Self-reported prevalence of childhood allergic diseases in three cities of China: a multicenter study

Characteristics of Pediatric Allergic Rhinitis With Different Disease Severity

Background: Although numerous studies have focused on diagnostic biomarkers to help identify allergic rhinitis (AR), data on the characteristics of pediatric AR with different severity is limited. We aimed to compare the characteristics of pediatric AR with different severity. Methods: A total of 1054 children with AR were enrolled and classified into mild intermittent AR, mild persistent AR, moderate-to-severe intermittent AR, and moderate-to-severe persistent AR. All children were surveyed using a questionnaire that included detailed demographic information. Blood cell analysis was performed using an automatic hematology analyzer. Results: No significant differences were observed in feeding patterns, dietary habits, outdoor activity time, total IgE, eosinophil count, and eosinophil percentage among the different AR subgroups. However, a higher prevalence of a family history of AR was noted in the moderate-to-severe persistent group. Symptoms were more likely to exacerbate when using air conditioning in children with moderate-to-severe persistent AR. Multivariate regression analysis also showed that symptom exacerbation when using air conditioning was associated with disease severity. Conclusions: This study suggests that exacerbation of symptoms during air conditioning use can be considered a predictive factor for the severity of pediatric AR. Doctors and parents should pay special attention to these children to prevent more severe symptoms and improve the quality of life of these patients as early as possible.

Prevalence of aeroallergen sensitization in children in Northern China

OBJECTIVE

This study aimed to analyze the sensitization rate of different aeroallergens in children of different age, sex, and disease groups, describe the changing trend of different aeroallergens in different ages, and analyze the sensitization risk factors for asthma.

METHODS

Children (<18 years old) with suspected atopic diseases who visited the Department of Allergy of Children's Hospital Affiliated to Capital Institute of Pediatrics and underwent a skin prick test (SPT) were retrospectively enrolled from January 2019 to November 2021.

RESULTS

A total of 5465 patients (3514 boys, 1951 girls; mean age, 7 ± 3 years) were enrolled. Of them, 3703 patients (67.8%) were sensitized to at least one aeroallergen. Before 4 years of age, mold was the most prevalent aeroallergen (103/380 [27.1%]), whereas after 4 years of age, weed pollen was the most prevalent aeroallergen. After 6 years of age, tree pollen became the second most prevalent aeroallergen. After 12 years of age, the sensitization rate of indoor aeroallergens was lower than that of outdoor aeroallergens. Logistic regression showed that sensitization to mold (odds ratio [OR]:1.4, 95% confidence interval (CI): 1.2-1.7, p < 0.001), animal dander (OR: 1.6, 95% CI: 1.4-1.9, p < 0.001), and polysensitization (OR: 1.4, 95% CI: 1.0-1.8, p = 0.038) were potential sensitization risk factors for asthma.

CONCLUSIONS

Mold is an important allergen in early life. Different kinds of allergens affect different age groups. Patients who are sensitized to mold or animal dander or experience polysensitization should be carefully monitored for asthma risk.

An Inflammatory Question? Prenatal Air Pollution, Childhood Allergic Rhinitis, and Healthy Fats

A study of more than 650 toddlers found that two polyunsaturated fatty acids were associated with fewer cases of allergic rhinitis (hay fever) in children who had been exposed prenatally to higher levels of PM2.5.

Impact of comorbid allergic diseases on health-related quality of life of Hong Kong schoolchildren

BACKGROUND

Studies on the relationship between childhood allergic disease and health-related quality of life (HRQOL) have mostly been confined to a single allergic condition. Therefore, a composite allergic score (CAS) was derived to assess the accumulated effect of eczema, asthma, and allergic rhinitis on HRQOL in Hong Kong schoolchildren.

METHODS

Parents of grade one/two or grade eight/nine schoolchildren completed a questionnaire assessing the prevalence and severity of eczema (POEM), asthma (C-ACT/ACT), and allergic rhinitis (VAS) and schoolchildren's HRQOL (PedsQL). Three rounds of recruitment were conducted. A total of 19 primary and 25 secondary schools agreed to participate.

RESULTS

Data from 1140 caregivers of grade one/two schoolchildren and 1048 grade eight/nine schoolchildren were imputed and analyzed. The proportion of female respondents were lower in grade one/two (37.7%) but higher in grade eight/nine (57.3%). 63.8% of grade one/two and 58.1% of grade eight/nine schoolchildren reported having at least one allergic disease. In general, greater disease severity was significantly associated with lower HRQOL. After controlling for age, gender, and allergic comorbidity in hierarchical regressions, CAS significantly predicted all HRQOL outcomes in both grade one/two and grade eight/nine schoolchildren. Female grade eight/nine schoolchildren reported lower HRQOL outcomes.

CONCLUSION

Composite allergic score may be a practical tool to evaluate allergic comorbidity and the effectiveness of treatments targeting common pathological mechanisms of allergic diseases. Non-pharmaceutical approaches should be considered, especially for patients with more than one allergic disease and greater severity.

Prevalence and risk factors of allergic rhinitis among Chinese adults: A nationwide representative cross-sectional study

Background

The prevalence of allergic rhinitis (AR) has been increasing steadily worldwide, especially in countries with increasing industrialization such as China. However, available evidence regarding AR prevalence among Chinese adults is scarce and limited to regional data collected in earlier years. We therefore aimed to provide a more recent and robust estimate of AR prevalence using a nationwide representative cross-sectional study in China.

Methods

Data of 184 326 participants aged 18 years or older were obtained from the China Chronic Disease and Risk Factor Surveillance conducted in 2018-2019. AR was determined by self-reported sneezing, nasal itching, obstruction, or rhinorrhea symptoms for at least 1 h in the absence of a cold or flu within the last 12 months. Multivariable logistic model was used to examine the risk factors of AR, and a possible non-linear relationship was further tested by restricted cubic spline. Potential additive interactions of risk factors with sex, residence, and geographic region were assessed by relative excess risk due to interaction (RERI).

Results

The weighted prevalence of AR was 8.1% (95% confidence interval [CI], 7.4%-8.7%), of whom 23.7% (95% CI, 21.3%-26.0%) were aware of their diagnosis. Increased odds of AR were associated with younger age, men, living in urban area or north region, more education, smoking, underweight, and higher income. Despite the nonsignificant linear trend, the spline regression demonstrated a non-linear association between AR and sleep duration, with higher odds at both ends. Additionally, the observed associations were generally stronger among men and people living in urban area and north region, with significant RERI ranging from 0.07 (95% CI, 0.00-0.14) to 0.40 (95% CI, 0.12-0.67).

Conclusions

AR is prevalent in China and the associated factors and interactions are helpful to design targeted preventive strategies towards certain subpopulations. The low awareness of AR calls for a national effort on AR screening.

Structures and Anti-Allergic Activities of Natural Products from Marine Organisms

In recent years, allergic diseases have occurred frequently, affecting more than 20% of the global population. The current first-line treatment of anti-allergic drugs mainly includes topical corticosteroids, as well as adjuvant treatment of antihistamine drugs, which have adverse side effects and drug resistance after long-term use. Therefore, it is essential to find alternative anti-allergic agents from natural products. High pressure, low temperature, and low/lack of light lead to highly functionalized and diverse functional natural products in the marine environment. This review summarizes the information on anti-allergic secondary metabolites with a variety of chemical structures such as polyphenols, alkaloids, terpenoids, steroids, and peptides, obtained mainly from fungi, bacteria, macroalgae, sponges, mollusks, and fish. Molecular docking simulation is applied by MOE to further reveal the potential mechanism for some representative marine anti-allergic natural products to target the H1 receptor. This review may not only provide insight into information about the structures and anti-allergic activities of natural products from marine organisms but also provides a valuable reference for marine natural products with immunomodulatory activities.

The effect of fine particulate matter exposure on allergic rhinitis of adolescents aged 10-13 years: A cross-sectional study from Chongqing, China

Background

Allergic rhinitis (AR) has become a tremendous disease burden worldwide. Only a few studies have explored the effects of environmental exposure on the prevalence of AR in children in China.

Methods

In the present study, we investigated the associations of environmental exposure (including fine particulate matter (PM_2.5), air humidity, temperature, and passive smoking) with AR in adolescents aged 10-13 years in Chongqing. Data from 4,146 participants in urban and rural areas between March 2019 and May 2019 were collected.

Results

The overall prevalence of AR was 17.50% in adolescents. After adjusting for other covariates, AR was positively correlated with the annual mean PM_2.5 concentration, monthly mean PM_2.5 concentration and air temperature, and negatively related to air humidity. Furthermore, the annual mean PM_2.5 was positively associated with the risk of AR after adjusting for air temperature and humidity. Passive smoking (PS) was marginally associated with a high risk of AR.

