The prevalence of and risk factors for atopy in early childhood: a whole population birth cohort study

Transepidermal water loss measurement during infancy can predict the subsequent development of atopic dermatitis regardless of filaggrin mutations

BACKGROUND

Atopic dermatitis (AD) is characterized by skin barrier dysfunction. Few studies have used noninvasive techniques to measure epidermis function in asymptomatic neonates.

METHODS

Data of 116 infants from our previous randomized controlled study were analyzed. Skin barrier function was measured through transepidermal water loss (TEWL), stratum corneum hydration (SCH), and pH. The association between skin barrier function and time to AD development was evaluated. Patients were classified with high or low TEWL, and SCH and pH were assessed. The survival function of the time to AD development and hazard ratios were estimated. Allergic sensitization to egg white and ovomucoid at 32 weeks was assessed.

RESULTS

Regardless of a filaggrin mutation, TEWL (optimal cutoff, 6.5 g/m(2)/h) of the forehead within the first week of life showed a lower p-value than TEWL of the leg, and the SCH and pH measurements. Baseline TEWL of the forehead was not different between groups, except for the mean gestational age, and it was not affected by humidity. We found a significant difference in the cumulative AD incidence between the high and low TEWL groups for the forehead only (p < 0.05). The probability without AD was lower in the high TEWL group than in the low TEWL group. For only the high TEWL group, AD development decreased significantly with daily emollient use. The high TEWL group exhibited a higher rate of sensitization to ovomucoid (p = 0.07).

CONCLUSIONS

TEWL of the forehead during the first week of life is associated with AD development.

Clinical phenotype and allergen sensitization in the first 2 years as predictors of atopic disorders at age 5 years

Introduction

From a birth cohort of at-risk Asian infants, we prospectively investigated the role of early onset allergen sensitization and clinical phenotypes as risk factors for atopic disorders at the age of 5 years.

Methods and materials

The study recruited 253 families with a history of allergic disease in a first degree relative from an antenatal clinic in Singapore. The children were followed prospectively to assess clinical outcomes and skin prick test was performed at 2 and 5 years of age.

Results

Allergen sensitization (food and/or house dust mites) alone at 2 years of age was not associated with increased risk of wheeze and eczema at 5 years. However, the clinical phenotype (eczema and wheeze) with or without the presence of concomitant allergen sensitization at 2 years increased this risk. For eczema, eczema alone at year 2 increased the risk of eczema at year 5 (adjOR = 7.1; 95 % CI: 1.8–27.8) and this was further increased by the presence of allergen sensitization (adjOR = 25.4; 95 % CI: 4.7–138.5) and the concomitant presence of both wheeze and allergen sensitization (adjOR = 64.9; 95 % CI: 4.7–900.0). For wheeze, wheeze alone at 2 years (adjOR = 4.5; 95 % CI: 1.4 -14.8), and wheeze with concomitant allergen sensitization and eczema (adjOR = 13.9; 95 % CI: 1.2–168.5) increased the risk of wheeze at 5 years. The exception was rhinitis, where allergen sensitization alone at 2 years (adjOR = 5.6; 95 % CI: 1.1–29.2) increased the risk of rhinitis at 5 years. Early onset of eczema at 2 years also increased the risk of rhinitis (adjOR = 6.8; 95 % CI: 2.0–23.1).

Conclusion

In this Asian birth cohort, the clinical phenotype (eczema and wheeze) with or without concomitant allergen sensitization in the first 2 years of life were strong predictors of atopic disorders at 5 years.

What's more general than a whole population?

Statistical inference is commonly said to be inapplicable to complete population studies, such as censuses, due to the absence of sampling variability. Nevertheless, in recent years, studies of whole populations, e.g., all cases of a certain cancer in a given country, have become more common, and often report p values and confidence intervals regardless of such concerns. With reference to the social science literature, the current paper explores the circumstances under which statistical inference can be meaningful for such studies. It concludes that its use implicitly requires a target population which is wider than the whole population studied - for example future cases, or a supranational geographic region - and that the validity of such statistical analysis depends on the generalizability of the whole to the target population.

