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Katsanakis N, Xepapadaki P, Koumprentziotis IA, Vidalis P, Lakoumentas J, Kritikou M, Papadopoulos NG. Total IgE Trends in Children with Allergic Diseases. J Clin Med 2024; 13:3990. [PMID: 38999554 PMCID: PMC11242130 DOI: 10.3390/jcm13133990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 06/23/2024] [Accepted: 07/05/2024] [Indexed: 07/14/2024] Open
Abstract
Background/Objectives: The importance of non-invasive biomarkers for the diagnosis and monitoring of allergic diseases in childhood is currently unknown. From this perspective, data on the role of the total (t) immunoglobulin E (IgE) in relation to different allergic diseases across different age groups until adulthood remain unclear. The potential association of tIgE levels with types of allergic diseases diagnosed in an specialized tertiary allergy center, in relation to sex and the age group spanning from birth to 20 years, are evaluated in the present study. Methods: In this retrospective study, the tIgE values were obtained from children assessed for allergy-associated symptoms in our department from January 2015 to December 2020. The tIgE values were analyzed in relation to age and diagnosis. Results: Data from 2127 patients (1321 boys (62.1%)), with a median age of 6.31 (3.01-9.95) years, were available. The tIgE median values for the studied population were 132 (37.7-367.5) kU/lt. The tIgE values showed a significant increase from 0-2 years to 2-5 and 5-12 years, but not from 5-12 to 12-20 years. Boys exhibited significantly higher tIgE values compared to girls. Furthermore, the tIgE levels were significantly increased in children with asthma, allergic rhinitis, food allergy, and atopic dermatitis in comparison to children without these diagnoses. Conclusions: The total IgE values exhibit a significant and progressive longitudinal increase in children with allergic diseases, particularly notable in the 0-2 and 5-12 age groups, in boys, and in children diagnosed with atopic conditions.
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Affiliation(s)
| | | | | | | | | | - Maria Kritikou
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, 11527 Athens, Greece; (N.K.); (P.X.); (I.-A.K.); (P.V.); (J.L.); (N.G.P.)
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Ding B, Lu Y. Omalizumab in combination with subcutaneous immunotherapy for the treatment of multiple allergies associated with attention-deficit/hyperactivity disorder: a case report and a literature review. Front Pharmacol 2024; 15:1367551. [PMID: 38887551 PMCID: PMC11180729 DOI: 10.3389/fphar.2024.1367551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 05/08/2024] [Indexed: 06/20/2024] Open
Abstract
We describe the case of a 10-year-old boy with asthma (AS), accompanied by allergic rhinitis (AR), food allergy (FA), and combined attention-deficit/hyperactivity disorder (ADHD), who was treated at Shanghai Renji Hospital on 11 July 2020. The efficiency of the previous treatment with salmeterol/ticlosone was poor. Treatment with montelukast sodium resulted in development of neurological symptoms. Treatment with omalizumab in combination with subcutaneous immunotherapy (SCIT) was then initiated in our department based on anti-asthmatic therapy. Symptoms of asthma were completely controlled, and FA and AR symptoms improved. The treatment regimen led to a significant improvement in ADHD symptoms and the overall quality of life of the patient. The literature search was done in the PubMed database using "attention deficit/hyperactivity disorder/ADHD" and "asthma" as keywords, and we identified 47 relevant articles. In conclusion, our results show that treating asthma with omalizumab in combination with salmeterol/ticlosone and SCIT is efficient in controlling symptoms of multiple allergies and may lead to the improvement in ADHD symptoms and the overall quality of life of pediatric patients with ADHD. While current studies suggest that allergic diseases are closely related to ADHD, there is still a lack of studies or case reports of complete treatment protocols to provide clinical clues for management of the disease.
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Affiliation(s)
| | - Yanming Lu
- Department of Pediatrics, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Chen J, Liu X, Su W, Liu Z, Sun G, Yang Y, Tian M, Li J, Dong Y. Unveiling the hidden risk: paternal smoking and alcohol exposure prior to conception as independent factors for allergic rhinitis in children. Front Pediatr 2024; 12:1394400. [PMID: 38873584 PMCID: PMC11172151 DOI: 10.3389/fped.2024.1394400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 05/02/2024] [Indexed: 06/15/2024] Open
Abstract
Introduction Limited knowledge exists regarding the impact of paternal smoking and alcohol exposure on the development of allergic rhinitis in offspring. Our study aimed to investigate the potential association between preconception paternal smoking and alcohol exposure and the likelihood of children allergic rhinitis. Methods A retrospective case-control study of 556 prepubertal children aged 3-12 years was performed. The participants were 278 children with allergic rhinitis and 278 healthy controls matched for age and gender. Self-administered questionnaires were distributed and collected on-site, focusing on various factors related to the children's fathers, mothers, and the children themselves during the first year of life and the past 12 months, from March to October 2022. Results Multivariate analysis demonstrated that paternal smoking, paternal alcohol consumption prior to conception, paternal allergic diseases, children with a family history of allergies, maternal allergic diseases and pregnancy complications were identified as independent risk factors for allergic rhinitis in their offspring. Moreover, after considering confounding factors, it was observed that paternal smoking exceeding 5 cigarettes per day in the year preceding pregnancy and exceeding 11 years significantly elevated the likelihood of allergic rhinitis in children (OR = 2.009 and 2.479, respectively). Furthermore, the consumption of alcohol by the father at intervals of less than one month in the year prior to pregnancy and a duration of alcohol consumption exceeding 11 years prior to pregnancy are both associated with a significantly increased risk of allergic rhinitis in children (OR = 2.005 and 3.149, respectively). Conclusions Paternal smoking and alcohol consumption prior to conception contribute to an increased risk of allergic rhinitis in children, with the risk being dependent on the dosage and duration of exposure. Therefore, it is important to not only focus on personal and maternal environmental exposures when considering the occurrence risk of allergic rhinitis in children, but also to consider paternal detrimental exposures prior to conception.
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Affiliation(s)
- Junrong Chen
- Key Laboratory of Model Animals and Stem Cell Biology in Hunan Province, School of Medicine, Hunan Normal University, Hunan, China
- Nursing Department, Changde Vocational Technical College, Changde, Hunan, China
| | - Xiaohua Liu
- Key Laboratory of Model Animals and Stem Cell Biology in Hunan Province, School of Medicine, Hunan Normal University, Hunan, China
- Department of Medical Consortium Work, Changsha Hospital for Maternal & Child Health Care Affiliated to Hunan Normal University, Changsha, Hunan, China
| | - Wenwen Su
- Key Laboratory of Model Animals and Stem Cell Biology in Hunan Province, School of Medicine, Hunan Normal University, Hunan, China
- Hunan Provincial People's Hospital Affiliated to Hunan Normal University, Changsha, Hunan, China
| | - Zixin Liu
- Key Laboratory of Model Animals and Stem Cell Biology in Hunan Province, School of Medicine, Hunan Normal University, Hunan, China
- Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Guoying Sun
- Key Laboratory of Model Animals and Stem Cell Biology in Hunan Province, School of Medicine, Hunan Normal University, Hunan, China
| | - Yide Yang
- Key Laboratory of Model Animals and Stem Cell Biology in Hunan Province, School of Medicine, Hunan Normal University, Hunan, China
| | - Mei Tian
- Key Laboratory of Model Animals and Stem Cell Biology in Hunan Province, School of Medicine, Hunan Normal University, Hunan, China
| | - Jian Li
- Key Laboratory of Model Animals and Stem Cell Biology in Hunan Province, School of Medicine, Hunan Normal University, Hunan, China
- Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan Province, School of Medicine, Hunan Normal University, Changsha, Hunan, China
- The Engineering Research Center of Reproduction and Translational Medicine of Hunan Province, Changsha, China
| | - Yunpeng Dong
- Department of Otolaryngology-Head and Neck Surgery, Yichang Central People's Hospital, Three Gorges University, Hubei, China
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Abstract
Paediatric chronic health conditions are associated with poorer psychological wellbeing and quality of life for children and families. This study investigated differences in child and parent/family quality of life between families of children with asthma only, eczema only, or both asthma and eczema, and tested predictors of child and parent/family quality of life. A convenience sample of 106 families completed parent-report measures of child and parent/family quality of life, child emotional and behavioural difficulties, parent adjustment and parenting practices. Between-groups ANOVAs indicated no differences for child quality of life, whereas parent/family quality of life was worse for those with eczema only compared to asthma only. Multiple linear regression revealed that child emotional difficulties predicted worse child quality of life, whereas worse parent adjustment, child emotional difficulties and eczema only (compared to both asthma and eczema) predicted worse parent quality of life. Results suggest that families of children with eczema may be at particular risk for impaired parent/family quality of life. Interventions that take a family-centred approach to improving child and parent adjustment should be investigated as an adjunct to medical treatment to reduce the impact of chronic health conditions on quality of life for children and families.
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Affiliation(s)
- Alina Morawska
- Parenting and Family Support Centre, School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
| | - Evren Etel
- School of Applied Psychology, Griffith University, Mount Gravatt, Queensland, Australia
| | - Amy E Mitchell
- Parenting and Family Support Centre, School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
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Liu Z, Xie L, Liu X, Chen J, Zhou Y, Zhang J, Su H, Yang Y, Tian M, Li J, Dong Y. Cesarean section and the risk of allergic rhinitis in children: a systematic review and meta-analysis. Sci Rep 2023; 13:18361. [PMID: 37884557 PMCID: PMC10603136 DOI: 10.1038/s41598-023-44932-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 10/13/2023] [Indexed: 10/28/2023] Open
Abstract
Multiple evidence indicates that perinatal factors make impact on immune development and affect offspring allergic rhinitis (AR) risk. In this systematic review and meta-analysis, we examined available published studies to clarify the relationship between cesarean section (C-section) and offspring AR in children. To explore the relationship between C-section, especially the special attention was paid to different cesarean delivery mode, and the risk of AR in children. Articles were searched using PubMed, Web of Science, EMBASE, Cochrane Library, China knowledge Network, Wanfang, and China Science and Technology Journal databases. A meta-analysis of 22 studies published before August 1, 2022, which included 1,464,868 participants, was conducted for statistical analysis with RevMan5.4. The correlation strength between C-section and offspring AR was determined by combining odds ratio (OR) and 95% confidence interval (95% CI). Meta-regression and subgroup analyses were used to explore potential sources of heterogeneity. Publication bias was detected using the funnel chart and Egger tests. Meta-analysis revealed that there was a significant correlation between C-section and children AR (OR = 1.19, 95% CI: 1.12-1.27, P < 0.001), especially C-section with a family history of allergy (OR = 1.82, 95% CI: 1.36-2.43, P < 0.001). Moreover, elective C-section (without genital tract microbe exposure) had the higher risk of offspring AR (OR = 1.24, 95% CI: 1.05-1.46, P = 0.010) compared with the whole study. Meta-regression demonstrated that sample size explained 38.0% of the variability between studies, and year of publication explained 18.8%. Delivery by C-section, particularly elective C-section and C-section with a family history of allergy can increase the risk of AR in children.
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Affiliation(s)
- Zixin Liu
- Key Laboratory of Model Animals and Stem Cell Biology in Hunan Province, School of Medicine, Hunan Normal University, 410013, Hunan, China
- Third Xiangya Hospital, Central South University, 138 Tongzipo Road, 410013, Changsha, Hunan, China
| | - Li Xie
- Key Laboratory of Model Animals and Stem Cell Biology in Hunan Province, School of Medicine, Hunan Normal University, 410013, Hunan, China
| | - Xiaohua Liu
- Key Laboratory of Model Animals and Stem Cell Biology in Hunan Province, School of Medicine, Hunan Normal University, 410013, Hunan, China
- Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan Province, School of Medicine, Hunan Normal University, 410013, Changsha, Hunan, China
| | - JunRong Chen
- Key Laboratory of Model Animals and Stem Cell Biology in Hunan Province, School of Medicine, Hunan Normal University, 410013, Hunan, China
| | - Yaqian Zhou
- Second Xiangya Hospital, Central South University, 139 Renmin Road, 410011, Changsha, Hunan, China
| | - Jialin Zhang
- Key Laboratory of Model Animals and Stem Cell Biology in Hunan Province, School of Medicine, Hunan Normal University, 410013, Hunan, China
| | - Honghui Su
- Third Xiangya Hospital, Central South University, 138 Tongzipo Road, 410013, Changsha, Hunan, China
| | - Yide Yang
- Key Laboratory of Model Animals and Stem Cell Biology in Hunan Province, School of Medicine, Hunan Normal University, 410013, Hunan, China
| | - Mei Tian
- Key Laboratory of Model Animals and Stem Cell Biology in Hunan Province, School of Medicine, Hunan Normal University, 410013, Hunan, China
| | - Jian Li
- Key Laboratory of Model Animals and Stem Cell Biology in Hunan Province, School of Medicine, Hunan Normal University, 410013, Hunan, China.
- Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan Province, School of Medicine, Hunan Normal University, 410013, Changsha, Hunan, China.
- The Engineering Research Center of Reproduction and Translational Medicine of Hunan Province, Hunan Normal University, 410013, Changsha, Hunan, China.
| | - Yunpeng Dong
- Department of Otolatyngoloty-Head and Neck Surgery, Yichang Central People's Hospital, Three Gorges University, 443000, Hubei, China.