Conclusion

High PM_2.5 exposure, high air temperature, and low air humidity were associated with a high risk of AR in adolescents. Our findings have potential implications for public health strategies and interventions aimed at reducing the burden of AR in adolescents.

Time-trends for eczema prevalences among children and adults from 1985 to 2015 in China: a systematic review

Background

Several studies have reported that childhood prevalence of eczema has been increasing worldwide. However, none study quantitatively evaluated prevalence trends of eczema among children and adults in the last 30 years in China.

Methods and Findings

Via a systematic review of literature databases in English and Chinese, we summarized all studies reporting eczema prevalences from 1985 to 2015 in China as well as diagramed prevalence and eczematous population trends against year for different age groups. A total of 93 studies and 17 studies (16 for children and one for adults) were selected for qualitative and quantitative synthesis, respectively. Childhood lifetime-ever eczema prevalences ranged from 10.0% to 30.0%. Prevalences among 3-12-year-olds children showed increasing trends in most specific cities, but national lifetime-ever eczema prevalences among 13-14-year-olds children decreased from 10.6% in 2001 to 8.6% in 2009 in mainland China. We estimated that about 1.5 million children aged 13-14-year-olds in 2009 and 15.5 million children aged 3-6-year-olds in 2012 had lifetime-ever eczema in mainland China. Similar studies were too few to ascertain time-trends of eczema prevalence among adults. About 39.4, 20.0, and 11.6 million adults aged 15-86-year-olds in 2010 had contact dermatitis, seborrheic dermatitis, and atopic dermatitis in the mainland China, respectively.

Conclusions

The burden of eczema became heavier in young children, whereas perhaps had been reduced in adolescent in China. More studies for eczema prevalence in adults are warranted.

Serum IgE Predicts Difference of Population and Allergens in Allergic Diseases: Data from Weifang City, China

Background

Immunoglobulin E (IgE) is the most important promoter of allergic inflammation. However, there are few systematic studies on IgE in age range, genders, disease spectrum, and time regularity.

Aim

To screen the common allergens, allergen spectrum, and IgE difference between type 2 inflammatory allergic diseases and other allergic diseases in Weifang, China.

Methods

A retrospective study was performed by estimating patients' clinical data suffering from allergic diseases (urticaria, pollinosis, allergic rhinitis, atopic dermatitis, and bronchial asthma) between May 2019 and April 2020 using an allergen detection kit of Macro-Union Pharmaceutical.

Results

732 of the 1367 patients showed different antigen positive, and the positive rate was 53.5%. The most common allergens were dust mites, mixed fungi, Artemisia pollen, cat/dog dander, and cockroaches. There were 27.0% (369/1367) of the patients with single positive allergen-specific IgE (sIgE), 26.5% (363/1367) with multiple-positive IgE. The total immunoglobulin E (tIgE) levels varied with gender, age, and type of disease. There was a difference in the distribution of allergens between children and adults. A positive correlation between the serum-specific IgE and the corresponding local inhaled allergen density was observed.

Conclusions

In this study, we found that type 2 inflammatory allergic diseases have higher serum IgE and a higher probability of inhaled sIgE positive. According to age, gender, and condition, serological IgE detection of allergens provides new insight into the early diagnosis and prevention of allergic diseases.

Household mold exposure interacts with inflammation-related genetic variants on childhood asthma: a case-control study

BACKGROUND

A number of studies have examined the association between mold exposure and childhood asthma. However, the conclusions were inconsistent, which might be partly attributable to the lack of consideration of gene function, especially the key genes affecting the pathogenesis of childhood asthma. Research on the interactions between genes and mold exposure on childhood asthma is still very limited. We therefore examined whether there is an interaction between inflammation-related genes and mold exposure on childhood asthma.

METHODS

A case-control study with 645 asthmatic children and 910 non-asthmatic children aged 3-12 years old was conducted. Eight single nucleotide polymorphisms (SNPs) in inflammation-related genes were genotyped using MassARRAY assay. Mold exposure was defined as self-reported visible mold on the walls. Associations between visible mold exposure, SNPs and childhood asthma were evaluated using logistic regression models. In addition, crossover analyses were used to estimate the gene-environment interactions on childhood asthma on an additive scale.

RESULTS

After excluding children without information on visible mold exposure or SNPs, 608 asthmatic and 839 non-asthmatic children were included in the analyses. Visible mold exposure was reported in 151 asthmatic (24.8%) and 119 non-asthmatic children (14.2%) (aOR 2.19, 95% CI 1.62-2.97). The rs7216389 SNP in gasdermin B gene (GSDMB) increased the risk of childhood asthma with each C to T substitution in a dose-dependent pattern (additive model, aOR 1.32, 95% CI 1.11-1.57). Children carrying the rs7216389 T allele and exposed to visible mold dramatically increased the risk of childhood asthma (aOR 3.21; 95% CI 1.77-5.99). The attributable proportion due to the interaction (AP: 0.47, 95% CI 0.03-0.90) and the relative excess risk due to the interaction (RERI: 1.49, 95% CI 0-2.99) were statistically significant.

CONCLUSIONS

In the present study, there was a significant additive interaction between visible mold exposure and rs7216389 SNP on childhood asthma. Future studies need to consider the gene-environment interactions when exploring the risk factors of childhood asthma.

Respiratory tract infections in children with allergic asthma on allergen immunotherapy during influenza season

To describle how respiratory tract infections (RTIs) that occurred in children with allergic asthma (AA) on allergen immunotherapy (AIT) during an influenza season. Data including clinical symptoms and treatment history of children (those with AA on AIT and their siblings under 14 years old), who suffered from RTIs during an influenza season (Dec 1st, 2019–Dec 31st, 2019), were collected (by face to face interview and medical records) and analyzed. Children on AIT were divided into 2 groups: stage 1 (dose increasing stage) and stage 2 (dose maintenance stage). Their siblings were enrolled as control. During the study period, 49 children with AA on AIT (33 patients in stage 1 and 16 patients in stage 2) as well as 49 children without AA ( their siblings ) were included. There were no significant differences in occurrences of RTIs among the three groups (p > 0.05). Compared with children in the other two groups, patients with RTIs in stage 2 had less duration of coughing and needed less medicine. Children on AIT with maintenance doses had fewer symptoms and recovered quickly when they were attacked by RTIs, which suggested that AIT with dose maintenance may enhance disease resistance of the body.

Effects of Sublingual Duster Mite Drops on Lung Function and Exhaled Nitric Oxide in Children with Multiple and Single Allergic Respiratory Diseases

Objective

To evaluate the efficiency of sublingual immunotherapy with Dermatophagoides Farinae Drops in children with single and multiple respiratory allergic diseases.

Methods

Seventy-one children with allergic respiratory diseases who had been treated with Dermatophagoides Farinae Drops for one year or more were divided into a single allergic group (12 cases) and multiple allergic group (59 cases). The rhinitis score, daytime and night symptom score of asthma, VAS score, drug score, pulmonary function, and FeNO level before and after treatment were evaluated and compared between the two groups.

Results

The rhinitis score, night symptom score, VAS score, and drug score in the single allergic group after treatment were significantly lower than those before treatment (p < 0.05), but there was no significant difference in the daytime symptom score before and after treatment (p > 0.05). The rhinitis score, VAS score, and drug score in the multiple allergic group after treatment were significantly lower than those before treatment (p < 0.05), but there was no significant difference in the scores of daytime symptoms and nighttime symptoms before and after treatment (p > 0.05). In both the single allergic group and multiple allergic group, the pulmonary function indexes of the patients were significantly improved after treatment, and the FeNO after treatment was significantly lower than that before treatment (p < 0.05). There was no significant difference in scores, pulmonary function, and FeNO between the two groups (p > 0.05).

Conclusion

Sublingual specific immunotherapy is effective in treating multiple and single allergic respiratory diseases in children.