Breast Milk and Solid Food Shaping Intestinal Immunity

After birth, the intestinal immune system enters a critical developmental stage, in which tolerogenic and pro-inflammatory cells emerge to contribute to the overall health of the host. The neonatal health is continuously challenged by microbial colonization and food intake, first in the form of breast milk or formula and later in the form of solid food. The microbiota and dietary compounds shape the newborn immune system, which acquires the ability to induce tolerance against innocuous antigens or induce pro-inflammatory immune responses against pathogens. Disruption of these homeostatic mechanisms might lead to undesired immune reactions, such as food allergies and inflammatory bowel disease. Hence, a proper education and maturation of the intestinal immune system is likely important to maintain life-long intestinal homeostasis. In this review, the most recent literature regarding the effects of dietary compounds in the development of the intestinal immune system are discussed.

A multinational study to compare prevalence of atopic dermatitis in the first year of life

BACKGROUND

Atopic dermatitis (AD) is common in childhood, with peak prevalence in early childhood. However, international comparisons of prevalence have focused on older children. We analysed differences in prevalence rates of AD and the associations with putative risk and protective factors, among infants in two European and two Central American countries.

METHODS

In 1-yr old infants participating in the International Study of Wheezing in Infants (EISL), prevalence of AD and putative risk and protective factors were assessed by a questionnaire applied to parents. For each risk/protective factor summary, odds ratios with 95% confidence intervals were calculated by means of random effects meta-analysis.

RESULTS

Data from 9803 infants were analysed. AD prevalence varied from 10.6% (Valencia, Spain) to 28.2% (San Pedro Sula, Honduras). Average AD prevalences were lower in Europe (14.2%) than in Central America (18.2%, p < 0.01). Consistent with older children, presence of siblings decreased (OR 0.82 [0.72-0.94]), whereas family history of asthma (OR 1.32 [1.10-1.59]), rhinitis (OR 1.33 [1.14-1.54]) and atopic dermatitis (OR 2.40 [1.89-3.05]) increased the risk of infantile AD. However, gender, family size, breastfeeding and socio-economic status were not associated with AD prevalence.

CONCLUSIONS

This study shows almost threefold differences in the prevalence of AD in infancy between countries. Risk and protective factors involved in the expression of infantile AD differ from those in older children, possibly suggesting a different pathophysiology. There is a need for additional international epidemiological surveys on AD in young children, the peak prevalence age of this condition.

Smoke exposure, wheezing, and asthma development: a systematic review and meta-analysis in unselected birth cohorts

BACKGROUND

The understanding of the role of smoking exposure in the induction of wheezing and asthma in children is important for prevention.

METHODS

A systematic review of literature and a meta-analysis were conducted to identify studies on unselected prospective birth cohorts. The effect of exposure to maternal/parental smoking on the induction of current wheezing or asthma was evaluated in children aged 6 months, <6 years, and ≥6 years. Pooled odds ratios (OR) with 95% confidence intervals (CI) were estimated.

RESULTS

We identified 43 papers. Exposure to maternal prenatal smoking was associated with an increased risk of wheezing in <6-year-olds (OR 1.36; 95% CI: 1.19-1.55) and of wheezing or asthma in ≥6-year-olds (OR: 1.22, 95% CI: 1.03-1.44). A positive association (OR: 1.24, 95% CI: 1.11-1.38) was also found in the only three studies that evaluated exposure to maternal prenatal smoking alone. Postnatal exposures to maternal/parental smoking were associated with wheezing in <6-year-olds (OR: 1.21; 95% CI: 1.13-1.31 and OR: 1.30; 95% CI: 1.13-1.51), although it was often impossible to separate the role of postnatal from that of prenatal exposure; data in schoolchildren are limited and this precluded a meta-analysis. No clear association was found between exclusive postnatal exposure and wheezing or asthma.