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Plaza Moral V, Alobid I, Álvarez Rodríguez C, Blanco Aparicio M, Ferreira J, García G, Gómez-Outes A, Garín Escrivá N, Gómez Ruiz F, Hidalgo Requena A, Korta Murua J, Molina París J, Pellegrini Belinchón FJ, Plaza Zamora J, Praena Crespo M, Quirce Gancedo S, Sanz Ortega J, Soto Campos JG. GEMA 5.3. Spanish Guideline on the Management of Asthma. OPEN RESPIRATORY ARCHIVES 2023; 5:100277. [PMID: 37886027 PMCID: PMC10598226 DOI: 10.1016/j.opresp.2023.100277] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023] Open
Abstract
The Spanish Guideline on the Management of Asthma, better known by its acronym in Spanish GEMA, has been available for more than 20 years. Twenty-one scientific societies or related groups both from Spain and internationally have participated in the preparation and development of the updated edition of GEMA, which in fact has been currently positioned as the reference guide on asthma in the Spanish language worldwide. Its objective is to prevent and improve the clinical situation of people with asthma by increasing the knowledge of healthcare professionals involved in their care. Its purpose is to convert scientific evidence into simple and easy-to-follow practical recommendations. Therefore, it is not a monograph that brings together all the scientific knowledge about the disease, but rather a brief document with the essentials, designed to be applied quickly in routine clinical practice. The guidelines are necessarily multidisciplinary, developed to be useful and an indispensable tool for physicians of different specialties, as well as nurses and pharmacists. Probably the most outstanding aspects of the guide are the recommendations to: establish the diagnosis of asthma using a sequential algorithm based on objective diagnostic tests; the follow-up of patients, preferably based on the strategy of achieving and maintaining control of the disease; treatment according to the level of severity of asthma, using six steps from least to greatest need of pharmaceutical drugs, and the treatment algorithm for the indication of biologics in patients with severe uncontrolled asthma based on phenotypes. And now, in addition to that, there is a novelty for easy use and follow-up through a computer application based on the chatbot-type conversational artificial intelligence (ia-GEMA).
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Affiliation(s)
| | - Isam Alobid
- Otorrinolaringología, Hospital Clinic de Barcelona, España
| | | | | | - Jorge Ferreira
- Hospital de São Sebastião – CHEDV, Santa Maria da Feira, Portugal
| | | | - Antonio Gómez-Outes
- Farmacología clínica, Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Madrid, España
| | - Noé Garín Escrivá
- Farmacia Hospitalaria, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | | | | | - Javier Korta Murua
- Neumología Pediátrica, Hospital Universitario Donostia, Donostia-San, Sebastián, España
| | - Jesús Molina París
- Medicina de familia, semFYC, Centro de Salud Francia, Fuenlabrada, Dirección Asistencial Oeste, Madrid, España
| | | | - Javier Plaza Zamora
- Farmacia comunitaria, Farmacia Dr, Javier Plaza Zamora, Mazarrón, Murcia, España
| | | | | | - José Sanz Ortega
- Alergología Pediátrica, Hospital Católico Universitario Casa de Salud, Valencia, España
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Peñaranda A, Pérez-Herrera LC, Gantiva M, Moreno-López S, Manrique J, Peñaranda D, García E. Factors associated with allergic rhinitis and combined allergic rhinitis and asthma syndrome (CARAS) in adults undergoing immunotherapy in a tropical country: Is ISAAC-III questionnaire useful in adult populations? Allergol Immunopathol (Madr) 2023; 51:78-86. [PMID: 37422783 DOI: 10.15586/aei.v51i4.833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 03/30/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Allergic diseases affect about 10-30% of the population in low- or middle-income tropical countries. Few studies describe the factors associated with allergic diseases in adult patients undergoing immunotherapy in Latin American countries. OBJECTIVE This study aimed to determine the factors associated with allergic rhinitis (AR) and AR in comorbidity with asthma (CARAS) in adults treated with immunotherapy in two allergy referral centers in Bogotá (Colombia). MATERIAL AND METHODS Observational, cross-sectional study conducted between January 2018 and January 2019. ISAAC-III and sociodemographic questionnaires were applied to determine the factors associated with AR and CARAS in adults treated with immunotherapy who attended the allergy consult at the Fundación Santa Fe de Bogotá and Unimeq-Orl. RESULTS Among 416 adults aged 18-68 years, 71.4% (n = 297) were women. Regarding the sensitization results obtained by skin prick test, the most frequent allergens were house dust mites (64.18%): 49.03% were positive for both Dermatophagoides pteronyssinus and Dermatophagoides farinae, while 28.61% were positive for Blomia tropicalis. Excluding house dust mites, the most frequent allergens were dog hair (31.01%), cat hair (15.1%), grasses (15.9%), and food (15.9%). The main factor associated with exclusive AR was regular acetaminophen use more than four times a year: Prevalence ratio (PR) = 1.77 (95% CI: 1.12-2.25). The main factor associated with CARAS was cesarean delivery PR: 1.44 (95% CI: 1.09-1.78). CONCLUSION The main factor associated with AR was regular acetaminophen use, while that associated with CARAS was cesarean delivery. The ISAAC-III questionnaire can be a useful low-cost tool to assess the factors associated with allergic diseases in adults in tropical countries.
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Affiliation(s)
- Augusto Peñaranda
- School of Medicine, Universidad de Los Andes, Bogotá, Colombia
- Departmen of Otolaryngology, Fundación Santa Fe de Bogotá, Bogotá, Colombia
- Allergy and Otolaryngology Research Groups, UNIMEQ-ORL, Bogotá, Colombia
| | - Lucía C Pérez-Herrera
- School of Medicine, Universidad de Los Andes, Bogotá, Colombia
- Departmen of Otolaryngology, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Manuela Gantiva
- School of Medicine, Universidad de Los Andes, Bogotá, Colombia
- Departmen of Otolaryngology, Fundación Santa Fe de Bogotá, Bogotá, Colombia
- Section of Otolaryngology, Fundación Universitaria de Ciencias de la Salud - Hospital de San José, Bogotá, Colombia
| | - Sergio Moreno-López
- School of Medicine, Universidad de Los Andes, Bogotá, Colombia
- Departmen of Otolaryngology, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Julian Manrique
- School of Medicine, Universidad de Los Andes, Bogotá, Colombia
- Allergy section, Department of Pediatrics, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Daniel Peñaranda
- Allergy and Otolaryngology Research Groups, UNIMEQ-ORL, Bogotá, Colombia
- Section of Otolaryngology, Fundación Universitaria de Ciencias de la Salud - Hospital de San José, Bogotá, Colombia
| | - Elizabeth García
- School of Medicine, Universidad de Los Andes, Bogotá, Colombia
- Departmen of Otolaryngology, Fundación Santa Fe de Bogotá, Bogotá, Colombia
- Section of Otolaryngology, Fundación Universitaria de Ciencias de la Salud - Hospital de San José, Bogotá, Colombia;
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Blöndal V, Sundbom F, Zhou X, Movérare R, Borres MP, Högman M, Alving K, Malinovschi A, Janson C. Allergic sensitisation and type-2 inflammation is associated with new-onset and persistent allergic disease. Clin Transl Allergy 2023; 13:e12240. [PMID: 37186426 PMCID: PMC10080081 DOI: 10.1002/clt2.12240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 03/14/2023] [Accepted: 03/20/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Allergic disease is common. The aim of this study was to look at the change in asthma and rhinitis over time and to characterise factors contributing to remission and persistence of disease. METHODS This cohort study included 255 individuals with or without asthma and or rhinitis that participated in a population survey and a follow-up 10 years later. The participants were tested for allergic sensitisation, total IgE, multiplex allergen component analysis and type-2 inflammatory markers: exhaled nitric oxide (FE NO), eosinophil cationic protein (ECP) and eosinophil-derived neurotoxin (EDN). RESULTS Of the 132 healthy individuals, 112 remained healthy, 16 developed rhinitis, 4 asthma and rhinitis over the 10 years. Out of 82 subjects with rhinitis, 26 went into remission, 53 remained unchanged and 3 developed asthma in addition to rhinitis. None of the 41 participants with asthma and rhinitis went into remission. Subjects with persistent rhinitis and asthma had higher levels of total IgE (odds ratio [OR] 95% confidence interval [CI]: 6.16 [3.05-12.5]) at baseline and after 10 years, and FE NO and ECP at baseline (OR per log unit increase, 95% CI 5.21 [1.20-22.7] and 6.32 [1.52-26.4], respectively), compared with those that remained healthy. Subjects with persistent rhinitis were more likely to be sensitised to grass pollen and had higher total IgE levels than those that went into remission. Individuals with persistent asthma were more likely to be sensitised to tree pollen and furry animals than those with only persistent rhinitis (OR 95% CI: 3.50 [1.29-9.49] and 6.73 [2.00-22.6], respectively). CONCLUSION IgE sensitisation and total IgE levels are associated with the persistence of rhinitis and asthma. Participants with persistent allergic disease had higher levels of allergen sensitisation and type 2 inflammation markers at baseline than those who remained healthy.
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Affiliation(s)
- Viiu Blöndal
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Fredrik Sundbom
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Xingwu Zhou
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
- Department of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden
| | - Robert Movérare
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
- Thermo Fischer Scientific, Uppsala, Sweden
| | - Magnus P Borres
- Thermo Fischer Scientific, Uppsala, Sweden
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Marieann Högman
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Kjell Alving
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Andrei Malinovschi
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
- Department of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden
| | - Christer Janson
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
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Multimorbidity of Allergic Conditions in Urban Citizens of Southern China: A Real-World Cross-Sectional Study. J Clin Med 2023; 12:jcm12062226. [PMID: 36983228 PMCID: PMC10059830 DOI: 10.3390/jcm12062226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/15/2023] [Accepted: 03/02/2023] [Indexed: 03/15/2023] Open
Abstract
Background: Extensive knowledge of allergic multimorbidities is required to improve the management of allergic diseases with the industrialization of China. However, the demography and allergen distribution patterns of allergic multimorbidities in China remain unclear, despite the increasing prevalence of allergies. Methods: This was a real-world, cross-sectional study of 1273 outpatients diagnosed with one or more allergic diseases in Guangzhou, the most populated city of southern China, with leading industrial and commercial centers, between April 2021 and March 2022. Seven allergic diseases (allergic rhinitis (AR), asthma (AS)/cough variant asthma (CVA), atopic dermatitis (AD)/eczema, food allergy (FA), allergic conjunctivitis (AC), drug allergy (DA), and anaphylaxis) were assessed. Positive rates of sensitization to different allergens were measured using an allergen detection system of the UniCAP (Pharmacia Diagnostics, Sweden) instrument platform to compare the groups of allergic multimorbidities against a single entity. Results: There were 659 (51.8%) males and 614 (48.2%) females aged from 4 months to 74 years included in the analysis. The study participants who were diagnosed with allergic diseases had an average of 1.6 diagnoses. Overall, 46.5% (592 of 1273) of the patients had more than one allergic condition, and allergic rhinitis was the most common type of multimorbidity. Women were more likely to suffer from an allergic disease alone, whereas allergic multimorbidities were more likely to be diagnosed in men (p = 0.005). In addition, allergic multimorbidities were common in all age groups, with an incidence ranging from 37.1% to 57.4%, in which children and adolescents were more frequently diagnosed with allergic multimorbidities than adults (18–60 years old) (all p < 0.05). Allergic multimorbidity was observed throughout the year. A difference in the positive rate of allergens sensitization and total immunoglobulin E (tIgE) levels between different allergic multimorbidities was observed. Conclusions: Allergic multimorbidities were very commonly found in nearly half of all patients with allergies. The proportion of allergic multimorbidities varied with the type of disease, sex, age, and allergen distribution pattern. These findings may help clinicians to develop “One health” strategies for the clinical management of allergic diseases.
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10
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Chen J, Liu X, Liu Z, Zhou Y, Xie L, Zhang J, Tan J, Yang Y, Tian M, Dong Y, Li J. Early exposure to infections increases the risk of allergic rhinitis-a systematic review and meta-analysis. BMC Pediatr 2023; 23:96. [PMID: 36859178 PMCID: PMC9976500 DOI: 10.1186/s12887-023-03870-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 01/30/2023] [Indexed: 03/03/2023] Open
Abstract
OBJECTIVE The purpose of this study was to provide evidence for early life care by meta-analyzing the relationship between infection during pregnancy and up to 2 years of age and the risk of subsequent allergic rhinitis (AR). METHODS Published studies up to April 2022 were systematically searched in PubMed, Embase, Web of Science, Cochrane Library, SinoMed, CNKI, Wanfang Database, and VIP. Literature screening, including quality assessment, was performed, and the effect values (OR, HR, RR) and 95% confidence intervals (95% CI) of infection during pregnancy and up to 2 years of age and allergic rhinitis were extracted from each qualified study. RESULTS In total, 5 studies with a sample size of 82,256 reported the relationship between infection during pregnancy and offspring AR. Meta-analysis showed that maternal infection during pregnancy was associated with an increased risk of childhood AR in offspring (OR = 1.34, 95% CI: 1.08-1.67). Altogether, 13 studies with a sample size of 78,426 reported evidence of an association between infection within 2 years of age and subsequent AR in children. A pooled meta-analysis of all studies showed that early infection within 2 years of age was closely associated with childhood AR (OR = 1.25, 95% CI: 1.12-1.40), especially upper respiratory tract infection (OR = 1.32, 95% CI: 1.06-1.65) and gastrointestinal infections (OR = 1.37, 95% CI: 1.01-1.86), but ear infection showed similar results in the cohort study (OR = 1.13, 95% CI: 1.04-1.22). CONCLUSION Current evidence suggests that infection during pregnancy, early upper respiratory infection, gastrointestinal infections and ear infection within 2 years of age would increase the risk of AR in children. Therefore, the prevention of infection during pregnancy and in infancy and young children needs to be emphasized.