Associations between household airborne culturable fungi and allergies and airway illnesses in childhood in Shanghai, China

Associations of household airborne fungi with allergies in childhood were inconsistent in the epidemiologic studies. During 2013-2014, we conducted a case-control study (phase two), which was nested in a cross-sectional study (phase one) during 2011-2012 in Shanghai, China. We inspected indoor air quality of 454 residences for 5-10 years old children. We defined cases as those children who were reported illnesses in the questionnaire of phase one or phase two and defined controls as those children who were not reported illnesses in both phases. A total of 436 living rooms and 445 bedrooms had valid data of household airborne fungi, and their mean concentrations were 301 cfu/m³ and 310 cfu/m³, respectively. In the multiple logistic regression analyses with adjusting for potential confounders, most associations of 16 studied illnesses with airborne fungi concentration were not statistically significant. Taking children in the 1st quartile that was stratified according to airborne fungi concentration in the living room as reference, only children in the 3rd quartile were significantly associated with a higher odd of lifetime-ever ear infections (adjusted OR, 95% CI 3.05, 1.29-7.21), and children in the 4th quartile were significantly associated with a higher odd of lifetime-ever wheeze (2.72, 1.28-5.75); but children in the 3rd quartile (0.33, 0.17-0.68) and in the 4th quartile (0.47, 0.23-0.97) were significantly associated with a lower odd of rhinitis in the past 12 months prior to the home inspection. Our results indicate that exposures to indoor airborne fungi in low concentrations seemingly have no significant impacts on the risks of most allergic and airway illnesses in childhood. Since families with sick participants might pay more attention to improve indoor air quality, effects of "avoidance behavior" on associations between indoor pollutants and childhood health should be considered in the data analysis and design of the nested case-control study.

Prevalence of Allergic Rhinitis and Associated Risk Factors in 6 to 12 Years Schoolchildren From Wuhan in Central China: A Cross-sectional Study

BACKGROUND

Over the past decade, the prevalence of allergic rhinitis (AR) in China increased and showed a trend of younger age. The clinical features of AR in primary schoolchildren are still not clear enough.

OBJECTIVE

To investigate the prevalence and epidemiological characteristics of AR among 6- to 12-year-old children in the central region of China.

METHODS

Children from 6 primary schools were randomly selected from urban area of Wuhan, which lies in the central region of China. The questionnaires were distributed by mobile APP and filled out by the children and their parents online together. AR was diagnosed by Score for Allergic Rhinitis. Logistic regression analysis was performed to assess the risk factors for AR.

RESULTS

A total of 5550 valid questionnaires were returned for evaluation. The prevalence of AR among 6- to 12-year-old children in urban area of Wuhan was 28.6%. Multivariate analysis revealed that male (odds ratio [OR] = 1.521, 95% confidence interval [CI] = [1.335, 1.732]), family history of atopy (OR = 3.220, 95% CI = [2.818, 3.681]), previous food allergy (OR = 1.590, 95% CI = [1.302, 1.942]), air purifier (OR = 1.420, 95% CI = [1.240, 1.625]), exposure to dust (OR = 1.764, 95% CI = [1.410, 2.207]), maternal exposure to smoke during pregnancy (OR = 1.242, 95% CI = [1.047, 1.473]), living in towns (OR = 1.468, 95% CI = [1.043, 2.006]) or metropolis (OR = 1.629, 95% CI = [1.205, 2.201]) before 2 years old, frequent application of antibiotics are risk factors for AR, while daily outdoor time for more than 1 hour (OR = 0.770, 95% CI = [0.673, 0.881]) and breastfeeding for more than 6 months (OR = 0.799, 95% CI = [0.701, 0.910]) reduced the risk significantly.

CONCLUSIONS

We found an unexpectedly high prevalence of AR among primary schoolchildren aged 6 to 12 years in the central region of China. Both genetic and environmental factors were associated with the development of AR.

Prevalence of metabolic syndrome among ethnic groups in China

Background

Metabolic syndrome (MetS) is common in China, which has a multi-ethnic population of 1·3 billion. We set out to determine the prevalence of MetS and its components in different ethnic groups.

Methods

This nationwide cross-sectional survey involved 24,796 participants from eight ethnicities in six provinces in China from 2008 to 2011. MetS was defined using the modified National Cholesterol Education Program Adult Treatment Panel III criteria. Results were analysed using SPSS version 22·0 in 2018. Logistic regression was used for deriving odds ratios and 95% confidence intervals of risk factors for the MetS.

Results

The prevalence of MetS increased with age from 3·60% to 21·68%. After age standardization, the prevalence of MetS, in descending order, was 35·42% (Korean), 22·82% (Hui), 19·80% (Han), 13·72% (Miao), 12·90% (Tujia), 12·04% (Li), 11·61% (Mongolian), 6·17% (Tibetan). Korean ethnicity was associated with a higher prevalence in five components of MetS, while Tibetan ethnicity was associated with lower prevalence except decreased HDL cholesterol. Logistic regression analyses showed that age, drinking and being non-Tibetan were associated with a higher risk of MetS.

Conclusions

Within one country, albeit a large one, the prevalence of MetS can vary greatly. Chinese of Korean ethnicity had a much higher prevalence than Tibetan ethnicity. Measures to tackle MetS should be tailored to the ethnic groups within a population.

Home environmental and lifestyle factors associated with asthma, rhinitis and wheeze in children in Beijing, China

BACKGROUND

The prevalence of asthma and allergic diseases has increased rapidly in urban China since 2000. There has been limited study of associations between home environmental and lifestyle factors with asthma and symptoms of allergic disease in China.

METHODS

In a cross-sectional analysis of 2214 children in Beijing, we applied a two-step hybrid Least Absolute Shrinkage and Selection Operator (LASSO) algorithm to identify environmental and lifestyle-related factors associated with asthma, rhinitis and wheeze from a wide range of candidates. We used group LASSO to select variables, using cross-validation as the criterion. Effect estimates were then calculated using adaptive LASSO. Model performance was assessed using Area Under the Curve (AUC) values.

RESULTS

We found a number of environmental and lifestyle-related factors significantly associated with asthma, rhinitis or wheeze, which changed the probability of asthma, rhinitis or wheeze from -5.76% (95%CI: -7.74%, -3.79%) to 27.4% (95%CI: 16.6%, 38.3%). The three factors associated with the largest change in probability of asthma were short birth length, carpeted floor and paternal allergy; for rhinitis they were maternal smoking during pregnancy, paternal allergy and living close to industrial area; and for wheeze they were carpeted floor, short birth length and maternal allergy. Other home environmental risk factors identified were living close to a highway, industrial area or river, sharing bedroom, cooking with gas, furry pets, cockroaches, incense, printer/photocopier, TV, damp, and window condensation in winter. Lifestyle-related risk factors were child caretakers other than parents, and age<3 for the day-care. Other risk factors included use of antibiotics, and mother's occupation. Major protective factors for wheeze were living in a rural/suburban region, air conditioner use, and mother's occupation in healthcare.

CONCLUSIONS

Our findings suggest that changes in lifestyle and indoor environments associated with the urbanization and industrialization of China are associated with asthma, rhinitis, and wheeze in children.

Principles of Allergen Immunotherapy and Its Clinical Application in China: Contrasts and Comparisons with the USA

Allergen immunotherapy (AIT) for allergic rhinitis (AR), asthma, and other allergic diseases has developed quickly. House dust mite (HDM), Artemisia (wormwood), Humulus japonicus (Japanese hop), Alternaria alternata, and Cladosporium herbarum are the five most common inhalant allergens in China. AIT has been performed in China for over 60 years. With the support of the Chinese Medical Association (CMA) and the Chinese Medical Doctors Association (CMDA), the Chinese College of Allergy and Asthma (CCAA) was established in 2016 as a specialized branch of CDMA and is the main certification authority for AIT. Chinese allergists and scientists have made tremendous progress in the development of AIT. There have been many publications by Chinese allergists and scientists worldwide encompassing original research studies, systematic reviews, case studies, and clinical trials. Currently, conventional subcutaneous immunotherapy (SCIT) is the preferred AIT in China, but sublingual immunotherapy (SLIT) is beginning to gain recognition. An increasing number of clinical trials have been conducted to investigate the clinical efficacy and side effects of SLIT and SCIT. In China, HDM is the only commercial standardized allergen extracts in clinical use, whereas the others are crude allergen extracts. Besides standardized allergen extracts, other forms of hypoallergenic extracts are still being investigated and developed in China. Immunotherapy in China is similar to that in the USA in which allergen extracts can be mixed for SCIT. However, allergen extracts cannot be mixed for SCIT in Europe.

Associations of gestational and the first year of life exposure to ambient air pollution with childhood eczema in Hubei, China

Whether exposure to air pollution is associated with the increased incidence of childhood eczema is controversial. Only a few previous researches about the relationship between gestational and early-life exposures to ambient air pollutants and childhood eczema were conducted in China, and there is a lack of studies in Hubei province. This study aimed to explore the associations between air pollution exposure in gestation and the first year of life and childhood eczema. From November to December 2017, a total of 3383 children aged 3-6 years were recruited from 12 kindergartens in Hubei, China; 3167 were included in the final analysis. Parent-reported data involved with childhood eczema was inquired by questionnaire, and the concentrations of NO₂, PM_2.5, and PM₁₀ were acquired from air quality monitoring stations which were the nearest to the twelve kindergartens. A binary logistic regression model was used to evaluate the associations of period-mean concentrations of individual pollutant exposure with childhood eczema. Of the 3167 children, 848 (26.8%) had a history of doctor-diagnosed eczema. After adjusting for the covariates, high levels of NO₂, PM_2.5, and PM₁₀ exposures were significantly associated with a positive increase in risk of childhood eczema during the gestational period and the first year of life. In the gestational period, the estimate OR in the 3rd and 4th quartiles of NO₂ was 1.256 and 1.496, respectively. During the first year of life, the estimate OR in the 3rd and 4th quartiles of NO₂ was 1.371 and 1.335, respectively. Our study indicated that the gestational period and the first year of life exposures to high levels of ambient NO₂, PM_2.5, and PM₁₀ were significantly associated with increased eczema among preschool children. Some effective measures of prevention and intervention could be developed for preschool children.

