Childhood asthma and indoor allergens in Native Americans in New York

Health effects associated with exposure to secondhand smoke: a Burden of Proof study

Despite a gradual decline in smoking rates over time, exposure to secondhand smoke (SHS) continues to cause harm to nonsmokers, who are disproportionately children and women living in low- and middle-income countries. We comprehensively reviewed the literature published by July 2022 concerning the adverse impacts of SHS exposure on nine health outcomes. Following, we quantified each exposure-response association accounting for various sources of uncertainty and evaluated the strength of the evidence supporting our analyses using the Burden of Proof Risk Function methodology. We found all nine health outcomes to be associated with SHS exposure. We conservatively estimated that SHS increases the risk of ischemic heart disease, stroke, type 2 diabetes and lung cancer by at least around 8%, 5%, 1% and 1%, respectively, with the evidence supporting these harmful associations rated as weak (two stars). The evidence supporting the harmful associations between SHS and otitis media, asthma, lower respiratory infections, breast cancer and chronic obstructive pulmonary disease was weaker (one star). Despite the weak underlying evidence for these associations, our results reinforce the harmful effects of SHS on health and the need to prioritize advancing efforts to reduce active and passive smoking through a combination of public health policies and education initiatives.

Osborne N. Phthalates and asthma in children and adults: US NHANES 2007-2012

Environmental exposure to phthalates may contribute to an increased risk of asthma in children and adults. We aimed to assess the direction and strength of the association between urinary phthalates metabolites and current asthma in children and adults that participated in the National Health and Nutrition Examination Survey (NHANES) 2007-2012. Data on ten urinary phthalate metabolites, self-reported questionnaires, spirometry measures, and covariates were obtained from 7765 participants (28.1% were children aged 6-17 years) taking part in the NHANES 2007-2012. Asthma was assessed using self-reported questionnaires for children and adults, and via spirometry measures for adults alone. We used crude and adjusted logistic regression models to estimate the odds ratios (ORs) and 95% confidence interval (CI) per one log₁₀ unit change in the concentration of phthalate metabolites. We further modeled the effect modification by sex. Out of 10 metabolites, only mono-benzyl phthalate (MBzP) was positively associated with the prevalence of self-reported asthma in children, after adjusting for a range of potential confounders (odds ratio 1.54; 95% confidence interval 1.05-2.27). No significant relationship was observed for adults. The association of mono-ethyl phthalate (MEP) was modified by sex, with significantly increased odds of asthma among males [boys (2.00; 1.14-3.51); adult males (1.32; 1.04-1.69)]. While no other phthalates showed a positive relationship with current asthma in males, mono-(carboxynonyl) phthalate (MCNP) and mono-(3-carboxylpropyl) phthalate (MCPP) were inversely associated with spirometrically defined asthma in adult females. A sex-specific relationship in adults was evident when spirometry, but not self-reported measures were used to define asthma. We found no clear association between exposure to phthalates and current asthma, except for a significant relationship between MBzP metabolites and self-reported asthma in children. As a result, exposure to phthalates and asthma development and/or exacerbations remains controversial, suggesting a need for a well-designed longitudinal study.

Outdoor Air Emissions, Land Use, and Land Cover around Schools on Tribal Lands

Children from tribes are more burdened with adverse respiratory well-being outcomes versus other U.S. children. The objectives of this study were to identify stressors from the built and natural environments for tribal school-aged children. Outdoor air concentrations around U.S. tribal schools were linked to National Emission Inventories; ecoregions and National Land Cover Database; and American Community Survey and school map layers. Nine school sites (seven tribes, five U.S. states) were in three ecoregions: North American Deserts, Northern Forests, and Mediterranean California. Closest emission sources were oil, gas, airport, and manufacturing facilities. Maximum annual outdoor air concentrations were measured for toluene at two schools (29 ppb and 15 ppb, 2011), located four miles from a solid waste landfill and eight miles from paperboard/saw mills. Maximum annual concentrations of metals in particulate matter 10 micrometers and smaller were highest for manganese (68 ng/m³, 2011). Schools were in mainly arid and heavily forested lands. Closest emission sources were predominantly off tribal lands. Measurements were limited (<30/year). Compared to schools off tribal lands, schools on tribal lands were further away from roadway sources. Future research may examine outdoor air quality around schools with more developed land and indoor air for tribal children's total exposure.