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Affiliation(s)
- JunRong Chen
- Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan Province, School of Medicine, Hunan Normal University, Hunan, 410013, China
| | - Xiaohua Liu
- Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan Province, School of Medicine, Hunan Normal University, Hunan, 410013, China.,Changsha Woman and Children Health Care Hospital Affilated to Hunan Normal University, NO. 416 Chengnan East Road, Changsha, 410007, Hunan, China
| | - Zixin Liu
- Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan Province, School of Medicine, Hunan Normal University, Hunan, 410013, China.,Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, 410013, Hunan, China
| | - Yaqian Zhou
- Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan Province, School of Medicine, Hunan Normal University, Hunan, 410013, China.,Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, China
| | - Li Xie
- Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan Province, School of Medicine, Hunan Normal University, Hunan, 410013, China
| | - Jialin Zhang
- Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan Province, School of Medicine, Hunan Normal University, Hunan, 410013, China
| | - Jin Tan
- Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan Province, School of Medicine, Hunan Normal University, Hunan, 410013, China
| | - Yide Yang
- Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Hunan, 410081, China
| | - Mei Tian
- Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan Province, School of Medicine, Hunan Normal University, Hunan, 410013, China
| | - Yunpeng Dong
- Department of Otolatyngoloty-Head and Neck Surgery, the First College of Clinical Medical Science, Yichang Central People's Hospital, Three Gorges University, Hubei, 443000, China.
| | - Jian Li
- Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan Province, School of Medicine, Hunan Normal University, Hunan, 410013, China. .,Key Laboratory of Model Animals and Stem Cell Biology in Hunan Province, School of Medicine, Hunan Normal University, Hunan, 410013, China.
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11
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Alatawi AM, Alanazi AMM, Almutairi ABS, Albalawi RFA, Alhakami AAM, Alnuaman AAS, Alzahrani LDD, Albalwi ZS, Alabawy AAH, Aljohani LMM, Alatawi NAS. Prevalence and Risk Factors of Allergic Diseases Among School Students in Tabuk: A Cross-Sectional Study. Cureus 2023; 15:e36658. [PMID: 37101984 PMCID: PMC10123386 DOI: 10.7759/cureus.36658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Allergic diseases such as bronchial asthma, allergic rhinitis, and atopic dermatitis are common health problems among children. The prevalence of different allergic diseases is increasing in the Kingdom of Saudi Arabia. OBJECTIVES This study aimed to estimate the prevalence and risk factors of allergic diseases among school students in Tabuk, Saudi Arabia. METHODS This cross-sectional analytical study was conducted in Tabuk city, Saudi Arabia, between the first of August and the end of September, 2022. Students from primary, intermediate, and secondary schools were included. A predesigned, structured, self-administered questionnaire in the Arabic language was used to collect data. RESULTS This study included 384 school students from Tabuk, Saudi Arabia. The age of the recruited students ranged from five to 19 years old. The prevalence of clinically diagnosed bronchial asthma that occurred at any time in the past was 31.8%. The prevalence of asthma symptoms was 51.0% for lifetime wheezing and 45.8% for current wheezing (in the past 12 months). The prevalence rates of clinically diagnosed allergic rhinitis and atopic dermatitis were 56.8% and 30.2%, respectively. Further, 68.2% of the school students had one or more of the diagnosed allergic diseases. The second or more childbirth orders were significantly associated with an increased risk of allergic diseases (adjusted odds ratio [AOR] = 3.140, 95% CI: 1.864-5.288). A family history of asthma or atopic conditions showed 3.118 times increased likelihood of allergic conditions (AOR = 3.118, 95% CI: 1.827-5.320). Other significant risk factors were the father's smoking (AOR = 1.698, 95% CI: 1.024-2.817) and having a dog, cat, or bird at home (AOR = 0.493, 95% CI: 0.257-0.946). CONCLUSION The prevalence of bronchial asthma and other allergic diseases such as allergic rhinitis and atopic dermatitis among school students in Tabuk city, Saudi Arabia, is alarmingly high. Furthermore, both genetic and environmental components of allergic disease pathogenesis have been identified as risk factors.
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Affiliation(s)
- Amirah M Alatawi
- Department of Family and Community Medicine, Faculty of Medicine, University of Tabuk, Tabuk, SAU
| | | | | | | | | | | | | | - Ziad Saleh Albalwi
- Department of Pediatrics, Faculty of Medicine, University of Tabuk, Tabuk, SAU
| | - Abeer Ali H Alabawy
- Department of Pediatrics, Faculty of Medicine, University of Tabuk, Tabuk, SAU
| | | | - Nouf Ali S Alatawi
- Department of Pediatrics, Faculty of Medicine, University of Tabuk, Tabuk, SAU
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12
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León B. Understanding the development of Th2 cell-driven allergic airway disease in early life. FRONTIERS IN ALLERGY 2023; 3:1080153. [PMID: 36704753 PMCID: PMC9872036 DOI: 10.3389/falgy.2022.1080153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 12/21/2022] [Indexed: 01/12/2023] Open
Abstract
Allergic diseases, including atopic dermatitis, allergic rhinitis, asthma, and food allergy, are caused by abnormal responses to relatively harmless foreign proteins called allergens found in pollen, fungal spores, house dust mites (HDM), animal dander, or certain foods. In particular, the activation of allergen-specific helper T cells towards a type 2 (Th2) phenotype during the first encounters with the allergen, also known as the sensitization phase, is the leading cause of the subsequent development of allergic disease. Infants and children are especially prone to developing Th2 cell responses after initial contact with allergens. But in addition, the rates of allergic sensitization and the development of allergic diseases among children are increasing in the industrialized world and have been associated with living in urban settings. Particularly for respiratory allergies, greater susceptibility to developing allergic Th2 cell responses has been shown in children living in urban environments containing low levels of microbial contaminants, principally bacterial endotoxins [lipopolysaccharide (LPS)], in the causative aeroallergens. This review highlights the current understanding of the factors that balance Th2 cell immunity to environmental allergens, with a particular focus on the determinants that program conventional dendritic cells (cDCs) toward or away from a Th2 stimulatory function. In this context, it discusses transcription factor-guided functional specialization of type-2 cDCs (cDC2s) and how the integration of signals derived from the environment drives this process. In addition, it analyzes observational and mechanistic studies supporting an essential role for innate sensing of microbial-derived products contained in aeroallergens in modulating allergic Th2 cell immune responses. Finally, this review examines whether hyporesponsiveness to microbial stimulation, particularly to LPS, is a risk factor for the induction of Th2 cell responses and allergic sensitization during infancy and early childhood and the potential factors that may affect early-age response to LPS and other environmental microbial components.
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Affiliation(s)
- Beatriz León
- Department of Microbiology, University of Alabama at Birmingham, Birmingham, AL, United States
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13
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Ranasinghe C, Prashar J. Is montelukast monotherapy effective for the management of allergic rhinitis in children? Arch Dis Child 2022; 107:197-201. [PMID: 34725046 DOI: 10.1136/archdischild-2021-322788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 10/18/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Chavini Ranasinghe
- Division of Medicine, University College London Medical School, London, UK
| | - Jai Prashar
- Division of Medicine, University College London Medical School, London, UK
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14
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Olajide-Ibiejugba AO, Nkosi V, Takalani-Rathogwa F, Shirinde J, Wichmann J, Green RJ, Voyi K. Allergy and Household Living Conditions among Adolescents Living near Gold Mine Tailing Dumps in the Gauteng and North West Provinces of South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:122. [PMID: 35010377 PMCID: PMC8750766 DOI: 10.3390/ijerph19010122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/14/2021] [Accepted: 12/17/2021] [Indexed: 06/14/2023]
Abstract
This quantitative exploratory baseline study aimed to investigate whether allergy among adolescents was associated with household living conditions, including living near gold mine tailing dumps in South Africa. A questionnaire based on the International Study of Asthma and Allergies was used to collect information on allergy and household risk factors among adolescents (n = 5611). A chi-square test was applied to determine the relationship between community (exposed/unexposed) and confounding variables. Crude and adjusted odds ratios (ORs) and 95% confidence intervals (CI) were calculated using univariate and multiple logistic regression analysis (LRA) to estimate the likelihood of having doctor-diagnosed allergies. The overall prevalence of doctor-diagnosed allergies was 25.5%. The exposed communities had a higher prevalence of doctor-diagnosed allergies (26.97%) compared with the unexposed (22.69%) communities. The study found an association between doctor-diagnosed allergy and having fungus in the house, being female, currently having pets in and around the house, residing in the community for more than three years and living in communities located close to gold mine tailing dumps. Actions to implement buffer zones between gold mine tailing dumps and communities would support Sustainable Development Goals 3 (health) and 11 (sustainable cities and communities), while failing to address the current potential identified risk factors may pose a significant public health challenge. Local policymakers should also apply the precautionary principle to protect the health of children, especially with the location of human settlements relative to air pollution sources.
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Affiliation(s)
- Abike O. Olajide-Ibiejugba
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria 0001, South Africa; (A.O.O.-I.); (J.S.); (J.W.); (K.V.)
| | - Vusumuzi Nkosi
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria 0001, South Africa; (A.O.O.-I.); (J.S.); (J.W.); (K.V.)
- Environment and Health Research Unit, South African Medical Research Council, Johannesburg 2094, South Africa
- Department of Environmental Health, Faculty of Health Sciences, Doornfontein Campus, University of Johannesburg, Johannesburg 2094, South Africa
| | - Funzani Takalani-Rathogwa
- Department of Advanced Nursing Science, Faculty of Health Sciences, University of Venda, Thohoyandou 0950, South Africa;
| | - Joyce Shirinde
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria 0001, South Africa; (A.O.O.-I.); (J.S.); (J.W.); (K.V.)
| | - Janine Wichmann
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria 0001, South Africa; (A.O.O.-I.); (J.S.); (J.W.); (K.V.)
| | - Robin J. Green
- Steve Biko Academic Hospital, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Pretoria, Pretoria 0001, South Africa;
| | - Kuku Voyi
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria 0001, South Africa; (A.O.O.-I.); (J.S.); (J.W.); (K.V.)
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15
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Gazibara T, Reljic V, Jankovic S, Peric J, Nikolic M, Maksimovic N. Quality of life in children with atopic dermatitis: A one-year prospective cohort study. Indian J Dermatol Venereol Leprol 2021; 88:65-69. [PMID: 34245539 DOI: 10.25259/ijdvl_529_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 10/01/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Literature on the quality of life trends across time in children with atopic dermatitis are scarce. AIMS To assess factors associated with quality of life of children with atopic dermatitis after a one-year follow-up and to examine the factors contributing to greater improvement in the atopic dermatitis-related quality of life over one year. METHODS Our cohort consisted of 98 children who were treated for atopic dermatitis at the clinic of dermatovenereology. Data collection included atopic dermatitis scoring using the SCORing Atopic Dermatitis (SCORAD) index, Children's Dermatology Life Quality Index (CDLQI) for children aged > four years and Infants' Dermatitis Quality of Life Index (IDLQI) for children aged 0-4 years. Categorization of the impairment of quality of life score due to atopic dermatitis was as follows: mild (score from 0 to 6), moderate (score from 7 to 12) and severe (score from 13 to 30). The cohort was followed for one year after which a total of 80 children were reassessed. RESULTS Improvements of both CDLQI and IDLQI were observed in children whose impairment of quality of life due to atopic dermatitis after one year was 'mild'. This was not observed in children whose atopic dermatitis caused either 'moderate' or 'severe impairment' of their quality of life. Adjusted analysis showed that lower initial SCORAD and greater improvement in SCORAD after the one-year follow-up were associated with a better quality of life at follow-up. LIMITATIONS The size of our cohort was relatively small. Study participants were recruited from the largest urban and medical referral center in Serbia. Persons from suburban or rural regions may have had different perceptions of atopic dermatitis-related quality of life. CONCLUSION Children with less severe atopic dermatitis were more likely to improve their atopic dermatitis-related quality of life. Lower SCORAD was associated with both better quality of life initially and greater improvement in quality of life after one year of follow-up.