Effects of childhood exposure to PM2.5 in a Memphis pediatric asthma cohort

The effects of childhood exposure to ambient air pollution and their influences on healthcare utilization and respiratory outcomes in Memphis pediatric asthma cohort are still unknown. This study seeks to (1) investigate individual-level associations between asthma and exposure measures in high asthma rate and low asthma rate areas and (2) determine factors that influence asthma at first year of a child's life, first 2 years, first 5 years, and during their childhood. Datasets include physician-diagnosed asthma patients, on-road and individual PM_2.5 emissions, and high-resolution spatiotemporal PM_2.5 estimates. Spatial analytical and logistic regression models were used to analyze the effects of childhood exposure on outcomes. Increased risk was associated with African American (AA) (odds ratio (OR) = 3.09, 95% confidence interval (CI) 2.80-3.41), aged < 5 years old (OR = 1.31, 95% 1.17-1.47), public insurance (OR = 2.80, 95% CI 2.60-3.01), a 2.5-km radius from on-road emission sources (OR = 3.06, 95% CI 2.84-3.30), and a 400-m radius from individual PM_2.5 sources (OR = 1.33, 95% CI 1.25-1.41) among the cohort with residence in high asthma rate areas compared to low asthma rates areas. A significant interaction was observed between race and insurance with the odds of AA being approximately five times (OR = 4.68, 95% CI 2.23-9.85), public insurance being about three times (OR = 2.65, 95% CI 1.68-4.17), and children in their first 5 years of life have more hospital visits than other age groups. Findings from this study can guide efforts to minimize emissions, manage risk, and design interventions to reduce disease burden.

Household dampness-related exposures in relation to childhood asthma and rhinitis in China: A multicentre observational study

During 2010-2012, we conducted an observational study on household environment and health outcomes among 40,010 preschool children from seven cities of China. Here we examined associations of six dampness-related indicators (visible mold spots, visible damp stains, damp clothing and/or bedding, water damage, condensation on windowpane, moldy odor) in the current residence and three dampness-related indicators (visible mold spots, condensation on windowpane, moldy odor) in the early residence with childhood asthma and rhinitis. In the multi-level logistic regression analyses, visible mold spots and visible damp stains in the current residence were significantly associated with the increased odds of doctor-diagnosed asthma and allergic rhinitis during lifetime-ever (adjusted odd ratios (AORs) range: 1.18-1.35). All dampness-related indicators were significantly associated with increased odds of wheeze and rhinitis during lifetime-ever and in the past 12 months (AORs range: 1.16-2.64). The cumulative numbers of damp indicators had positively dose-response relationships with the increased odds of the studied diseases. These associations for wheeze and rhinitis were similar between northern children and southern children. Similar results were found in the sensitive analyses among children without a family history of allergies and among children without asthma and allergic rhinitis. For 3-6 years-old children in mainland of China in 2011, we speculated that about 90,000 (2.02%) children with asthma and about 59,000 (1.09%) children with allergic rhinitis could be attributable to exposing to visible mold spots in the current residence. Our results suggested that early and lifetime exposures to household dampness indicators are risk factors for childhood asthma and rhinitis.

Modern life makes children allergic. A cross-sectional study: associations of home environment and lifestyles with asthma and allergy among children in Tianjin region, China

PURPOSE

In the past 60 years, the prevalences of asthma and allergy among children have increased around the world. Neither genetic nor outdoor environmental factors can explain this increase.

METHODS

We performed a cross-sectional study of 7366 children in Tianjin, China, on associations of home environment and lifestyles with asthma and allergy.

RESULTS

The prevalences of diagnosed asthma, rhinitis and eczema among 0- to 8-year-old children in the Tianjin area were 4%, 9% and 39%. Home environment and lifestyle, together with infections, were strong risk factors. For asthma and allergy, the population attributable fraction (PAF) due to modern floors and wall coverings (i.e., laminated wooden floors and painted walls compared to tile floors and lime-coated walls) was 22%. Window condensation in winter and air conditioner use in summer, both of which are proxies for less ventilation, accounted for 7-17% of rhinitis and eczema. Cesarean delivery accounted for 10% of eczema symptoms. We developed a modern life index from appropriate home characteristics and lifestyle and food consumption habits and found it to have a clear dose-response relationship with asthma and allergy in Tianjin children.

CONCLUSIONS

The results indicate that a "modern" home environment together with a modern lifestyle is associated with increased prevalences of asthma and allergies among children. Appropriate indoor environmental interventions and education of children's caregivers are important in the management of childhood asthma and allergy.

Increasing Prevalence of Allergic Rhinitis in China

Allergic rhinitis (AR) is a critical public health, medical and economic problem in China. AR is also an important risk factor which will cause many diseases or disorders, especially in children. The trend of AR incidence is still on the rise in recent years and has had a significant effect on the general public. This significant increase is alarming, which highlights an urgent need for better understanding of the prevalence status and characteristics, sensitization patterns, and the associated risk factors of AR in order to improve treatment and develop effective prevention strategies.

The association between sixteen genome-wide association studies-related allergic diseases loci and childhood allergic rhinitis in a Chinese Han population

BACKGROUND

Allergic rhinitis (AR) is one of the most common respiratory diseases in children. It is caused by a combination of genetic and environmental factors. Moderate-to-severe AR decreases the quality of life and social performance in children.

OBJECTIVE

To investigate whether polymorphisms in previously published genome-wide association studies (GWAS) allergic disease loci are associated with childhood AR and the severity of AR symptoms in a Chinese Han population.

METHODS

A case-control study was conducted in 503 pediatric patients with AR and 393 control Chinese school-aged subjects. AR severity was classified as mild or moderate-to-severe according to the AR and its Impact on Asthma (ARIA) guidelines. Overall, 16 tagged single-nucleotide polymorphisms (tSNPs) of published GWAS associations with allergic diseases were selected. All subjects were genotyped and analyzed for the 16 selected tSNPs using the improved multiplex ligation detection reaction (iMLDR) technique.

RESULTS

Both rs7130588_AG and rs7927894_CT genotypes in EMSY region were associated with a significantly increased risk of AR (1.75-fold and 1.50-fold) compared to the AA and CC genotypes, respectively, specific to moderate-to-severe AR. The difference of rs7130588 genotypes in cases vs. controls was still statistically significant under the additive model after multiple test correction to adjust the false discovery rate (FDR) with an adjusted odds ratio of 1.818 and 95% confidence interval (CI) of 1.240-2.664 (P_FDR = 0.0349). The rs7130588_G allele was only associated with a high risk of moderate-to-severe AR (1.85-fold, P_{age and gender_adjustment} = 0.003). The rs2227284_TG genotype at the IL4 locus was significantly associated with a 0.65-fold decreased risk of AR compared to the TT genotype. The protective effect of the rs2227284_G allele was also found in different severity of AR. Haplotype analysis showed a significantly increased AR risk associated with the haplotype G-T-T (rs7130588-rs2155219-rs7927894) and a protective effect with the haplotype C-G-C (rs2243250-rs2227284-s2243290).

CONCLUSIONS

The loci in EMSY and IL4 can be considered as a hereditary marker for childhood AR. The rs7130588_G allele seems to predispose only to moderate-to-severe AR, though other mechanisms are also likely to be involved.

The current prevalence of asthma, allergic rhinitis, and eczema related symptoms in school-aged children in Costa Rica

OBJECTIVE

Asthma prevalence in Costa Rica is among the highest worldwide. We aimed to determine the prevalence of asthma among school-age children in the Central Highland Area of Costa Rica.

METHODS

Cross-sectional study using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire was performed. Parents or guardians of children aged 6-13 years completed written questionnaires.

