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Lin TJ, Huang CC, Lee MC, Lee YP, Huang WC, Chuang HL, Wang IJ. Effects of Lactobacillus salivarius ssp. salicinius SA-03 Supplementation on Reversing Phthalate-Induced Asthma in Mice. Nutrients 2024; 16:1160. [PMID: 38674852 PMCID: PMC11054125 DOI: 10.3390/nu16081160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 04/02/2024] [Accepted: 04/07/2024] [Indexed: 04/28/2024] Open
Abstract
Probiotics may protect against asthma. We want to investigate whether probiotics can reverse the adverse effects of phthalate exposure on asthma. We selected the female offspring of BALB/c mice, born from pregnant female mice fed with diethylhexyl phthalate (DEHP). They were continuously administrated DEHP and Lactobacillus salivarius ssp. salicinius SA-03 when they were 5 weeks old, and ovalbumin (OVA) for asthma induction started at 6 weeks for 32 days. The mice were divided into four groups (n = 6/group): 1. control group (C), 2. OVA/DEHP group (OD), 3. OVA/DEHP/probiotics low-dose group (ODP-1X), and OVA/DEHP/probiotics high-dose group (ODP-5X). We found that the administration of probiotics significantly reduced the asthma severity of the mice, as well as serum IgE and IL-5. In the ODP-5X group, the proportion of CD4+ cells in the lung was reduced, whereas IL-10 in serum and CD8+ cells in BALF were increased. In histopathology, the ODP group showed reduced infiltration of inflammatory cells, bronchial epithelial cell hyperplasia, and tracheal mucus secretion. These results might indicate that high-dose probiotics may affect anti-inflammatory cytokines and reduce asthma-relative indicators. The above results may provide evidence that high-dose probiotics supplementation might play a modulating role in DEHP causes of allergic asthma in the pediatric animal model.
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Affiliation(s)
- Tien-Jen Lin
- Department of Anaesthesiology, Taipei Medical University-Wan Fang Hospital, Taipei City 116081, Taiwan;
- Division of Neurosurgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei City 110301, Taiwan
| | - Chi-Chang Huang
- Graduate Institute of Sports Science, National Taiwan Sport University, Taoyuan City 333325, Taiwan; (C.-C.H.); (M.-C.L.)
| | - Mon-Chien Lee
- Graduate Institute of Sports Science, National Taiwan Sport University, Taoyuan City 333325, Taiwan; (C.-C.H.); (M.-C.L.)
| | - Yen-Peng Lee
- Graduate Institute of Veterinary Pathobiology, College of Veterinary Medicine, National Chung Hsing University, Taichung City 402202, Taiwan;
| | - Wen-Chung Huang
- Graduate Institute of Health Industry Technology, Chang Gung University of Science and Technology, Taoyuan 333324, Taiwan;
| | - Hsiao-Li Chuang
- National Laboratory Animal Center, National Applied Research Laboratories Research Institute, Taipei 115202, Taiwan;
| | - I-Jen Wang
- Department of Pediatrics, Taipei Hospital, Ministry of Health and Welfare, New Taipei City 242033, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- College of Public Health, China Medical University, Taichung 400439, Taiwan
- National Institutes of Environmental Health Sciences, National Health Research Institutes, Miaoli 350401, Taiwan
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Cho CI, Chen JJ, Chuang KJ, Chuang HC, Wang IJ, Chang TY. Associations of particulate matter, gaseous pollutants, and road traffic noise with the prevalence of asthma in children. Chemosphere 2023; 338:139523. [PMID: 37459931 DOI: 10.1016/j.chemosphere.2023.139523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 07/12/2023] [Accepted: 07/14/2023] [Indexed: 07/25/2023]
Abstract
The purposes of this study were to elucidate the associations between exposure to particulate matter, gaseous pollutants, and road traffic noise and asthma prevalence and to determine the interaction between exposure to multiple pollutants and asthma in children. A total of 3,246 children were recruited from 11 kindergartens in New Taipei City, Taiwan. Land use regression (LUR) was used to establish predictive models for estimating individual exposure levels of particulate matter, gaseous pollutants, and the 24 h A-weighted equivalent sound pressure level (LAeq,24). Multiple logistic regression was performed to test the associations between exposure to these environmental factors and asthma prevalence in children. Multiple-exposure models revealed that an interquartile-range (IQR) increase in PM2.5 (1.17 μg/m3) and PM10 (10.69 μg/m3) caused a 1.34-fold (95% confidence interval [CI] = 1.05-1.70) and 1.17-fold (95% CI = 1.01-1.36) increase in risk of asthma prevalence in children after adjusting for LAeq,24 and NO2. Co-exposure to PM2.5, LAeq,24, and O3, SO2, or CO, as well as co-exposure to PM10, LAeq,24, and CO produced similar findings. Only exposure to one IQR of SO2 (0.15 ppb) was observed a significant association (odds ratio = 1.16, 95% CI = 1.00-1.34) with the asthma prevalence in children after adjusting for PM10 and LAeq,24. Exposure to PM2.5, PM10, and SO2 may be associated with a higher asthma prevalence in children, while other gaseous pollutants and road traffic noise did not demonstrate significant associations. The interaction of exposure to air pollutants and road traffic noise on asthma prevalence in children was not observed in this study.
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Affiliation(s)
- Chih-I Cho
- Department of Occupational Safety and Health, College of Public Health, China Medical University, Taichung, Taiwan
| | - Jing-Jie Chen
- Department of Occupational Safety and Health, College of Public Health, China Medical University, Taichung, Taiwan
| | - Kai-Jen Chuang
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan; Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hsiao-Chi Chuang
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan; Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei, Taiwan; Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei, Taiwan; Cell Physiology and Molecular Image Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - I-Jen Wang
- Department of Occupational Safety and Health, College of Public Health, China Medical University, Taichung, Taiwan; Department of Pediatrics, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan; Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan.
| | - Ta-Yuan Chang
- Department of Occupational Safety and Health, College of Public Health, China Medical University, Taichung, Taiwan.
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Lin PY, Wang JY, Hwang BF, Pawankar R, Wang IJ. Monitoring ambient air pollution and pulmonary function in asthmatic children by mobile applications in COVID-19 pandemic. Int J Hyg Environ Health 2023; 251:114186. [PMID: 37156054 PMCID: PMC10156986 DOI: 10.1016/j.ijheh.2023.114186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 04/12/2023] [Accepted: 05/03/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Several public health measures were implemented during the COVID-19 pandemic. However, little is known about the real-time assessment of environmental exposure on the pulmonary function of asthmatic children. Therefore, we developed a mobile phone application for capturing real-time day-to-day dynamic changes in ambient air pollution during the pandemic. We aim to explore the change in ambient air pollutants between pre-lockdown, lockdowns, and lockdowns and analyze the association between pollutants and PEF mediated by mite sensitization and seasonal change. METHOD A prospective cohort study was conducted among 511 asthmatic children from January 2016 to February 2022. Smartphone-app used to record daily ambient air pollution, particulate matter (PM2.5, PM10) Ozon (O3), nitrogen dioxide (NO2), Carbon Monoxide (CO), sulfur dioxide (SO2), average temperature, and relative humidity, which measured and connected from 77 nearby air monitoring stations by linking to Global Positioning System (GPS)-based software. The outcome of pollutants' effect on peak expiratory flow meter (PEF) and asthma is measured by a smart peak flow meter from each patient or caregiver's phone for real-time assessment. RESULTS The lockdown (May 19th, 2021, to July 27th, 2021) was associated with decreased levels of all ambient air pollutants aside from SO2 after adjusting for 2021. NO2 and SO2 were constantly associated with decreased levels of PEF across lag 0 (same day when the PEF was measured), lag 1 (one day before PEF was measured), and lag 2 (two days prior when the PEF was measured. Concentrations of CO were associated with PEF only in children who were sensitized to mites in lag 0, lag 1, and lag 2 in the stratification analysis for a single air pollutant model. Based on the season, spring has a higher association with the decrease of PEF in all pollutant exposure than other seasons. CONCLUSION Using our developed smartphone apps, we identified that NO2, CO, and PM10 were higher at the pre-and post-COVID-19 lockdowns than during the lockdown. Our smartphone apps may help collect personal air pollution data and lung function, especially for asthmatic patients, and may guide protection against asthma attacks. It provides a new model for individualized care in the COVID era and beyond.
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Affiliation(s)
- Pei-Yu Lin
- Clinical Medicine, China Medical University, 77 Puhe Road, Shenbei New District, Shen Yang, 110122, China
| | - Jiu-Yao Wang
- Center of Allergy, Immunology, and Microbiome, China Medical University Children's Hospital, Taichung, Taiwan
| | - Bing-Fang Hwang
- Department of Occupational Safety and Health, College of Public Health, China Medical University, Taichung, Taiwan
| | - Ruby Pawankar
- Department of Pediatrics, Nippon Medical School, Tokyo, Japan
| | - I-Jen Wang
- Department of Pediatrics, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan; College of Public Health, China Medical University, Taichung, Taiwan.
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Lin EK, Chang WW, Jhong JH, Tsai WH, Chou CH, Wang IJ. Lacticaseibacillus paracasei GM-080 Ameliorates Allergic Airway Inflammation in Children with Allergic Rhinitis: From an Animal Model to a Double-Blind, Randomized, Placebo-Controlled Trial. Cells 2023; 12:cells12050768. [PMID: 36899903 PMCID: PMC10000597 DOI: 10.3390/cells12050768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/16/2023] [Accepted: 02/24/2023] [Indexed: 03/06/2023] Open
Abstract
Background: Probiotics may facilitate the clinical management of allergic diseases. However, their effects on allergic rhinitis (AR) remain unclear. We examined the efficacy and safety of Lacticaseibacillus paracasei GM-080 in a mouse model of airway hyper-responsiveness (AHR) and in children with perennial AR (PAR) by using a double-blind, prospective, randomized, placebo-controlled design. Methods: The production of interferon (IFN)-γ and interleukin (IL)-12 was measured by using an enzyme-linked immunosorbent assay. GM-080 safety was evaluated via the whole-genome sequencing (WGS) of virulence genes. An ovalbumin (OVA)-induced AHR mouse model was constructed, and lung inflammation was evaluated by measuring the infiltrating leukocyte content of bronchoalveolar lavage fluid. A clinical trial was conducted with 122 children with PAR who were randomized to receive different doses of GM-080 or the placebo for 3 months, and their AHR symptom severity scores, total nasal symptom scores (TNSSs), and Investigator Global Assessment Scale scores were examined. Results: Among the tested L. paracasei strains, GM-080 induced the highest IFN-γ and IL-12 levels in mouse splenocytes. WGS analysis revealed the absence of virulence factors or antibiotic-resistance genes in GM-080. The oral administration of GM-080 at 1 × 107 colony forming units (CFU)/mouse/day for 8 weeks alleviated OVA-induced AHR and reduced airway inflammation in mice. In children with PAR, the oral consumption of GM-080 at 2 × 109 CFU/day for 3 months ameliorated sneezing and improved Investigator Global Assessment Scale scores significantly. GM-080 consumption led to a nonsignificant decrease in TNSS and also nonsignificantly reduced IgE but increased INF-γ levels. Conclusion: GM-080 may be used as a nutrient supplement to alleviate airway allergic inflammation.
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Affiliation(s)
- En-Kwang Lin
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- Division of Colorectal Surgery, Department of Surgery, Wanfang Hospital, Taipei Medical University, Taipei 110301, Taiwan
| | - Wen-Wei Chang
- School of Biomedical Sciences, Chung Shan Medical University, Taichung 402306, Taiwan
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 402306, Taiwan
| | - Jhih-Hua Jhong
- Department of Medical Research, Hsinchu MacKay Memorial Hospital, Hsinchu 300044, Taiwan
| | - Wan-Hua Tsai
- Research and Development Department, GenMont Biotech Incorporation, Tainan 741014, Taiwan
| | - Chia-Hsuan Chou
- Research and Development Department, GenMont Biotech Incorporation, Tainan 741014, Taiwan
| | - I-Jen Wang
- Department of Pediatrics, Taipei Hospital, Ministry of Health and Welfare, New Taipei 242033, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- College of Public Health, China Medical University, Taichung 406040, Taiwan
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli 350401, Taiwan
- Correspondence: ; Tel.: +886-2-2276-5566 (ext. 2532); Fax: +886-2-2998-8028
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Yang CY, Zhang FY, Wang IJ. Probiotics' Efficacy in Preventing Asthmatic Allergic Reaction Induced by Air Particles: An Animal Study. Nutrients 2022; 14:nu14245219. [PMID: 36558377 PMCID: PMC9784300 DOI: 10.3390/nu14245219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 12/02/2022] [Accepted: 12/02/2022] [Indexed: 12/13/2022] Open
Abstract
Global air pollution and diesel exhaust particles (DEPs) generated by intratracheal instillation aggravate asthma. In this study, we evaluated the effect of probiotics via tracheal- or oral-route administration on allergies or asthma. We continuously perfused rats daily, using the oral and tracheal routes, with approximately 106-108 CFU probiotics, for 4 weeks. During this period, we used OVA-sensitized rats to build the asthma models. We orally or intratracheally administered Lactobacillus paracasei 33 (LP33) to the rats, which reduced the number of total inflammatory cells, lymphocytes, and eosinophils in the bronchoalveolar-lavage fluid, the IgE concentration, and the cytokine levels of TH2 cells, but we found no significant difference in the cytokine levels of TH1 cells. LP33 can be used to prevent asthmatic allergic reactions induced by aerosol particles. Nevertheless, the dosage form or use of LP33 needs to be adjusted to reduce the irritation of lung tissues, which may produce lesions of the trachea. We observed that DEP dosage can alleviate emphysema, and that LP33 has a substantial effect on improving or slowing allergic asthma.
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Affiliation(s)
- Chi-Yu Yang
- Animal Technology Research Center, Agriculture Technology Research Institute, Miaoli 35053, Taiwan
| | - Fang-Yu Zhang
- Animal Technology Research Center, Agriculture Technology Research Institute, Miaoli 35053, Taiwan
| | - I-Jen Wang
- Department of Pediatrics, Taipei Hospital, Ministry of Health and Welfare, Taipei 11267, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- College of Public Health, China Medical University, Taichung 40402, Taiwan
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli 35053, Taiwan
- Correspondence: ; Tel.: +886-2-2276-5566 (ext. 2532)
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Yao TC, Wang IJ, Sun HL, Ou LS, Yu HH, Wang L, Hung CH. Taiwan guidelines for the diagnosis and management of pediatric atopic dermatitis: Consensus statement of the Taiwan Academy of Pediatric Allergy, Asthma and Immunology. J Microbiol Immunol Infect 2022; 55:561-572. [PMID: 35487815 DOI: 10.1016/j.jmii.2022.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 02/19/2022] [Accepted: 03/24/2022] [Indexed: 06/14/2023]
Abstract
Atopic dermatitis (also known as atopic eczema) is a chronic relapsing inflammatory skin disease commonly seen in children, with increasing prevalence over the past few decades in many countries including Taiwan. The management of pediatric atopic dermatitis can be challenging, particularly as treatment options are expanding with the emergence of novel systemic and topical anti-inflammatory medications in recent years. The Taiwan Academy of Pediatric Allergy, Asthma and Immunology (TAPAAI) has developed the Taiwan guidelines for the diagnosis and management of pediatric atopic dermatitis, which provides a concise overview of its epidemiology, clinical characteristics and diagnosis, mechanisms, treatments, and education. The contents of this guideline integrate the principles of recent national and international guidelines for the diagnosis and management of atopic dermatitis, latest research findings, and expert opinions of experienced pediatric allergy specialists in Taiwan. For practical purposes, this guideline presents simplified and easy-to-use diagnostic criteria and severity grading for pediatric atopic dermatitis. A stepwise treatment algorithm is also proposed to expedite rational, cost-effective, and evidence-based management strategy. This guideline, developed based on current best evidence and real-world experience of pediatric allergy experts in Taiwan, is intended to facilitate practical, up-to-date management of pediatric atopic dermatitis among physicians.
