allergic diseases are among the common causes of morbidity and mortality globally. Various environmental pollutants are linked to the development of asthma and allergic diseases. Evidence on the role of oxidative stress and immune markers in the association of environmental pollutants with asthma and allergy is scant. We examined cross-sectional associations between environmental pollutants and asthma and allergy, investigated mixture effects and possible mediation by oxidative stress or immune markers.

METHODS

We used data from the Flemish Environment and Health Study 2016-2020 (FLEHS IV), including 409 adolescents aged 13-16 years. Fifty-four pollutants, including metals, phthalates, Di(isononyl) cyclohexane-1,2-dicarboxylate (DINCH), bisphenols, currently used and legacy pesticides, flame retardants, per- and polyfluoroalkyl substances (PFAS), polyaromatic hydrocarbons (PAHs), and polychlorinated biphenyls (PCBs) were analyzed. Outcomes were self-reported asthma, rhinitis, eczema, allergies, respiratory infection, and airway inflammation, measured through fractional exhaled nitric oxide (FeNO). Single pollutant models using multiple regression analysis and multipollutant models using Bayesian Kernel Machine Regression (BKMR) were fitted. As sensitivity analysis, Bayesian model averaging (BMA) and elastic net (ENET) models were also performed. For Bayesian models, posterior inclusion probabilities (PIP) were used to identify the most important chemicals. Mediation analysis was performed to investigate the role of oxidative stress, measured by urinary 8-hydroxy-2' -deoxyguanosine (8-OHdG), and immune markers (eosinophils, basophils, InterLeukin 8, InterLeukin 6, and Interferon-ᵧ in blood).

RESULTS

In single pollutant models, FeNO was significantly higher by 20% (95% CI: 6, 36%) and 13% (95% CI: 2, 25%) per interquartile range (IQR) fold in mono-n-butyl phthalate (MnBP) and mono-benzyl phthalate (MBzP), respectively. In BKMR analysis, the group PIPs indicated phthalates and DINCH as the most important group (group PIP = 0.509), with MnBP being the most important pollutant within that group (conditional PIP = 0.564; %change = 28%; 95%CI: 6, 54%). Similar patterns were observed in all multipollutant models. Eosinophil count mediated 37.8% (p = 0.018) and 27.9% (p = 0.045) of the association between MBzP and FeNO, and the association between MnBP and FeNO, respectively. 8-OHdG plays a significant mediating role in the association of 2,4-Dichlorophenoxyacetic acid (2,4-D) (55.4%), 3,5,6-Trichloro-2-pyridinol (TCPY) (48.1%), and 1-Naphthylamine (1-NAP) (32.7%) with rhinitis, while the total effects of these chemicals on rhinitis were not statistically significant.

CONCLUSIONS

This study found associations between phthalates, MnBP and MBzP, and elevated FeNO, which appeared to be mediated by eosinophil count. 8-OHdG plays a significant mediating role in the association between 2,4-D, TCPY, and 1-NAP with rhinitis, while their direct effects remain non-significant. Use of inflammatory and oxidative stress markers can enhance the understanding of inflammatory processes in asthma and allergic diseases due to environmental pollutants.

Association of Helicobacter pylori Infection with Pediatric Asthma in Palestine

Purpose

Significant debate exists on the association between Helicobacter pylori infection and childhood asthma. We aimed to explore this association in a cohort of children in Palestine while estimating the prevalence of H. pylori in this population.

Methods

We conducted a prospective case-control study among children aged 6-15 years in Palestine, including 44 asthma cases diagnosed by pediatric pulmonologists and 99 age-matched healthy controls recruited through cluster sampling from schools. H. pylori status was determined using a stool antigen test. Asthma severity was assessed using the International Study of Asthma and Allergies in Childhood questionnaire. Data on recent antibiotic use, which could affect H. pylori status, were collected for both groups. Multiple logistic regression analyzed the association between H. pylori and asthma, adjusting for age and sex. The chi-square test assessed the impact of antibiotic use on H. pylori status.

Results

The prevalence of H. pylori infection in the study population was 45%. Children with asthma had a lower prevalence of H. pylori infection compared to healthy controls (32% vs. 51%, adjusted odds ratios, 0.46; 95% confidence interval, 0.22-0.99; p=0.04). Antibiotic use in the past month or year did not significantly impact H. pylori status. Among children with asthma, H. pylori infection rates did not vary by asthma severity (p=0.05).

Conclusion

H. pylori infection is associated with a reduced risk of asthma in children, suggesting a potential protective role. Further prospective cohort studies are warranted to clarify the mechanisms underlying this association.