RESULTS

Total of 2817 school-aged children returned these questionnaires (74.1% return rate). The prevalence of asthma, rhinitis, and eczema was 21.9%, 42.6%, and 19.2%, respectively. The co-existence of the 3 diseases was seen in 22.6% of children with asthma. Boys had a slightly higher prevalence of these conditions, and younger children had higher prevalence of asthma and eczema, but lower prevalence of rhinitis than older children. The use of acetaminophen and antibiotics in the first 12 months of life showed a significant association with the prevalence of asthma, rhinitis, and eczema. Wheezing with exercise, dry cough at night, and ever rhinitis was highly associated with asthma symptoms in the last 12 months. In contrast, no association was found between children exposed to smoking at home. Frequent traffic next to the house was reported more frequently by the parents of children with asthma, although no significant association was found.

CONCLUSION

The prevalence of asthma showed a significant decrease compared to previous studies. However, there was an unexpected high prevalence of rhinitis. Exposure to acetaminophen and antibiotic during the first year of life was highly associated with asthma symptoms.

Efficacy and safety of sublingual immunotherapy with Dermatophagoides farinae drops in pre-school and school-age children with allergic rhinitis

BACKGROUND

The safety and efficacy of sublingual immunotherapy (SLIT) have been confirmed by many studies. However, in China, the research on efficacy and safety in young and older children with allergic rhinitis (AR) is still rare.

OBJECTIVE

The aim of this retrospective study is to evaluate the efficacy and safety of SLIT with Dermatophagoides farinae drops in pre-school and school-age children with AR.

METHODS

A total of 282 subjects aged 2-13 years with AR received a two-year course of sublingual immunotherapy along with pharmacotherapy. According to the age, patients were defined as the pre-school group (2-6 years old, n=116) and school-age group (7-13 years old, n=166). Total nasal rhinitis symptom scores (TNSS), visual analogue score (VAS) and total medication scores (TMS) were evaluated at four time points: baseline, after SLIT for half a year, one year and two years. The adverse events (AEs) were evaluated at each visit.

RESULTS

After two-year SLIT, the four rhinitis symptom scores, TNSS, VAS and TMS scores were significantly lower than baseline (all P<0.05). The comparison of efficacy between one and two-year duration showed no significant difference in global clinical outcomes (all P>0.05). In addition, there were no significant differences between the pre-school and school-age group in TNSS (all P>0.05), VAS (all P>0.05) and TMS scores (P>0.05) after SLIT for half a year, one year and two years. No severe systemic AEs were reported.

CONCLUSION

SLIT with D. farinae drops is clinically effective and safe in pre-school and school-age patients with house dust mites (HDMs)-induced AR.

The Prevalence of Ocular Allergy and Comorbidities in Chinese School Children in Shanghai

Objective

To investigate the prevalence and features of ocular allergy (OA) and comorbidities among school children in Shanghai, China.

Methods

This was a population-based cross-sectional study. Each participant completed an ISAAC-based questionnaire. The prevalence of OA symptoms, allergic rhinitis (AR) asthma, atopic dermatitis (AD), and sensitization to mites, pollen, and food was analyzed.

Results

A total of 724 and 942 completed questionnaires from the 7–9-year-old (young group) and the 12–14-year-old (teen group) groups were analyzed, respectively. The overall prevalence of OA symptoms was 28%. However, more young students (10.6%) reported mild to severe daily life interference caused by OA than the teens (5.7%). The young group had higher prevalence of diagnosed allergic conjunctivitis (10.2%). The overall prevalence of AR symptom, diagnosed asthma, and diagnosed AD was 40.4%, 11.6%, and 16.7%, respectively. Young children had higher prevalence of diagnosed AR and AD than the teens. There were gender associated differences in the prevalence of AR and asthma among young children, but not among the teens. The comorbidities associated with OA was also analyzed. Sensitization to mites, food, and pollen was associated with higher prevalence of allergic conditions.

Conclusions

OA together with other allergic conditions affected a significant number of children in Shanghai.

Protective effect of Bifidobacterium infantis CGMCC313-2 on ovalbumin-induced airway asthma and β-lactoglobulin-induced intestinal food allergy mouse models

AIM

To determine whether oral administration of Bifidobacterium infantis CGMCC313-2 (B. infantis CGMCC313-2) inhibits allergen-induced airway inflammation and food allergies in a mouse model.

METHODS

Ovalbumin (OVA)-induced allergic asthma and β-lactoglobulin-induced food allergy mouse models were used in this study. Following oral administration of B. infantis CGMCC313-2 during or after allergen sensitization, histopathologic changes in the lung and intestine were evaluated by hematoxylin and eosin (HE) staining. In the allergic asthma mouse model, we evaluated the proportion of lung-infiltrating inflammatory cells. OVA-specific IgE and IgG1 levels in serum and cytokine levels in bronchoalveolar lavage fluid (BALF) were also assessed. In the food allergy mouse model, the levels of total IgE and cytokines in serum were measured.

RESULTS

Oral administration of B. infantis CGMCC313-2 during or after allergen sensitization suppressed allergic inflammation in lung and intestinal tissues, while the proportion of infiltrating inflammatory cells was significantly decreased in the BALF of allergic asthma mice. Moreover, B. infantis CGMCC313-2 decreased the serum levels of total IgE in food allergy mice, and reductions in IgE and IgG1 were also observed in OVA-induced allergic asthma mice. The expression of interleukin-4 (IL-4) and IL-13 in both serum and BALF was suppressed following the administration of B. infantis CGMCC313-2, while an effect on serum IL-10 levels was not observed.

CONCLUSION

B. infantis CGMCC313-2 inhibits the secretion of allergen-induced IgE, IL-4 and IL-13, and attenuates allergic inflammation.

Sleep disorders and allergic diseases in Chinese toddlers

OBJECTIVE

Optimal sleep is important for child growth, development, and immune function. We aimed to explore whether sleep disorders were associated with the risk of allergic diseases in Chinese toddlers.

METHODS

This study included 566 children (aged 23.9 ± 0.7 months; 51.1% boys) in Shanghai, China. Sleep parameters (total sleep time, sleep onset latency, nocturnal awaking and snoring) were assessed by an expanded version of the Brief Infant Sleep Questionnaire (BISQ-expanded). Information on four allergic diseases (wheeze, eczema, food allergy, and allergic rhinitis) in the past year was collected via standard questionnaire and judged by pediatricians. We used logistic regression to calculate odds ratios (ORs) and their 95% confidence intervals (CIs) for having any/and each of the four allergic diseases, based on sleep parameters, adjusting for children's age and gender, mode of delivery, any breastfeeding duration, children's body mass index (BMI), children's exposure to passive smoking, maternal education, family income, family allergic history, and children's antibiotic use.

RESULTS

There were 23.3% of children with at least one of the four allergic diseases. Snoring was significantly associated with increased odds of having any allergy (adjusted OR = 1.95; 95% CI: 1.17, 3.26), eczema (OR = 1.83, 95% CI: 1.03, 3.23) and food allergy (OR = 4.31, 95% CI: 1.23, 15.14), after adjustment for potential confounders. Nocturnal awaking ≥2 times per night was associated with higher risk of food allergy (OR = 3.92, 95% CI: 1.00, 15.35) and wheeze (OR = 6.16, 95% CI: 1.28, 29.74).

CONCLUSION

In this study, presence of certain sleep disorders was associated with higher risk of having allergic diseases in Chinese toddlers.

The Association between Ambient Air Pollution and Allergic Rhinitis: Further Epidemiological Evidence from Changchun, Northeastern China

With the continuous rapid urbanization process over the last three decades, outdoors air pollution has become a progressively more serious public health hazard in China. To investigate the possible associations, lag effects and seasonal differences of urban air quality on respiratory health (allergic rhinitis) in Changchun, a city in Northeastern China, we carried out a time-series analysis of the incidents of allergic rhinitis (AR) from 2013 to 2015. Environmental monitoring showed that PM_2.5 and PM₁₀ were the major air pollutants in Changchun, followed by SO₂, NO₂ and O₃. The results also demonstrated that the daily concentrations of air pollutants had obvious seasonal differences. PM₁₀ had higher daily mean concentrations in spring (May, dust storms), autumn (October, straw burning) and winter (November to April, coal burning). The mean daily number of outpatient AR visits in the warm season was higher than in the cold season. The prevalence of allergic rhinitis was significantly associated with PM_2.5, PM₁₀, SO₂ and NO₂, and the increased mobility was 10.2% (95% CI, 5.5%–15.1%), 4.9% (95% CI, 0.8%–9.2%), 8.5% (95% CI, −1.8%–19.8%) and 11.1% (95% CI, 5.8%–16.5%) for exposure to each 1-Standard Deviation (1-SD) increase of pollutant, respectively. Weakly or no significant associations were observed for CO and O₃. As for lag effects, the highest Relative Risks (RRs) of AR from SO₂, NO₂, PM₁₀ and PM_2.5 were on the same day, and the highest RR from CO was on day 4 (L4). The results also indicated that the concentration of air pollutants might contribute to the development of AR. To summarize, this study provides further evidence of the significant association between ambient particulate pollutants (PM_2.5 and PM₁₀, which are usually present in high concentrations) and the prevalence of respiratory effects (allergic rhinitis) in the city of Changchun, located in Northeastern China. Environmental control and public health strategies should be enforced to address this increasingly challenging problem.