CONCLUSIONS

We confirmed an important role of prenatal exposure to maternal smoking on the induction of wheezing and asthma in offspring, particularly in the first years of life. More studies with a consistent number of subjects only exposed to smoke postnatally are needed to better investigate the harmful effects on the induction of wheezing or asthma, particularly in schoolchildren.

The diversity of young adult wheeze: a cluster analysis in a longitudinal birth cohort

BACKGROUND

Cluster analyses have enhanced understanding of the heterogeneity of both paediatric and adult wheezing. However, while adolescence represents an important transitional phase, the nature of young adult wheeze has yet to be clearly characterised.

OBJECTIVES

To use cluster analysis to define, for the first time, clinically relevant young adult wheeze clusters in a longitudinal birth cohort.

METHODS

K-means cluster analysis was undertaken among 309 currently wheezing subjects at 18 years in the Isle of Wight birth cohort (N = 1456). Thirteen disease-characterising clustering variables at 18 years were used. Resulting clusters were then further characterised by severity indices plus potential risk factors for wheeze development throughout the 1st 18 years of life.

RESULTS

Six wheeze clusters were identified. Cluster 1 (12.3%) male-early-childhood-onset-atopic-wheeze-with-normal-lung-function had male predominance, normal spirometry, low bronchodilator reversibility (BDR), intermediate bronchial hyper-responsiveness (BHR), high atopy prevalence and more admissions. Cluster 2 (24.2%) early-childhood-onset-wheeze-with-intermediate-lung-function had no specific sex association, intermediate spirometry, BDR, BHR, more significant BTS step therapy and admissions. Cluster 3 (9.7%) female-early-childhood-onset-atopic-wheeze-with-impaired-lung-function showed female predominance, high allergic disease comorbidity, more severe BDR and BHR, greatest airflow obstruction, high smoking prevalence, higher symptom severity and admissions. Cluster 4 (19.4%) female-undiagnosed-wheezers had adolescent-onset non-atopic wheeze, low BDR and BHR, impaired but non-obstructed spirometry, high symptom frequency and highest smoking prevalence. Cluster 5 (24.6%) female-late-childhood-onset-wheeze-with-normal-lung-function showed no specific atopy association, normal spirometry, low BDR, BHR and symptom severity. Cluster 6 (9.7%) male-late-childhood-onset-atopic-wheeze-with-impaired-lung-function had high atopy and rhinitis prevalence, increased BDR and BHR, moderately impaired spirometry, high symptom severity and higher BTS step therapy.

CONCLUSIONS AND CLINICAL RELEVANCE

Young adult wheeze is diverse and can be classified into distinct clusters. More severe clusters merit attention and are associated with childhood onset, atopy, impaired lung function and in some, smoking. Smoking-associated undiagnosed wheezers also merit recognition. Better understanding of young adult wheeze could facilitate better later adult respiratory health.

Dietary habits and prevalence of allergic rhinitis in 6 to 7-year-old schoolchildren in Turkey

BACKGROUND

The prevalence of allergic rhinitis and other allergies has risen worldwide. Dietary habits are considered to be among the potential risk factors. The aim of this study was to evaluate the prevalence of allergic rhinitis and its relationship with dietary habits and other risk factors among 6 to 7-year-old Turkish schoolchildren.

METHODS

In this cross-sectional study, a total of 11483 children aged 6-7 years were surveyed. The prevalence of symptoms of allergic rhinitis was assessed using the ISAAC protocol. Dietary information was collected using a food frequency questionnaire.