Relationship between dental erosion and asthma medication in children: a systematic review

Introduction

Dental erosion is an alteration that affects the integrity of teeth, which has several aetiologies. It is mentioned that asthma medications may be an etiologic factor; however, studies fail to clarify the possible association between these variables in children with asthma. Therefore, the purpose of this study will be to determine the relationship between dental erosion and asthma medication consumption in paediatric patients.

Materials and methods

A systematic research was performed in databases such as MEDLINE (PubMed), Scopus, Web of Science, Scielo, Cochrane Library, Embase, LILACS and gray literature (Open Gray). Two researchers independently selected the articles according to the population, exposure, outcome, study design (PEOS) question using the Rayyan program. Newcastle-Ottawa scale was used to assess the risk of bias.

Results

Six articles were included from 120 selected articles. The studies by Bairappan, Domenzain and Arafa studies show a higher prevalence of dental erosion in children with asthma medication as opposed to healthy children, whereas the studies by Dugmore and Rock, Alazmah and Rezende report a higher prevalence of erosive lesions in healthy children.

Conclusions

Asthma medications are not a determining factor for the occurrence of erosive lesions in the teeth of paediatric patients with this systemic condition.

The association of parental age at delivery with childhood allergic disease and the modified effect of breastfeeding

BACKGROUND

Childhood allergic diseases are a global concern; quite limited studies have examined the impacts of parental age at delivery. This study aimed to explore the association between separate and combined parental age at delivery and childhood allergic diseases and whether adequate breastfeeding could modify this association.

METHODS

This cross-sectional study sampled 15,976 children from Shanghai, China. The International Study of Asthma and Allergies in Childhood questionnaire was adopted to evaluate allergic diseases. Multivariate logistic regression models were used to examine the association of parental age and exclusive breastfeeding with allergic diseases.

RESULTS

The prevalence of allergic rhinitis, asthma, food allergy, drug allergy, urticaria, and eczema was 21.2%, 14.2%, 8.7%, 3.9%, 15.6%, and 35.5%, respectively. Either of parental age at delivery ≥25 years could increase the risk of allergic diseases in most cases, where paternal age showed a stronger effect. The risk was further elevated when parental age were both ≥25 years (OR ranged from 1.266 to 1.541, all p < .05 except for drug allergy). Breastfeeding >6 months was inversely associated with all types of allergic diseases and involved in attenuating the risk caused by parental age ≥25 years. These findings were generally validated by sensitivity examination as well as stratified analyses.

CONCLUSIONS

Parental age at delivery ≥25 years was a risk factor for most childhood allergic diseases. Breastfeeding >6 months applied to modifying the risk chalked up to parental age. These findings are significant given the rising age of parents and increasing prevalence of childhood allergic diseases.

V Brazilian Consensus on Rhinitis - 2024

Since we published the "IV Brazilian Consensus on Rhinitis", in2017, several advances have been achieved and have enabled a further understanding of the different aspects of "Rhinitis". This new guideline, developed jointly by ASBAI, SBP and SBORL, represents a relevant milestone in the updated and integrated management of the different forms of the disease, and it aims to unify evidence-based approaches to improve the diagnosis and treatment of this common and often underestimated condition. The document covers a wide range of topics, including clear definitions of the different phenotypes and endotypes of rhinitis, risk factors, updated diagnostic criteria, and recommended methods for clinical and laboratory investigation. We stress the importance of detailed clinical history and objective assessment, as well as tools for control and assessing severity tools an accurate diagnostic approach to the disease. Regarding treatment, it emphasizes the treatment customization, considering the severity of symptoms, the presence of comorbidities and the impact on the patient's quality of life. We discuss different drug treatment, in addition to non-pharmacological measures, such as environmental control and specific immunotherapy; and the possible role of immunobiological agents. Furthermore, the consensus addresses issues related to patient education, prevention and management of special situations, such as rhinitis in children, in pregnant women and in the elderly. In short, the "V Brazilian Consensus on Rhinitis" represents a comprehensive and updated guide for healthcare professionals involved in the diagnosis and management of rhinitis, aiming to improve patients' quality of life through an integrated and evidence-based approach.

Respiratory syncytial virus infection, non-respiratory syncytial virus respiratory infections, and later wheezing

BACKGROUND

Studies investigating whether respiratory syncytial virus (RSV) infection, non-RSV respiratory infections, respiratory-related disorders, and non-respiratory-related disorders are associated with subsequent wheezing are limited in Japan. We aimed to elucidate the relationship between hospitalization for RSV infection, non-RSV respiratory infections, respiratory-related disorders, as well as non-respiratory-related disorders and subsequence wheezing in Japanese children.