Preconceptional and perinatal exposure to traffic-related air pollution and eczema in preschool children

BACKGROUND

Evidence linking prenatal exposure to outdoor air pollution with eczema in early childhood is scare, and the role of components of air pollution and exposure timing remains unclear.

OBJECTIVES

We investigated the association between exposure to air pollution during preconceptional and perinatal period and the risk of eczema in preschool children.

METHODS

We conducted a prospective cohort study of 2598 children aged 3-6 years in Changsha, China. The prevalence of eczema was assessed by a standardized health questionnaire administered by the parents. Individual exposures to nitrogen dioxide (NO₂), sulfur dioxide (SO₂) and particulate matter with an aerodynamic diameter≤10μm (PM₁₀) during the 4th-6th and 1st-3rd month before pregnancy, entire pregnancy, and three trimesters were estimated by an inverse distance weighted (IDW) method based on concentrations measured at monitoring stations. Association between childhood eczema and exposure to air pollution was examined by logistic regression models in terms of odds ratio (OR) and 95% confidence interval (CI) for an interquartile range (IQR) increase in exposure.

RESULTS

Life-time prevalence of eczema in preschool children in Changsha was 28.6%. Childhood eczema was associated with traffic-related air pollutant NO₂ during 3 months before pregnancy and entire pregnancy with adjusted ORs=1.19 (95% CI: 1.04-1.37) and 1.21 (95% CI: 1.03-1.42) respectively. The highest risk of eczema was observed for the 1st trimester exposure to NO₂ [OR=1.26 (95% CI: 1.09-1.46)]. However, no association was detected for SO₂ and PM₁₀ exposure during any window. High-level exposure to NO₂ during the whole time period significantly increased the effect of NO₂ in all windows on eczema risk as compared with low-level exposure. Sensitivity analysis indicated that the association between both preconceptional and perinatal exposure to NO₂ and childhood eczema was consistent and robust, and this association was modified by some personal, parental hereditary and indoor environmental factors.

CONCLUSION

Our findings support the hypothesis that early childhood eczema is associated with exposure to traffic-related air pollutant during both preconceptional and perinatal period, especially at a high level of exposure.

Household environment, lifestyle behaviors, and dietary habits in relation to childhood atopic eczema in Shanghai, China

PURPOSES

We aim to investigate associations of the child's individual characteristics, building characteristics, home environmental exposures, family lifestyle behaviors, and dietary habits on childhood eczema during lifetime-ever and in the last year before the survey.

METHODS

During April 2011-April 2012, we conducted a cross-sectional study and collected 13,335 parents-reported questionnaires of 4-6-year-old children from 72 kindergartens in Shanghai, China. Logistic regression model was used to investigate associations.

RESULTS

After adjusted for sex, age, family history of atopy, and questionnaire reporter, the factors which were strongly associated (increased odds >30% and p value <0.05) with lifetime-ever eczema included mother employed during pregnancy (adjusted OR 1.33), residence renovated during pregnancy (1.49) and in the child's first year of life (1.31), using laminate (1.58) and solid (1.42) wood as material of floor covering (compared to using cement), residence located in urban district (1.38), and dampness-related exposures in the early residence (mold spots/stains: 1.41; mold odor: 1.41) and in the current residence (water damage: 1.33; damp stains: 1.34; mold spots: 1.32; and windows pane condensation: 1.31). Parental smoking, pet-keeping, and incense-burning had no significant associations with childhood eczema. Similar associations were found for eczema in the last year before the survey. Families with sick children likely changed lifestyle behaviors and dietary habits.

CONCLUSIONS

Childhood eczema could be influenced by many household environmental and non-environmental factors. Exposures during early lifetime likely have greater impact on childhood eczema than current exposures. Associations of lifestyle behaviors and dietary habits with childhood eczema could be modified by family avoidance behaviors.

Prevalence of metabolic syndrome in Mainland China: a meta-analysis of published studies

Background

Metabolic syndrome (MS) comprises a set of conditions that are risk factors for cardiovascular diseases and diabetes. Numerous epidemiological studies on MS have been conducted, but there has not been a systematic analysis of the prevalence of MS in the Chinese population. Therefore, the aim of this study was to estimate the pooled prevalence of MS among subjects in Mainland China.

Methods

We performed a systematic review by searching both English and Chinese literature databases. Random or fixed effects models were used to summarize the prevalence of MS according to statistical tests for heterogeneity. Subgroup, sensitivity, and meta-regression analyses were performed to address heterogeneity. Publication bias was evaluated using Egger’s test.

Results

Thirty-five papers were included in the meta-analysis, with a total population of 226,653 Chinese subjects. Among subjects aged 15 years and older, the pooled prevalence was 24.5 % (95 % CI: 22.0–26.9 %). By sex, the prevalences were 19.2 % (95 % CI: 16.9–21.6 %) in males and 27.0 % (95 % CI: 23.5–30.5 %) in females. The pooled prevalence of MS increased with age (15–39 years: 13.9 %; 40–59 years: 26.4 %; and ≥60 years: 32.4 %). Individuals living in urban areas (24.9 %, 95 % CI: 18.5–31.3 %) were more likely to suffer from MS than those living in rural areas (19.2 %, 95 % CI: 14.8–23.7 %). Hypertension was the most prevalent component of MS in males (52.8 %), while the most prevalent component of MS for females was central obesity (46.1 %).

Conclusions

Our systematic review suggested a high prevalence of MS among subjects in Mainland China, indicating that MS is a serious public health problem. Therefore, more attention should be paid to the prevention and control of MS.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-2870-y) contains supplementary material, which is available to authorized users.

Role of bilastine in the management of allergic rhinitis and urticaria: an Asia-Pacific consensus statement

The prevalence of allergic diseases is increasing globally, most particularly in middle- to low-income countries. This article examines the burden of allergic rhinitis and chronic urticaria in the Asia-Pacific region, unmet clinical needs, and the potential role of bilastine in the management of these conditions. An International Advisory Group meeting was convened in association with the Asian Pacific Society of Respirology Annual Congress in November 2014, followed by a literature review, and consensus-based outcomes from the meeting and literature review are described. Regional estimates of the prevalence of allergic rhinitis range from 10% to 50%, while little is known regarding the burden of urticaria in the Asia-Pacific region. A survey of allergy patients in the region identified fast, complete, and long-lasting symptom relief as the medication attributes most important to patients. International treatment guidelines for allergic rhinitis and urticaria advocate the first-line use of second-generation, no-sedating H1-antihistamines, such as bilastine, over their first-generation counterparts and a range of these agents are available to Asia-Pacific patients. The newer agents possess many of the properties of an "ideal" antihistamine (once daily administration, rapid and complete symptom relief, limited potential for drug-drug interactions, minimal side effects). The burgeoning prevalence of allergic diseases in the Asia-Pacific region and the uncontrolled symptoms that these patients experience demand a new antihistamine that offers the highest number of positive features according to the international guidelines.

Asthma prevalence and risk factors in early childhood at Northern Portugal

Asthma is the commonest and most important chronic non-infectious disease in childhood and it has become more prevalent in recent years. There is a shortage of studies in relation to early childhood and so, as part of the INAIRCHILD project, this cross-sectional study aimed to assess the prevalence of asthma and its associated risk factors, namely demographic, environmental, psychosocial and clinical factors for infants and preschoolers living in Northern Portugal. Data concerning asthma prevalence were collected through questionnaires based on those from the International Study of Asthma and Allergies in Childhood (ISAAC-derived), the questionnaires were distributed to 1042 children attending the 17 nurseries involved in the INAIRCHILD project (10 in urban and suburban context, and 7 in rural context). The response rate was 48%. Prevalence of asthma based on symptomatology and odds ratio was calculated. Around 52% of the studied children presented at least one of the respiratory symptoms investigated (wheeze, dyspnea and cough) in the absence of upper respiratory infections. The prevalence of asthma was 10.7%, comparable to the figures for Portuguese schoolchildren (6-7 years old) reported by the national Directorate-General of Health, thus showing that an early diagnosis might be possible and helpful for the mitigation of childhood asthma. Environmental context (urban, suburban or rural), gender and family asthma history showed clear associations with asthma prevalence, namely non-rural location, male gender, and having an asthmatic parent were found to be risk factors.