RESULTS

Of them, 9875 (50.7% M 49.3% F) questionnaires were appropriately completed. The prevalence rates of lifetime rhinitis, current rhinitis, current rhinoconjunctivitis and physician-diagnosed allergic rhinitis, were 44.3%, 29.2%, 8.5% and 8.1%, respectively. Consumption of rice, and cereals ≥3 times per week showed protective effect on physician-diagnosed allergic rhinitis (aOR = 0.53, 95% CI = 0.32-0.87 and aOR = 0.58, 95% CI = 0.36-0.92). Eating pasta, and chocolates ≥3 times per week showed protective effect on current rhinoconjunctivitis (aOR = 0.45, 95% CI = 0.25-0.79 and aOR = 0.50, 95% CI = 0.29-0.86). Eating lollipops, candies and animal fats ≥3 times per week was positively associated with current rhinoconjunctivitis (aOR = 1.47, 95% CI = 1.00-2.17 and aOR = 2.25, 95% CI = 1.11-4.56). Protective effect of the Mediterranean diet was not significant.

CONCLUSIONS

Frequent consumption of cereals, rice, pasta and chocolates may have beneficial effect on symptoms of rhinoconjunctivitis. Although dietary habits may affect the prevalence of symptoms of current rhinoconjunctivitis, the Mediterranean diet alone may not be protective against rhinoconjunctivitis.

Pathophysiological characterization of asthma transitions across adolescence

Background

Adolescence is a period of change, which coincides with disease remission in a significant proportion of subjects with childhood asthma. There is incomplete understanding of the changing characteristics underlying different adolescent asthma transitions. We undertook pathophysiological characterization of transitional adolescent asthma phenotypes in a longitudinal birth cohort.

Methods

The Isle of Wight Birth Cohort (N = 1456) was reviewed at 1, 2, 4, 10 and 18-years. Characterization included questionnaires, skin tests, spirometry, exhaled nitric oxide, bronchial challenge and (in a subset of 100 at 18-years) induced sputum. Asthma groups were “never asthma” (no asthma since birth), “persistent asthma” (asthma at age 10 and 18), “remission asthma” (asthma at age 10 but not at 18) and “adolescent-onset asthma” (asthma at age 18 but not at age 10).

Results

Participants whose asthma remitted during adolescence had lower bronchial reactivity (odds ratio (OR) 0.30; CI 0.10 -0.90; p = 0.03) at age 10 plus greater improvement in lung function (forced expiratory flow 25-75% gain: 1.7 L; 1.0-2.9; p = 0.04) compared to persistent asthma by age 18. Male sex (0.3; 0.1-0.7; p < 0.01) and lower acetaminophen use (0.4; 0.2-0.8; p < 0.01) independently favoured asthma remission, when compared to persistent asthma. Asthma remission had a lower total sputum cell count compared to never asthma (31.5 [25–75 centiles] 12.9-40.4) vs. 47.0 (19.5-181.3); p = 0.03). Sputum examination in adolescent-onset asthma showed eosinophilic airway inflammation (3.0%, 0.7-6.6), not seen in persistent asthma (1.0%, 0–3.9), while remission group had the lowest sputum eosinophil count (0.3%, 0–1.4) and lowest eosinophils/neutrophils ratio of 0.0 (Interquartile range: 0.1).

Conclusion

Asthma remission during adolescence is associated with lower initial BHR and greater gain in small airways function, while adolescent-onset asthma is primarily eosinophilic.

Electronic supplementary material

The online version of this article (doi:10.1186/s12931-014-0153-7) contains supplementary material, which is available to authorized users.

Integrated genome-wide association, coexpression network, and expression single nucleotide polymorphism analysis identifies novel pathway in allergic rhinitis

BACKGROUND

Allergic rhinitis is a common disease whose genetic basis is incompletely explained. We report an integrated genomic analysis of allergic rhinitis.

METHODS

We performed genome wide association studies (GWAS) of allergic rhinitis in 5633 ethnically diverse North American subjects. Next, we profiled gene expression in disease-relevant tissue (peripheral blood CD4+ lymphocytes) collected from subjects who had been genotyped. We then integrated the GWAS and gene expression data using expression single nucleotide (eSNP), coexpression network, and pathway approaches to identify the biologic relevance of our GWAS.