Review of built and natural environment stressors impacting American-Indian/Alaska-Native children

Children's exposures to chemical and non-chemical stressors from their everyday environment affects their overall health and well-being. American-Indian/Alaska-Native (AI/AN) children may have a disproportionate burden of stressors from their built and natural environments when compared to children from other races/ethnicities. Our objectives were to identify chemical and non-chemical stressors from AI/AN children's built and natural environments and evaluate their linkages with health and well-being outcomes from the peer reviewed literature. Library databases (e.g. PubMed) were searched to identify studies focused on these stressors. References were excluded if they: did not discuss AI/AN children or they were not the primary cohort; discussed tribes outside the United States (U.S.); were reviews or intervention studies; or did not discuss stressors from the built/natural environments. Out of 2539 references, 35 remained. Sample populations were predominantly (70%) in New York (NY) and Alaska (AK); 14 studies reported on the same cohort. Studies with matching stressors and outcomes were few, ruling out a quantitative review. Respiratory and developmental outcomes were the main outcomes evaluated. Primary non-chemical stressors were residential proximity to polluted landscapes, lack of indoor plumbing, and indoor use of wood for heating or cooking. The main chemical stressors were volatile organic compounds (VOCs), particulate matter (PM2.5), polychlorinated biphenyls (PCBs), p,p'-DDE, hexachlorobenzene (HCB), lead, and mercury. Our qualitative review was suggestive of a potential increase in respiratory illness from indoor wood use or no plumbing, which can be used as a guide to promote healthy environments for AI/AN children. We identified limited studies (<40), demonstrating this population as understudied. Future studies need to consider: sample populations from other tribes in the U.S., stressors outside the household, other elements of the natural environment, and an evaluation of stressors from AI/AN children's total environment (built, natural, and social).

Exposure to indoor pollutants and Wheeze and asthma development during early childhood

Background: This review aimed to summarize existing epidemiological evidence of the association between quantitative estimates of indoor air pollution with early childhood respiratory disease. Methods: We carried out a systematic literature search of peer-reviewed epidemiological studies undertaken in “westernized” countries that have assessed exposure to indoor pollutants and asthma and wheeze from infancy up to the age of 5. Results: The search, between January 2004 and February 2014 yielded 1840 studies for consideration. Following application of eligibility criteria to titles and abstracts 22 independent studies were deemed relevant for further review. Two additional studies were next identified through examination of the references’ lists of these studies. Of these 24 selected studies, 16 adopted a prospective cohort design and 8 were case-control studies. Fourteen studies assessed exposure to bio-aerosols, 8 studies assessed exposure to specific air chemicals and two studies assessed exposure to bio-aerosols and air chemicals. Furthermore, 11 studies examined the association of exposure with asthma and 16 with wheeze. Findings indicate that existing studies have reported contradictory effects of indoor pollutants levels and occurrence of asthma/wheeze. Conclusion: Additional research to establish causality and evaluate interventions to prevent disease onset is needed.

Breastfeeding and childhood asthma: systematic review and meta-analysis

Asthma and wheezing disorders are common chronic health problems in childhood. Breastfeeding provides health benefits, but it is not known whether or how breastfeeding decreases the risk of developing asthma. We performed a systematic review and meta-analysis of studies published between 1983 and 2012 on breastfeeding and asthma in children from the general population. We searched the PubMed and Embase databases for cohort, cross-sectional, and case-control studies. We grouped the outcomes into asthma ever, recent asthma, or recent wheezing illness (recent asthma or recent wheeze). Using random-effects meta-analyses, we estimated pooled odds ratios of the association of breastfeeding with the risk for each of these outcomes. We performed meta-regression and stratified meta-analyses. We included 117 of 1,464 titles identified by our search. The pooled odds ratios were 0.78 (95% confidence interval: 0.74, 0.84) for 75 studies analyzing "asthma ever," 0.76 (95% confidence interval: 0.67, 0.86) for 46 studies analyzing "recent asthma," and 0.81 (95% confidence interval: 0.76, 0.87) for 94 studies analyzing recent wheezing illness. After stratification by age, the strong protective association found at ages 0-2 years diminished over time. We found no evidence for differences by study design or study quality or between studies in Western and non-Western countries. A positive association of breastfeeding with reduced asthma/wheezing is supported by the combined evidence of existing studies.

Allergy sensitization and asthma among 13-14 year old school children in Nigeria

BACKGROUND

The prevalence of asthma and role of atopy in asthma among children has not been clearly defined in Nigeria.