Home environment, lifestyles behaviors, and rhinitis in childhood

The prevalence of children allergic rhinitis has been increasing in China and associated factors still are not clear. In the present paper, we selected 13,335 parent-reported questionnaires of 4-6 years-old children, in a cross-sectional study from April 2011 to April 2012 in Shanghai city, and investigated associations of various factors with parent-reported allergic rhinitis (doctor-diagnosed) and rhinitis symptoms in childhood. After adjusted by age, sex, family history of atopy, and respondent of questionnaire, we find that no siblings, mother in older age during pregnancy, shorter breastfeeding, using antibiotics in the first year, and home dampness-related exposures, had significant associations with increased prevalence of the studied diseases. Location, type, building area, decoration materials and construction period of the residence, also had significant associations with these diseases. Current parental smoking and pet-keeping had no significant associations with the studied diseases. Incense-burning and using mosquito coils had significant associations with reduced risk of allergic rhinitis and with increased risk of rhinitis symptoms. Using air cleaner and cleaning the residence in high frequency had associations with increased risk, but eating fast food and ice cream often had associations with the reduced risk, of the studied diseases. Families with children being diagnosed allergic rhinitis likely change their lifestyle behaviors. In conclusion, childhood rhinitis could be influenced by heredity and many "environmental exposures". Avoidance behaviors and reverse causation in parental smoking, pet-keeping, and dietary habits for childhood rhinitis should be carefully considered.

Prevalence of allergic rhinitis among elementary and middle school students in Changsha city and its impact on quality of life

OBJECTIVES

To investigate the prevalence of allergic rhinitis among elementary and middle school students and examine its impact on their quality of life.

METHODS

Stratified sampling and cluster sampling surveys were performed among 10-17-year-old students in Changsha city from June 2011 to April 2012.

RESULTS

In the stratified sampling survey, the self-reported allergic rhinitis rate was 42.5 per cent. Further examination demonstrated that the average prevalence of allergic rhinitis was 19.4 per cent. The cluster sampling survey demonstrated that 214 of 814 students appeared to be atopic (26.3 per cent). The prevalence of allergic rhinitis and asthma was 17.2 and 2.1 per cent, respectively. In total, 71 atopic individuals (8.7 per cent) were without any symptoms of allergic disease. Further analysis showed that allergic rhinitis influenced the students' sleep, emotions and memory (p < 0.001).

CONCLUSION

The prevalence of allergic rhinitis was 15.8 -19.4 per cent, showing an increase with age. Allergic rhinitis affected students' sleep, emotions and memory.

A multicenter study of the clinical features of allergic rhinitis in central China

BACKGROUND

Several epidemiological surveys of allergic rhinitis (AR) have been conducted in China. However, the clinical features of AR are still not clear enough. The aim of the current study was to perform a multicenter investigation to evaluate the clinical features of AR in China.

METHODS

A multicenter investigation was performed in 13 allergy centers in central China. A disease-related questionnaire was completed by each patient themselves or with guardian assistance after the diagnosis of AR. The clinical features of AR and allergen profile were analyzed.

RESULTS

Eleven thousand four patients who were diagnosed with AR were recruited in this study. The percentages of classification of AR according to the Allergic Rhinitis and Its Impact on Asthma guidelines were 9.7% intermittent mild (IM), 3.1% persistent mild (PM), 33.9% intermittent moderate-severe (IMS), and 53.3% persistent moderate-severe (PMS). There were 61.6 and 42.2% AR patients who had concomitant ocular or lower respiratory symptoms in clinic. The occurrence of ocular and lower respiratory symptoms was found to be gradually increased from IM, PM, and IMS to PMS. Cold air and temperature change were the two most common factors triggering the nasal symptoms. Dermatophagoides pteronyssinus and Dermatophagoides farinae were the most important allergens of central China.

CONCLUSIONS

This study has contributed to a better understanding of clinical features of AR in China.

Diversity of House Dust Mite Species in Xishuangbanna Dai, a Tropical Rainforest Region in Southwest China

PURPOSE

To survey the species diversity of home dust mites (HDM) in Xishuangbanna, a tropical rainforest region in Southwest China.

METHODS

From August 2010 to January 2011, mite-allergic patients and healthy controls were invited to participate. Dust samples from the patients' homes were collected, and mites in the samples were isolated. Permanent slides were prepared for morphologically based species determination.

RESULTS

In total, 6316 mite specimens of morphologically identifiable species were found in 233 dust samples taken from 41 homes. The result shows that the mite family of Pyroglyphidae occupied the highest percentage of the total amount of mites collected, followed by Cheyletidae family. The most common adult Pyroglyphidae mites were Dermatophagoides (D.) farinae, D. pteronyssinus, and D. siboney. The most common mites found from other families were Blomia tropicalis, Tyrophagus putrescentiae, and Aleuroglyphus ovatus. Four main allergenic dust mite species D. farinae, D. pteronyssinus, D. siboney, and Blomia tropicalis were found to be coinhabiting in 6/41 homes.

CONCLUSION

The HDM population in homes in Xishuangbanna, a tropical rainforest region in Southwest China, has its own characteristics. It has rich dust mite species and the dust mite densities do not show significant variation across seasons.

Updated prevalences of asthma, allergy, and airway symptoms, and a systematic review of trends over time for childhood asthma in Shanghai, China

BACKGROUND

The prevalence of asthma among Shanghai children has increased over time. This increase might be associated with changes in environmental exposures. Investigation of the time-trend of asthma and current prevalences is essential to understanding the causes.

OBJECTIVE

To estimate the current prevalences of asthma, allergies and other respiratory symptoms among Shanghai preschool children, and to investigate the time-trend of childhood asthma prevalence of from 1990 to 2011.

METHODS

From April 2011 to April 2012, the CCHH (China, Children, Homes, Health) cross-sectional study was conducted in Shanghai. Questionnaires were distributed to 17,898 parents or guardians of preschool children from 72 kindergartens in 5 districts. Previous similar studies were also summarized by a systematic literature review.

RESULTS

From a total of 14,884 questionnaires for 3-7 year old children, prevalences of the following diseases and symptoms were calculated: asthma 10.2%, wheeze (ever) 28.1%, pneumonia (ever) 33.5%, otitis media 11.0%, rhinitis (ever) 54.1%, hay fever 12.2%, eczema (ever) 22.7%, and food allergy 15.7%. Urban children had higher prevalences of most symptoms than suburban children. The prevalence of asthma has increased significantly, almost five-fold, from 2.1% in 1990 to 10.2% in the present study. The prevalence of asthma in boys was higher than in girls in the present study and in all reviewed studies.

CONCLUSIONS

Asthma, allergy and airway symptoms are common among preschool children in Shanghai. The prevalence of childhood asthma in Shanghai has increased rapidly from 1990 to 2011.

Pre- and postnatal risk factors in relation to allergic rhinitis in school-aged children in China

Objective

The objective of this study was to investigate the relationship between prenatal and postnatal risk factors and the prevalence of allergic rhinitis (AR) in Chinese children of specific ages.

Study Design

This study was a cross-sectional survey. Students from 8 metropolitan cities in China were studied in November and December, 2005. There were 20,803 elementary-school Chinese children (49.6% boys, mean age, 9.19 years) enrolled. Questions from the standard questionnaire of the International Study of Asthma and Allergies in Children were completed to enable us to examine the pattern of current AR. The potential confounders and pre-and postnatal risk factors were analyzed using logistic regression.

Results

The overall prevalence of AR was found in this study to be 9.8%. After adjusting for several likely confounders, there was a higher likelihood of AR in school-aged children who were not exclusively breastfed in the first 4 months of their lives (odds ratio [OR]: 1.28; 95% confidence interval [CI]: 1.16–1.41), children who were born post-term (OR: 1.34; 95% CI: 1.12–1.60), children delivered by cesarean section (OR: 1.07; 95% CI: 1.00–1.19), or children born to mothers who experienced depressive symptoms during the pre- and postnatal periods (OR: 1.28; 95% CI: 1.15–1.42).

Conclusions

AR in school-aged children was found to be associated with pre- and postnatal events. These findings indicate that strategies to reduce exposure to risk factors during pre- and postnatal periods for childhood allergies might be warranted.

Time Trends in Racial and Ethnic Disparities in Asthma Prevalence in the United States From the Behavioral Risk Factor Surveillance System (BRFSS) Study (1999-2011)

OBJECTIVES

We examined whether racial/ethnic disparities in the United States increased over time.

METHODS

We analyzed data from 3 868 956 adults across the United States from the Behavioral Risk Factor Surveillance System from 1999 to 2011. We used random intercepts models (individuals nested in states) to examine racial/ethnic disparities and time trends in asthma lifetime and its current prevalence, adjusted for covariates. We also investigated the heterogeneity in asthma prevalence by ethnicity of the major zone of residence.