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Affiliation(s)
- Tatjana Gazibara
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Vesna Reljic
- Clinic of Dermatovenereology, Clinical Center of Serbia, Belgrade, Serbia
| | - Slavenka Jankovic
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jelena Peric
- Clinic of Dermatovenereology, Clinical Center of Serbia, Belgrade, Serbia
| | - Milos Nikolic
- Clinic of Dermatovenereology, Clinical Center of Serbia, Belgrade, Serbia
| | - Natasa Maksimovic
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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16
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Logan K, Du Toit G, Giovannini M, Turcanu V, Lack G. Pediatric Allergic Diseases, Food Allergy, and Oral Tolerance. Annu Rev Cell Dev Biol 2020; 36:511-528. [PMID: 32634325 DOI: 10.1146/annurev-cellbio-100818-125346] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Pediatric allergic disease is a significant health concern worldwide, and the prevalence of childhood eczema, asthma, allergic rhinitis, and food allergy continues to increase. Evidence to support specific interventions for the prevention of eczema, asthma, and allergic rhinitis is limited, and no consensus on prevention strategies has been reached. Randomized controlled trials investigating the prevention of food allergy via oral tolerance induction and the early introduction of allergenic foods have been successful in reducing peanut and egg allergy prevalence. Infant weaning guidelines in the United Sates were recently amended to actively encourage the introduction of peanut for prevention of peanut allergy.
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Affiliation(s)
- Kirsty Logan
- Paediatric Allergy Research Group, Department of Women and Children's Health, School of Life Course Sciences, King's College London, London SE1 7EH, United Kingdom;
| | - George Du Toit
- Paediatric Allergy Research Group, Department of Women and Children's Health, School of Life Course Sciences, King's College London, London SE1 7EH, United Kingdom;
| | - Mattia Giovannini
- Paediatric Allergy Research Group, Department of Women and Children's Health, School of Life Course Sciences, King's College London, London SE1 7EH, United Kingdom; .,Allergy Unit, Department of Pediatrics, Anna Meyer Children's University Hospital, 50139 Florence, Italy
| | - Victor Turcanu
- School of Immunology and Microbial Sciences and School of Life Course Sciences, King's College London, London WC2R 2LS, United Kingdom
| | - Gideon Lack
- Paediatric Allergy Research Group, Department of Women and Children's Health, School of Life Course Sciences, King's College London, London SE1 7EH, United Kingdom;
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17
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Yan Z, Liu L, Jiao L, Wen X, Liu J, Wang N. Bioinformatics Analysis and Identification of Underlying Biomarkers Potentially Linking Allergic Rhinitis and Asthma. Med Sci Monit 2020; 26:e924934. [PMID: 32460303 PMCID: PMC7278529 DOI: 10.12659/msm.924934] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background Rhinitis is the most common clinical manifestation of allergy, affecting more than 400 million people around the world. Rhinitis increases the risk of developing bronchial hyper-responsiveness and asthma. Previous studies have shown that rhinitis is closely related with the physiology, pathology, and pathogenesis of asthma. We analyzed co-expressed genes to explore the relationships between rhinitis and asthma and to find biomarkers of comorbid rhinitis and asthma. Material/Methods Asthma- and rhinitis-related differentially-expressed genes (DEGs) were identified by bioinformatic analysis of GSE104468 and GSE46171 datasets from the Gene Expression Omnibus (GEO) database. After assessment of Gene Ontology (GO) terms and pathway enrichment for DEGs, a protein–protein interaction (PPI) network was conducted via comprehensive target prediction and network analyses. We also evaluated co-expressed DEGs and corresponding predicted miRNAs involved in the developing process of rhinitis and asthma. Results We identified 687 and 1001 DEGs in bronchial and nasal epithelia samples of asthma patients, respectively. For patients with rhinitis, we found 245 DEGs. The hub-genes of PAX6, NMU, NTS, NMUR1, PMCH, and KRT6A may be associated with rhinitis, while CPA3, CTSG, POSTN, CLCA1, HDC, and MUC5B may be involved in asthma. The co-expressed DEGs of BPIFA1, CCL26, CPA3, and CST1, together with corresponding predicted miRNAs (e.g., miR-195-5p and miR-125a-3p) were found to be significantly correlated with rhinitis and asthma. Conclusions Rhinitis and asthma are related, and there are significant correlations of BPIFA1, CCL26, CPA3, and CST1 genes with novel biomarkers involved in the comorbidity of rhinitis and asthma.
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Affiliation(s)
- Zhanfeng Yan
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China (mainland).,Department of Otorhinolaryngology, Dongzhimen Hospital, The First Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China (mainland)
| | - Lili Liu
- Department of Otorhinolaryngology, Dongzhimen Hospital, The First Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China (mainland)
| | - Lulu Jiao
- Department of Otorhinolaryngology, Dongzhimen Hospital, The First Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China (mainland)
| | - Xiaohui Wen
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China (mainland)
| | - Jianhua Liu
- Department of Otorhinolaryngology, Dongzhimen Hospital, The First Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China (mainland)
| | - Ningyu Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China (mainland)
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18
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Resolving Clinical Phenotypes into Endotypes in Allergy: Molecular and Omics Approaches. Clin Rev Allergy Immunol 2020; 60:200-219. [PMID: 32378146 DOI: 10.1007/s12016-020-08787-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Allergic diseases are highly complex with respect to pathogenesis, inflammation, and response to treatment. Current efforts for allergic disease diagnosis have focused on clinical evidence as a binary outcome. Although outcome status based on clinical phenotypes (observable characteristics) is convenient and inexpensive to measure in large studies, it does not adequately provide insight into the complex molecular determinants of allergic disease. Individuals with similar clinical diagnoses do not necessarily have similar disease etiologies, natural histories, or responses to treatment. This heterogeneity contributes to the ineffective response to treatment leading to an annual estimated cost of $350 billion in the USA alone. There has been a recent focus to deconvolute the clinical heterogeneity of allergic diseases into specific endotypes using molecular and omics approaches. Endotypes are a means to classify patients based on the underlying pathophysiological mechanisms involving distinct functions or treatment response. The advent of high-throughput molecular omics, immunophenotyping, and bioinformatics methods including machine learning algorithms is facilitating the development of endotype-based diagnosis. As we move to the next decade, we should truly start treating clinical endotypes not clinical phenotype. This review highlights current efforts taking place to improve allergic disease endotyping via molecular omics profiling, immunophenotyping, and machine learning approaches in the context of precision diagnostics in allergic diseases. Graphical Abstract.
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19
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Bai XF, Wu ZX, Zhao CH, Wu Y, Fei CS, Zhang LQ, Chen ZH. Maternal oral contraceptive pill use and the risk of atopic diseases in the offspring: A systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e19607. [PMID: 32311929 PMCID: PMC7220114 DOI: 10.1097/md.0000000000019607] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Studies of maternal oral contraceptive pill (OCP) exposure and the offspring's risk of atopic diseases are of current interest due to concerns about widespread use of OCP before or during pregnancy.We evaluated whether maternal OCP exposure is associated with an increased risk of atopic diseases by reviewing the literature and performing a meta-analysis. The PubMed and Embase databases were searched to identify potential studies for inclusion. Three common atopic outcomes were included: asthma, eczema, and rhinitis.We found 693 titles, abstracts, and citations, and 6 studies were included in this analysis. A meta-analysis revealed that maternal OCP exposure was associated with higher odds of asthma (odds ratio [OR] 1.1; 95% confidence interval [CI] 1.02-1.19; P = .014), rhinitis (OR 1.34; 95% CI 1.07-1.68; P = .011) during childhood, whereas there was no association with eczema (OR 1.17; 95% CI 0.81-1.68; P = .383). This analysis was limited by the small number of studies included and the limited adjustments for the possible confounders in the studies.Current evidence suggests that maternal OCP exposure increases the risk for respiratory allergic diseases (asthma and rhinitis) in the offspring, but not for eczema. Given the few studies included, future larger, prospective studies that control for important confounders are needed to verify our findings.
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Affiliation(s)
- Xue-Feng Bai
- Otolaryngology Head Neck Surgery, Tongxiang First People's Hospital
| | - Zheng-Xiang Wu
- Department of Pediatrics, Tongxiang Second People's Hospital, Tongxiang
| | - Chun-Hong Zhao
- Otolaryngology Head Neck Surgery, Tongxiang First People's Hospital
| | - Yong Wu
- Otolaryngology Head Neck Surgery, Tongxiang First People's Hospital
| | - Chang-Shun Fei
- Otolaryngology Head Neck Surgery, Tongxiang First People's Hospital
| | - Li-Qin Zhang
- Otolaryngology Head Neck Surgery, Tongxiang First People's Hospital
| | - Zhao-Hui Chen
- Department of Otolaryngology Head and Neck Surgery, Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang, China
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Blöndal V, Sundbom F, Borres MP, Högman M, Alving K, Malinovschi A, Janson C. Study of atopic multimorbidity in subjects with rhinitis using multiplex allergen component analysis. Clin Transl Allergy 2020; 10:6. [PMID: 32110380 PMCID: PMC7033937 DOI: 10.1186/s13601-020-0311-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 02/06/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Rhinitis is a common problem within the population. Many subjects with rhinitis also have atopic multimorbidity, such as asthma and eczema. The purpose of this investigation was to compare subjects with only rhinitis to those that have rhinitis, asthma and/or eczema in relation to immunoglobulin E (IgE) sensitization, inflammatory markers, family history, lung function and body mass index (BMI). METHODS A total of 216 adult subjects with rhinitis from the European Community Respiratory Health Survey II were investigated with multiplex component allergen analysis (103 allergen components), total IgE, C-reactive protein, eosinophilic cationic protein, fractional exhaled nitric oxide and spirometry. Rhinitis, eczema, asthma and parental allergy were questionnaire-assessed. RESULTS Of the 216 participants with rhinitis, 89 also had asthma and/or eczema. Participants with rhinitis that also had asthma or eczema were more likely to be IgE-sensitized (3.44, odds ratio, OR: 95% CI 1.62-7.30, adjusted for sex, age, mother's allergy, total IgE and forced expiratory volume (FEV1)). The number of IgE-positive components was independently associated with atopic multimorbidity (1.11, OR: 95% Cl 1.01-1.21) adjusted for sex, age, mother's allergy, total IgE and FEV1. When analysing different types of sensitization, the strongest association with atopic multimorbidity was found in participants that were IgE-sensitized both to perennial and seasonal allergens (4.50, OR: 95% CI 1.61-12.5). Maternal allergy (2.75, OR: 95% CI 1.15-4.46), high total IgE (2.38, OR: 95% CI 1.21-4.67) and lower FEV1 (0.73, OR: 95% CI 0.58-0.93) were also independently associated with atopic multimorbidity, while no association was found with any of the other inflammatory markers. CONCLUSION IgE polysensitization, to perennial and seasonal allergens, and levels of total IgE seem to be the main determinants of atopic multimorbidity in subjects with rhinitis. This indicates that disease-modifying treatment that targets IgE sensitization may be of value when decreasing the risk of developing atopic multimorbidity.
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Affiliation(s)
- Viiu Blöndal
- Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
- Department of Medical Sciences, Lung Allergy and Sleep Research, Uppsala University Hospital, Uppsala University, 751 85 Uppsala, Sweden
| | - Fredrik Sundbom
- Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Magnus P. Borres
- Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
- Thermo Fischer Scientific, Uppsala, Sweden
| | - Marieann Högman
- Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Kjell Alving
- Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Andrei Malinovschi
- Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Christer Janson
- Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
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21
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James P, Caballero MR. Illness perception of adolescents with allergic conditions under specialist care. Pediatr Allergy Immunol 2020; 31:197-202. [PMID: 31680338 DOI: 10.1111/pai.13169] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 10/15/2019] [Accepted: 10/28/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Our understanding of how adolescents perceive and cope with their allergic condition/s is limited. This study used the Brief Illness Perception Questionnaire (BIPQ) in a group of adolescents with allergies and correlates the findings with demographic and clinical conditions. METHODS In this retrospective questionnaire-based study, we analysed 100 valid questionnaires from adolescents (11-18 years) attending our service after receiving management and treatment for their allergic condition/s. RESULTS The overall BIPQ score was 4.8 (IQR 3.6-5.6). The highest item-related scores were for "timeline" (illness duration) followed by "concern." The lowest scores were found for "coherence/understanding," demonstrating that adolescents do not perceive that they have a sound understanding of their condition/s. We found a significant difference in the overall BIPQ scores between the genders and in the emotional representation score, with females showing a highest score. Older adolescents reported a more chronic perception of the allergic disease/s. CONCLUSION Our results suggest that a better understanding and support of the allergic condition/s in adolescents, particularly in females, are likely an important target for intervention intended to improve their quality of life. BIPQ can be used as adjunct to routine allergy clinic appointments for further exploration of the wider impact of allergies on adolescents' lives.