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Affiliation(s)
- Tsung-Chieh Yao
- Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan; School of Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - I-Jen Wang
- Department of Pediatrics, Taipei Hospital, Ministry of Health and Welfare, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; College of Public Health, China Medical University, Taichung, Taiwan
| | - Hai-Lun Sun
- Department of Pediatrics, Chung Shan Medical University Hospital, School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Liang-Shiou Ou
- Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan; School of Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Hsin-Hui Yu
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Lin Wang
- Department of Pediatrics, Pojen Hospital, Kaohsiung, Taiwan
| | - Chih-Hsing Hung
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Pediatrics, Faculty of Pediatrics, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Pediatrics, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan.
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Chang JW, Chen HC, Hu HZ, Chang WT, Huang PC, Wang IJ. Phthalate Exposure and Oxidative/Nitrosative Stress in Childhood Asthma: A Nested Case-Control Study with Propensity Score Matching. Biomedicines 2022; 10:biomedicines10061438. [PMID: 35740459 PMCID: PMC9219890 DOI: 10.3390/biomedicines10061438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 06/03/2022] [Accepted: 06/14/2022] [Indexed: 11/27/2022] Open
Abstract
Whether low-dose phthalate exposure triggers asthma among children, and its underlying mechanisms, remain debatable. Here, we evaluated the individual and mixed effects of low-dose phthalate exposure on children with asthma and five (oxidative/nitrosative stress/lipid peroxidation) mechanistic biomarkers—8-hydroxy-2′-deoxyguanosine (8-OHdG), 8-nitroguanine (8-NO2Gua), 4-hydroxy-2-nonenal-mercapturic acid (HNE-MA), 8-isoprostaglandin F2α (8-isoPF2α), and malondialdehyde (MDA)—using a propensity score-matched case-control study (case vs. control = 41 vs. 111). The median monobenzyl phthalate (MBzP) concentrations in the case group were significantly higher than those in the control group (3.94 vs. 2.52 ng/mL, p = 0.02), indicating that dust could be an important source. After adjustment for confounders, the associations of high monomethyl phthalate (MMP) (75th percentile) with 8-NO2Gua (adjusted odds ratio (aOR): 2.66, 95% confidence interval (CI): 1.03–6.92) and 8-isoPF2α (aOR: 4.04, 95% CI: 1.51–10.8) and the associations of mono-iso-butyl phthalate (MiBP) with 8-isoPF2α (aOR: 2.96, 95% CI: 1.13–7.79) were observed. Weighted quantile sum regression revealed that MBzP contributed more than half of the association (56.8%), followed by MiBP (26.6%) and mono-iso-nonyl phthalate (MiNP) (8.77%). Our findings supported the adjuvant effect of phthalates in enhancing the immune system response.
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Affiliation(s)
- Jung-Wei Chang
- Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan; (J.-W.C.); (H.-Z.H.)
| | - Hsin-Chang Chen
- Department of Chemistry, Tunghai University, Taichung 407224, Taiwan;
| | - Heng-Zhao Hu
- Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan; (J.-W.C.); (H.-Z.H.)
| | - Wan-Ting Chang
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli 35042, Taiwan;
| | - Po-Chin Huang
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli 35042, Taiwan;
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung 406040, Taiwan
- Department of Safety, Health and Environmental Engineering, National United University, Miaoli 36003, Taiwan
- Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Correspondence: (I-J.W.); (P.-C.H.); Tel.: +886-222-765-566 (ext. 2532) (I-J.W.); +886-37-206166 (ext. 38507) (P.-C.H.)
| | - I-Jen Wang
- Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan; (J.-W.C.); (H.-Z.H.)
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli 35042, Taiwan;
- Department of Pediatrics, Taipei Hospital, Ministry of Health and Welfare, Taipei 10341, Taiwan
- College of Public Health, China Medical University, Taichung 406040, Taiwan
- Correspondence: (I-J.W.); (P.-C.H.); Tel.: +886-222-765-566 (ext. 2532) (I-J.W.); +886-37-206166 (ext. 38507) (P.-C.H.)
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8
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Wang YC, Lin SW, Wang IJ, Yang CY, Hong C, Sun JR, Feng PH, Lee MH, Shen CF, Lee YT, Cheng CM. Interleukin-6 Test Strip Combined With a Spectrum-Based Optical Reader for Early Recognition of COVID-19 Patients With Risk of Respiratory Failure. Front Bioeng Biotechnol 2022; 10:796996. [PMID: 35242747 PMCID: PMC8886233 DOI: 10.3389/fbioe.2022.796996] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 01/24/2022] [Indexed: 01/08/2023] Open
Abstract
The COVID-19 pandemic has had a globally devastating impact. This highly contagious virus has significantly overburdened and undermined medical systems. While most infected patients experience only mild symptoms, those who are severely affect require urgent medical interventions and some develop acute respiratory failure and require mechanical ventilation. The broad and potentially deadly impact of infection underscores the critical need for early recognition, especially for those at risk for respiratory failure. Those who are severely impacted and at high risk for respiratory failure have been found to present high levels of serum cytokines, such as interleukin-6 (IL-6). Timely diagnosis and management of those at risk for respiratory failure is crucial. Measurement of IL-6 may provide a means for distinguishing such patients. Currently, most serum IL-6 detection relies on the use of laboratory-based conventional enzyme-linked immunosorbent assays. Although some rapid assays have been developed recently, they need to be conducted by specific technicians in central laboratory settings with advanced and expensive equipment. In this study, we propose an IL-6 test strip combined with a spectrum-based optical reader for early recognition of COVID-19-infected patients at imminent risk of acute respiratory failure requiring mechanical ventilator support. For our analyses, clinical demographic data and sera samples were obtained from three medical centers, and test strip specificity and detection performance were analyzed. This would help healthcare personnel stratify the risk of respiratory failure and provide prompt, and suitable management.
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Affiliation(s)
- Yung-Chih Wang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Sheng-Wen Lin
- Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu, Taiwan
| | - I-Jen Wang
- Department of Pediatrics, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan.,College of Public Health, China Medical University, Taichung, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | | | | | - Jun-Ren Sun
- Institute of Preventive Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Po-Hao Feng
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei, Taiwan
| | - Mei-Hui Lee
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Division of Infectious Diseases, Department of Internal Medicine, Shuang Ho Hospital, Taipei, Taiwan
| | - Ching-Fen Shen
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Tzu Lee
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chao-Min Cheng
- Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu, Taiwan
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Huang RL, Fu YC, Wang YC, Hong C, Yang WC, Wang IJ, Sun JR, Chen Y, Shen CF, Cheng CM. A Lateral Flow Immunoassay Coupled with a Spectrum-Based Reader for SARS-CoV-2 Neutralizing Antibody Detection. Vaccines (Basel) 2022; 10:vaccines10020271. [PMID: 35214731 PMCID: PMC8877288 DOI: 10.3390/vaccines10020271] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 01/25/2022] [Accepted: 02/08/2022] [Indexed: 12/29/2022] Open
Abstract
As of August 2021, there have been over 200 million confirmed case of coronavirus disease 2019 caused by severe acute respiratory syndrome coronavirus and more than 4 million COVID-19-related deaths globally. Although real-time polymerase chain reaction is considered to be the primary method of detection for SARS-CoV-2 infection, the use of serological assays for detecting COVID-19 antibodies has been shown to be effective in aiding with diagnosis, particularly in patients who have recovered from the disease and those in later stages of infection. Since it has a high detection rate and few limitations compared to conventional enzyme-linked immunosorbent assay protocols, we used a lateral flow immunoassay as our diagnostic tool of choice. Since lateral flow immunoassay results interpreted by the naked eye may lead to erroneous diagnoses, we developed an innovative, portable device with the capacity to capture a high-resolution reflectance spectrum as a means of promoting diagnostic accuracy. We combined this spectrum-based device with commercial lateral flow immunoassays to detect the neutralizing antibody in serum samples collected from 30 COVID-19-infected patients (26 mild cases and four severe cases). The results of our approach, lateral flow immunoassays coupled with a spectrum-based reader, demonstrated a 0.989 area under the ROC curve, 100% sensitivity, 95.7% positive predictive value, 87.5% specificity, and 100% negative predictive value. As a result, our approach exhibited great value for neutralizing antibody detection. In addition to the above tests, we also tested plasma samples from 16 AstraZeneca-vaccinated (ChAdOx1nCoV-19) patients and compared our approach and enzyme-linked immunosorbent assay results to see whether our approach could be applied to vaccinated patients. The results showed a high correlation between these two approaches, indicating that the lateral flow immunoassay coupled with a spectrum-based reader is a feasible approach for diagnosing the presence of a neutralizing antibody in both COVID-19-infected and vaccinated patients.
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Affiliation(s)
- Rui-Lin Huang
- Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu 30013, Taiwan; (R.-L.H.); (Y.-C.F.); (Y.C.)
| | - Yi-Chen Fu
- Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu 30013, Taiwan; (R.-L.H.); (Y.-C.F.); (Y.C.)
| | - Yung-Chih Wang
- National Defense Medical Center, Department of Internal Medicine, Division of Internal Medicine and Tropical Medicine, Tri-Service General Hospital, Taipei 11490, Taiwan;
| | | | | | - I-Jen Wang
- Department of Pediatrics, Taipei Hospital, Ministry of Health and Welfare, New Taipei City 24213, Taiwan;
- College of Public Health, China Medical University, Taichung 406040, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Jun-Ren Sun
- National Defense Medical Center, Institute of Preventive Medicine, Taipei 23742, Taiwan;
| | - Yunching Chen
- Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu 30013, Taiwan; (R.-L.H.); (Y.-C.F.); (Y.C.)
| | - Ching-Fen Shen
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan
- Correspondence: (C.-F.S.); (C.-M.C.)
| | - Chao-Min Cheng
- Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu 30013, Taiwan; (R.-L.H.); (Y.-C.F.); (Y.C.)
- Correspondence: (C.-F.S.); (C.-M.C.)
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Lin MH, Chiu SY, Ho WC, Chi KH, Liu TY, Wang IJ. Effect of triclosan on the pathogenesis of allergic diseases among children. J Expo Sci Environ Epidemiol 2022; 32:60-68. [PMID: 33654271 DOI: 10.1038/s41370-021-00304-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 01/19/2021] [Accepted: 01/28/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Few studies have assessed associations between allergic diseases and antibacterial agents in Taiwanese children. OBJECTIVE This study aimed to investigate the association of triclosan (TCS) exposure with allergic diseases among preschoolers, disease-specific IgE titers, and a child's sex. METHODS Pediatric data were obtained from the Childhood Environment and Allergic Diseases Study (CEAS; 2010) cohort, and their urine and blood samples were used to analyze TCS and IgE concentrations (age 3 group). Three years later, clinical data were obtained again from the age 3 group (age 6 group). Correlations of TCS levels at ages 3 and 6 years with IgE levels and allergic diseases were evaluated. RESULTS The TCS levels were higher at age 3 than at age 6 (geometric mean, 1.05 ng/ml vs 0.37 ng/ml). TCS levels were positively correlated with serum IgE levels at ages 3 and 6 years. Asthma and atopic dermatitis were significantly associated with TCS (adjusted OR 1.14, 95% confidence interval [CI] 1.01-1.29; OR 1.22, 95% CI 1.05-1.41). Sex-stratified analysis revealed that TCS levels were positively correlated with IgE levels among boys in the age 6 group and significantly associated with asthma, allergic rhinitis, and atopic dermatitis among boys. SIGNIFICANCE TCS exposure is associated with IgE levels and a potentially high risk of pediatric atopic disorders.
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Affiliation(s)
- Min-Hua Lin
- Department of Nutrition, China Medical University, No.100, Sec.1, Jingmao Road, Beitun Dist, Taichung, 4046040, Taiwan
- Department of Dietetics, Yunlin Christian Hospital, No.375, Shichang S Road, Xiluo Township, Yunlin, 648102, Taiwan
| | - She-Yu Chiu
- Institute of Population Health Sciences, National Health Research Institutes, No.35, Keyan Road, Zhunan Township, Miaoli, 35053, Taiwan
| | - Wen-Chao Ho
- College of Public Health, China Medical University, No.100, Sec.1, Jingmao Road, Beitun Dist, Taichung, 406040, Taiwan
- Department of Nursing & Graduate Institute of Nursing, Asia University, No.500, Lioufeng Road, Wufeng, Taichung, 41354, Taiwan
| | - Kai-Hsien Chi
- School of Medicine, National Yang Ming Chiao Tung University, No.155, Sec.2, Linong Street, Taipei, 11221, Taiwan
| | - Tsung-Yun Liu
- School of Medicine, National Yang Ming Chiao Tung University, No.155, Sec.2, Linong Street, Taipei, 11221, Taiwan
| | - I-Jen Wang
- College of Public Health, China Medical University, No.100, Sec.1, Jingmao Road, Beitun Dist, Taichung, 406040, Taiwan.
- School of Medicine, National Yang Ming Chiao Tung University, No.155, Sec.2, Linong Street, Taipei, 11221, Taiwan.
- Department of Pediatrics, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, 24213, Taiwan.
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, 350401, Taiwan.
- National Taiwan University, Taipei, 10617, Taiwan.
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Chen PY, Ko CH, Wang CJ, Chen CW, Chiu WH, Hong C, Cheng HM, Wang IJ. The early detection of immunoglobulins via optical-based lateral flow immunoassay platform in COVID-19 pandemic. PLoS One 2021; 16:e0254486. [PMID: 34283860 PMCID: PMC8291656 DOI: 10.1371/journal.pone.0254486] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 06/29/2021] [Indexed: 12/24/2022] Open
Abstract
The coronavirus disease (COVID-19) is the global public health challenge currently persisting at a grand scale. A method that meets the rapid quantitative detection of antibodies to assess the body's immune response from natural COVID-19 illness or vaccines' effects is urgently needed. In the present study, an attempt was made to integrate a newly designed spectrometer to the COVID-19 test strip procedure; this augmentation provides the quantitative capacity to a lateral flow immunoassay (LFIA). Optical interpretation of results by quantitative α index, rather than visual qualification, can be done quickly, in 5-10 minutes. The developed product was compared with several other serological IgM/IgG antibody reagents on the market by recruiting 111 participants suspected of having COVID-19 infection from March to May 2020 in a hospital. Taking RT-PCR as the diagnostic gold standard, the quantitative spectral LIFA platform could correctly detect all 12 COVID-19 patients. Concerning RT-PCR negative patients, all three antibody testing methods found positive cases. The optical-based platform exhibited the ability of early detection of immunoglobulins of RT-PCR negative patients. There was an apparent trend that elevation of IgM levels in the acute phase of infection; then IgG levels rose later. It exhibited the risk of a false-negative diagnosis of RT-PCR in COVID-19 testing. The significant detection ability of this new optical-based platform demonstrated clinical potential.