RESULTS

Lifetime and current asthma prevalence were higher among non-Hispanic Black populations, with time trends highlighting increasing differences over time (b = 0.0078; 95% confidence interval [CI] = 0.0043, 0.0106). Lower odds ratios (ORs) of asthma were noted for Hispanic populations (OR = 0.74; 95% CI = 0.73, 0.76). Hispanics in states with more Puerto Rican residents reported greater risks of asthma (OR = 1.55; 95% CI = 1.24, 1.93) compared with Hispanics in states with larger numbers of Mexican or other ethnicities.

CONCLUSIONS

Disparities in asthma prevalence by racial/ethnic groups increased in the last decade, with non-Hispanic Blacks and Puerto Rican Hispanics at greater risk. Interventions targeting asthma treatments need to recognize racial, ethnic, and geographic disparities.

Home dampness, childhood asthma, hay fever, and airway symptoms in Shanghai, China: associations, dose-response relationships, and lifestyle's influences

Numerous studies of associations between dampness and respiratory diseases have been conducted, but their implications remain inconclusive. In this study of 13,335 parent-reported questionnaires (response rate: 85.3%), we analyzed associations between home dampness and asthma and related symptoms in 4- to 6-year-old children in a cross-sectional study of Shanghai. Indicators of home dampness were strongly and significantly associated with dry cough, wheeze, and rhinitis symptoms. In the current residence, children with visible mold spots (VMS) exposure had 32% higher risk of asthma (adjusted OR, 95% CI: 1.32, 1.07-1.64); damp clothing and/or bedding (frequently) was strongly associated with dry cough (1.78, 1.37-2.30); condensation on windows was strongly associated with hay fever (1.60, 1.27-2.01). In the early-life residence, VMS or damp stains (frequently) were strongly associated with dry cough (2.20, 1.55-3.11) and rhinitis ever (1.57, 1.11-2.21). Associations between dampness and diseases among children with or without family history of atopy were similar. The total number of dampness indicators had strong dose-response relationships with investigated health outcomes. Actions, including opening windows of the child's room at night and cleaning the child's room frequently, could potentially mitigate 25% of home VMS, thereby preventing more than 1.5% of attributable risk of the studied symptoms.

Acute effects of air pollution on asthma hospitalization in Shanghai, China

Air pollution has been accepted as an important contributor to asthma development and exacerbation. However, the evidence is limited in China. In this study, we investigated the acute effect of air pollution on asthma hospitalization in Shanghai, China. We applied over-dispersed generalized additive model adjusted for weather conditions, day of the week, long-term and seasonal trends. An interquartile range increase in the moving average concentrations of PM10, SO2, NO2 and BC on the concurrent day and previous day corresponded to 1.82%, 6.41%, 8.26% and 6.62% increase of asthmatic hospitalization, respectively. The effects of SO2 and NO2 were robust after adjustment for PM10. The associations appeared to be more evident in the cool season than in the warm season. Our results contribute to the limited data in the scientific literature on acute effects of air pollution on asthma in high exposure settings, which are typical in developing countries.

Asthma research in China: a five-year review

Asthma is one of the most common chronic diseases worldwide with increasing morbidity. China has the largest asthmatic population and is one of the countries with the highest asthma mortality. Fortunately, asthma research in China, both clinical and scientific, has developed markedly over the past few years. This has resulted in significant increases in our understanding of Chinese asthma prevalence, risk factors, control status, pathogenesis, and new prevention or treatment strategies. In this review, the major achievements of asthma research in China from 2008 to 2012 are summarized.

Follow-up formula consumption in 3- to 4-year-olds and respiratory infections: an RCT

OBJECTIVE

Children are vulnerable to diet inadequacies, which may affect immune function. Our objective was to determine if a follow-up formula (FUF) containing DHA, the prebiotics PDX and GOS, and yeast β-glucan affects incidence of respiratory infections and diarrheal disease in healthy children.

METHODS

In a double-blind, randomized, controlled, prospective trial, 3-4 year old children were fed 3 servings per day of either a FUF with 25 mg DHA, 1.2 g PDX/GOS, and 8.7 mg yeast β-glucan per serving or an unfortified, cow's milk-based beverage (control) for 28 weeks. Fecal and blood samples were collected to assess immune markers and iron/zinc status. Incidence of acute respiratory infections (ARI), diarrheal disease, and antibiotic treatment were obtained from medical records.

RESULTS

The FUF group had fewer episodes and shorter duration of ARI (mean days [SE]; control = 4.3 [0.2]; FUF = 3.5 [0.2]; P = .007), less antibiotic use (n [%]; control = 21 [14%]; FUF = 8 [5%]; P = .01), and fewer missed days of day care due to illness. No diarrheal disease was diagnosed in either group. The FUF group had higher interleukin-10 and white blood cell count at the end of the study. There were no differences in hemoglobin, serum ferritin and zinc, or fecal secretory immunoglobulin A.

CONCLUSIONS

Daily consumption of a FUF was associated with fewer episodes and shorter duration of ARI, as well as less antibiotic use. The children who consumed the FUF had increased interleukin-10 and white blood cells, suggesting an antiinflammatory mechanism and/or an increase of effector immune cells.

Efficacy and safety of sublingual immunotherapy in children aged 3-13 years with allergic rhinitis

BACKGROUND

Sublingual immunotherapy (SLIT) is recommended for allergic diseases. However, clinical studies containing evidence-based data of this treatment in young children, which is rarely reported in the literature, are needed. This study was designed to assess the efficacy and safety of SLIT in children, including very young children.

METHODS

Two hundred sixty-four children aged 3-13 years old (133 children, 3-5 years old) with Dermatophagoides farinae-induced allergic rhinitis with or without asthma treated by standard pharmacotherapy had randomly received either SLIT (SLIT group) or no SLIT (control group) for 12 months. Symptoms, medications, visual analog scale (VAS) and presence of adverse events (AEs) were assessed at monthly visits. Skin-prick test and Dermatophagoides farinae-specific IgE and IgG4 were measured before and after treatment.

RESULTS

Both treatments were effective in the global clinical scores during the first seven visits when compared with baseline (all, p < 0.01), and SLIT showed lower symptoms scores and VAS scores throughout this period (all, p < 0.01). These improvements continued until the later visits only in the SLIT group. Also, the asthma medication consumption was decreased by SLIT treatment only at the end of study (p < 0.01). The specific IgG4 was significantly increased after SLIT treatment when compared with the control group, but no significant change of specific IgE was observed in either groups. In the SLIT group, there was no significant difference between children less than or more than 5 years old in terms of clinical efficacy, onset of action, immunologic parameters, and safety. No severe systemic AEs were reported.

CONCLUSION

SLIT is effective and well-tolerated in children with allergic rhinitis 3-13 years old.

Comparison of patients hospitalized with influenza A subtypes H7N9, H5N1, and 2009 pandemic H1N1

Hospitalization with H7N9 virus infection is associated with older age and chronic heart disease, and patients have a longer duration of hospitalization than patients with H5N1 or pH1N1. This suggests that host factors are an important contributor to H7N9 severity.

Background. Influenza A(H7N9) viruses isolated from humans show features suggesting partial adaptation to mammals. To provide insights into the pathogenesis of H7N9 virus infection, we compared risk factors, clinical presentation, and progression of patients hospitalized with H7N9, H5N1, and 2009 pandemic H1N1 (pH1N1) virus infections.

Methods. We compared individual-level data from patients hospitalized with infection by H7N9 (n = 123), H5N1 (n = 119; 43 China, 76 Vietnam), and pH1N1 (n = 3486) viruses. We assessed risk factors for hospitalization after adjustment for age- and sex-specific prevalence of risk factors in the general Chinese population.

Results. The median age of patients with H7N9 virus infection was older than other patient groups (63 years; P < .001) and a higher proportion was male (71%; P < .02). After adjustment for age and sex, chronic heart disease was associated with an increased risk of hospitalization with H7N9 (relative risk, 9.68; 95% confidence interval, 5.24–17.9). H7N9 patients had similar patterns of leukopenia, thrombocytopenia, and elevated alanine aminotransferase, creatinine kinase, C-reactive protein, and lactate dehydrogenase to those seen in H5N1 patients, which were all significantly different from pH1N1 patients (P < .005). H7N9 patients had a longer duration of hospitalization than either H5N1 or pH1N1 patients (P < .001), and the median time from onset to death was 18 days for H7N9 (P = .002) vs 11 days for H5N1 and 15 days for pH1N1 (P = .154).

Conclusions. The identification of known risk factors for severe seasonal influenza and the more protracted clinical course compared with that of H5N1 suggests that host factors are an important contributor to H7N9 severity.