RESULTS

GWAS revealed ethnicity-specific findings, with 4 genome-wide significant loci among Latinos and 1 genome-wide significant locus in the GWAS meta-analysis across ethnic groups. To identify biologic context for these results, we constructed a coexpression network to define modules of genes with similar patterns of CD4+ gene expression (coexpression modules) that could serve as constructs of broader gene expression. 6 of the 22 GWAS loci with P-value ≤ 1x10-6 tagged one particular coexpression module (4.0-fold enrichment, P-value 0.0029), and this module also had the greatest enrichment (3.4-fold enrichment, P-value 2.6 × 10-24) for allergic rhinitis-associated eSNPs (genetic variants associated with both gene expression and allergic rhinitis). The integrated GWAS, coexpression network, and eSNP results therefore supported this coexpression module as an allergic rhinitis module. Pathway analysis revealed that the module was enriched for mitochondrial pathways (8.6-fold enrichment, P-value 4.5 × 10-72).

CONCLUSIONS

Our results highlight mitochondrial pathways as a target for further investigation of allergic rhinitis mechanism and treatment. Our integrated approach can be applied to provide biologic context for GWAS of other diseases.

Identifying the heterogeneity of young adult rhinitis through cluster analysis in the Isle of Wight birth cohort

BACKGROUND

Rhinitis affects many young adults and often shows comorbidity with asthma.

OBJECTIVE

We hypothesized that young adult rhinitis, like asthma, exhibits clinical heterogeneity identifiable by means of cluster analysis.

METHODS

Participants in the Isle of Wight birth cohort (n = 1456) were assessed at 1, 2, 4, 10, and 18 years of age. Cluster analysis was performed on those with rhinitis at age 18 years (n = 468) by using 13 variables defining clinical characteristics.

RESULTS

Four clusters were identified. Patients in cluster 1 (n = 128 [27.4%]; ie, moderate childhood-onset rhinitis) had high atopy and eczema prevalence and high total IgE levels but low asthma prevalence. They showed the best lung function at 18 years of age, with normal fraction of exhaled nitric oxide (Feno), low bronchial hyperresponsiveness (BHR), and low bronchodilator reversibility (BDR) but high rhinitis symptoms and treatment. Patients in cluster 2 (n = 199 [42.5%]; ie, mild-adolescence-onset female rhinitis) had the lowest prevalence of comorbid atopy, asthma, and eczema. They had normal lung function and low BHR, BDR, Feno values, and total IgE levels plus low rhinitis symptoms, severity, and treatment. Patients in cluster 3 (n = 59 [12.6%]; ie, severe earliest-onset rhinitis with asthma) had the youngest rhinitis onset plus the highest comorbid asthma (of simultaneous onset) and atopy. They showed the most obstructed lung function with high BHR, BDR, and Feno values plus high rhinitis symptoms, severity, and treatment. Patient 4 in cluster 4 (n = 82 [17.5%]; ie, moderate childhood-onset male rhinitis with asthma) had high atopy, intermediate asthma, and low eczema. They had impaired lung function with high Feno values and total IgE levels but intermediate BHR and BDR. They had moderate rhinitis symptoms.

CONCLUSION

Clinically distinctive adolescent rhinitis clusters are apparent with varying sex and asthma associations plus differing rhinitis severity and treatment needs.

Trends in eczema, rhinitis, and rye grass sensitization in a longitudinal asthma cohort

BACKGROUND

Atopic conditions are prevalent in the Western world, with limited long-term data on atopic trends in patients with asthma.

OBJECTIVE

To describe the trends in eczema, rhinitis, and allergic sensitization in a longitudinal childhood asthma cohort.

METHODS

Four hundred eighty-four patients were recruited at 7 years of age and followed regularly to 50 years of age. Subjects completed an interviewer-administered questionnaire to define current eczema and rhinitis. Skin prick testing to rye grass also was performed.