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Affiliation(s)
- Pang-Yen Chen
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei, Taiwan
- Institute of Environmental and Occupational Health Sciences, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan
- Institute of Public Health, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan
| | - Cheng-Hao Ko
- SpectroChip Inc., Hsinchu, Taiwan
- Graduate Institute of Automation and Control, National Taiwan University of Science and Technology, Taipei, Taiwan
| | - C. Jason Wang
- Department of Pediatrics and Medicine, Stanford University School of Medicine, Stanford, California, United States of America
| | - Chien-Wei Chen
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital Chiayi Branch, Chiayi, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Chung Shan Medical University, Taichung, Taiwan
| | - Wei-Huai Chiu
- Graduate Institute of Automation and Control, National Taiwan University of Science and Technology, Taipei, Taiwan
| | | | - Hao-Min Cheng
- Institute of Public Health, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan
- Department of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan
- Center for Evidence-based Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - I-Jen Wang
- Institute of Environmental and Occupational Health Sciences, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan
- Department of Pediatrics, Taipei Hospital, Ministry of Health and Welfare, Taipei, Taiwan
- College of Public Health, China Medical University, Taichung, Taiwan
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan
- National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
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12
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Pu C, Tseng YC, Tang GJ, Lin YH, Lin CH, Wang IJ. Perception and Willingness to Maintain Continuity of Care by Parents of Children with Asthma in Taiwan. Int J Environ Res Public Health 2021; 18:ijerph18073600. [PMID: 33808479 PMCID: PMC8037309 DOI: 10.3390/ijerph18073600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/19/2021] [Accepted: 03/22/2021] [Indexed: 11/16/2022]
Abstract
To investigate caregivers’ attitudes toward continuity of care (COC) and their willingness to maintain continuity for their children with asthma under a national health insurance (NHI) system without strict referral management. We sampled 825 individuals from six pediatric outpatient departments in different parts of Taiwan from 2017 to 2018. We used a contingent valuation with a payment card method. Post-stratification weighting adjustment and coarsened exact matching were utilized. Multiple logistic regression was used to compare the willingness to pay and spend extra time maintaining continuity by parents. More than 80% of caregivers in the asthma group believed having a primary pediatrician was important for children’s health. Only 27.5% and 15.8% of caregivers in the asthma and control groups, respectively, believed changing pediatricians would negatively affect therapeutic outcomes. Regression analysis showed that the predicted willingness to pay for the asthma and non-asthma groups were NT$508 (SD = 196) and NT$402 (SD = 172), respectively, and there was a significant positive dose–response relationship between household income and willingness to pay for maintaining health care provider continuity. Caregivers’ free choices among health care providers may reduce willingness to spend extra effort to maintain high COC. Caregivers should be educated on the importance of COC.
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Affiliation(s)
- Christy Pu
- Institute of Public Health, National Yang Ming Yang Ming Chiao Tung University, Taipei 112304, Taiwan;
| | - Yu-Chen Tseng
- Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan; (Y.-C.T.); (G.-J.T.)
| | - Gau-Jun Tang
- Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan; (Y.-C.T.); (G.-J.T.)
| | - Yen-Hsiung Lin
- Hengchun Tourism Hospital, Ministry of Health and Welfare, Hengchun 946, Taiwan;
| | - Chien-Heng Lin
- Division of Pediatric Pulmonology, Children’s Hospital, China Medical University, Taichung 404, Taiwan;
| | - I-Jen Wang
- Department of Pediatrics, Taipei Hospital, Ministry of Health and Welfare, Taipei 242033, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- College of Public Health, China Medical University, Taichung 40402, Taiwan
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli 350401, Taiwan
- National Taiwan University, Taipei 10617, Taiwan
- Correspondence: ; Tel.: +886-2-2276-5566 (ext. 2532)
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Wang IJ, Chen YC, Su C, Tsai MH, Shen WT, Bai CH, Yu KP. Effectiveness of the Nanosilver/TiO 2-Chitosan Antiviral Filter on the Removal of Viral Aerosols. J Aerosol Med Pulm Drug Deliv 2021; 34:293-302. [PMID: 33761275 DOI: 10.1089/jamp.2020.1607] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background: The precaution of airborne transmission of viruses, such as influenza, SARS, MERS, and COVID-19, is essential for reducing infection. In this study, we applied a zero-valent nanosilver/titania-chitosan (nano-Ag0/TiO2-CS) filter bed, whose broad-spectrum antimicrobial efficacy has been proven previously, for the removal of viral aerosols to minimize the risk of airborne transmission. Methods: The photochemical deposition method was used to synthesize the nano-Ag0/TiO2-CS antiviral material. The surface morphology, elemental composition, and microstructure of the nano-Ag0/TiO2-CS were analyzed by a scanning electron microscopy/energy dispersive X-ray spectroscopy and a transmission electron microscopy, respectively. The MS2 bacteriophages were used as surrogate viral aerosols. The antiviral efficacy of nano-Ag0/TiO2-CS was evaluated by the MS2 plaque reduction assay (PRA) and filtration experiments. In the filtration experiments, the MS2 aerosols passed through the nano-Ag0/TiO2-CS filter, and the MS2 aerosol removal efficiency was evaluated by an optical particle counter and culture method. Results and Conclusions: In the MS2 PRA, 3 g of nano-Ag0/TiO2-CS inactivated 97% of MS2 bacteriophages in 20 mL liquid culture (2 ± 0.5 × 1016 PFU/mL) within 2 hours. The removal efficiency of nano-Ag0/TiO2-CS filter (thickness: 6 cm) for MS2 aerosols reached up to 93%. Over 95% of MS2 bacteriophages on the surface of the nano-Ag0/TiO2-CS filter were inactivated within 20 minutes. The Wells-Riley model predicted that when the nano-Ag0/TiO2-CS filter was used in the ventilation system, airborne infection probability would reduce from 99% to 34.6%. The nano-Ag0/TiO2-CS filter could remain at 50% of its original antiviral efficiency after continuous operation for 1 week, indicating its feasibility for the control of the airborne transmission.
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Affiliation(s)
- I-Jen Wang
- Institute of Environmental and Occupational Health Sciences, National Yang Ming Chiao Tung University, Taipei City, Taiwan (ROC).,Department of Pediatrics, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan (ROC).,School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan.,College of Public Health, China Medical University, Taichung 40402, Taiwan.,National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Yen-Chi Chen
- Institute of Environmental and Occupational Health Sciences, National Yang Ming Chiao Tung University, Taipei City, Taiwan (ROC)
| | - Chien Su
- Institute of Environmental and Occupational Health Sciences, National Yang Ming Chiao Tung University, Taipei City, Taiwan (ROC)
| | - Ming-Hsuan Tsai
- Institute of Environmental and Occupational Health Sciences, National Yang Ming Chiao Tung University, Taipei City, Taiwan (ROC)
| | - Wan-Tien Shen
- Institute of Environmental and Occupational Health Sciences, National Yang Ming Chiao Tung University, Taipei City, Taiwan (ROC)
| | - Chun-Hsuan Bai
- Institute of Environmental and Occupational Health Sciences, National Yang Ming Chiao Tung University, Taipei City, Taiwan (ROC)
| | - Kuo-Pin Yu
- Institute of Environmental and Occupational Health Sciences, National Yang Ming Chiao Tung University, Taipei City, Taiwan (ROC)
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Chen YC, Wang IJ, Cheng CC, Wu YC, Bai CH, Yu KP. Effect of selected sampling media, flow rate, and time on the sampling efficiency of a liquid impinger packed with glass beads for the collection of airborne viruses. Aerobiologia (Bologna) 2021; 37:243-252. [PMID: 33462522 PMCID: PMC7805564 DOI: 10.1007/s10453-020-09683-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 12/11/2020] [Indexed: 06/12/2023]
Abstract
The liquid impingers can be used for sampling of viral aerosols, such as COVID-19 virus, influenza, and measles. However, the lowest cutoff diameter of commercially available liquid impingers was about 0.3 μm, and the physical collection efficiency for nano-bioaerosol is only about 10-20%. Here, we enhanced the impinger's collection efficiency and recovery of viable viral aerosols by using packed glass beads and selected sampling media (1% peptone and lysogeny broth, LB). Single-stranded RNA (ssRNA) MS2 bacteriophage with uranine (as a physical tracer) was used as model viral aerosols. The effects of different sampling flow rates (4, 6, and 12.5 L per minute) and different sampling time (10, 20, and 30 min) on the collection efficiency and recovery of MS2 aerosols were also tested. Collection efficiency and recovery of viable viral aerosols were analyzed as a function of sampling media, flow rate, and sampling time and packed glass beads by using a general linear model. Although the packed glass beads considerably enhanced the collection efficiency of the liquid impinger for MS2 aerosols, the recovery of viable MS2 becomes lower due to the higher pressure drop across the impinger. Using peptone or LB as sampling media, reducing sampling flow rate, and decreasing sampling time was proven to improve the recovery of viable MS2. Conclusively, this study provides some practical methods to improve the collection efficiency of liquid impinger for viral aerosols and preserve their viability.
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Affiliation(s)
- Yen-Chi Chen
- Institute of Environmental and Occupational Health Sciences, National Yang-Ming University, No. 155, Sec. 2, Li-Nong Street, Taipei City, 11221 Taiwan (ROC)
| | - I-Jen Wang
- Institute of Environmental and Occupational Health Sciences, National Yang-Ming University, No. 155, Sec. 2, Li-Nong Street, Taipei City, 11221 Taiwan (ROC)
- Department of Pediatrics, Taipei Hospital, Ministry of Health and Welfare, No.127, Su-Yuan Road, New Taipei City, 24213 Taiwan (ROC)
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- College of Public Health, China Medical University, Taichung, Taiwan
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan
- National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
| | - Chih-Ching Cheng
- Institute of Environmental and Occupational Health Sciences, National Yang-Ming University, No. 155, Sec. 2, Li-Nong Street, Taipei City, 11221 Taiwan (ROC)
| | - Yu-Chiao Wu
- Institute of Environmental and Occupational Health Sciences, National Yang-Ming University, No. 155, Sec. 2, Li-Nong Street, Taipei City, 11221 Taiwan (ROC)
| | - Chun-Hsuan Bai
- Institute of Environmental and Occupational Health Sciences, National Yang-Ming University, No. 155, Sec. 2, Li-Nong Street, Taipei City, 11221 Taiwan (ROC)
| | - Kuo-Pin Yu
- Institute of Environmental and Occupational Health Sciences, National Yang-Ming University, No. 155, Sec. 2, Li-Nong Street, Taipei City, 11221 Taiwan (ROC)
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15
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Huang CF, Chie WC, Wang IJ. Effect of environmental exposures on allergen sensitization and the development of childhood allergic diseases: A large-scale population-based study. World Allergy Organ J 2021; 14:100495. [PMID: 33510830 PMCID: PMC7804989 DOI: 10.1016/j.waojou.2020.100495] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 11/18/2020] [Accepted: 11/22/2020] [Indexed: 11/18/2022] Open
Abstract
Background Changing environmental factors are likely responsible for the rising prevalence of allergic diseases in children. However, whether environmental exposures induce allergen sensitizations, and which allergen sensitization is related to the development of allergic diseases, is not clear. The study is aimed to investigate the association between environmental exposure, allergen sensitization, and the development of allergic diseases for further preventive intervention. Methods We conducted the Taiwan Childhood Environment and Allergic diseases Study (TCEAS) in kindergarten children in Taiwan. Skin prick tests for 6 allergens were performed. Information on the development of allergic diseases and environmental exposure was collected using standardized questionnaires. Multiple logistic regressions were used to estimate the association between environmental factors, allergen sensitization, and the development of allergic diseases. Results A total of 3192 children were recruited. 485 (15.2%) children had atopic dermatitis (AD), 1126 (35.3%) had allergic rhinitis (AR), and 552 (17.3%) had asthma. Children with environmental tobacco smoke exposure and fungi on the house wall had a higher risk of asthma, with ORs (95% CIs) of 1.25 (1.03–1.52) and 1.22 (1.01–1.47), respectively. The mite sensitization rate was found to be the highest. Mite sensitization was associated with significant increases in the risks of AD, AR, and asthma, with ORs (95% CIs) of 2.15 (1.53–3.03), 1.94 (1.46–2.58), and 2.31 (1.63–3.29), respectively. Cockroach sensitization also increased the risk of asthma, with an OR (95% CI) of 2.38 (1.01–5.61). Mite sensitization was associated with carpet in the home and fungi on the house wall, and milk sensitization was associated with breastfeeding duration. Conclusion Environmental exposures play a role in the development of allergic diseases. Allergen sensitizations were associated with certain environmental exposures. Early environmental interventions are urgently needed to prevent the development of childhood allergic diseases.
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Affiliation(s)
- Chian-Feng Huang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei 10055, Taiwan.,Miaoli General Hospital, Ministry of Health and Welfare, Miaoli 36054, Taiwan
| | - Wei-Chu Chie
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei 10055, Taiwan
| | - I-Jen Wang
- Department of Pediatrics, Taipei Hospital, Ministry of Health and Welfare, New Taipei City 24213, Taiwan.,School of Medicine, National Yang-Ming University, Taipei 112, Taiwan.,College of Public Health, China Medical University, Taichung 40402, Taiwan.,National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli 350, Taiwan.,National Taiwan University Hospital, National Taiwan University,Taipei 100, Taiwan
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Chen PY, Chen CW, Su YJ, Chang WH, Kao WF, Yang CC, Wang IJ. Associations between Levels of Urinary Oxidative Stress of 8-OHdG and Risk of Atopic Diseases in Children. Int J Environ Res Public Health 2020; 17:ijerph17218207. [PMID: 33172083 PMCID: PMC7664398 DOI: 10.3390/ijerph17218207] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/28/2020] [Accepted: 10/30/2020] [Indexed: 02/07/2023]
Abstract
The oxidative stress biomarker of urinary 8-hydroxy-2'-deoxyguanosine (8-OHdG) was reported to be changed in patients with allergic diseases. Measurement of urinary oxidative products is noninvasive. However, correlations between the severity levels of atopic diseases and oxidative stress remain unclear. This study aimed to investigate the association among urinary 8-OHdG, atopic dermatitis (AD), and the phenotypes of atopic diseases in children. In a nested case-control study, participants of kindergarten children were enrolled from the Childhood Environment and Allergic Diseases Study (CEAS). Urinary analyses and urinary 8-OHdG were performed on samples from 200 children with AD as cases and 200 age- and sex-matched controls. Our study presents the following main findings: (1) The urinary 8-OHdG levels were significantly higher in cases than controls. Higher urinary 8-OHdG levels were associated with the risk of AD in a dose-response-manner; (2) Children's AD history was associated with higher risks of asthma, allergic rhinitis, and night pruritus; (3) For children with AD, urinary 8-OHdG levels of >75th percentile were associated with higher risk of asthma, compared with the reference group of 0-25th percentiles. In summary, this study provides better understanding of the underlying mechanisms of AD and urinary 8-OHdG by analyzing a large-scale sample survey in Taiwan.