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Affiliation(s)
- Polly James
- Clinical Psychologist in Paediatric Allergy, Children's Allergy Service, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Maria Rosario Caballero
- Consultant in Allergy, Department of Allergy, Guy's and St Thomas' NHS Foundation Trust, London, UK
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22
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Sorokina E, Mikailova D, Krakhaleva J, Krinitsyna J, Yakubovich A, Sergeeva I. Ultrasonography patterns of atopic dermatitis in children. Skin Res Technol 2020; 26:482-488. [PMID: 31930616 DOI: 10.1111/srt.12839] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 11/20/2019] [Accepted: 12/18/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Atopic dermatitis (AD) is one of the most common allergic diseases in children. The aim of the study was to evaluate the ultrasound picture of lesional and non-lesional skin in children with AD. MATERIALS AND METHODS The study included a group of children with AD and a control group. Inclusion criteria were as follows: age 0-8 years and clinical diagnosis of AD. An ultrasound scanner with a 75 MHz transducer probe was used to produce B-mode skin images in lesions and non-lesional skin. The thickness and the echogenicity of epidermis, dermis, and subepidermal low-echogenic band (SLEB) were measured, and the ratio coefficient per body site was calculated. RESULTS Ultrasonography of non-lesional skin in children with AD showed uneven epidermis contour, a tendency to increased epidermis and decreased dermis thickness, and the SLEB was observed in 77% of cases. In lesions, there was an increased thickness and a decreased echogenicity of epidermis and dermis, and epidermis had irregular contours in most cases. The SLEB was in all lesions, showing greater thickness and lower echogenicity compared with non-lesional skin. CONCLUSION HF-USG of the skin allows visualizing the epidermal barrier disruption and inflammation in dermis in children with AD on the entire surface of the skin.
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Affiliation(s)
- Elena Sorokina
- Federal State Autonomous Educational Institution of Higher Education "Novosibirsk National Research State University", Novosibirsk, Russian Federation
| | - Daria Mikailova
- Federal State Autonomous Educational Institution of Higher Education "Novosibirsk National Research State University", Novosibirsk, Russian Federation
| | - Julia Krakhaleva
- Federal State Autonomous Educational Institution of Higher Education "Novosibirsk National Research State University", Novosibirsk, Russian Federation
| | - Julia Krinitsyna
- Federal State Autonomous Educational Institution of Higher Education "Novosibirsk National Research State University", Novosibirsk, Russian Federation.,Federal State Budget Scientific Institution "Federal Research Center of Fundamental and Translational Medicine", Novosibirsk, Russian Federation
| | - Andrey Yakubovich
- Federal State Autonomous Educational Institution of Higher Education "Irkutsk State Medical University", Irkutsk, Russian Federation
| | - Irina Sergeeva
- Federal State Autonomous Educational Institution of Higher Education "Novosibirsk National Research State University", Novosibirsk, Russian Federation
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23
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Looman KIM, Meel ER, Grosserichter‐Wagener C, Vissers FJM, Klingenberg JH, Jong NW, Jongste JC, Pasmans SGMA, Duijts L, Zelm MC, Moll HA. Associations of Th2, Th17, Treg cells, and IgA + memory B cells with atopic disease in children: The Generation R Study. Allergy 2020; 75:178-187. [PMID: 31385614 DOI: 10.1111/all.14010] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 06/10/2019] [Accepted: 06/18/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND New insights into immune cells could contribute to treatment and monitoring of atopic disease. Because nongenetic factors shape the human immune system, we here studied these immune cells in a large cohort with atopic children with adjustment for prenatal and postnatal confounders. METHODS Information on atopic dermatitis, inhalant- and food-allergic sensitization, asthma lung function scores was obtained from 855 10-year-old children within the Generation R cohort. 11-color flow cytometry was performed to determine CD27+ and CD27- IgG+ , IgE+ and IgA+ memory B cells, Th1, Th2, Th17, and Treg-memory cells from venous blood. Associations between any atopic disease, the individual atopic diseases, and immune cell numbers were determined. RESULTS Children with any atopic disease had higher Th2, Treg, Treg-memory, and CD27+ IgA+ memory B-cell numbers compared to children without atopic disease. When studying the individual diseases compared to children without the individual diseases, children with atopic dermatitis, inhalant-, and food-allergic sensitization had higher memory Treg cell numbers 12.3% (95% CI 4.2; 21.0), (11.1% (95% CI 3.0; 19.8), (23.7% (95% CI 7.9; 41.8), respectively. Children with food-allergic sensitization had higher total B and CD27+ IgA+ memory B-cell numbers (15.2% [95% CI 3.2; 28.7], 22.5% [95% CI 3.9; 44.3], respectively). No associations were observed between asthma and B- or T-cell numbers. CONCLUSION Children with any atopic disease and children with inhalant- and food-allergic sensitization or atopic dermatitis had higher circulating memory Treg cells, but not higher IgE+ B-cell numbers. The associations of higher Treg and CD27+ IgA+ B-cell numbers in children with food-allergic sensitization are suggestive of TGF-β-mediated compensation for chronic inflammation.
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Affiliation(s)
- Kirsten I. M. Looman
- Generation R Study Group Erasmus MC, University Medical Center Rotterdam the Netherlands
- Department of Pediatrics Sophia Children's Hospital, Erasmus MC, University Medical Center Rotterdam the Netherlands
| | - Evelien R. Meel
- Generation R Study Group Erasmus MC, University Medical Center Rotterdam the Netherlands
- Department of Pediatrics, Division of Respiratory Medicine and Allergology Erasmus MC, University Medical Center Rotterdam Rotterdam the Netherlands
- Department of Epidemiology Erasmus MC, University Medical Center Rotterdam the Netherlands
| | | | - Floor J. M. Vissers
- Generation R Study Group Erasmus MC, University Medical Center Rotterdam the Netherlands
- Department of Pediatrics Sophia Children's Hospital, Erasmus MC, University Medical Center Rotterdam the Netherlands
| | - Janice H. Klingenberg
- Generation R Study Group Erasmus MC, University Medical Center Rotterdam the Netherlands
- Department of Pediatrics Sophia Children's Hospital, Erasmus MC, University Medical Center Rotterdam the Netherlands
| | - Nicolette W. Jong
- Department of Internal Medicine, Division of Allergology Erasmus MC, University Medical Center Rotterdam the Netherlands
| | - Johan C. Jongste
- Department of Pediatrics, Division of Respiratory Medicine and Allergology Erasmus MC, University Medical Center Rotterdam Rotterdam the Netherlands
| | | | - Liesbeth Duijts
- Department of Pediatrics, Division of Respiratory Medicine and Allergology Erasmus MC, University Medical Center Rotterdam Rotterdam the Netherlands
- Department of Pediatrics, Division of Neonatology Erasmus MC, University Medical Center Rotterdam Rotterdam the Netherlands
| | - Menno C. Zelm
- Department of Immunology and Pathology, Central Clinical School Monash University and Alfred Hospital Melbourne Victoria Australia
| | - Henriëtte A. Moll
- Department of Pediatrics Sophia Children's Hospital, Erasmus MC, University Medical Center Rotterdam the Netherlands
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24
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Folwarczna J, Konarek N, Freier K, Karbowniczek D, Londzin P, Janas A. Effects of loratadine, a histamine H 1 receptor antagonist, on the skeletal system of young male rats. DRUG DESIGN DEVELOPMENT AND THERAPY 2019; 13:3357-3367. [PMID: 31576110 PMCID: PMC6767469 DOI: 10.2147/dddt.s215337] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 07/26/2019] [Indexed: 01/03/2023]
Abstract
Background Histamine H1 receptor antagonists are widely used in the treatment of allergic diseases. H1 receptors are expressed on bone cells and histamine takes part in regulation of bone metabolism. Loratadine is often prescribed to children. Purpose The aim of the present study was to investigate the effects of loratadine on the skeletal system of young rats. Material and methods Loratadine (0.5, 5, and 50 mg/kg p.o. daily) was administered for 4 weeks to male Wistar rats, 6-week-old at the start of the experiment. Bone mass, mass of bone mineral, calcium, and phosphorus content in the bone mineral of the tibia, femur, and L-4 vertebra, histomorphometric parameters of the femur, mechanical properties of the proximal tibial metaphysis, femoral diaphysis and femoral neck, and serum levels of bone turnover markers were examined. Results Loratadine at 0.5 and 5 mg/kg did not significantly affect the skeletal system of young rats. At 50 mg/kg, loratadine decreased the femoral length, increased content of calcium and phosphorus in the bone mineral of the vertebra, and tended to improve mechanical properties of the tibial metaphysis. Conclusion High-dose loratadine slightly but significantly affected development of the skeletal system in rapidly growing rats.
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Affiliation(s)
- Joanna Folwarczna
- Department of Pharmacology, School of Pharmacy with the Division of Laboratory Medicine in Sosnowiec, Medical University of Silesia, Katowice, Sosnowiec 41-200, Poland
| | - Natalia Konarek
- Department of Pharmacology, School of Pharmacy with the Division of Laboratory Medicine in Sosnowiec, Medical University of Silesia, Katowice, Sosnowiec 41-200, Poland
| | - Karolina Freier
- Department of Pharmacology, School of Pharmacy with the Division of Laboratory Medicine in Sosnowiec, Medical University of Silesia, Katowice, Sosnowiec 41-200, Poland
| | - Dawid Karbowniczek
- Department of Pharmacology, School of Pharmacy with the Division of Laboratory Medicine in Sosnowiec, Medical University of Silesia, Katowice, Sosnowiec 41-200, Poland
| | - Piotr Londzin
- Department of Pharmacology, School of Pharmacy with the Division of Laboratory Medicine in Sosnowiec, Medical University of Silesia, Katowice, Sosnowiec 41-200, Poland
| | - Aleksandra Janas
- Department of Pharmacology, School of Pharmacy with the Division of Laboratory Medicine in Sosnowiec, Medical University of Silesia, Katowice, Sosnowiec 41-200, Poland
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25
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Deckers J, Lambrecht BN, Hammad H. How a farming environment protects from atopy. Curr Opin Immunol 2019; 60:163-169. [PMID: 31499321 DOI: 10.1016/j.coi.2019.08.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 08/02/2019] [Indexed: 12/15/2022]
Abstract
It is now well established that the exposure to certain environments such as farms has the potential to protect from the development of allergies later in life. This protection is achieved when repeated exposure to the farming environment occurs early in life, but persists when children spend sufficient amount of time in contact with livestock and hay, and drink unpasteurized milk. The capacity of farm dust to protect from allergy development lies, amongst others, in the microbe composition in the farm. These protective microbes release various metabolites and cell wall components that change farmers' home dust composition, when compared to urbanized home dust. Additionally, they can colonize various barrier sites (skin, lung, intestine) in farmers' children, leading to persistent changes in the way their immune system and their barrier cells respond to environmental allergens.
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Affiliation(s)
- Julie Deckers
- Laboratory of Immunoregulation and Mucosal Immunology, VIB Center for Inflammation Research, Technologiepark-Zwijnaarde 71, B-9052 Ghent (Zwijnaarde), Belgium; Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Bart N Lambrecht
- Laboratory of Immunoregulation and Mucosal Immunology, VIB Center for Inflammation Research, Technologiepark-Zwijnaarde 71, B-9052 Ghent (Zwijnaarde), Belgium; Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium; Department of Respiratory Medicine, Erasmus Medical Center, Rotterdam, The Netherlands.
| | - Hamida Hammad
- Laboratory of Immunoregulation and Mucosal Immunology, VIB Center for Inflammation Research, Technologiepark-Zwijnaarde 71, B-9052 Ghent (Zwijnaarde), Belgium; Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
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26
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Giallongo A, Parisi GF, Licari A, Pulvirenti G, Cuppari C, Salpietro C, Marseglia GL, Leonardi S. Novel therapeutic targets for allergic airway disease in children. Drugs Context 2019; 8:212590. [PMID: 31391855 PMCID: PMC6668505 DOI: 10.7573/dic.212590] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 05/30/2019] [Accepted: 06/03/2019] [Indexed: 12/22/2022] Open
Abstract
The aim of precision medicine is setting up targeted therapies for selected patients that would ideally have high effectiveness and few side effects. This is made possible by targeted therapy drugs that selectively act on a specific pathway. Precision medicine is spreading to many medical specialties, and there is increasing interest in the context of allergic airway diseases, such as allergic rhinitis, chronic rhinosinusitis, and asthma. This review is an update of new targets in the treatment of childhood allergic upper airway diseases and asthma, including the most recent biologic drugs that have already been licensed or are in the pipeline to be tested with children.
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Affiliation(s)
- Alessandro Giallongo
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Giuseppe Fabio Parisi
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Amelia Licari
- Department of Pediatrics, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Giulio Pulvirenti
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Caterina Cuppari
- Department of Human Pathology of the Adult and Developmental Age 'Gaetano Barresi,' Unit of Pediatric Emergency, University of Messina, Messina, Italy
| | - Carmelo Salpietro
- Department of Human Pathology of the Adult and Developmental Age 'Gaetano Barresi,' Unit of Pediatric Emergency, University of Messina, Messina, Italy
| | - Gian Luigi Marseglia
- Department of Pediatrics, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Salvatore Leonardi
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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27
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Khaleva E, Gridneva Z, Geddes DT, Oddy WH, Colicino S, Blyuss O, Boyle RJ, Warner JO, Munblit D. Transforming growth factor beta in human milk and allergic outcomes in children: A systematic review. Clin Exp Allergy 2019; 49:1201-1213. [PMID: 31058363 DOI: 10.1111/cea.13409] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 03/25/2019] [Accepted: 04/20/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Human milk (HM) transforming growth factor beta (TGF-β) is critical for inflammation regulation and oral tolerance promotion. Previous reports suggested that variations in HM TGF-β levels are associated with allergic outcomes. OBJECTIVE We undertook a systematic review (PROSPERO 2017 CRD42017069920) to reassess the evidence on the relationships between HM TGF-β and allergic outcomes in children. METHODS Electronic bibliographic databases (MEDLINE, EMBASE and Cochrane Library) were systematically searched. Two independent reviewers screened reference lists, extracted the data and assessed risk of bias using the National Institute for Clinical Excellence methodological checklist. RESULTS A total of 21 studies were identified. Sixteen studies assessed relationships between HM TGF-β and risk of eczema; 14, allergic sensitization; nine, wheezing/asthma; six, food allergy; three, allergic rhinitis/conjunctivitis. Five cohorts (5/18, 28%) reported a protective effect of TGF-β1, while 3 (3/10, 30%) suggested increased risk of allergic outcomes development and 1 (1/10, 10%), a protective effect of TGF-β2 on eczema. Meta-analysis was not possible due to significant heterogeneity in methodology, age of outcome assessment and differing statistical approaches. 71% (15/21) of studies carried a high risk of bias. CONCLUSION AND CLINICAL RELEVANCE In contrast with previous findings, we did not find strong evidence of associations between HM TGF-β and allergic outcomes. Differences in studies' methodology and outcomes do not allow unconditional rejection or acceptance of the hypothesis that HM TGF-β influences the risk of allergy development. Future studies on diverse populations employing standardized methods, accurate phenotyping of outcomes and evaluation of the effect of TGF-β in combination with other HM immune markers, microbiome and oligosaccharides are required.