RESULTS

The participation rate over the past 4 decades has been maintained at 72% to 91%. There was a decrease in the prevalence of eczema in the past 12 months in groups with viral-associated wheeze (21% to 8%, P = .002), asthma (47% to 18%, P < .001), and severe asthma (69% to 28%, P < .001) from 14 to 21 years of age. Conversely, there was an increase in the prevalence of rhinitis in the previous 12 months in groups without asthma (1% to 6%, P = .04; 1% to 20%, P = .008), with viral-associated wheeze (16% to 28%, P = .006; 16% to 49%, P < .001), and with asthma (45% to 56%, P = .2; 45% to 73%, P = .014) from recruitment to 10 and 14 years of age, respectively. There were 2 peaks in prevalence in the sensitization to rye grass in this cohort from 7 to 10 years of age and from 14 to 21 years of age in all groups.

CONCLUSION

The adolescence phase appears to be an important period in the body's response to allergens whereby eczema decreases in prevalence, whereas rhinitis and rye grass sensitization increase in prevalence.

Active or passive exposure to tobacco smoking and allergic rhinitis, allergic dermatitis, and food allergy in adults and children: a systematic review and meta-analysis

BACKGROUND

Allergic rhinitis, allergic dermatitis, and food allergy are extremely common diseases, especially among children, and are frequently associated to each other and to asthma. Smoking is a potential risk factor for these conditions, but so far, results from individual studies have been conflicting. The objective of this study was to examine the evidence for an association between active smoking (AS) or passive exposure to secondhand smoke and allergic conditions.

METHODS AND FINDINGS

We retrieved studies published in any language up to June 30th, 2013 by systematically searching Medline, Embase, the five regional bibliographic databases of the World Health Organization, and ISI-Proceedings databases, by manually examining the references of the original articles and reviews retrieved, and by establishing personal contact with clinical researchers. We included cohort, case-control, and cross-sectional studies reporting odds ratio (OR) or relative risk (RR) estimates and confidence intervals of smoking and allergic conditions, first among the general population and then among children. We retrieved 97 studies on allergic rhinitis, 91 on allergic dermatitis, and eight on food allergy published in 139 different articles. When all studies were analyzed together (showing random effects model results and pooled ORs expressed as RR), allergic rhinitis was not associated with active smoking (pooled RR, 1.02 [95% CI 0.92-1.15]), but was associated with passive smoking (pooled RR 1.10 [95% CI 1.06-1.15]). Allergic dermatitis was associated with both active (pooled RR, 1.21 [95% CI 1.14-1.29]) and passive smoking (pooled RR, 1.07 [95% CI 1.03-1.12]). In children and adolescent, allergic rhinitis was associated with active (pooled RR, 1.40 (95% CI 1.24-1.59) and passive smoking (pooled RR, 1.09 [95% CI 1.04-1.14]). Allergic dermatitis was associated with active (pooled RR, 1.36 [95% CI 1.17-1.46]) and passive smoking (pooled RR, 1.06 [95% CI 1.01-1.11]). Food allergy was associated with SHS (1.43 [1.12-1.83]) when cohort studies only were examined, but not when all studies were combined. The findings are limited by the potential for confounding and bias given that most of the individual studies used a cross-sectional design. Furthermore, the studies showed a high degree of heterogeneity and the exposure and outcome measures were assessed by self-report, which may increase the potential for misclassification.

CONCLUSIONS

We observed very modest associations between smoking and some allergic diseases among adults. Among children and adolescents, both active and passive exposure to SHS were associated with a modest increased risk for allergic diseases, and passive smoking was associated with an increased risk for food allergy. Additional studies with detailed measurement of exposure and better case definition are needed to further explore the role of smoking in allergic diseases.