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Affiliation(s)
- Pang-Yen Chen
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei 10449, Taiwan; (P.-Y.C.); (Y.-J.S.); (W.-H.C.)
- Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang-Ming University, Taipei 112, Taiwan;
- Institute of Public Health, School of Medicine, National Yang-Ming University, Taipei 112, Taiwan
- Department of Nursing, Yuanpei University of Medical Technology, Hsinchu 300, Taiwan
| | - Chien-Wei Chen
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital Chiayi Branch, Chiayi 613, Taiwan;
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Yu-Jang Su
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei 10449, Taiwan; (P.-Y.C.); (Y.-J.S.); (W.-H.C.)
- Department of Medicine, Mackay Medical College, New Taipei City 252, Taiwan
- Mackay Junior College of Medicine, Nursing, and Management, Taipei 11260, Taiwan
| | - Wen-Han Chang
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei 10449, Taiwan; (P.-Y.C.); (Y.-J.S.); (W.-H.C.)
- Department of Medicine, Mackay Medical College, New Taipei City 252, Taiwan
- Mackay Junior College of Medicine, Nursing, and Management, Taipei 11260, Taiwan
- Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei 110, Taiwan
- Institute of Mechatronic Engineering, National Taipei University of Technology, Taipei 106, Taiwan
- Department of Emergency Medicine, School of Medicine, Taipei Medical University, Taipei 110, Taiwan;
| | - Wei-Fong Kao
- Department of Emergency Medicine, School of Medicine, Taipei Medical University, Taipei 110, Taiwan;
- Department of Emergency and Critical Care Medicine, Taipei Medical University Hospital, Taipei 110301, Taiwan
| | - Chen-Chang Yang
- Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang-Ming University, Taipei 112, Taiwan;
- Department of Internal Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan
| | - I-Jen Wang
- Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang-Ming University, Taipei 112, Taiwan;
- Department of Pediatrics, Taipei Hospital, Ministry of Health and Welfare, Taipei 242, Taiwan
- College of Public Health, China Medical University, Taichung 404, Taiwan
- National Taiwan University Hospital, National Taiwan University, Taipei 100, Taiwan
- Correspondence: ; Tel.: +886-2-2276-5566 (ext. 2532); Fax: +886-2-2998-8028
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Huang PC, Chang WH, Wu MT, Chen ML, Wang IJ, Shih SF, Hsiung CA, Liao KW. Characterization of phthalate exposure in relation to serum thyroid and growth hormones, and estimated daily intake levels in children exposed to phthalate-tainted products: A longitudinal cohort study. Environ Pollut 2020; 264:114648. [PMID: 32380394 DOI: 10.1016/j.envpol.2020.114648] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 04/20/2020] [Accepted: 04/20/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND No information is available on the long-term effects on thyroid and growth hormones of children exposed to phthalate-tainted products, despite the infamous 2011 Taiwan phthalate episode. We investigated estimated daily intake levels and their long-term effects on serum thyroid and growth hormone levels in children. METHODS We recruited 166 children (2-18 years old) in three visits who provided specimens and filled out a questionnaire from the Risk Assessment of Phthalate Incident in Taiwan (RAPIT) project study from 2012 to 2016. Morning spot urine samples were analyzed for nine phthalate metabolites. Serum thyroid (triiodothyronine [T3], thyroxine [T4], and free T4) and growth hormone (insulin-like growth factor-1 [IGF-1] and its binding protein 3 [IGF-BP3]) levels were measured. A generalized estimating equation model was used to evaluate associations between phthalate metabolite levels and children's thyroid and growth hormone levels. RESULTS The median metabolite levels of monomethyl phthalate (MMP), Σdibutyl phthalate (DBP), and Σdi-(2-ethylhexyl) phthalate (DEHP) at visits 1, 2, and 3 were 6.59, 10.5, and 21.0 ng/mL, 0.15, 0.24, and 0.20 nmol/mL, and 0.15, 0.17, and 0.12 nmol/mL, respectively. After adjusting for potential confounding factors, we found that levels of urinary MMP were negatively associated with T3 (β = -0.013, p = 0.047), T4 (β = -0.016, p = 0.006), free T4 (β = -0.012, p = 0.002), and IGF-BP3 (β = -0.025, p = 0.003). Urinary mono-ethyl phthalate (MEP) was negatively associated with IGF-1 (β = -0.027, p = 0.029) and IGF-BP3 (β = -0.016, p = 0.018). In addition, serum free T4 was positively associated with urinary mono-2-ethyl-5-hydroxy hexyl phthalate (MEHHP) (β = 0.016, p = 0.043), mono-2-ethyl-5-oxohexyl phthalate (MEOHP) (β = 0.015, p = 0.024), and ΣDEHPm (β = 0.019, p = 0.020). CONCLUSIONS Our findings support the hypothesis that specific phthalates disturb the hemostasis of thyroid and growth hormone levels in children exposed to phthalate-tainted products.
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Affiliation(s)
- Po-Chin Huang
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan; Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan; Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Safety, Health and Environmental Engineering, National United University, Miaoli, Taiwan
| | - Wei-Hsiang Chang
- Research Center of Environmental Trace Toxic Substances, National Cheng Kung University, Tainan, Taiwan; Department of Food Safety & Hygiene and Risk Management, National Cheng Kung University, Tainan, Taiwan
| | - Ming-Tsang Wu
- Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Mei-Lien Chen
- Institute of Environmental and Occupational Health Sciences, College of Medicine, National Yang Ming University, Taipei, Taiwan
| | - I-Jen Wang
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan; Institute of Environmental and Occupational Health Sciences, College of Medicine, National Yang Ming University, Taipei, Taiwan; Department of Pediatrics, Taipei Hospital, Ministry of Health and Welfare, Taipei, Taiwan; College of Public Health, China Medical University, Taichung, Taiwan
| | - Shu-Fang Shih
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, United States
| | - Chao A Hsiung
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan.
| | - Kai-Wei Liao
- School of Food Safety, College of Nutrition, Taipei Medical University, Taipei, Taiwan.
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Pawankar R, Wang JY, Wang IJ, Thien F, Chang YS, Latiff AHA, Fujisawa T, Zhang L, Thong BYH, Chatchatee P, Leung TF, Kamchaisatian W, Rengganis I, Yoon HJ, Munkhbayarlakh S, Recto MT, Neo AGE, Le Pham D, Lan LTT, Davies JM, Oh JW. Asia Pacific Association of Allergy Asthma and Clinical Immunology White Paper 2020 on climate change, air pollution, and biodiversity in Asia-Pacific and impact on allergic diseases. Asia Pac Allergy 2020; 10:e11. [PMID: 32099833 PMCID: PMC7016319 DOI: 10.5415/apallergy.2020.10.e11] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 02/05/2020] [Indexed: 12/17/2022] Open
Abstract
Air pollution, climate change, and reduced biodiversity are major threats to human health with detrimental effects on a variety of chronic noncommunicable diseases in particular respiratory and cardiovascular diseases. The extent of air pollution both outdoor and indoor air pollution and climate change including global warming is increasing-to alarming proportions particularly in the developing world especially rapidly industrializing countries worldwide. In recent years, Asia has experienced rapid economic growth and a deteriorating environment and increase in allergic diseases to epidemic proportions. Air pollutant levels in many Asian countries especially in China and India are substantially higher than are those in developed countries. Moreover, industrial, traffic-related, and household biomass combustion, indoor pollutants from chemicals and tobacco are major sources of air pollutants, with increasing burden on respiratory allergies. Here we highlight the major components of outdoor and indoor air pollutants and their impacts on respiratory allergies associated with asthma and allergic rhinitis in the Asia-Pacific region. With Asia-Pacific comprising more than half of the world's population there is an urgent need to increase public awareness, highlight targets for interventions, public advocacy and a call to action to policy makers to implement policy changes towards reducing air pollution with interventions at a population-based level. 1. Epidemiological studies show that indoor and outdoor pollutions affect respiratory health, including an increased prevalence of asthma and allergic diseases. Global warming will increase the effects of outdoor air pollution on health. 2. The Asia-Pacific is the most populated region in the world, with a huge burden of both outdoor and indoor pollutants, including PM2.5, PM10, SPM, CO, O3, NO2, SO2, NO and household pollutants including biomass and tobacco. 3. The risk factors for the epidemic rise of allergic diseases in the Asia-Pacific are due to the increasing urbanization, environmental factors of air pollution and climate changes in recent decades than in the other parts of the world. 4. In light of the different environmental exposures in different countries of the Asia-Pacific region, strategies to combat allergic disease in this region should be focused on active government policies to fight air pollution based on the local conditions. 5. Substantial efforts need to be implemented with a concerted strategy at legislative, administrative, and community levels to improve air quality. 6. Abatement of the main risk factors for respiratory diseases, in particular, environmental tobacco smoke, indoor biomass fuels, and outdoor air pollution, as well as better control of asthma and rhinitis will achieve huge health benefits.
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Affiliation(s)
- Ruby Pawankar
- Department of Pediatrics, Nippon Medical School, Tokyo, Japan
| | - Jiu-Yao Wang
- Division of Allergy and Clinical Immunology, Department of Pediatrics, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - I-Jen Wang
- Department of Pediatrics, Taipei Hospital, Ministry of Health and Welfare; School of Medicine, National Yang-Ming University, Taipei; College of Public Health, China Medical University, Taichung, Taiwan
| | - Francis Thien
- Eastern Health, Monash University, Melbourne, Australia
| | - Yoon-Seok Chang
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | | | - Takao Fujisawa
- Institute for Clinical Research, Mie National Hospital, Tsu, Japan
| | - Luo Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital, Medical University, Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
| | - Bernard Yu-Hor Thong
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore
| | - Pantipa Chatchatee
- Pediatric Allergy & Clinical Immunology Research Unit, Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Ting Fan Leung
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Wasu Kamchaisatian
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Iris Rengganis
- Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Cipto Mangunkusumo National Hospital, Jakarta, Indonesia
| | - Ho Joo Yoon
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Sonomjamts Munkhbayarlakh
- Department of Pulmonology and Allergology, School of Medicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Marysia T Recto
- Division of Adult and Pediatric Allergy and Immunology, University of the Philippines College of Medicine, Philippine General Hospital, Manila, the Philippines
| | - Anne Goh Eng Neo
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore
| | - Duy Le Pham
- Medicine Faculty, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Le Thi Tuyet Lan
- Hochiminh city Asthma, Allergy and Clinical Immunology Society, UMC, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Janet Mary Davies
- School of Biomedical Sciences, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD; AustraliaOffice of Research, Metro North Hospital and Health Service, Herston, QLD, Australia
| | - Jae Won Oh
- Department of Pediatrics, Hanyang University Guri Hospital, Hanyang University College of Medicine, Seoul, Korea
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19
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Wang IJ. Plasma microRNA as a noninvasive biomarker for asthma. J Allergy Clin Immunol 2020. [DOI: 10.1016/j.jaci.2019.12.574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Yang CF, Karmaus WJJ, Yang CC, Chen ML, Wang IJ. Bisphenol a Exposure, DNA Methylation, and Asthma in Children. Int J Environ Res Public Health 2020; 17:ijerph17010298. [PMID: 31906378 PMCID: PMC6981376 DOI: 10.3390/ijerph17010298] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 12/16/2019] [Accepted: 12/19/2019] [Indexed: 12/29/2022]
Abstract
Epidemiological studies have reported the relationship between bisphenol A (BPA) exposure and increased prevalence of asthma, but the mechanisms remain unclear. Here, we investigated whether BPA exposure and DNA methylation related to asthma in children. We collected urinary and blood samples from 228 children (Childhood Environment and Allergic Diseases Study cohort) aged 3 years. Thirty-three candidate genes potentially interacting with BPA exposure were selected from a toxicogenomics database. DNA methylation was measured in 22 blood samples with top-high and bottom-low exposures of BPA. Candidate genes with differential methylation levels were validated by qPCR and promoter associated CpG islands have been investigated. Correlations between the methylation percentage and BPA exposure and asthma were analyzed. According to our findings, MAPK1 showed differential methylation and was further investigated in 228 children. Adjusting for confounders, urinary BPA glucuronide (BPAG) level inversely correlated with MAPK1 promoter methylation (β = -0.539, p = 0.010). For the logistic regression analysis, MAPK1 methylation status was dichotomized into higher methylated and lower methylated groups with cut off continuous variable of median of promoter methylation percentage (50%) while performing the analysis. MAPK1 methylation was lower in children with asthma than in children without asthma (mean ± SD; 69.82 ± 5.88% vs. 79.82 ± 5.56%) (p = 0.001). Mediation analysis suggested that MAPK1 methylation acts as a mediation variable between BPA exposure and asthma. The mechanism of BPA exposure on childhood asthma might, therefore, be through the alteration of MAPK1 methylation. The mechanism of BPA exposure on childhood asthma might, therefore, be through the alteration of MAPK1 methylation.
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Affiliation(s)
- Chia-Feng Yang
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei 112, Taiwan;
- Institute of Environmental and Occupational Health Sciences, National Yang-Ming University, Taipei 112, Taiwan; (C.-C.Y.); (M.-L.C.)
| | - Wilfried J. J. Karmaus
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN 38152, USA;
| | - Chen-Chang Yang
- Institute of Environmental and Occupational Health Sciences, National Yang-Ming University, Taipei 112, Taiwan; (C.-C.Y.); (M.-L.C.)
| | - Mei-Lien Chen
- Institute of Environmental and Occupational Health Sciences, National Yang-Ming University, Taipei 112, Taiwan; (C.-C.Y.); (M.-L.C.)
| | - I-Jen Wang
- Department of Pediatrics, Taipei Hospital, Ministry of Health and Welfare, Taipei 242, Taiwan
- School of Medicine, National Yang-Ming University, Taipei 112, Taiwan
- College of Public Health, China Medical University, Taichung 400-439, Taiwan
- National Institutes of Environmental Health Sciences, National Health Research Institutes, Miaoli 35053,Taiwan
- Correspondence: ; Tel.: +886-2-2276-5566 (ext. 2532); Fax: +886-2-2998-8028
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21
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Lin TJ, Yin SY, Hsiao PW, Yang NS, Wang IJ. Transcriptomic analysis reveals a controlling mechanism for NLRP3 and IL-17A in dextran sulfate sodium (DSS)-induced colitis. Sci Rep 2018; 8:14927. [PMID: 30297787 PMCID: PMC6175949 DOI: 10.1038/s41598-018-33204-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 09/25/2018] [Indexed: 12/27/2022] Open
Abstract
The incidence of inflammatory bowel disease (IBD) has markedly increased. Our research findings during the past showed that medicinal plant extracts and the derived phytochemical components from Wedelia chinensis (WC) can have strong anti-colitis activities. Here, we further identified the key component phytochemicals from active fractions of different WC preparations (WCHA) that are responsible for the protective effect of WCHA in colitis mice. Of the 3 major compounds (wedelolactone, luteolin and apigenin) in this fraction, luteolin had the highest anti-inflammatory effect in vivo. Using a next-generation sequencing (NGS) (e.g., RNA-seq) system to analyze the transcriptome of colorectal cells/tissues in mice with dextran sulfate sodium (DSS)-induced colitis with/without phytochemicals treatment, luteolin was found to strongly suppress the DSS-activated IL-17 pathway in colon tissue. In addition, co-treatment with wedelolactone and luteolin had a synergistic effect on the expression level of some IL-17 pathway-related genes. Interestingly, our NGS analyses also indicated that luteolin and wedelolactone can specifically suppress the expression of NLRP3 and NLRP1. Using a 3-dimensional cell co-culture system, we further demonstrated that luteolin could efficiently suppress NLRP3 expression via disruption of IL-17A signaling in inflamed colon tissue, which also indicates the pharmacological potential of luteolin and wedelolactone in treating IBD.