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Affiliation(s)
- Ekaterina Khaleva
- University of Southampton, Southampton, UK.,inVIVO Planetary Health, Research Group of the Worldwide Universities Network, West New York, New Jersey
| | - Zoya Gridneva
- inVIVO Planetary Health, Research Group of the Worldwide Universities Network, West New York, New Jersey.,School of Molecular Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Donna T Geddes
- inVIVO Planetary Health, Research Group of the Worldwide Universities Network, West New York, New Jersey.,School of Molecular Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Wendy H Oddy
- Nutritional Epidemiology, Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Silvia Colicino
- The National Heart and Lung Institute, Imperial College London, London, UK
| | - Oleg Blyuss
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK.,Department of Applied Mathematics, Lobachevsky State University of Nizhny Novgorod, Nizhny Novgorod, Russia.,Department of Pediatrics, Faculty of Pediatrics, Sechenov University, Moscow, Russia
| | - Robert J Boyle
- inVIVO Planetary Health, Research Group of the Worldwide Universities Network, West New York, New Jersey.,Department of Paediatrics, Imperial College London, London, UK.,Centre of Evidence-based Dermatology, University of Nottingham, Nottingham, UK
| | - John O Warner
- inVIVO Planetary Health, Research Group of the Worldwide Universities Network, West New York, New Jersey.,Department of Paediatrics, Imperial College London, London, UK.,Paediatrics and NIHR Collaboration for Leadership in Applied Health Research and Care for NW London, London, UK
| | - Daniel Munblit
- inVIVO Planetary Health, Research Group of the Worldwide Universities Network, West New York, New Jersey.,Department of Pediatrics, Faculty of Pediatrics, Sechenov University, Moscow, Russia.,Department of Paediatrics, Imperial College London, London, UK.,Healthcare Department of Moscow, Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russia
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28
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Raherison C, Baldi I, Pouquet M, Berteaud E, Moesch C, Bouvier G, Canal-Raffin M. Pesticides Exposure by Air in Vineyard Rural Area and Respiratory Health in Children: A pilot study. ENVIRONMENTAL RESEARCH 2019; 169:189-195. [PMID: 30466012 DOI: 10.1016/j.envres.2018.11.002] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 10/23/2018] [Accepted: 11/02/2018] [Indexed: 05/23/2023]
Abstract
RATIONALE Asthma, frequently associated with rhinitis, is the most common chronic disease in children, and a significant role is played by a range of environmental exposures. Among them, air pollution is of foremost concern. However, little is known about the impact of airborne pesticide exposure on children's respiratory health in rural areas. The objective of this study was to analyze the association between airborne pesticide exposure and asthma and rhinitis in children. METHODS In a French vineyard rural area, children (3-10 years old) from 4 selected schools were invited to participate in this study over two periods: winter, with no or low air pesticide levels, and summer when fields are frequently treated with pesticides. Two health outcomes were considered: asthma and rhinitis symptoms (ISAAC questionnaire), and peak expiratory flow (PEF). A quantitative score of symptoms was built. Exposure to pesticides was evaluated 1) by measuring 56 pesticides in the ambient outdoor air around schools in the two periods and building a cumulative exposure index, and 2) by measuring ethylenethiourea (ETU) concentrations in urine in a subsample of children (n = 96), ETU being a urine biomarker of exposure to dithiocarbamates fungicides. Next, the association between pesticide exposure and respiratory health was studied using a logistic regression model, adjusted for confounders and respiratory status at baseline. RESULTS 281 children participated in the study (47% girls, mean age: 7.5 yrs). 25% of the children were living on a farm. 22% had experienced wheezing at least once. 15.8% had asthma diagnosed by a doctor, 12% had current asthma and 35% had allergic rhinitis. The main pesticides detected in the ambient outdoor air around schools were fungicides (89,3%; mainly folpet and dithiocarbamates) and insecticides (10.6%). No association was found between the symptom score and pesticides in the outdoor air around schools during summer, when pesticides were applied to vineyards. However, an association was found between ETU urinary concentration (>0.974 μg/g creatinine) and asthma and rhinitis symptoms (OR=3.56; IC 95% 1.04-12.12). This result could be explained by extracurricular exposure, which was not considered in our air measurements in the schools. No association was found between peak expiratory flow and exposure to pesticides in the air. CONCLUSIONS Children living in vineyard rural areas are at a higher risk of airborne dithiocarbamates exposure during the summer period. Despite the limited size of our sample, our results suggest possible links between some pesticide measurements and respiratory and allergic symptoms such as rhinitis.
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Affiliation(s)
- C Raherison
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, team EPICENE, UMR 1219, F-33000 Bordeaux, France; Service des Maladies Respiratoires, CHU Bordeaux, France.
| | - I Baldi
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, team EPICENE, UMR 1219, F-33000 Bordeaux, France
| | - M Pouquet
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, team EPICENE, UMR 1219, F-33000 Bordeaux, France
| | - E Berteaud
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, team EPICENE, UMR 1219, F-33000 Bordeaux, France
| | - C Moesch
- Service de Pharmacologie et de Toxicologie, CHU Dupuytren, Limoges, France
| | - G Bouvier
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, team EPICENE, UMR 1219, F-33000 Bordeaux, France
| | - M Canal-Raffin
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, team EPICENE, UMR 1219, F-33000 Bordeaux, France; Laboratoire de Pharmacologie Clinique et de Toxicologie, CHU Bordeaux, France
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29
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Terada T, Kawata R. Early Intervention is Important to Prevent Sensitization to New Allergens. Med Sci (Basel) 2018; 6:E114. [PMID: 30545018 PMCID: PMC6313720 DOI: 10.3390/medsci6040114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 12/03/2018] [Accepted: 12/07/2018] [Indexed: 11/17/2022] Open
Abstract
We review current management for allergic rhinitis and possible new treatments for this condition. Management of allergic rhinitis includes promotion of protective factors, avoidance of allergens, and possibly immunotherapy. In recent years, the incidence of allergic rhinitis has increased in many countries. Early intervention at different stages is an important part of management. Allergic disease in infants has been described as the allergic march, commencing with atopic dermatitis accompanied by infantile asthma and progressing to perennial allergic rhinitis induced by house dust mite allergy. In order to prevent polysensitization, allergen-specific immunotherapy should probably be initiated at an earlier age, especially in children with rhinitis who show monosensitization to house dust mite antigens.
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Affiliation(s)
- Tetsuya Terada
- Department of Otolaryngology, Osaka Medical College, 2-7 Daigakumachi Takatsuki, Osaka 569-8686, Japan.
| | - Ryo Kawata
- Department of Otolaryngology, Osaka Medical College, 2-7 Daigakumachi Takatsuki, Osaka 569-8686, Japan.
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30
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Yoon J, Kim EM, Lee MY, Jung S, Cho HJ, Kim Y, Choi YJ, Lee E, Yang SI, Lee SY, Lee JR, Yi Y, Hong SJ. Perinatal maternal negative life events as risk factors of atopic dermatitis in female offspring. Ann Allergy Asthma Immunol 2018; 121:641-642.e1. [PMID: 30036583 DOI: 10.1016/j.anai.2018.07.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 07/09/2018] [Accepted: 07/14/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Jisun Yoon
- Department of Pediatrics, Mediplex Sejong Hospital, Incheon, Korea
| | - Eun Mi Kim
- Asan Institute for Life Science, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Mi Young Lee
- Asan Institute for Life Science, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sungsu Jung
- Department of Pediatrics, Childhood Asthma Atopy Center, Environmental Health Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyun-Ju Cho
- Department of Pediatrics, International St Mary's Hospital, Catholic Kwandong University, Incheon, Korea
| | - Yeongho Kim
- Department of Pediatrics, Childhood Asthma Atopy Center, Environmental Health Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yean Jung Choi
- Asan Institute for Life Science, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Lee
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Song-I Yang
- Department of Pediatrics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - So-Yeon Lee
- Department of Pediatrics, Childhood Asthma Atopy Center, Environmental Health Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Rim Lee
- Korea Institute of Child Care and Education, Seoul, Korea
| | - Yejin Yi
- Korea Institute of Child Care and Education, Seoul, Korea
| | - Soo-Jong Hong
- Department of Pediatrics, Childhood Asthma Atopy Center, Environmental Health Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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On-Demand Intranasal Corticosteroids for Treatment of Seasonal Allergic Rhinitis in Children. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 6:1430-1431. [DOI: 10.1016/j.jaip.2018.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 03/12/2018] [Accepted: 03/26/2018] [Indexed: 02/04/2023]
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Chronischer Pruritus bei atopischer Dermatitis. Monatsschr Kinderheilkd 2018. [DOI: 10.1007/s00112-017-0298-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Al-Abri R, Al-Amri AS, Al-Dhahli Z, Varghese AM. Allergic Rhinitis in Relation to Food Allergies: Pointers to future research. Sultan Qaboos Univ Med J 2018; 18:e30-e33. [PMID: 29666678 DOI: 10.18295/squmj.2018.18.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 11/12/2017] [Accepted: 01/18/2018] [Indexed: 11/16/2022] Open
Abstract
Allergic rhinitis is a ubiquitous type of allergic reaction which results in significant costs to affected patients and their families. Although allergic rhinitis can coexist with other atopic conditions, the role of food allergies in the development of allergic rhinitis has not been well studied. This article explores relevant literature on this subject in order to identify gaps in the available body of knowledge and elucidate scope for further research.
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Affiliation(s)
- Rashid Al-Abri
- Department of Surgery, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Asdaf S Al-Amri
- Post-Internship Programme, Directorate General of Health Services, Ministry of Health, Muscat, Oman
| | - Zaina Al-Dhahli
- Otolaryngology Residency Programme, Oman Medical Specialty Board, Muscat, Oman
| | - Ajoy M Varghese
- Department of Surgery, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman.,Department of Ear, Nose & Throat, Christian Medical College, Vellore, Tamil Nadu, India
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Wise SK, Lin SY, Toskala E, Orlandi RR, Akdis CA, Alt JA, Azar A, Baroody FM, Bachert C, Canonica GW, Chacko T, Cingi C, Ciprandi G, Corey J, Cox LS, Creticos PS, Custovic A, Damask C, DeConde A, DelGaudio JM, Ebert CS, Eloy JA, Flanagan CE, Fokkens WJ, Franzese C, Gosepath J, Halderman A, Hamilton RG, Hoffman HJ, Hohlfeld JM, Houser SM, Hwang PH, Incorvaia C, Jarvis D, Khalid AN, Kilpeläinen M, Kingdom TT, Krouse H, Larenas-Linnemann D, Laury AM, Lee SE, Levy JM, Luong AU, Marple BF, McCoul ED, McMains KC, Melén E, Mims JW, Moscato G, Mullol J, Nelson HS, Patadia M, Pawankar R, Pfaar O, Platt MP, Reisacher W, Rondón C, Rudmik L, Ryan M, Sastre J, Schlosser RJ, Settipane RA, Sharma HP, Sheikh A, Smith TL, Tantilipikorn P, Tversky JR, Veling MC, Wang DY, Westman M, Wickman M, Zacharek M. International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis. Int Forum Allergy Rhinol 2018; 8:108-352. [PMID: 29438602 PMCID: PMC7286723 DOI: 10.1002/alr.22073] [Citation(s) in RCA: 218] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 12/01/2017] [Accepted: 12/01/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Critical examination of the quality and validity of available allergic rhinitis (AR) literature is necessary to improve understanding and to appropriately translate this knowledge to clinical care of the AR patient. To evaluate the existing AR literature, international multidisciplinary experts with an interest in AR have produced the International Consensus statement on Allergy and Rhinology: Allergic Rhinitis (ICAR:AR). METHODS Using previously described methodology, specific topics were developed relating to AR. Each topic was assigned a literature review, evidence-based review (EBR), or evidence-based review with recommendations (EBRR) format as dictated by available evidence and purpose within the ICAR:AR document. Following iterative reviews of each topic, the ICAR:AR document was synthesized and reviewed by all authors for consensus. RESULTS The ICAR:AR document addresses over 100 individual topics related to AR, including diagnosis, pathophysiology, epidemiology, disease burden, risk factors for the development of AR, allergy testing modalities, treatment, and other conditions/comorbidities associated with AR. CONCLUSION This critical review of the AR literature has identified several strengths; providers can be confident that treatment decisions are supported by rigorous studies. However, there are also substantial gaps in the AR literature. These knowledge gaps should be viewed as opportunities for improvement, as often the things that we teach and the medicine that we practice are not based on the best quality evidence. This document aims to highlight the strengths and weaknesses of the AR literature to identify areas for future AR research and improved understanding.