Breastfeeding and wheeze prevalence in pre-schoolers and pre-adolescents: the Genesis and Healthy Growth studies

BACKGROUND

To date, extensive research has been undertaken on a potential link of breastfeeding (BF) to wheezing illnesses. Nevertheless, an association remains to be established, partly due to age-dependent discrepancies and different definitions of exposures/outcomes across studies. We thus investigated the relation of diverse infantile feeding patterns with wheeze/asthma prevalence in two cohorts of children of different ages (preschool and preadolescent).

METHODS

Wheeze ever/in the last 12 months (current) and doctor-diagnosed asthma were retrospectively reported by parents of the participants of two cross-sectional studies: the Genesis study (1871 children aged 1-5) and the Healthy Growth study (1884 children aged 9-13). Information on feeding practices (exclusive breastfeeding vs. mixed vs. formula feeding) and their duration (2 vs. 4 vs. 6 months) was recorded. Perinatal and anthorpometric data were also collected.

RESULTS

In pre-schoolers, regimes that did not entail exclusive BF were positively correlated to current/ever wheeze, both before and after adjustment for confounders. No differences between the associations of regimes with 2, 4 or 6 months of exclusive BF with current/ever wheeze were shown. Furthermore, there was no consistent correlation of feeding practices with physician-diagnosed asthma. In pre-adolescents, no association of infantile feeding patterns with the wheeze/asthma outcomes was observed.

CONCLUSIONS

Exclusive BF is associated with reduced prevalence of current/ever wheeze in pre-schoolers; however, this appears to wane in older children. The association of a period of exclusive BF as low as 2 months with pre-school wheeze prevalence, appeared to be comparable with that of 6 months of exclusivity.

Effects of dietary habits and risk factors on allergic rhinitis prevalence among Turkish adolescents

BACKGROUND

Allergic rhinitis (AR) is a global health problem affecting many people from childhood to adulthood. The aim of this study was to evaluate the prevalence of AR and related symptoms, and to assess the risk factors, dietary habits and the Mediterranean diet affecting AR.

METHODS

In a cross-sectional study design, 9991 children, aged 13-14 years in 61 primary schools in 32 districts of Istanbul were evaluated. The prevalence of AR symptoms among the children was evaluated using the ISAAC protocol.

RESULTS

In our study, total of 10,984 questionnaires were distributed to 13-14yr-old schoolchildren to 61 schools in 32 district of Istanbul and 9991 questionnaires were suitable for analysis with an overall response of 91.7%. The rates of lifetime rhinitis, rhinitis in last 12 months and lifetime doctor diagnosed AR prevalence were 53.5%, 38.3% and 4.5%, respectively. The variation among districts in the prevalence of doctor diagnosed AR was very high. The highest prevalence was about 10 times higher than in the district with the lowest prevalence (range: 1.4-14.5) of Istanbul. A family history of atopy, mother with a university degree, presence of cat at home during last 12 months and adenoidectomy were significant for increased doctor diagnosed AR risk. Additionally, although fish and other sea foods, fermented drinks made from millets and various seeds, animal fats and butter were independent risk factors for doctor diagnosed AR, fish oil and hamburger were protective foods for doctor diagnosed AR. The MD was not associated with the prevalence of doctor diagnosed AR.

CONCLUSIONS

This study shows that that there are wide variations for the prevalence of AR related symptoms in 13-14yr-old schoolchildren among districts of Istanbul in Turkey. Socio-economical, environmental factors, some dietary habits, but not Mediterranean diet may affect the prevalence of AR.

Pet exposure and risk of atopic dermatitis at the pediatric age: a meta-analysis of birth cohort studies

BACKGROUND

Findings on pet exposure and the risk of atopic dermatitis (AD) in children are inconsistent.

OBJECTIVE

With the aim to summarize the results of exposure to different pets on AD, we undertook a meta-analysis of epidemiologic studies on this issue.

METHODS

In August 2012, we conducted a systematic literature search in Medline and Embase. We included analytic studies considering exposure to dogs, cats, other pets, or pets overall during pregnancy, infancy, and/or childhood, with AD assessment performed during infancy or childhood. We calculated summary relative risks and 95% CIs using both fixed- and random-effects models. We computed summary estimates across selected subgroups.