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Affiliation(s)
- Tien-Jen Lin
- Department of Neurosurgery, Wan Fang Hospital, Taipei Medical University, Taipei, ROC, Taiwan.,Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, ROC, Taiwan.,Graduate Institute of Sports Science, College of Exercise and Health Sciences, National Taiwan Sport University, Taoyuan City, ROC, Taiwan
| | - Shu-Yi Yin
- Agricultural Biotechnology Research Center, Academia Sinica, Taipei, 115-29, ROC, Taiwan
| | - Pei-Wen Hsiao
- Agricultural Biotechnology Research Center, Academia Sinica, Taipei, 115-29, ROC, Taiwan
| | - Ning-Sun Yang
- Agricultural Biotechnology Research Center, Academia Sinica, Taipei, 115-29, ROC, Taiwan
| | - I-Jen Wang
- Department of Pediatrics, Taipei Hospital, Ministry of Health and Welfare, Taipei, Taiwan. .,School of Medicine, National Yang-Ming University, Taipei, Taiwan. .,College of Public Health, China Medical University, Taichung, Taiwan.
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22
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Lin TJ, Guo YL, Hsu JC, Wang IJ. 2-Naphthol Levels and Allergic Disorders in Children. Int J Environ Res Public Health 2018; 15:ijerph15071449. [PMID: 29987264 PMCID: PMC6069002 DOI: 10.3390/ijerph15071449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 07/03/2018] [Accepted: 07/04/2018] [Indexed: 11/25/2022]
Abstract
Background: The measurement of polycyclic aromatic hydrocarbons (PAH) in ambient air is quite difficult to perform. Using urine biomarkers of PAH such as 2-naphthol is one approach to this problem. This study explored the association between urine 2-naphthol levels and allergic diseases. The associations between 2-naphthol levels and oxidative stress biomarkers for the possible disease pathogenesis were also investigated. Method: A total of 453 kindergarten children from the (Childhood Environment and Allergic Diseases Study) CEAS cohort with urine samples were recruited. Urine 2-naphthol levels were measured by high-performance liquid chromatography mass spectrometry (HPLC-MS/MS) and markers of oxidative stress (8OHdG) were measured by enzyme-linked immunosorbent assays (ELISA). Information on environmental risk factors and allergic diseases were also collected. The association between 2-naphthol levels, 8OHdG levels, IgE, and allergic diseases were evaluated by multivariate linear regression and logistic regression. Results: Levels of 2-naphthol were positively correlated with 8OHdG levels. A one ln-unit increase in the 2-naphthol level was positively associated to 8OHdG levels (per ln-unit: β = 100.61, p < 0.001). When dividing 2-naphthol levels into quartiles, asthma was significantly associated with 2-naphthol levels at a concentration of >1.60 ng/mL (adjusted OR: 3.14, 95% CI 1.34–7.35). Conclusion: Urine 2-naphthol levels are associated with markers of oxidative stress and the risk of allergic diseases in young children.
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Affiliation(s)
- Tien-Jen Lin
- Department of Neurosurgery, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan.
- Graduate Institute of Sports Science, College of Exercise and Health Sciences, National Taiwan Sport University, Taoyuan 333, Taiwan.
- Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei 110, Taiwan.
| | - Yueliang Leon Guo
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli 350, Taiwan.
- Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei 100, Taiwan.
| | - Jiin-Chyr Hsu
- Department of Internal Medicine, Taipei Hospital, Ministry of Health and Welfare, No. 127, Su-Yuan Road, Hsin-Chuang Dist., Taipei 242, Taiwan.
- Yuanpei University of Medical Technology, Hsinchu 300, Taiwan.
| | - I-Jen Wang
- Department of Pediatrics, Taipei Hospital, Ministry of Health and Welfare, No. 127, Su-Yuan Road, Hsin-Chuang Dist., Taipei 242, Taiwan.
- College of Public Health, China Medical University, Taichung 404, Taiwan.
- School of Medicine, National Yang-Ming University, Taipei 112, Taiwan.
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23
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Yang CF, Yang CC, Wang IJ. Association between allergic diseases, allergic sensitization and attention-deficit/hyperactivity disorder in children: A large-scale, population-based study. J Chin Med Assoc 2018; 81:277-283. [PMID: 29239851 DOI: 10.1016/j.jcma.2017.07.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 07/25/2017] [Accepted: 07/28/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Increasing prevalence of allergic diseases has been matched by parallel trends in attention-deficit/hyperactivity disorder (ADHD). However, previous studies concerning the association between ADHD and allergic diseases have been inconsistent. Moreover, it is not clear whether this association is modified by allergic sensitization status. Therefore, we evaluated the association between allergic diseases, allergic sensitization, and ADHD in children. METHODS We conducted a large-scale cross-sectional, population-based survey to investigate the relationship between allergic diseases, allergic sensitization, and ADHD. Children aged between 3 and 6 years were selected from kindergartens, and received skin prick tests (SPTs) for mite, cockroach, dog, milk, egg, and crab allergens. Information about allergic diseases, environmental exposures, and physician-diagnosed ADHD were collected. Multiple logistic regressions were performed to estimate the association between allergic diseases and ADHD, with adjustments made for potential confounders. RESULT A total of 2772 children were found to be eligible for analysis; of these 411 (14.8%) had atopic dermatitis (AD), 954 (34.4%) had allergic rhinitis (AR), 451 (16.3%) had asthma, and 28 (1.01%) had ADHD. Children who had AD and asthma with allergic sensitization were found to be at increased risk for ADHD, with adjusted ORs (95% CI) of 4.50 (1.28-15.86) and 3.65 (1.07-12.49). Children who had AR, allergic conjunctivitis, or food allergies were also related to ADHD, though failed to reach statistical significance. CONCLUSION Our results suggest that AD and asthma with allergic sensitization are associated with ADHD in children. As allergic sensitization is an increased factor of developing allergic diseases, early control of environmental and allergens exposure could help to modify the burden of ADHD.
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Affiliation(s)
- Chia-Feng Yang
- Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chen-Chang Yang
- Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Division of Clinical Toxicology & Occupational Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - I-Jen Wang
- Department of Pediatrics, Taipei Hospital, Ministry of Health and Welfare, Taipei, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Health Risk Management, China Medical University, Taichung, Taiwan, ROC.
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Abstract
BACKGROUND It is unclear whether inhaled corticosteroids (ICS) have chemopreventive effect on lung cancer (LC) development in humans. We investigated the association between the ICS use in asthma patients and the risk of LC. METHODS We conducted a nationwide, population-based retrospective cohort study using the National Health Insurance database. We identified 4210 asthmatics who were initially free of LC and regularly used ICS between 2001 and 2005 and 37,228 asthmatics without regular ICS use. Patients with documented history of tobacco use were excluded from the analyses. Asthmatics were categorized into a mild and a severe asthma group. Each patient was tracked until the end of 2010 to identify incident cases of LC. Cox proportional hazards models were used to evaluate the effect of ICS on the risk of LC, further stratifying by asthma severity and comorbidities. RESULTS During follow-up, we identified 747 incident cases of LC diagnosed in the asthma cohort. Compared with severe asthmatics without regular ICS use, the risk of LC for those with mild asthma with regular ICS use was lower (adjusted hazard ratio = 0.42, 95% confidence interval = 0.31-0.56, P < 0.0001). The risk of LC was calculated among the following rankings of risk severe asthma without regular ICS use, low severity without regular ICS, high severity with regular ICS, and low severity with regular ICS group showed a decreasing trend of LC incidence (P = 0.041). Analyses stratified by comorbidities revealed that the protective effect of ICS was assessed with better precision and more pronounced in those with renal diseases, stroke, and hyperlipidemia. CONCLUSIONS For patients with asthma, regular ICS use might have a protective effect against LC. Further studies are required to assess this potential association from both immunohistopathological and clinical aspects.
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Affiliation(s)
- I-Jen Wang
- Department of Pediatrics, Taipei Hospital, Ministry of Health and Welfare, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,College of Public Health, China Medical University, Taichung, Taiwan
| | - Wen-Miin Liang
- Graduate Institute of Biostatistics, China Medical University, Taichung, Taiwan
| | | | - Wilfried J J Karmaus
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN, USA
| | - Jiin-Chyr Hsu
- Department of Respiratory Medicine, Taipei Hospital, Ministry of Health and Welfare, Taipei, Taiwan
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25
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Wang IJ, Karmaus WJJ, Yang CC. Lead exposure, IgE, and the risk of asthma in children. J Expo Sci Environ Epidemiol 2017; 27:478-483. [PMID: 28401896 DOI: 10.1038/jes.2017.5] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 02/20/2017] [Indexed: 05/02/2023]
Abstract
Lead (Pb) has adverse effects on our nervous system and renal systems. Young children are more vulnerable to Pb exposure. However, the role of low-level Pb exposure in the immune system and allergic diseases in children is not well established. The aims of this study are to investigate the associations between Pb exposure and allergic diseases; between Pb and immunoglobulin E (IgE) as an intervening variable; and gender-based differences. We used multistage stratified random sampling to recruit kindergarten children nationwide in Taiwan. Information about allergic diseases and environmental exposures was collected by questionnaire. We compared children with and without allergic diseases for blood Pb levels measured by inductively coupled plasma mass spectrometry. The association between blood Pb and allergic diseases was assessed by logistic regression and those between Pb and IgE by generalized linear models. We also conducted mediation analysis to evaluate how much risk of allergic diseases related to Pb exposure is explained by IgE. A total of 930 children completed specimen collections. There was a positive association between Pb and asthma. Blood Pb were also positively linked with serum IgE (β=0.26 kU/l per ln-unit increase Pb concentration; 95% CI 0.009-0.50 kU/l), after adjusting for potential confounders. Analyses stratified by gender revealed that blood Pb correlated with IgE only in boys (β=0.40 kU/l; 95% CI 0.03-0.76 kU/l). We estimated that 38% of the total effect of Pb exposure on asthma is mediated by IgE levels. In conclusion, Pb exposure is associated with both blood IgE and asthma in boys. Moreover, the effect of Pb exposure on asthma may be mediated by IgE levels.
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Affiliation(s)
- I-Jen Wang
- Department of Pediatrics, Taipei Hospital, Ministry of Health and Welfare, Taipei, Taiwan
- Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Health Risk Management, China Medical University, Taichung, Taiwan
| | - Wilfried J J Karmaus
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, Tennessee, USA
| | - Chen-Chang Yang
- Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Clinical Toxicology &Occupational Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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26
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Huang CF, Wang IJ. Changes in Urinary Phthalate Metabolite Levels Before and After the Phthalate Contamination Event and Identification of Exposure Sources in a Cohort of Taiwanese Children. Int J Environ Res Public Health 2017; 14:ijerph14080935. [PMID: 28825610 PMCID: PMC5580637 DOI: 10.3390/ijerph14080935] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 08/13/2017] [Accepted: 08/15/2017] [Indexed: 11/16/2022]
Abstract
In 2011, the Taiwan Food and Drug Administration inadvertently discovered that, for decades, manufacturers had replaced expensive natural emulsifiers in food products with diethylhexyl phthalate (DEHP). We wanted to compare urinary phthalate metabolite levels of children before and after the DEHP food contamination event and identify source(s) of phthalate exposure in addition to the illegal food additives. In the present study, morning urine samples were collected from a cohort of 453 children in 2010 in Taipei. After the DEHP food contamination event, there were 200 cohort children left at follow-up in 2013. The geometric means (GMs) of urinary mono(2-ethyl-5-hydroxyhexyl) phthalate (5OH-MEHP) levels before and after the event were 9.39 and 13.34 µg/g of creatinine, respectively, with no significant difference (p = 0.093). After the DEHP food contamination event, we found that urinary phthalate metabolite levels were significantly higher in people who frequently consumed microwave-heated food and used fragrance-containing products (p < 0.05). In addition, children who did not frequently wash hands before eating had significantly higher urinary phthalate metabolite levels than those who did (p < 0.05). These results demonstrate that urinary phthalate metabolite levels did not decrease after the DEHP food contamination event, thus, other sources must contribute to phthalate exposure in daily life. Public awareness of approaches to reducing phthalate exposure is necessary.
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Affiliation(s)
- Chian-Feng Huang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei 10055, Taiwan.
- Taoyuan Psychiatric Center, Ministry of Health and Welfare, Taoyuan 33058, Taiwan.
| | - I-Jen Wang
- Department of Pediatrics, Taipei Hospital, Ministry of Health and Welfare, Taipei 11267, Taiwan.
- Institute of Environmental & Occupational Health Sciences, School of Medicine, National Yang-Ming University, Taipei 100044, Taiwan.
- Department of Health Risk Management, China Medical University, Taichung 110001, Taiwan.
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Wang IJ, Karmaus WJJ. Oxidative Stress-Related Genetic Variants May Modify Associations of Phthalate Exposures with Asthma. Int J Environ Res Public Health 2017; 14:ijerph14020162. [PMID: 28208751 PMCID: PMC5334716 DOI: 10.3390/ijerph14020162] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 01/30/2017] [Accepted: 02/04/2017] [Indexed: 12/12/2022]
Abstract
Background: Phthalate exposure may increase the risk of asthma. Little is known about whether oxidative-stress related genes may alter this association. First, this motivated us to investigate whether genetic polymorphisms of the oxidative-stress related genes glutathione S-transferase Mu 1 (GSTM1), glutathione S-transferase pi 1 (GSTP1), superoxide dismutase 2 (SOD2), catalase (CAT), myeloperoxidase (MPO), and EPHX1 in children are associated with phthalate urine concentrations. Second, we addressed the question whether these genes may affect the influence of phthalates on asthma. Methods: In a case-control study composed of 126 asthmatic children and 327 controls, urine phthalate metabolites (monoethyl phthalate (MEP), monobutyl phthalate (MBP), monobenzyl phthalate (MBzP), and mono(2-ethyl-5-hydroxyhexyl)phthalate (MEHHP) were measured by UPLC-MS/MS at age 3. Genetic variants were analyzed by TaqMan assay. Information on asthma and environmental exposures was also collected. Analyses of variance and logistic regressions were performed. Results: Urine MEHHP levels were associated with asthma (adjusted OR 1.33, 95% CI (1.11–1.60). Children with the GSTP1 (rs1695) AA and SOD2 (rs5746136) TT genotypes had higher MEHHP levels as compared to GG and CC types, respectively. Since only SOD2 TT genotype was significantly associated with asthma (adjusted OR (95% CI): 2.78 (1.54–5.02)), we estimated whether SOD2 variants modify the association of MEHHP levels and asthma. As MEHHP concentrations were dependent on GSTP1 and SOD2, but the assessment of interaction requires independent variables, we estimated MEHHP residuals and assessed their interaction, showing that the OR for SOD2 TT was further elevated to 3.32 (1.75–6.32) when the residuals of MEHHP were high. Conclusions: Urine phthalate metabolite concentrations are associated with oxidative-stress related genetic variants. Genetic variants of SOD2, considered to be reflect oxidative stress metabolisms, might modify the association of phthalate exposure with asthma.