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Affiliation(s)
| | | | | | | | - Cezmi A. Akdis
- Allergy/Asthma, Swiss Institute of Allergy and Asthma Research, Switzerland
| | | | - Antoine Azar
- Allergy/Immunology, Johns Hopkins University, USA
| | | | | | | | | | - Cemal Cingi
- Otolaryngology, Eskisehir Osmangazi University, Turkey
| | | | | | | | | | | | | | - Adam DeConde
- Otolaryngology, University of California San Diego, USA
| | | | | | | | | | | | | | - Jan Gosepath
- Otorhinolaryngology, Helios Kliniken Wiesbaden, Germany
| | | | | | | | - Jens M. Hohlfeld
- Respiratory Medicine, Hannover Medical School, Airway Research Fraunhofer Institute for Toxicology and Experimental Medicine, German Center for Lung Research, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | - Amber U. Luong
- Otolaryngology, McGovern Medical School at the University of Texas Health Science Center Houston, USA
| | | | | | | | - Erik Melén
- Pediatric Allergy, Karolinska Institutet, Sweden
| | | | | | - Joaquim Mullol
- Otolaryngology, Universitat de Barcelona, Hospital Clinic, IDIBAPS, Spain
| | | | | | | | - Oliver Pfaar
- Rhinology/Allergy, Medical Faculty Mannheim, Heidelberg University, Center for Rhinology and Allergology, Wiesbaden, Germany
| | | | | | - Carmen Rondón
- Allergy, Regional University Hospital of Málaga, Spain
| | - Luke Rudmik
- Otolaryngology, University of Calgary, Canada
| | - Matthew Ryan
- Otolaryngology, University of Texas Southwestern, USA
| | - Joaquin Sastre
- Allergology, Hospital Universitario Fundacion Jiminez Diaz, Spain
| | | | | | - Hemant P. Sharma
- Allergy/Immunology, Children's National Health System, George Washington University School of Medicine, USA
| | | | | | | | | | | | - De Yun Wang
- Otolaryngology, National University of Singapore, Singapore
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Davies E, Rogers NK, Lloyd-Lavery A, Grindlay DJC, Thomas KS. What's new in atopic eczema? An analysis of systematic reviews published in 2015. Part 1: epidemiology and methodology. Clin Exp Dermatol 2018; 43:375-379. [PMID: 29314180 DOI: 10.1111/ced.13377] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2017] [Indexed: 02/04/2023]
Abstract
This review forms part of a series of annual updates that summarize the evidence base for atopic eczema (AE), providing a succinct guide for clinicians and patients. It provides a summary of key findings from 15 systematic reviews that were published during 2015, and focuses on the epidemiology and methodology issues of AE. For systematic reviews on the prevention and treatment of AE, see Part 2 of this update. The worldwide prevalence of AE during childhood has been calculated to be 7.89% (95% CI 7.88-7.89), based on studies of 1 430 329 children from 102 countries. Children with AE are four times more likely than controls to have allergic rhinitis and asthma [relative risk (RR) = 4.24, 95% CI 3.75-4.79]. Twin studies show the heritability of AE to be about 75%. AE is more prevalent in patients with vitiligo and alopecia, and is positively associated with a high body mass index in America and Asia but not in Europe. Possible relationships between AE and exercise, maternal folate supplementation, maternal stress and autism spectrum disorder (ASD) have been assessed, but more high-quality studies are needed for definitive conclusions. The Harmonising Outcomes Measures for Eczema (HOME) Initiative is developing a core set of outcome measures for AE trials. Suitable instruments for measuring quality of life are yet to be agreed, and use of Investigator Global Assessment in trials requires standardization. Transparent reporting of AE trials remains problematic.
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Affiliation(s)
- E Davies
- Department of Dermatology, The Royal Liverpool and Broadgreen University Hospitals, Thomas Drive, Liverpool, UK
| | - N K Rogers
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - A Lloyd-Lavery
- Department of Dermatology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - D J C Grindlay
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - K S Thomas
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
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Pols DHJ, Bohnen AM, Nielen MMJ, Korevaar JC, Bindels PJE. Risks for comorbidity in children with atopic disorders: an observational study in Dutch general practices. BMJ Open 2017; 7:e018091. [PMID: 29133326 PMCID: PMC5695444 DOI: 10.1136/bmjopen-2017-018091] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE This study aimed to investigate both atopic and non-atopic comorbid symptoms and diseases in children with physician-diagnosed atopic disorders (atopic eczema, asthma and allergic rhinitis). METHODS All children aged 0-18 years listed in a nationwide primary care database (the Netherlands Institute for Health Services Research-Primary Care Database) with routinely collected healthcare data in 2014 were selected. Children with atopic disorders were matched on age and gender with non-atopic controls within the same general practice. A total of 404 International Classification of Primary Care codes were examined. Logistic regression analyses were performed to examine the associations between the presence of atopic disorders and (non-)atopic symptoms and diseases by calculating ORs. RESULTS Having one of the atopic disorders significantly increased the risk of having other atopic-related symptoms, even if the child was not registered as having the related atopic disorder. Regarding non-atopic comorbidity, children with atopic eczema (n=15 530) were at significantly increased risk for (infectious) skin diseases (OR: 1.2-3.4). Airway symptoms or (infectious) diseases (OR: 2.1-10.3) were observed significantly more frequently in children with asthma (n=7887). Children with allergic rhinitis (n=6835) had a significantly distinctive risk of ear-nose-throat-related symptoms and diseases (OR: 1.5-3.9). Neither age nor gender explained these increased risks. CONCLUSION General practitioners are not always fully aware of relevant atopic and non-atopic comorbidity. In children known to have at least one atopic disorder, specific attention is required to avoid possible insufficient treatment and unnecessary loss of quality of life.
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Affiliation(s)
- David H J Pols
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Arthur M Bohnen
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Mark M J Nielen
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Joke C Korevaar
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Patrick J E Bindels
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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Sacchetti M, Baiardini I, Chini L, Moschese V, Bruscolini A, Lambiase A. Development and preliminary validation of a new screening questionnaire for identifying atopic children. PEDIATRIC HEALTH MEDICINE AND THERAPEUTICS 2017; 8:99-105. [PMID: 29388629 PMCID: PMC5774591 DOI: 10.2147/phmt.s142271] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background Allergic diseases represent a frequent and increasing condition affecting children. A screening questionnaire allowing an easy identification of children with symptoms of allergic diseases may improve management and clinical outcome. The aim of this study was to develop and validate an easy-to-use screening questionnaire to detect children requiring further allergological evaluations. Methods A 10-item questionnaire, evaluating the presence and the history of the most frequent allergic conditions affecting children, including allergic asthma, allergic rhinitis and conjunctivitis, food allergy, and atopic dermatitis, was developed and administered to 214 parents of children from 5 to 10 years of age (163 with allergic disease and 51 healthy, nonallergic children). Validation was performed by Pearson’s correlation between the clinical diagnosis and the responses to the questionnaire. Internal consistency was computed by Cronbach’s alpha correlation coefficient. Sensitivity and specificity of the novel questionnaire were assessed by the receiver operating characteristic (ROC) curve. Results Validation analysis of the new children atopy (ChAt) questionnaire showed good internal consistency with a Cronbach’s alpha of 0.757. Responses to the items evaluating the presence of individual allergic conditions significantly correlated with the clinical diagnosis (p<0.001). The ROC curve showed an area of 0.956 and identified a cutoff value >2 of the ChAt questionnaire total score for detection of allergy (sensitivity =0.92 and specificity =0.902). Conclusion The novel ChAt questionnaire represents a simple tool able to detect the presence of all major allergic diseases in a pediatric population allowing an early identification of allergic multimorbidity and potentially facilitating clinical management.
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Affiliation(s)
- Marta Sacchetti
- Cornea and Ocular Surface Unit, IRCCS-Ospedale San Raffaele di Milano, Milan.,Department of Sense Organs, Sapienza University, Rome
| | - Ilaria Baiardini
- Allergy and Respiratory Diseases Clinic, DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa
| | - Loredana Chini
- Pediatric Allergology and Immunology Unit, Policlinico Tor Vergata, University of Rome Tor Vergata, Rome, Italy
| | - Viviana Moschese
- Pediatric Allergology and Immunology Unit, Policlinico Tor Vergata, University of Rome Tor Vergata, Rome, Italy
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Prevalence and Risk Factors of Asthma, Rhinitis, and Eczema and Their Multimorbidity among Young Adults in Kuwait: A Cross-Sectional Study. BIOMED RESEARCH INTERNATIONAL 2017; 2017:2184193. [PMID: 28951868 PMCID: PMC5603128 DOI: 10.1155/2017/2184193] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 07/11/2017] [Accepted: 07/26/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To estimate the prevalence of allergic diseases and allergic multimorbidity (coexistence) among young adults in Kuwait and to examine associations between risk factors with allergic diseases and allergic multimorbidity. METHODS A cross-sectional study was conducted by enrolling 1,154 students, aged 18-26 years, attending Kuwait University. Participants self-completed a questionnaire on symptoms and clinical history of allergic diseases. Prevalence ratios (PRs) and 95% confidence intervals (CIs) were estimated by applying Poisson regression with robust variance estimation. RESULTS The prevalence of current asthma, rhinitis, and eczema was estimated to be 11.9% (135/1135), 20.4% (232/1138), and 9.2% (105/1143), respectively. The coexistence of "asthma and rhinitis" (5.1%, 57/1125) was the most frequent allergic multimorbidity. Both maternal history (PR = 3.97, 95% CI: 2.32-6.80) and paternal history (PR = 1.72, 95% CI: 1.10-2.68) of allergy were independently associated with having two or more coexisting allergic diseases. The joint effect of having both maternal and paternal history of allergy was associated with 8.16 times (95% CI: 4.19-15.90) higher risk of allergic multimorbidity. CONCLUSION Allergic diseases and allergic multimorbidity are common among young adults in Kuwait and their burden mirrors that of westernized countries. Parental history of allergy is a strong predisposing factor for allergic multimorbidity.
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Doğruel D, Bingöl G, Altıntaş DU, Seydaoğlu G, Erkan A, Yılmaz M. The Trend of Change of Allergic Diseases over the Years: Three Repeated Surveys from 1994 to 2014. Int Arch Allergy Immunol 2017; 173:178-182. [PMID: 28787739 DOI: 10.1159/000477726] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 05/23/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Although it is known that there has been an increase in asthma and allergic diseases among school-aged children, results vary between countries. The aim of this study was to examine trends in the prevalence of these diseases in the city of Adana (south Turkey) over the last 20 years based on the results of 3 cross-sectional studies. METHODS Three cross-sectional surveys were performed 10 years apart in south Turkey. Here, we compare the surveys conducted among children between the ages of 6 and 14 years from 1994, 2004, and 2014. The participants were randomly chosen among children attending participating primary schools in Adana. The questionnaire in the first survey contained almost the same questions as the ISAAC. In the 2 latter surveys, we used the ISAAC questionnaire to investigate the prevalence of asthma and other allergic diseases. RESULTS A total of 2,334 children in 1994, 3,728 children in 2004, and 3,209 children in 2014 were included in the final analysis. The results showed a statistically significant increase in the prevalence of physician-diagnosed allergic diseases across the years, respectively: asthma (5, 4.6, and 8.9%), allergic rhinitis (8.8, 11.4, and 15.6%), and atopic dermatitis (5, 9.9, and 7%). In contrast, the prevalence of parent-reported current wheeze (16.2, 13.2%) decreased in the last 10 years. CONCLUSIONS Our findings were consistent with the increased prevalence of childhood asthma and other allergic diseases. However, this pattern did not occur in respiratory symptoms.