OBJECTIVE

To determine the prevalence of asthma and investigate risk factors related to allergy sensitization among urban and rural school children in southwest Nigeria.

METHODS

Validated ISAAC questionnaire was administered to 1736 high school children in randomly selected schools in rural and urban communities. Identified asthma cases were matched to controls. Allergy skin tests, blood eosinophil count, serum IgE and stool examination for parasites were performed. Dust samples from homes were also collected and analyzed for allergens.

RESULTS

The prevalence of asthma was 7.5% (95% CI 6.0 to 9.2%) and 8% (95% CI 6.0-10.4%) in the rural and urban communities respectively . Risk factors for asthma included cigarette-smoking, cats in the home and family size. Eosinophil count (109/L) was elevated in asthmatics [0.70 (95% CI 0.48-1.11) vs. 0.32 (95% CI 0.19-0.69); p<0.01], but IgE levels were similar between the two groups (298±229 IU/mL vs. 288±257; p=0.97). Positive skin tests to cat hair, cockroach, mango blossom and mouse epithelium were more frequent in asthmatics than in healthy controls, especially in the rural communities. There was no correlation between allergens in dust collected from homes and skin test reactivity.

CONCLUSION

Asthma prevalence is similar in rural and urban children in Southwest Nigeria and atopy with elevated IgE was not observed to be a major factor for asthma in our cohort of children in both communities.

Systematic review and meta-analysis investigating breast feeding and childhood wheezing illness

There is conflicting evidence concerning the relationship between breast feeding and wheezing illness. The objective of this study was to investigate whether there is any association between breast feeding and wheezing in children aged over 5 years and to discover possible sources of heterogeneity. An electronic search of MEDLINE and EMBASE databases was conducted from January 2000 to June 2010. In addition, reference lists from relevant publications were searched. Birth cohort, cross-sectional and case-control studies were included if they measured any breast feeding or exclusive breast feeding for 3 or 4 months. Wheezing illness, including asthma, was identified based on symptoms, reported diagnosis or objective criteria. Thirty-one publications were identified for meta-analysis. There was no association found between any or exclusive breast feeding and wheezing illness, although there was a high level of heterogeneity between the studies. Subgroup analysis revealed that any breast feeding slightly lowers the odds of wheeze (pooled odds ratio 0.92 [0.86, 0.98]) but slightly increases the odds of asthma defined by specific criteria (pooled odds ratio 1.10 [1.00, 1.22]). This meta-analysis does not provide evidence that breast feeding is protective against wheezing illness in children aged 5 years and over. The difference in the effects of breast feeding according to the nature of the wheezing illness highlights the importance of the heterogeneity of illness phenotypes.

Exposure assessment in Beijing, China: biological agents, ultrafine particles, and lead

In this study, air samples were taken using a BioSampler and gelatin filters from six sites in Beijing: office, hospital, student dormitory, train station, subway, and a commercial street. Dust samples were also collected using a surface sampler from the same environments. Limulus amoebocyte lysate (LAL) and Glucatell assays were used to quantify sample endotoxin and (1,3)-β-d-glucan concentration levels, respectively. Enzyme-linked immunosorbent assay (ELISA) was used to measure the dust mite allergens (Der p 1 and Der f 1). Ultrafine particle and lead concentrations in these sampling sites were also measured using P-Trak and atomic absorption spectrometer, respectively. Analysis of variance (ANOVA) and linear regression analysis were used to analyze the concentration data. Higher culturable bacteria (12,639 CFU/m3) and fungi (1,806 CFU/m3) concentrations were observed for the train station and the subway system, respectively. For the rest of sampling sites, their concentrations were comparable to those found in western countries, ranging from 990 to 2,276 CFU/m3 for bacteria, and from 119 to 269 CFU/m3 for fungi. ANOVA analysis indicated that there were statistically significant differences between the culturable bacterial and fungal concentration levels obtained for different sites (p value=0.0001 and 0.0047). As for dust allergens, endotoxin, and (1,3)-β-D-glucan, their concentrations also seemed to be comparable to those found in the developed countries. Airborne allergen concentrations ranged from 16 to 68 ng/m3. The dust-borne allergen concentration was observed to range from 0.063 to 0.327 ng/mg. As for endotoxin, the highest airborne concentration of 25.24 ng/m3 was observed for the commercial street, and others ranged from 0.0427 to 0.1259 ng/m3. And dust-borne endotoxin concentration ranged from 58.83 to 6,427.4 ng/mg. For (1,3)-β-D-glucan, the airborne concentration ranged from 0.02 to 1.2 ng/m3. Linear regression analyses showed that there existed poor correlations between those in airborne and dust-borne states (R2=0.002~0.43). In our study, the lowest ultrafine particle concentration about 5,203 pt/cm3 was observed in office and the highest was observed at the train station, up to 32,783 pt/cm3. Lead concentration was shown to range from 80 to 170 ng/mg with the highest also observed at the train station. The information provided in this work can be used to learn the general situation of relevant health risks in Beijing. And the results here suggested that when characterizing exposure both airborne and dust-borne as well as the environments should be considered.