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Affiliation(s)
- I-Jen Wang
- Department of Pediatrics, Taipei Hospital, Ministry of Health and Welfare, Taipei 11267, Taiwan.
- Institute of Environmental & Occupational Health Sciences, School of Medicine, National Yang-Ming University, Taipei 100044, Taiwan.
- Department of Health Risk Management, China Medical University, Taichung 110001, Taiwan.
| | - Wilfried J J Karmaus
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN 38152, USA.
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Wang IJ, Karmaus WJJ, Yang CC. Polycyclic aromatic hydrocarbons exposure, oxidative stress, and asthma in children. Int Arch Occup Environ Health 2017; 90:297-303. [PMID: 28175985 DOI: 10.1007/s00420-017-1198-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 01/09/2017] [Indexed: 12/29/2022]
Abstract
PURPOSE Polycyclic aromatic hydrocarbons (PAHs) are known for their carcinogenic and teratogenic properties. However, little is known about the effect of PAH on our immune and respiratory systems. Hence, we investigated associations (1) between PAH exposure and IgE levels and asthma in children and (2) between PAH exposure and the oxidative stress marker 8OHdG potentially involved in disease pathogenesis stratifying by (3) sex-based differences. METHODS A total of 453 kindergarten children were recruited and provided samples. Urine biomarker of PAH exposure (1-OHP levels) was measured by UPLC-MS/MS and a marker of oxidative stress (8OHdG) was measured by ELISA. Serum IgE were assessed and information on asthma was collected. Associations between 1-OHP levels, 8OHdG, IgE and asthma were analyzed by multivariate linear and logistic regression. A mediation analysis was conducted to evaluate whether the risk of increased IgE and asthma related to PAH exposure is explained by 8OHdG changes. RESULTS Urine 1-OHP levels were positively related to 8OHdG levels (per ln-unit: β = 0.30kU/l, p = 0.002). Similar results were also found for 1-OHP levels with IgE levels (per ln-unit: β = 0.27 kU/l, p = 0.027). 1-OHP levels (per ln-unit) were significantly associated with asthma, with an OR (95% CI) of 1.42 (1.18-1.70). In addition, 1-OHP levels were associated with asthma. It is estimated that 35% of the effect of PAH exposure on asthma is mediated by 8OHdG levels. CONCLUSION Exposure to PAH may enhance oxidative stress and may induce asthma. The effect of PAH exposure on asthma may be mediated by oxidative stress.
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Affiliation(s)
- I-Jen Wang
- Department of Pediatrics, Taipei Hospital, Ministry of Health and Welfare, Taipei, Taiwan, Republic of China. .,Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China. .,Department of Health Risk Management, China Medical University, Taichung, Taiwan, Republic of China.
| | - Wilfried J J Karmaus
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, USA
| | - Chen-Chang Yang
- Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China.,Division of Clinical Toxicology and Occupational Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China
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Wang IJ, Wen HJ, Chiang TL, Lin SJ, Guo YL. Maternal psychologic problems increased the risk of childhood atopic dermatitis. Pediatr Allergy Immunol 2016; 27:169-76. [PMID: 26647908 DOI: 10.1111/pai.12518] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/28/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Little is known about the effect of postnatal maternal psychologic problems on the development of childhood atopic disorders. OBJECTIVES To assess the association between early life maternal psychologic problems and atopic dermatitis (AD) in children in a national birth cohort. METHODS We used multistage, stratified systematic sampling to recruit 24,200 mother-newborn pairs from the Taiwan national birth registration. Maternal psychologic problems and potential confounders were gathered by the standard questionnaire at 6 months old. At 3 years of age, information about the development of AD was assessed by International Study of Asthma and Allergies in Childhood via home interviews. Multiple logistic regression analysis was performed to estimate the association of postnatal maternal psychologic problems (postpartum depression (PPD) and maternal mental health index) and AD. RESULTS The prevalence of physician-diagnosed AD was 10.5%. PPD increased the risk of subsequent physician-diagnosed AD in children after adjusting for potential confounders and other maternal mental health index (aOR = 1.42, 95% CI = 1.21-1.66). We observed that the risk of AD associated with PPD was not confounded by other social demographic factors such as maternal AD, maternal education, family income, breastfeeding, day care, and number of siblings. CONCLUSIONS Postpartum depression increased the risk of childhood AD even when other maternal mental health index and social demographic factors are considered. Early intervention of PPD might be helpful for AD prevention.
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Affiliation(s)
- I J Wang
- Department of Pediatrics, Taipei Hospital, Ministry of Health and Welfare, Taipei, Taiwan.,Institute of Environmental and Occupational Health Sciences, College of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Health Risk Management, China Medical University, Taichung, Taiwan
| | - H J Wen
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - T L Chiang
- Institute of Health Policy and Management, National Taiwan University College of Public Health, Taipei, Taiwan
| | - S J Lin
- Department of Pediatrics, National Cheng Kung University Hospital and College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Y L Guo
- Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan.,Department of Environmental and Occupational Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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Wang IJ, Chen CY, Bornehag CG. Bisphenol A exposure may increase the risk of development of atopic disorders in children. Int J Hyg Environ Health 2015; 219:311-6. [PMID: 26765087 DOI: 10.1016/j.ijheh.2015.12.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 11/30/2015] [Accepted: 12/01/2015] [Indexed: 12/01/2022]
Abstract
BACKGROUND Little is known about the effect of Bisphenol A (BPA) on atopic disorders. OBJECTIVE To investigated the associations (i) between postnatal BPA exposure and allergic diseases in children; (ii) between BPA and IgE levels for the possible disease pathogenesis; and (iii) gender-based differences. METHODS A total of 453 children from Childhood Environment and Allergic Diseases Study cohort with urine and blood samples were recruited in Taiwan. Urinary BPA glucoronide (BPAG) levels were measured by UPLC-MS/MS at ages 3 and 6 years. The associations between BPAG levels at different ages and IgE levels and the development of allergic diseases were evaluated by multivariate linear regression and logistic regression. A mediation analysis was also conducted to evaluate how much risk of allergic diseases in relation to BPA exposure is explained by IgE changes. RESULTS The BPAG levels at age 3 were positively associated with IgE levels at age 3 (β=64.85kU/l per ln-unit increase BPAG level; 95% CI, 14.59-115.11kU/l). Stratified by gender, BPAG levels at age 3 were positively associated with IgE levels at age 3, particularly in girls (β=139.23kU/l; 95% CI, 57.38-221.09kU/l). Similar results were also found at age 6. Urinary BPAG levels at age 3 were significantly associated with asthma at ages 3 and 6, with OR (95%CI) of 1.29(1.08-1.55) and 1.27(1.04-1.55). We estimated that 70% of the total effect of BPA exposure on asthma is mediated by IgE levels. CONCLUSIONS BPA exposures were associated with IgE levels and may increase the risk of development of allergic diseases in children particularly in girls.
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Affiliation(s)
- I-Jen Wang
- Department of Pediatrics, Taipei Hospital, Ministry of Health and Welfare, Taipei, Taiwan; Institute of Environmental and Occupational Health Sciences, College of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Health Risk Management, China Medical University, Taichung, Taiwan.
| | - Chia-Yang Chen
- Institute of Environmental Health, College of Public Health, National Taiwan University, Taipei, Taiwan
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Wang IJ, Tung TH, Tang CS, Zhao ZH. Allergens, air pollutants, and childhood allergic diseases. Int J Hyg Environ Health 2015; 219:66-71. [PMID: 26404109 DOI: 10.1016/j.ijheh.2015.09.001] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 08/03/2015] [Accepted: 09/09/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The synergistic effect of allergens and air pollutants on the risk of allergic diseases is unclear. OBJECTIVE To evaluate the joint effect of outdoor pollutants and indoor allergens on the risk of allergic diseases. METHODS We enrolled 2661 kindergarten children from the CEAS cohort. Data on allergic diseases and environmental exposure were collected. Skin prick tests were performed. Individual exposure to air pollution was estimated using a geographic information system with the mean concentration of air pollutants. Multiple logistic regression analysis was performed to estimate the association between air pollutants, allergen exposure and the risk of allergic diseases with adjustments for potential confounders. RESULTS Overall, 12.6% of the children had asthma, 30.0% had allergic rhinitis (AR), and 14.4% had atopic dermatitis (AD). Mite sensitization significantly increased the risk of AD, AR, and asthma (OR (95%CI) 2.15 (1.53-3.03), 1.94 (1.46-2.58), and 2.31 (1.63-3.29), respectively). Exposure to PM10, PM(2.5), CO, and O(3) was associated with asthma (OR (95% CI) 1.39 (1.03-1.87), 1.45 (1.07-1.97), 1.36 (1.01-1.83), and 0.68 (0.51-0.92), respectively). PM(2.5) may have increased the risk of AR (OR (95% CI) 1.54 (1.03-2.32). Mite sensitization showed a synergistic effect with PM(2.5) on the development of asthma (p < 0.001). Moreover, mite allergens may modify the effect of air pollutants on allergic diseases. CONCLUSION Dust mites and PM(2.5) play an important role on the risk of asthma and AR. Exposure to PM(2.5) and mite allergens had a synergistic effect on the development of asthma. Avoiding co-exposure to allergens and air pollutants is important.
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Affiliation(s)
- I-Jen Wang
- Department of Pediatrics, Taipei Hospital, Ministry of Health and Welfare, Taipei, Taiwan; Institute of Environmental and Occupational Health Sciences, College of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Health Risk Management, China Medical University, Taichung, Taiwan.
| | - Tao-Hsin Tung
- College of Public Health, Fu Jen Catholic University, Taipei, Taiwan; Department of Medical Research and Education, Cheng-Hsin General Hospital, Taiwan
| | - Chin-Sheng Tang
- College of Public Health, Fu Jen Catholic University, Taipei, Taiwan
| | - Zi-Hao Zhao
- College of Public Health, Fu Jen Catholic University, Taipei, Taiwan
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Lin MH, Hsieh CJ, Caffrey JL, Lin YS, Wang IJ, Ho WC, Chen PC, Wu TN, Lin RS. Fetal Growth, Obesity, and Atopic Disorders in Adolescence: a Retrospective Birth Cohort Study. Paediatr Perinat Epidemiol 2015. [PMID: 26218618 DOI: 10.1111/ppe.12215] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Developmental status at birth and subsequent obesity have been implicated in the development of childhood atopic dermatitis (AD) and allergic rhinitis (AR). METHODS The current study analysed the cohort data of 74 688 junior high school students from a national retrospective birth cohort study in Taiwan. A random 10% sample was selected from singleton livebirths with complete data on the analytical variables of interest. Atopic disorders, including AD and AR, were assessed by questionnaires (International Study of Asthma and Allergies in Childhood). Logistic regression analyses were applied with adjustments for related risk factors. RESULTS Among subjects mainly 13-15 years of age, the estimated prevalence was 7.6% for AD and 22.4% for AR. While the role of fetal growth in allergic disorders was less evident, the risk of developing AD and AR were both influenced by a combination of fetal growth status and adolescent body mass index (BMI). Compared with those with normal fetal growth and school-aged BMI, the risk of developing AD increased 64% among adolescents with both restricted fetal growth and high BMI (odds ratio 1.64, 95% confidence interval 1.37, 1.97). The risk for this combination was higher than that for either restricted fetal growth or high BMI alone. Nevertheless, the overall interaction between BMI and fetal growth status on atopic disorders did not reach statistical significance. CONCLUSIONS Excessive weight gain could be an important risk factor related to developing atopic dermatitis and allergic rhinitis during adolescence, especially among infants born small for gestational age.
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Affiliation(s)
- Meng-Hung Lin
- Department of Public Health, China Medical University, Taichung, Taiwan
| | - Chia-Jung Hsieh
- Department of Public Health, Tzu-Chi University, Hualien, Taiwan
| | - James L Caffrey
- Department of Integrative Physiology and Cardiovascular Research Institute, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Yu-Sheng Lin
- Department of Environmental and Occupational Health, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - I-Jen Wang
- Department of Health Risk Management, China Medical University, Taichung, Taiwan.,Department of Pediatrics, Taipei Hospital, Ministry of Health and Welfare, Taipei, Taiwan.,Institute of Environmental and Occupational Health Sciences, College of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wen-Chao Ho
- Department of Public Health, China Medical University, Taichung, Taiwan
| | - Pau-Chung Chen
- Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan
| | - Trong-Neng Wu
- Department of Public Health, China Medical University, Taichung, Taiwan
| | - Ruey-Shiung Lin
- Institute of Epidemiology and Preventive Medicine, National Taiwan University College of Public Health, Taipei, Taiwan
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Chen SF, Wang IJ, Lang HC. Risk of major depression in patients with chronic renal failure on different treatment modalities: A matched-cohort and population-based study in Taiwan. Hemodial Int 2015; 20:98-105. [PMID: 26179222 DOI: 10.1111/hdi.12334] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The influence of different treatment modalities on the risk of developing major depression in patients with chronic renal failure (CRF) is not well understood. We aimed to explore the incidence of major depression among patients with CRF who were on different dialysis modalities, who had received renal transplantation (RT), and those who had not yet received any of the aforementioned renal replacement therapies. We conducted a population-based retrospective cohort study using a national health insurance research database. This study investigated 89,336 study controls, 17,889 patients with chronic kidney disease on conservative treatment, 3823 patients on hemodialysis (HD), 351 patients on peritoneal dialysis (PD), and 322 patients who had RT. We followed all individuals until the occurrence of major depression or the date of loss to follow-up. The PD group had the highest risk (hazard ratio [HR] 2.43; 95% confidence interval [CI] 1.26-4.69), whereas the RT group had the lowest risk (HR 0.18; 95% CI 0.03-1.29) of developing major depression compared with the control group. Patients initiated on PD had a higher risk of developing major depression than patients initiated on HD (pairwise comparison: HR 2.20; 95% CI 1.09-4.46). Different treatment modalities are associated with different risks of developing major depression in patients with CRF. Among renal replacement therapies, patients who have had RT have the lowest risk of developing major depression. Patients who initiate renal therapy on PD may have a higher risk of major depression compared with patients who initiate renal therapy on HD.