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Affiliation(s)
- Dilek Doğruel
- Department of Pediatric Allergy and Immunology, Çukurova University Faculty of Medicine, Adana, Turkey
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Reliably estimating prevalences of atopic children: an epidemiological study in an extensive and representative primary care database. NPJ Prim Care Respir Med 2017; 27:23. [PMID: 28408759 PMCID: PMC5435092 DOI: 10.1038/s41533-017-0025-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 02/25/2017] [Accepted: 02/28/2017] [Indexed: 12/02/2022] Open
Abstract
Electronic health records stored in primary care databases might be a valuable source to study the epidemiology of atopic disorders and their impact on health-care systems and costs. However, the prevalence of atopic disorders in such databases varies considerably and needs to be addressed. For this study, all children aged 0–18 years listed in a representative primary care database in the period 2002–2014, with sufficient data quality, were selected. The effects of four different strategies on the prevalences of atopic disorders were examined: (1) the first strategy examined the diagnosis as recorded in the electronic health records, whereas the (2) second used additional requirements (i.e., the patient had at least two relevant consultations and at least two relevant prescriptions). Strategies (3) and (4) assumed the atopic disorders to be chronic based on strategy 1 and 2, respectively. When interested in cases with a higher probability of a clinically relevant disorder, strategy 2 yields a realistic estimation of the prevalence of atopic disorders derived from primary care data. Using this strategy, of the 478,076 included children, 28,946 (6.1%) had eczema, 29,182 (6.1%) had asthma, and 28,064 (5.9%) had allergic rhinitis; only 1251 (0.3%) children had all three atopic disorders. Prevalence rates are highly dependent on the clinical atopic definitions used. The strategy using cases with a higher probability of clinically relevant cases, yields realistic prevalences to establish the impact of atopic disorders on health-care systems. However, studies are needed to solve the problem of identifying atopic disorders that are missed or misclassified. The prevalence of atopic disorders in children can be more reliably calculated by incorporating clinical information with diagnosis data. Researchers in the Netherlands, led by David Pols from the Erasmus University Medical Center Rotterdam, examined the electronic health records of more than 660,000 children, aged 0 to 18, from a Dutch primary care database to determine the number of cases of atopic eczema, asthma, and allergic rhinitis. They looked for diagnosed children who also had at least two relevant clinical consultations and at least two relevant prescriptions. This strategy helps correct for the problem of overestimation, because it doesnot assume that a child, once diagnosed, will have an atopic disorder for life. However, other methods are still needed to identify cases that are missed or misclassified in the health database.
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Wartna JB, Bohnen AM, Elshout G, Pijnenburg MWH, Pols DHJ, Gerth van Wijk RR, Bindels PJE. Symptomatic treatment of pollen-related allergic rhinoconjunctivitis in children: randomized controlled trial. Allergy 2017; 72:636-644. [PMID: 27696447 DOI: 10.1111/all.13056] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND About 12% of children are affected by allergic rhinoconjunctivitis (AR). Although the main symptomatic treatments are intranasal corticosteroids (INCS) (daily or on demand) and oral antihistamines, it remains unclear which treatment provides the best relief of symptoms. Therefore, this study examines whether daily use of INCS is superior to on-demand use or to oral antihistamines on demand. METHODS A single-blinded randomized controlled trial in children (aged 6-18 years) with pollen-related AR. Patients received either INCS daily (fluticasone propionate), INCS on demand (fluticasone propionate) or oral antihistamine on demand (levocetirizine) for 3 months during the grass pollen season. A daily online symptom diary on both nose and eye symptoms was completed. The primary outcome was the percentage of symptom-free days. RESULTS A total of 150 children were randomized. The percentage symptom-free days was in favour of INCS on demand (30%) compared with INCS daily (22%), that is 8% difference (95% CI -5 to +21%; not significant). The antihistamine on-demand group had 15% symptom-free days, that is 7% difference compared to INCS daily (95% CI -6 to +19%;, not significant). Patients in the INCS on-demand group used on average 61% less fluticasone than patients in the INCS daily group during the study period (P < 0.0001). CONCLUSIONS This trial with three parallel treatment groups shows that INCS daily was not superior to INCS on demand or to antihistamine on demand regarding the number of symptom-free days. An on-demand INCS strategy has the advantage of a lower overall corticosteroid exposure and less costs.
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Affiliation(s)
- J. B. Wartna
- Department of General Practice; Erasmus MC; Rotterdam The Netherlands
| | - A. M. Bohnen
- Department of General Practice; Erasmus MC; Rotterdam The Netherlands
| | - G. Elshout
- Department of General Practice; Erasmus MC; Rotterdam The Netherlands
| | - M. W. H. Pijnenburg
- Department of Pediatrics; Erasmus MC/Sophia Children's Hospital; Rotterdam The Netherlands
| | - D. H. J. Pols
- Department of General Practice; Erasmus MC; Rotterdam The Netherlands
| | - R. R. Gerth van Wijk
- Section of Allergology; Department of Internal Medicine; Erasmus MC; Rotterdam The Netherlands
| | - P. J. E. Bindels
- Department of General Practice; Erasmus MC; Rotterdam The Netherlands
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Flokstra-de Blok BM, van der Molen T, Christoffers WA, Kocks JW, Oei RL, Oude Elberink JN, Roerdink EM, Schuttelaar ML, van der Velde JL, Brakel TM, Dubois AE. Development of an allergy management support system in primary care. J Asthma Allergy 2017; 10:57-65. [PMID: 28352197 PMCID: PMC5359130 DOI: 10.2147/jaa.s123260] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Management of allergic patients in the population is becoming more difficult because of increases in both complexity and prevalence. Although general practitioners (GPs) are expected to play an important role in the care of allergic patients, they often feel ill-equipped for this task. Therefore, the aim of this study was to develop an allergy management support system (AMSS) for primary care. Methods Through literature review, interviewing and testing in secondary and primary care patients, an allergy history questionnaire was constructed by allergists, dermatologists, GPs and researchers based on primary care and specialists’ allergy guidelines and their clinical knowledge. Patterns of AMSS questionnaire responses and specific immunoglobulin E (sIgE)-test outcomes were used to identify diagnostic categories and develop corresponding management recommendations. Validity of the AMSS was investigated by comparing specialist (gold standard) and AMSS diagnostic categories. Results The two-page patient-completed AMSS questionnaire consists of 12 (mainly) multiple choice questions on symptoms, triggers, severity and medication. Based on the AMSS questionnaires and sIgE-test outcome of 118 patients, approximately 150 diagnostic categories of allergic rhinitis, asthma, atopic dermatitis, anaphylaxis, food allergy, hymenoptera allergy and other allergies were identified, and the corresponding management recommendations were formulated. The agreement between the allergy specialists’ assessments and the AMSS was 69.2% (CI 67.2–71.2). Conclusion Using a systematic approach, it was possible to develop an AMSS that allows for the formulation of diagnostic and management recommendations for GPs managing allergic patients. The AMSS thus holds promise for the improvement of the quality of primary care for this increasing group of patients.
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Affiliation(s)
| | | | | | | | | | | | - Emmy M Roerdink
- Department of Pediatric Pulmonology and Pediatric Allergy, University of Groningen, University Medical Center Groningen
| | | | | | - Thecla M Brakel
- Department of General Practice; Teaching Unit, Department of Social Psychology, University of Groningen, Groningen, The Netherlands
| | - Anthony Ej Dubois
- GRIAC Research Institute; Department of Pediatric Pulmonology and Pediatric Allergy, University of Groningen, University Medical Center Groningen
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Alqahtani JM. Asthma and other allergic diseases among Saudi schoolchildren in Najran: the need for a comprehensive intervention program. Ann Saudi Med 2016; 36:379-385. [PMID: 27920408 PMCID: PMC6074205 DOI: 10.5144/0256-4947.2016.379] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND In the last three decades, an increasing incidence of allergic diseases has been associated with increasing morbidity and mortality in children and young adults. OBJECTIVES The study aimed to investigate the prevalence and risk factors associated with allergic diseases among Saudi schoolchildren in the southwestern Saudi region of Najran, and to determine the sensitization of patients to a set of allergens. DESIGN Cross-sectional observational study. SETTING Primary, intermediate and secondary schools, Najran, Saudi Arabia. SUBJECTS AND METHODS All participants completed the Arabic version of the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. Skin prick tests (SPT) were performed, using a panel of standardized allergenic extracts. MAIN OUTCOME MEASURE(S) Prevalence and risk factors associated with pediatric allergic diseases. RESULTS The study included 1700 Saudi schoolchildren. The overall prevalence of physician-diagnosed asthma, allergic rhinitis and atopic dermatitis was 27.5%, 6.3% and 12.5%, respectively. Multivariate analysis showed that male gender (adjusted odds ratio [aOR], 1.27), fast food consumption (aOR, 1.53), trucks passing near houses (aOR, 1.86), and having a dog or cat at home (aOR, 1.85) were significant risk factors. A total of 722 (42.5%) children had a positive SPT result to at least one allergen. The most prevalent allergens were grass pollens (60%), cat fur (41.6%), and house dust mites (25%). CONCLUSIONS The findings of this study highlight the urgent need for developing an effective interven- tion program including several components working in harmony to control and reduce the burden of allergic diseases. LIMITATIONS These results may not be generalizable to the rest of Saudi Arabia.
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Affiliation(s)
- Jobran M Alqahtani
- Prof. Jobran Miree Alqahtani, Department of Pediatrics,, Najran University,, Najran 61411,, Saudi Arabia, T: +9665428000,, F: +9665428333, , ORCID: http://orcid.org/0000-0003-3198-7576
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Pols DHJ, Wartna JB, Moed H, van Alphen EI, Bohnen AM, Bindels PJE. Atopic dermatitis, asthma and allergic rhinitis in general practice and the open population: a systematic review. Scand J Prim Health Care 2016; 34:143-50. [PMID: 27010253 PMCID: PMC4977936 DOI: 10.3109/02813432.2016.1160629] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 01/31/2016] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To examine whether significant differences exist between the self-reported prevalence of atopic disorders in the open population compared with physician diagnosed prevalence of atopic disorders in general practice. METHODS Medline (OvidSP), PubMed Publisher, EMBASE, Google Scholar and the Cochrane Controlled Clinical Trials Register databases were systematically reviewed for articles providing data on the prevalence of asthma, allergic rhinitis and eczema in a GP setting. Studies were only included when they had a cross-sectional or cohort design and included more than 100 children (aged 0-18 years) in a general practice setting. All ISAAC studies (i.e. the open population) that geographically matched a study selected from the first search, were also included. A quality assessment was conducted. The primary outcome measures were prevalence of eczema, asthma and allergic rhinitis in children aged 0-18 years. RESULTS The overall quality of the included studies was good. The annual and lifetime prevalences of the atopic disorders varied greatly in both general practice and the open population. On average, the prevalence of atopic disorders was higher in the open population. CONCLUSION There are significant differences between the self-reported prevalence of atopic disorders in the open population compared with physician diagnosed prevalence of atopic disorders in general practice. Data obtained in the open population cannot simply be extrapolated to the general practice setting. This should be taken into account when considering a research topic or requirements for policy development. GPs should be aware of the possible misclassification of allergic disorders in their practice. Key Points Epidemiological data on atopic disorders in children can be obtained from various sources, each having its own advantages and limitations. On average, the prevalence of atopic disorders is higher in the open population. GPs should take into account the possible misclassification of atopic disorders in their practice population. Policymakers should be aware that data obtained in the open population cannot simply be extrapolated to the general practice setting.
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Affiliation(s)
- D. H. J. Pols
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, The Netherlands
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Nanda MK, LeMasters GK, Levin L, Rothenberg ME, Assa'ad AH, Newman N, Bernstein D, Khurana-Hershey G, Lockey JE, Ryan PH. Allergic Diseases and Internalizing Behaviors in Early Childhood. Pediatrics 2016; 137:peds.2015-1922. [PMID: 26715608 PMCID: PMC4702018 DOI: 10.1542/peds.2015-1922] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/22/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The relationship between allergic diseases and internalizing disorders has not been well characterized with regard to multiple allergic diseases or longitudinal study. The objective of this study was to examine the association between multiple allergic diseases in early childhood with validated measures of internalizing disorders in the school-age years. METHODS Children enrolled in the Cincinnati Childhood Allergy and Air Pollution Study underwent skin testing and examinations at ages 1, 2, 3, 4, and 7 years. At age 7, parents completed the Behavior Assessment System for Children, Second Edition (BASC-2), a validated measure of childhood behavior and emotion. The association between allergic diseases at age 4, including allergic rhinitis, allergic persistent wheezing, atopic dermatitis, and allergic sensitization, and BASC-2 internalizing, anxiety, and depression T scores at age 7 was examined by logistic and linear regression, adjusting for covariates. RESULTS The cohort included 546 children with complete information on allergic disease and BASC-2 outcomes. Allergic rhinitis at age 4 was significantly associated with elevated internalizing (adjusted odds ratio [aOR]: 3.2; 95% confidence interval [CI]: 1.8-5.8), anxiety (aOR: 2.0; 95% CI: 1.2-3.6), and depressive scores (aOR: 3.2; 95% CI: 1.7-6.5) at age 7. Allergic persistent wheezing was significantly associated with elevated internalizing scores (aOR: 2.7; 95% CI: 1.2-6.3). The presence of >1 allergic disease (aOR: 3.6; 95% CI: 1.7-7.6) and allergic rhinitis with comorbid allergic disease(s) (aOR: 4.3; 95% CI: 2.0-9.2) at age 4 had dose-dependent associations with internalizing scores. CONCLUSIONS Children with allergic rhinitis and allergic persistent wheezing at age 4 are at increased risk of internalizing behaviors at age 7. Furthermore, multiple allergic diseases had a dose-dependent association with elevated internalizing scores.
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Affiliation(s)
- Maya K. Nanda
- Division of Asthma, Allergy, and Immunology, Children’s Mercy Hospital, Kansas City, Missouri
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- Division of Immunology, University of Cincinnati, Cincinnati, Ohio
| | | | | | - Patrick H. Ryan
- Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio; and,Department of Environmental Health and
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