Advantages of video questionnaire in estimating asthma prevalence and risk factors for school children: findings from an asthma survey in American Indian youth

OBJECTIVES

The aims of the present study were to estimate the prevalence and risk factors of asthma among a sample of American Indian youth and to evaluate survey instruments used in determining asthma prevalence and risk factors.

METHODS

Three hundred and fifty-two adolescents aged 9 to 21 years enrolled in an Indian boarding school completed an asthma screening. The survey instruments were a written questionnaire and a video-illustrated questionnaire prepared from the International Study of Asthma and Allergies in Childhood (ISAAC), school health records, and a health questionnaire. Participants also underwent spirometry testing.

RESULTS

The prevalence of self-reported asthma varied from 12.7% to 13.4% depending upon the instrument used and the questions asked. A history of hay fever, respiratory infections, and family history of asthma were found to be risk factors for asthma by all instruments. Female gender and living on a reservation were significantly associated with asthma by some, but not all, instruments. Airway obstruction was highly associated with one asthma symptom (wheeze) shown in the video questionnaire. Associations for most risk factors with asthma were strongest for the video questionnaire.

CONCLUSIONS

The prevalence of self-reported asthma among these American Indian youth was similar to rates reported for other ethnic groups. The video-based questionnaire may be the most sensitive tool for identifying individuals at risk for asthma.

The role of cats and dogs in asthma and allergy--a systematic review

Studies have reported contradictory effects of cat and dog exposure on allergy, resulting in inconsistent recommendations on animal avoidance. We conducted a systematic review of observational studies published in English from 2000 to January 2009. It shows in this review that the reported exposure-response relationships are contradictory. A total of 17 and 13 birth cohort studies on cat and dog exposure, respectively, are included in the review. Most of the birth cohort studies found that cat or dog exposure in early life had no effect on the development of asthma or wheezing symptoms and dog exposure during infancy was found to protect children from developing sensitization against aeroallergens. A total of 7 and 6 prospective studies in school-age children or adults on cat and dog exposure, respectively, are included in this review and most of these studies suggested an inverse association between cat exposure and asthma and wheezing symptoms. As for cross-sectional studies, 26 and 21 studies on cat and dog exposure, respectively, are included in this review, which cover a broad range of age groups and geographical areas, and reported inconsistent results. The evidence summarised in this systematic review needs to be interpreted with caution, the inconsistent study results may be due to study design, exposure assessment, and avoidance measure. The exposure-response relationships may also alter in geographical areas where the community prevalence of cats and dogs are significantly different. However, as the evidence of the effects of pet keeping on subsequent development of asthma or allergic diseases presented in this review are not overwhelmingly strong, the decision of whether to keep a cat or a dog in the family should be based on arguments other than the concern of developing asthma and allergy.

Breastfeeding and allergies: time for a change in paradigm?

PURPOSE OF REVIEW

This review examines recent studies of the relationships between breastfeeding and the epidemiology of allergic diseases, especially atopic dermatitis in infants and asthma in early and later childhood.

RECENT FINDINGS

Results from observational birth cohort studies, case-control studies, and one cluster randomized intervention trial have generally failed to demonstrate a protective effect of breastfeeding on outcomes of atopic dermatitis, allergic sensitization, wheezing, or asthma. Difficulties in interpretation relate to the absence of nonbreastfed control or reference groups in some studies, meaning outcomes can only be compared between different durations of breastfeeding. Studies with a nonbreastfed control group suggest there is an increased risk for atopy and asthma associated with breastfeeding and that prolonged breastfeeding may eventually reduce this increased risk. The family history, sex of the child, and the presence of other risk factors for allergy and asthma also influence the outcome.