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Affiliation(s)
- Shih-Feng Chen
- Nephrology Department, New Taipei City Hospital, New Taipei City, Taiwan.,Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan
| | - I-Jen Wang
- Psychiatry Department, Taipei City Hospital Jen-Ai Branch, Taipei, Taiwan
| | - Hui-Chu Lang
- Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan
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Lee YL, Yen JJY, Hsu LC, Kuo NW, Su MW, Yang MF, Hsiao YP, Wang IJ, Liu FT. Association of STAT6 genetic variants with childhood atopic dermatitis in Taiwanese population. J Dermatol Sci 2015; 79:222-8. [PMID: 26048407 DOI: 10.1016/j.jdermsci.2015.05.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 05/14/2015] [Accepted: 05/19/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) is the single most common allergic disease in children. STAT6 has been noted as a hub molecule in IL-4 mediated response and AD pathogenesis. However, the association between STAT6 genetic variants and childhood AD has never been thoroughly examined. OBJECTIVE We investigate the association between STAT6 genetic variants and childhood AD risk in Taiwanese population. METHODS We used data from the Han Chinese in Beijing genome panel of International HapMap Project and the Taiwan Children Health Study cohort to investigate the association of STAT6 genetic variants and childhood AD risks. Four tagged SNPs were selected from HapMap database and rs324011 was most significantly associated with childhood AD. Subsequently, deep sequencing around rs324011 and unconditional/conditional logistic models were applied. RESULTS rs324011 showed statistical significance for the occurrence of childhood AD (OR: 1.23; 95% CI: 1.01-1.51) and rs167769 showed borderline statistical significance (OR: 1.21; 95% CI: 0.99-1.49). Likelihood ratio tests revealed that haplotypes (rs167769/rs324011) were associated with childhood AD (global p=0.0018). T alleles of two STAT6 intron2 SNPs, rs324011 and rs167769, increased STAT6 promoter activity significantly in luciferase reporter assay. CONCLUSION T allele of rs324011 in STAT6 would increase the risk of AD occurrence in children. Haplotypes of rs324011/rs167769 were also significantly associated with childhood AD in Taiwanese population.
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Affiliation(s)
- Yungling Leo Lee
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan; Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan.
| | | | - Li-Chung Hsu
- Institute of Molecular Medicine, School of Medicine, National Taiwan University, Taipei, Taiwan
| | - Nai-Wei Kuo
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | - Ming-Wei Su
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan; Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Ming-Fong Yang
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan; Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Yu-Ping Hsiao
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Dermatology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - I-Jen Wang
- Institute of Environmental and Occupational Health Sciences, College of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Health Risk Management, China Medical University, Taichung, Taiwan
| | - Fu-Tong Liu
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
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Wang IJ, Lin TJ. FLG P478S polymorphisms and environmental risk factors for the atopic march in Taiwanese children: a prospective cohort study. Ann Allergy Asthma Immunol 2015; 114:52-7. [PMID: 25528737 DOI: 10.1016/j.anai.2014.10.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 10/10/2014] [Accepted: 10/21/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Little is known about the role of genetic and environmental modifiers in atopic march. OBJECTIVE To investigate the effects of filaggrin (FLG) P478S polymorphisms and environmental factors on the risk of asthma in a cohort of children with atopic dermatitis (AD). METHODS In 2010, 3,246 children from Childhood Environment and Allergic Diseases Cohort Study cohort were recruited. There were 485 children with AD who were invited for further clinical evaluation. Environmental exposures and skin prick tests for allergens were collected at 3 years of age and the development of asthma was determined at 6 years. Multivariate logistic regressions were performed to estimate the association between genetic and environmental factors and the development asthma in children with AD. RESULTS Of 397 children with AD who completed the follow-up, 97 developed asthma. After controlling for potential confounders, only mite sensitizations (odds ratio 1.89, 95% confidence interval 1.10-3.25) and the FLG TT genotype (odds ratio 2.26, 95% confidence interval 1.33-3.84) were significantly associated with the development of asthma in children with AD. Mite sensitizations and FLG variants had a synergistic effect on the development of asthma. When children with FLG variants were exposed to mite, the risk for asthma was compounded compared with those with FLG variants without mite exposure (odds ratio 3.58, 95% confidence interval 1.81-7.08). CONCLUSION Mite sensitization and the FLG TT genotype couldt be associated with the development of atopic march.
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Affiliation(s)
- I-Jen Wang
- Department of Pediatrics, Taipei Hospital, Ministry of Health and Welfare; College of Medicine, National Yang-Ming University; China Medical University, Taipei, Taiwan.
| | - Tien-Jen Lin
- Graduate Institute of Injury Prevention and Control, Taipei Medical University, Wan Fang Hospital, Taipei, Taiwan
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Wang IJ, Karmaus WJ, Chen SL, Holloway JW, Ewart S. Effects of phthalate exposure on asthma may be mediated through alterations in DNA methylation. Clin Epigenetics 2015; 7:27. [PMID: 25960783 PMCID: PMC4424541 DOI: 10.1186/s13148-015-0060-x] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 02/17/2015] [Indexed: 01/01/2023] Open
Abstract
Background Phthalates may increase the asthma risk in children. Mechanisms underlying this association remain to be addressed. This study assesses the effect of phthalate exposures on epigenetic changes and the role of epigenetic changes for asthma. In the first step, urine and blood samples from 256 children of the Childhood Environment and Allergic diseases Study (CEAS) were analyzed. Urine 5OH-MEHP levels were quantified as an indicator of exposure, and asthma information was collected. DNA methylation (DNA-M) was measured by quantitative PCR. In the screening part of step 1, DNA-M of 21 potential human candidate genes suggested by a toxicogenomic data were investigated in 22 blood samples. Then, in the testing part of step 1, positively screened genes were tested in a larger sample of 256 children and then validated by protein measurements. In step 2, we replicated the association between phthalate exposure and gene-specific DNA-M in 54 children in the phthalate contaminated food event. In step 3, the risk of DNA-M for asthma was tested in 256 children from CEAS and corroborated in 270 children from the Isle of Wight (IOW) birth cohort. Results Differential methylation in three genes (AR, TNFα, and IL-4) was identified through screening. Testing in 256 children showed that methylation of the TNFα gene promoter was lower when children had higher urine 5OH-MEHP values (β = −0.138, P = 0.040). Functional validation revealed that TNFα methylation was inversely correlated with TNFα protein levels (β = −0.18, P = 0.041). In an additional sample of 54 children, we corroborated that methylation of the TNFα gene promoter was lower when urine 5OH-MEHP concentrations were higher. Finally, we found that a lower methylation of 5′CGI region of TNFα was associated with asthma in 256 CEAS children (OR = 2.15, 95% CI = 1.01 to 4.62). We replicated this in 270 children from the IOW birth cohort study. Methylation of the CpG site cg10717214 was negatively associated with asthma, when children had ‘AA’ or ‘AG’ genotype of the TNFα single nucleotide rs1800610. Conclusions Effects of phthalate exposure on asthma may be mediated through alterations in DNA methylation. Electronic supplementary material The online version of this article (doi:10.1186/s13148-015-0060-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- I-Jen Wang
- Department of Pediatrics, Taipei Hospital, Ministry of Health and Welfare, #127, Su-Yuan Road, Hsin-Chuang Dist 242 New Taipei City, Taiwan ; Institute of Environmental and Occupational Health Sciences, College of Medicine, National Yang-Ming University, Taipei, 112 Taiwan ; Department of Health Risk Management, China Medical University, Taichung, 404 Taiwan
| | - Wilfried Jj Karmaus
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, 38152 USA
| | | | - John W Holloway
- Clinical and Experimental Sciences, Faculty of Medicine, and NIHR Respiratory Biomedical Research Unit, University of Southampton, Southampton, S016 6YD UK ; Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, SO16 6YD UK
| | - Susan Ewart
- Department of Large Animal Clinical Sciences, Michigan State University, East Lansing, 48824 MI USA
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Wang IJ, Karmaus WJJ. The effect of phthalate exposure and filaggrin gene variants on atopic dermatitis. Environ Res 2015; 136:213-8. [PMID: 25460639 DOI: 10.1016/j.envres.2014.09.032] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 08/30/2014] [Accepted: 09/16/2014] [Indexed: 05/08/2023]
Abstract
BACKGROUND Phthalate exposure may increase the risk of atopic disorders. However, little is known about the joint effects of phthalate exposure and filaggrin (FLG) gene variants on atopic dermatitis (AD). We want to investigate whether FLG variants are related to a higher urine concentration of phthalates and whether an interaction of FLG and phthalates increases the risk of AD. METHODS We conducted a case-control study comprised of 106 AD children and 347 controls, all of whom were selected from CEAS cohort. Urine phthalate metabolite levels (MEP, MBP, MBzP, and 5OH-MEHP) were measured by UPLC-MS/MS. FLG variants were analyzed by TaqMan assay. At 3 years of age, information about the development of AD and environmental exposures were collected. Logistic regressions were performed to estimate the association of genotypes and phthalate metabolite levels with AD. RESULTS Urine MBP and MBzP levels were higher in children with AD than in controls (p<0.001). Children with the FLG P478S TT genotype had higher urine phthalate metabolite levels as compared with CC carriers, with MBP and MBzP having a statistically significant difference (geometric mean(s.e.) 5.51(3.77) vs. 3.03(3.48), p=0.015 and 0.76(3.01) vs. 0.53(2.56), p=0.018). After stratifying by phthalate metabolite levels, FLG P478S TT genotype was related to a higher odds of AD in children with high MBP levels (aOR=4.74, 95% CI 1.45-15.5) and in children with high MBzP levels (aOR=3.46, 95%CI 1.03-11.58). CONCLUSIONS FLG variants may increase skin permeability leading to higher skin absorption of phthalate and thus confer a higher susceptibility for AD. Or alternatively, the internal burden of phthalates metabolites is increased in children with AD who also have risky variant of the FLG gene.
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Affiliation(s)
- I-Jen Wang
- Department of Pediatrics, Taipei Hospital, Ministry of Health and Welfare, Taipei, Taiwan; Institute of Environmental and Occupational Health Sciences, College of Medicine, National Yang-Ming University, Taipei, Taiwan; China Medical University, Taichung, Taiwan.
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Hwang YH, Lin YS, Lin CY, Wang IJ. Incense burning at home and the blood lead level of preschoolers in Taiwan. Environ Sci Pollut Res Int 2014; 21:13480-13487. [PMID: 25015713 DOI: 10.1007/s11356-014-3273-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 07/01/2014] [Indexed: 06/03/2023]
Abstract
The growth and intellectual development of children less than 6 years old may be affected by exposure to low levels of lead. To further reduce environmental lead exposure, this study examined possible household-related factors that affect the blood lead levels of Taiwanese children. In total, based on a stratified random sampling strategy, 934 kindergarten students were recruited throughout Taiwan from April to October 2011 after their parents signed a statement of consent. A venous blood sample was drawn from each participant and analyzed for lead content using inductively coupled plasma mass spectrometry. Information on the demographics and household environment of the study subjects was collected by administering a questionnaire (Table 1). The geometric mean lead level in the blood samples of the study subjects was 1.84 μg/dL with a geometric standard deviation of 1.55. The blood lead level was negatively correlated with household income and parental educational levels (p < 0.0001). Study subjects with more siblings also tended to have higher blood lead levels (p < 0.0001). Incense burning in the home, an ethnic tradition, was also identified as a significant factor for increased blood lead levels (p < 0.0003) and demonstrated a dose-dependent relationship with frequency of incense burning at home (p = 0.0022). Because the health effects of low levels of lead exposure have been reported in recent years and because no consensus has been reached regarding a safety threshold for blood lead level in children, any trivial factor is worth investigating to further prevent lead exposure in children. Incense burning at home is a common traditional religious activity in Taiwan; therefore, more study is warranted to further eliminate the lead content in incense and reduce lead exposure for the families who practice this activity.
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Wang IJ, Lin CC, Lin YJ, Hsieh WS, Chen PC. Early life phthalate exposure and atopic disorders in children: a prospective birth cohort study. Environ Int 2014; 62:48-54. [PMID: 24161446 DOI: 10.1016/j.envint.2013.09.002] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Revised: 09/03/2013] [Accepted: 09/03/2013] [Indexed: 05/26/2023]
Abstract
The role of phthalate exposure at different stages in the immune system and atopic disorders is not well-known. This study aims to evaluate the effects of prenatal and postnatal phthalate exposures on immunoglobulin E (IgE) levels and atopic dermatitis (AD) in children by objective biomarkers. We conducted a prospective Taiwan Birth Panel cohort study with 483 mother/infant pairs. Finally, 161 urine specimens at 3rd trimester of pregnancy, 219 urine specimens from children at age 2, and 192 urine specimens at age 5 were analyzed after excluding missing data and loss to follow-up. Urine monoethyl phthalate (MEP), monobutyl phthalate (MBP), monobenzyl phthalate (MBzP), and mono-(2-ethylhexyl) phthalate (MEHP) at 3rd trimester of pregnancy and at ages 2 and 5 were measured by ultra-performance liquid chromatography coupled with tandem mass spectrometry. At ages 2 and 5, information on the development of AD and serum total IgE was collected. The association between urine phthalate metabolite levels at different stages and serum IgE and AD was evaluated by multivariate linear regression and logistic regression. Urine phthalate metabolite levels were higher at age 2 than those at pregnancy and age 5. At each period, urine MBP levels were higher than MEP, MEHP, and MBzP. MEHP levels at age 2 positively correlated with serum IgE levels (per ln-unit: β=0.191, p=0.02). Analyses stratified by gender revealed that MEHP levels positively correlated with serum IgE levels only in boys (per ln-unit: β=0.256, p=0.03). When dividing into quartiles, urine MBzP levels at age 2 had a significant association with AD. We found no statistically significant association of other phthalate metabolites with IgE and AD. Early life phthalate exposure may increase the risk of allergic sensitization and atopic disorders.
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Affiliation(s)
- I-Jen Wang
- Department of Pediatrics, Taipei Hospital, Ministry of Health and Welfare, Taipei, Taiwan; China Medical University, Taichung, Taiwan; College of Medicine, National Yang-Ming University, Taipei, Taiwan
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Wang IJ, Wen HJ, Chiang TL, Lin SJ, Chen PC, Guo YL. Maternal employment and atopic dermatitis in children: a prospective cohort study. Br J Dermatol 2013; 168:794-801. [PMID: 23528059 DOI: 10.1111/bjd.12195] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Considering the early onset of atopic dermatitis (AD), which most often arises in the first year of life, risk factors occurring very early in life must be considered. Little is known about the effects of maternal occupational exposure on the development of atopic disorders in children. OBJECTIVES The aim of this study was to evaluate associations between maternal employment and childhood AD. METHODS We used multistage stratified systematic sampling to recruit 24,200 mother-newborn pairs from the Taiwan national birth register. Information on maternal occupation categories, work stress, working time, shift work and potential confounders during pregnancy was gathered by questionnaires after birth. At 3 years of age, information on the development of AD was assessed by home interviews. Multiple logistic regression analysis was performed to estimate the association of maternal employment and AD. RESULTS Overall, 11,962 out of 19,381 mothers (61·7%) worked during pregnancy. The children of mothers who worked during pregnancy had an increased risk of AD compared with those whose mothers did not work [odds ratio (OR) 1·38, 95% confidence interval (CI) 1·25-1·53]. The children of mothers with a professional or technical occupation had a higher risk of AD (OR 1·64, 95% CI 1·44-1·87). The risk of AD was found to increase with maternal work stress during pregnancy in a dose-response manner (P(trend)<0·01). The mothers of children with AD had a longer working time than those without AD (P<0·0001). However, no significant association between AD and maternal shift work was found. CONCLUSIONS Working in professional or technical occupations increased the risk of childhood AD in addition to work stress during pregnancy.