METHODS

This study included 7340 children and was conducted under the TMM BirThree Cohort Study (Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study). Data was collected from birth records and questionnaires. We categorized hospitalization history into five categories: "no hospitalization," hospitalizations for "RSV infection," "non-RSV respiratory infections," "respiratory-related disorders," and "non-respiratory-related disorders." The association of the five categories with later wheezing at 3 years of age was evaluated using multivariable logistic regression analysis.

RESULTS

After adjusting for covariates, an association was shown between hospitalization under 2 years of age and later wheezing (odds ratio [OR] = 2.78; 95% confidence interval [CI] = 1.97-3.88 for "RSV infection"; OR = 2.61; 95% CI = 1.44-4.57 for "non-RSV respiratory infections"; and OR = 3.33; 95% CI = 2.43-4.54 for "respiratory-related disorders").

CONCLUSION

Hospitalization of children under 2 years of age for RSV infection as well as non-RSV respiratory infections and respiratory-related disorders were associated with subsequent wheezing.

Associations between maternal fish intake and polyunsaturated fatty acid status with childhood asthma in a high fish-eating population

BACKGROUND

Studies investigating associations between prenatal polyunsaturated fatty acid status (PUFAs), in particular the anti-inflammatory n-3 PUFAs, and the development of childhood asthma have yielded conflicting results.

OBJECTIVE

To determine the associations between maternal fish intake (a rich source of the n-3 PUFAs), maternal or cord PUFAs with the prevalence of childhood asthma in a high fish-eating population.

METHODS

We examined these associations between fish intake and PUFA concentrations with childhood asthma prevalence in the Seychelles Child Development Study Nutrition Cohort 2, a large observational study in a high fish-eating population. Maternal fish intake during pregnancy and child's fish intake at 7 years were assessed by questionnaire, with frequency reported as meals/week. Serum concentrations of PUFAs were quantified in maternal blood collected at 28 weeks' gestation (n = 1448) and in cord blood (n = 1088). Asthma in children at 7 years was assessed using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire (n = 1098).

RESULTS

A total of 97 children (10.5%) were reported to have asthma. In regression analysis, the odds of childhood asthma were not associated with maternal fish intake or maternal PUFA status. Cord DHA concentrations were associated with increased asthma prevalence when the highest quartile (≥0.123 mg/mL) was compared with the lowest (<0.061 mg/mL).

CONCLUSION

The results from this current study add to the growing body of evidence that fish consumption during pregnancy is not associated with asthma development in offspring. The associations between cord blood DHA and asthma prevalence are unexpected and warrant further investigation.

Factors associated with asthma symptoms in Colombian subpopulations aged 1 to 17 and 18 to 59: Secondary analysis of the study "Prevalence of asthma and other allergic diseases in Colombia 2009-2010"

BACKGROUND

Asthma, a chronic inflammatory lung disease, is one of the leading causes of disability, demands on health resources, and poor quality of life. It is necessary to identify asthma-related risk factors to reduce the presence and development of symptoms.

OBJECTIVE

This study aimed to explore the association of multiple possible factors with asthma symptoms in two subpopulations, children, adolescents, and adults, in six cities in Colombia.

MATERIALS AND METHODS

This was an observational analytical case-control study based on a cross-sectional study conducted as a secondary analysis of the prevalence of asthma and other allergic diseases in Colombia during 2009 and 2010. Weighted logistic regressions were conducted for each population.

RESULTS

Out of the 5978 subjects in the cross-sectional survey, 747 were identified as cases, and 3109 were identified as controls. The prevalence of asthma was 30.8% in the child and adolescent population and 14.7% in the adult population. Among the various factors studied, those associated with asthma symptoms in children/adolescents were: a family history of asthma (OR 2.4; 95% CI 1.3-4.7) and rhinitis (OR 2.0; 95% CI 1.1-3.6); acetaminophen consumption at least once a month (OR 3.6; 95% CI 2.1-6.2); and the presence of birds at home (OR 2.0; 95% CI 1.1-3.8). Regarding food consumption: fruit consumption (OR 3.8; 95% CI 1.1-12.7). In adults, the factors that showed significant association were: a family history of allergic diseases (rhinitis OR 3.3; 95% CI 2.3-4.6), atopic eczema (OR 4.4; 95% CI 2.8-7.0), or asthma (OR 1.8;95% CI 1.3-2.6); acetaminophen consumption at least once a month (OR 2.0; 1.5-2.8); the presence of dogs at home (OR 1.4;95% CI 1.03-1.8), exposure to second-hand smoke (OR 1.7; 95% CI 1.2-2.2), and exposure to exhaust fumes during the day (OR 1.7; 95% CI 1.04-2.7).

CONCLUSIONS

Our findings suggest that different cultural, environmental, and family factors are associated with asthma symptoms in children and adolescents, and these associations are evident in both males and females.