SUMMARY

Although breastfeeding is strongly recommended for its multiple benefits on child health, most recent studies do not confirm the 'conventional wisdom' that breastfeeding is protective against allergy and asthma. Early reduction in childhood wheezing may reflect protection from viral infections, but allergies and asthma at later ages may be increased.

Environmental factors affecting children's respiratory health in the first years of life: a review of the scientific literature

The aim of this paper is to quantitatively summarize the original articles on the relationship between environmental hazards and respiratory health in young children. A search was carried out in the main biomedical bibliographical sources in December 2006 and then the results were updated in June 2007. The study period covered 11 years (1996-2006). The information was assessed by reviewing the abstracts. Six hundred and forty documents were recovered. Documents from the United States accounted for 23.5% of articles. The production tended to increase over the study period. The factor most widely studied was air pollution, with outdoor air pollution being studied more (just over 50% of articles) than indoor air pollution (40%). Asthma was the most often studied condition (75% of articles). In a third of the cases, the information was obtained from hospital or health center records, and in 20% from questionnaires. The main diagnostic criterion was clinical. Infection of the inferior respiratory tracts predominated in children less than 3 years of age. An awareness of the role played by pollution and environmental hazards is fundamental in the management and prevention of respiratory problems in childhood, and this is reflected in the literature reviewed. However, very few synthesis studies have been carried out on this matter.

Exposure to furry pets and the risk of asthma and allergic rhinitis: a meta-analysis

BACKGROUND

Exposure to pets has been implicated as a risk factor for asthma. However, this relation has been difficult to assess in individual studies because of the large potential of selection bias. We sought to examine the association between exposure to furry pets and asthma and allergic rhinitis by means of a meta-analysis.

METHODS

We retrieved studies published in any language by searching systematically Medline (1966-March 2007), Embase, LILACS and ISI Proceedings computerized databases, and by examining manually the references of the original articles and reviews retrieved. We included cohort and case-control studies reporting relative risk estimates and confidence intervals of exposure to cats, dogs and unspecified furry animals and subsequent asthma and allergic rhinitis. We excluded cross-sectional studies and those studies that did not measure exposure but rather sensitization to pets.

RESULTS

Thirty-two studies were included. For asthma, the pooled relative risk related to dog exposure was 1.14 (95% CI 1.01-1.29), that related to exposure to any furry pet was 1.39 (95% CI 1.00-1.95). Among cohort studies, exposure to cats yielded a relative risk of 0.72 (95% CI 0.55-0.93). For rhinitis, the pooled relative risk of exposure to any furry pet was 0.79 (95% CI 0.68-0.93).

CONCLUSIONS

Exposure to cats exerts a slight preventive effect on asthma, an effect that is more pronounced in cohort studies. On the contrary, exposure to dogs increases slightly the risk of asthma. Exposure to furry pets of undermined type is not conclusive. More studies with exact measurement of exposure are needed to elucidate the role of pet exposures in atopic diseases.

Predictivity of allergic sensitization (RAST) for the onset of allergic diseases in adults

BACKGROUND

Specific IgE antibodies are often detected without any clinical manifestation of allergies. We aimed to analyse the predictivity of allergic sensitization for incident symptoms of allergic diseases in adults during a 10-year follow-up.

METHODS

In 1994/95 specific IgE antibodies against five common inhalant allergens (grass pollen, birch pollen, house dust mite, cat dander and Cladosporium) were diagnosed by radioallergosorbent test in 4178 adults aged 25-74 years. A subset of 2656 participants could be re-evaluated in 2004/05. Information on socio-economic factors and medical history, including data on atopic diseases, was assessed by a combination of a personal interview and a self-administered questionnaire. Logistic regression models were applied to study associations between allergic sensitization and incident allergic diseases.

RESULTS

Allergic sensitization was an important predictor for incident hay fever (OR 7.95, CI 95% 4.64-13.62) and asthma (OR 1.82, CI 95% 1.29-2.57). Specific IgE antibodies were mainly related to outdoor allergens (grass and birch pollen) for hay fever and indoor allergens (mite and cat dander) for asthma, while for atopic dermatitis no specific IgE antibodies were identified as major predictors.

CONCLUSIONS

Allergic sensitization not only covers clinically apparent allergies, but indicates a prognostic factor for later allergies, even in adulthood.