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Affiliation(s)
- I J Wang
- Department of Pediatrics, Taipei Hospital, Department of Health, Taipei, Taiwan
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Wang IJ, Tsai CH, Kuo NW, Chiang BL, Tung KY, Lee YL. Home dampness, beta-2 adrenergic receptor genetic polymorphisms, and asthma phenotypes in children. Environ Res 2012; 118:72-78. [PMID: 22883364 DOI: 10.1016/j.envres.2012.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2011] [Revised: 07/10/2012] [Accepted: 07/12/2012] [Indexed: 06/01/2023]
Abstract
BACKGROUND Dampness in the home is a strong risk factor for respiratory symptoms and constitutes a significant public health issue in subtropical areas. However, little is known about the effects of dampness and genetic polymorphisms on asthma. METHODS In 2007, 6078 schoolchildren were evaluated using a standard questionnaire with regard to information about respiratory symptoms and environmental exposure. Multiple logistic regression analyses were performed to assess the effects of home dampness and beta-2-adrenergic receptor (ADRB2) gene polymorphisms on the prevalence of asthma and selected indicators of severity of asthma. RESULTS The frequency of mildewy odor, the number of walls with water stamp, and the duration of water damage were all associated with being awakened at night due to wheezing. However, no other clear-cut associations were found for any of the other indicators of asthma. Children exposed to mildewy odor with ADRB2 Arg/Arg genotype were associated with being awakened at night due to wheezing (OR=1.95, 95% CI, 1.14-3.36), compared to those without exposure and with the ADRB2 Gly allele. ADRB2 Arg16Gly showed a significant interactive effect with home dampness on being awakened at night due to wheezing and current wheezing, but no significant effect on active asthma and medication use. Frequency and degree of home dampness were also associated with the prevalence of asthma and selected indicators of severity of asthma, in an exposure-response manner among children with ADRB2 Arg/Arg genotype. CONCLUSIONS Home dampness prevention is one of the important steps of asthma control, especially in children carrying ADRB2 Arg/Arg genotypes.
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Affiliation(s)
- I-Jen Wang
- Department of Pediatrics, Taipei Hospital, Department of Health, Taipei, Taiwan
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Abstract
Keratinocyte apoptosis is a key pathogenetic mechanism in atopic dermatitis (AD). Fas and Fas ligand (FasL) interaction is an important pathway to induce apoptosis. However, the relationship between early life soluble FasL (sFasL) and AD still is not clear. This study was designed to evaluate if sFasL is associated with the development of AD in children. We performed a nested case-control study within a prospective Taiwan birth-panel cohort study. Umbilical cord blood and maternal plasma samples were gathered at birth. During follow-up, using the International Study of Asthma and Allergies in Childhood questionnaires, we identified 40 AD cases, which we matched to 80 unaffected controls chosen from this cohort. The concentrations of sFasL and immunoglobulin E in plasma were determined by enzyme-linked immunosorbent assay. The relationship of sFasL levels and AD was estimated by mix model. Receiver operating characteristic (ROC) curves were generated to see how well sFasL could predict AD. Cord blood sFasL levels were significantly higher in the AD patients than in the controls (p = 0.003). The concentration of sFasL in the cord blood was higher than in the maternal blood (p < 0.001). There also existed a correlation between the concentration of sFasL in the maternal blood and the cord blood (r = 0.23; p = 0.01). The subjective severity of AD was positively correlated with sFasL levels (r = 0.34; p = 0.02). Cold blood sFasL may be a biomarker in detecting pediatric AD (area under the ROC curve = 0.64). Our results showed a relation between cord blood sFasL and the development of AD in children.
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Affiliation(s)
- Kuan-Wen Su
- Department of Pediatrics, Taipei Hospital, Department of Health, Taipei, Taiwan
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Wang IJ, Hsieh WS, Chen CY, Fletcher T, Lien GW, Chiang HL, Chiang CF, Wu TN, Chen PC. The effect of prenatal perfluorinated chemicals exposures on pediatric atopy. Environ Res 2011; 111:785-91. [PMID: 21601844 DOI: 10.1016/j.envres.2011.04.006] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Revised: 02/26/2011] [Accepted: 04/19/2011] [Indexed: 05/22/2023]
Abstract
BACKGROUND The role of perfluorinated compounds (PFCs) in the immune system and allergic diseases is not well-known. This study examined the effects of pre-natal exposure to PFCs on immunoglobulin E (IgE) levels and atopic dermatitis (AD). METHODS In Taiwan Birth Panel cohort study, newborns with cord blood and peri-natal factors (i.e. birth body weight, weeks of gestation, and type of delivery) gathered at birth were evaluated. At the age of 2 years, information on the development of AD, environmental exposures, and serum total IgE were collected. The AD and non-AD children were compared for the concentration of cord blood serum PFCs measured by Ultra-performance liquid chromatography/triple-quadrupole mass (UPLC-MS/MS). Correlations among cord blood IgE, serum total IgE at 2 years of age, and cord blood PFC levels were made. RESULTS Of 244 children who completed the follow-up and specimen collections, 43 (17.6%) developed AD. Concentrations of cord blood serum perfluorooctanoic acid (PFOA), perfluorooctane sulfonate (PFOS), perfluorononanoic acid (PFNA), and perfluorohexane sulfonic acid (PFHxS) were median (range) 1.71 (0.75-17.40), 5.50 (0.11-48.36), 2.30 (0.38-63.87), and 0.035 (0.035-0.420)ng/mL, respectively. PFOA and PFOS levels positively correlated with cord blood IgE levels (per ln-unit: β=0.134 KU/l, p=0.047 for PFOA; β=0.161 KU/l, p=0.017 for PFOS). Analyses stratified by gender revealed that PFOA and PFOS levels positively correlated with cord blood IgE levels only in boys (per ln-unit: β=0.206 KU/l, p=0.025 for PFOA; β=0.175 KU/l, p=0.053 for PFOS). When dividing cord blood serum PFCs into quartiles in the fully adjusted models, AD had no significant association with PFOS. CONCLUSIONS Pre-natal PFOA and PFOS exposures positively correlated with cord blood IgE levels.
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Affiliation(s)
- I-Jen Wang
- Department of Pediatrics, Taipei Hospital, Department of Health, Taipei, Taiwan
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Abstract
BACKGROUND Whether environmental exposures may modulate the effect of the skin barrier gene on atopic dermatitis (AD) remains to be elucidated. OBJECTIVES To determine whether filaggrin (FLG) variants can serve as a predictor for atopic disorders in Chinese individuals and if allergen exposures may modify the effect of FLG variants on AD by total IgE levels. METHODS In total, 116 children aged 2-5years with AD and 212 control subjects were analysed for the FLG variants using DNA sequencing. Multiple logistic regression models were performed to estimate the association among FLG polymorphisms and atopic phenotypes. Serum total IgE level, standing for the degree of allergen exposures, was later stratified to determine the effects of FLG polymorphisms on AD. RESULTS A significant difference in genotype frequency was found among AD cases and controls in FLG P478S polymorphism. FLG P478S GG genotype significantly increased the risk of AD [odds ratio (OR) 4·60, 95% confidence interval (CI) 1·88-11·24]. In addition, among subjects with AD, GG genotypes also significantly increased the risk of developing asthma (OR 4·68, 95% CI 1·37-16·03). Further, a similar result was obtained for allergic rhinitis (OR 3·23, 95% CI 1·01-10·30). Interestingly, the P478S GG genotype was significantly related to AD (OR 5·67, 95% CI 1·93-16·60) in children with IgE level ≥100 kU L(-1) . However, the association was not evident when IgE level was < 100 kU L(-1) . CONCLUSIONS Our results suggest that the FLG P478S polymorphism may confer susceptibility to the development of AD among Chinese individuals and may be modified by IgE levels.
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Affiliation(s)
- I J Wang
- Department of Pediatrics, Taipei Hospital, Department of Health, Taipei, Taiwan
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Wang IJ, Lin SL, Tsou KI, Hsu MC, Chiu WT, Tsai SH, Lee LM, Lin TJ. Congenital midline nasal mass: cases series and review of the literature. Turk J Pediatr 2010; 52:520-524. [PMID: 21434538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Encephalocele, glioma and dermoid cyst are the most common midline nasal masses. Given their potential for intracranial extension, prompt treatment is necessary to prevent complications. Herein, we present two cases of midline nasal masses. A comparison was made to delineate the differences between their clinical courses, treatments and outcomes. Case 1 was a baby girl with respiratory distress beginning at birth. Nasal glioma without definite intracranial extension was present. The mass was completely excised with the aid of a video-assisted endoscope without complications. At follow-up two years after surgery, no recurrence was noted. Case 2 was a two-year-old boy with a midline nasal dermoid cyst. Extirpation of the lesion through a vertical-dorsal approach was performed. He was discharged three days after surgery with a satisfactory aesthetic result.
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Affiliation(s)
- I-Jen Wang
- Department of Pediatrics, Taipei Hospital Department of Health, National Taiwan University Hospital, Taiwan
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Wang IJ, Wu YN, Wu WC, Leonardi G, Sung YJ, Lin TJ, Wang CL, Kuo CF, Wu KY, Cheng WC, Chan CC, Chen PC, Lin SL. The association of clinical findings and exposure profiles with melamine associated nephrolithiasis. Arch Dis Child 2009; 94:883-7. [PMID: 19608552 DOI: 10.1136/adc.2009.163477] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Little is known about the exposure profiles of melamine in children. We evaluated the association of clinical findings, exposure patterns and biomarkers with nephrolithiasis in children with potential exposure to melamine. METHODS A case-control study was conducted in children aged 0-16 years with potential exposure to contaminated dairy products. Cases were defined as nephrolithiasis detected by renal ultrasonography. On the basis of different brands of contaminated dairy products consumed, subjects were classified into high exposure, low exposure and control groups with estimated melamine exposure levels of higher than 2.5 ppm, 0.05-2.5 ppm and lower than detection limits <0.05 ppm. We measured urine melamine for those with nephrolithiasis and age-matched and gender-matched controls within the subset of the study population. RESULTS The duration of consumption of contaminated products was longer in children with nephrolithiasis in the high exposure group than in controls (median (IQR) 12.0 (3.3-24.0) vs 6.0 (4.0-7.0) months; p = 0.048). High melamine exposure levels were significantly associated with nephrolithiasis (OR 61.04 (95% CI 12.73 to 292.84)). The risk was found to increase with estimate melamine exposure levels (p for trend <0.001). Two among 10 affected subjects with nephrolithiasis showed elevated urine melamine levels. In comparison, levels of all 20 controls were lower than the detection limit. CONCLUSIONS The risk of melamine-associated nephrolithiasis was related to duration of consumption of contaminated products and estimated melamine exposure levels. Though urine melamine was not a sensitive test, it might serve as an exposure biomarker in melamine-associated nephrolithiasis.
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Affiliation(s)
- I J Wang
- Department of Pediatrics,Taipei Hospital, Taipei, Taiwan
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Cheng WC, Chen SK, Lin TJ, Wang IJ, Kao YM, Shih DYC. Determination of urine melamine by validated isotopic ultra-performance liquid chromatography/tandem mass spectrometry. Rapid Commun Mass Spectrom 2009; 23:1776-1782. [PMID: 19437442 DOI: 10.1002/rcm.4071] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Little is known about melamine (MEL) analysis in children's urine. In this study, an isotopic ultra-performance liquid chromatography/tandem mass spectrometry (UPLC/MS/MS) method was developed and systematically validated for the analysis of MEL in urine. The method is easily performed and comprises acidification, solid-phase extraction (SPE) and UPLC/MS/MS analysis. (13)C(3)N(3)((15)NH(2))(3) was used as the internal standard (IS) for calibration. Transition ions m/z 127 > 85 of MEL and m/z 133 > 89 of the IS were used for quantification and m/z 127 > 68 of MEL was used for quantitative confirmation. Recovery and precision were assessed to guarantee the applicability of the method. The limit of quantification (LOQ) was 0.01 microg/mL while the calculated method detection limit was 0.006 microg/mL. The mean recoveries ranged from 96-99%. The method was then applied to analyze urine samples from children who had potentially consumed MEL-tainted dairy products during screening in Taiwan. Ten nephrolithiasis cases and 20 age- and gender-matched controls were selected for this study. Three out of the 10 nephrolithiasis cases had elevated levels of MEL. Comparatively, twenty age- and gender-matched non-nephrolithiasis controls consuming Taiwan brand milk powder all showed MEL levels lower than the detection limit except for two children with background levels of 0.02 microg/mL. The background level in these children urine samples was established by UPLC/MS/MS analysis. Positive results of urine MEL tests might be associated with nephrolithiasis in these candidates. Measurement of urine MEL concentration can be helpful in confirming MEL-related nephrolithiasis, but its clinical application needs further clarification.
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Affiliation(s)
- Wei-Chih Cheng
- Bureau of Food and Drug Analysis, Department of Health, Taipei, Taiwan
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Abstract
The adverse impact of smoking on respiratory diseases and birth outcomes in children is well-known. However, the influence of smoke exposure including environmental tobacco smoke (ETS) and maternal smoking during pregnancy on atopic dermatitis (AD) is not clear. The purpose of this study was to evaluate the effect of gestational smoke exposure on the development of AD in the offspring on the basis of the maternal and cord blood cotinine. We recruited 261 mother and newborn pairs in 2004. Cord blood and information on perinatal factors of children were gathered at birth. At 2 yr of age, information about development of AD and environmental exposures were collected. We compared AD with non-AD children for the concentration of cotinine in cord and maternal blood measured by high performance liquid chromatography-mass spectrometry. Multiple logistic regressions were performed to estimate the relationship of cotinine levels and AD. About 150 mother and child pairs completed the follow-up study and specimen collection with 38 (25.3%) children developing AD. Two (1.3%) out of 150 mothers smoked during pregnancy, while 38 (25.3%) mothers reported having ETS exposure. Cotinine levels in cord blood and maternal blood were highly correlated (r = 0.71, p < 0.001). The risk of AD was found to increase with maternal and cord blood cotinine levels in a dose-response manner (p for trend = 0.01). Children exposed to high levels (>75th percentile) had a significantly increased risk of AD. Smoke exposure during pregnancy might increase the risk of AD in children. Avoidance of prenatal smoke exposure may be warranted for early prevention.
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Affiliation(s)
- I-Jen Wang
- Department of Pediatrics, Taipei Hospital, Department of Health, Taipei, Taiwan
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