RESULTS

Twenty-six publications from 21 birth cohort studies were used in the meta-analyses. The pooled relative risks of AD for exposure versus no exposure were 0.72 (95% CI, 0.61-0.85; I(2) = 46%; results based on 15 studies) for exposure to dogs, 0.94 (95% CI, 0.76-1.16; I(2) = 54%; results based on 13 studies) for exposure to cats, and 0.75 (95% CI, 0.67-0.85; I(2) = 54%; results based on 11 studies) for exposure to pets overall. No heterogeneity emerged across the subgroups examined, except for geographic area.

CONCLUSION

This meta-analysis reported a favorable effect of exposure to dogs and pets on the risk of AD in infants or children, whereas no association emerged with exposure to cats.

Trends in cutaneous sensitization in the first 18 years of life: results from the 1989 Isle of Wight birth cohort study

BACKGROUND

Skin prick testing (SPT) is fundamental to the practice of clinical allergy identifying relevant allergens and predicting the clinical expression of disease. There are only limited data on the natural history of SPT results over childhood and adolescence.

OBJECTIVE

We aimed to describe the natural history of SPT and patterns of sensitization over childhood and adolescence.

METHODS

The 1989 Isle of Wight birth cohort (1456 participants) was followed up at 1, 2, 4, 10 and 18 years. SPT was undertaken from 4 years.

RESULTS

SPT was performed on 980 (80%), 1036 (75%) and 853 (65%) of participants at 4, 10 and 18 years. The prevalence of sensitization to any allergen at these time-points was 19.7%, 26.9% and 41.3% respectively. At each time-point, boys were significantly more likely to be sensitized (P < 0.016) and sensitization significantly increased over childhood and adolescence (average annual increase of 7%). Some children outgrew their sensitization. The rate of sensitization to most individual allergens increased over childhood and adolescence. A configural frequency analysis showed that whether an individual was sensitizated was relatively fixed over childhood and adolescence. Cluster analysis at 4 years demonstrated four major groups of individuals with similar co-sensitization to specific allergens. Children who were sensitized at age 4 years generally went onto become sensitized to additional allergens at 10 and 18 years.

CONCLUSIONS AND CLINICAL RELEVANCE

Allergic sensitization continues to increase over childhood into adolescence although the majority of children who were not sensitized at 4 years remain non-sensitized throughout childhood and adolescence. The presence of sensitization at 4 years predicted later sensitization to additional allergens.

Pollen aero allergens and the climate in Mediterranean region and allergen sensitivity in allergic rhinoconjunctivitis and allergic asthma patients

BACKGROUND

We evaluated the profiles of allergic rhino-conjunctivitis and asthma patients annually in Antalya, a Mediterranean coastal city in Turkey.

MATERIAL AND METHODS

We evaluated patients' allergic clinical status, and recorded the climate and pollens in the city center air, investigating any correlation between pollination, climatic conditions and allergic disorders. The meteorological conditions and the pollen count/cm2 during every month of the year and the concordance of this with the patient's clinical status were evaluated.

RESULTS

SPT positivity for plantago lanceolata, aspergillus fumigatus and d. pteronyssinus was significant in patients younger than 40 years old. Pollination levels are consistent from March 2010 to February 2011. In Antalya, high levels occur mostly from April to June, thus we performed skin prick tests mostly in May/June (~30%). During these months meteorological conditions of the city were windy with low humidity, without rain, and lukewarm temperatures, all of which contribute to high-risk conditions for seasonal allergies.

CONCLUSIONS

The major allergen between April and June was derived from Graminea; between February and March was Cupressus spp; and between March and June was Pinus spp. These results suggest that the pollination is correlated with allergic conditions and thus SPT might be best performed according to the pollen count.

Modes of infant feeding and the occurrence of coughing/wheezing in the first year of life

BACKGROUND

Controversies regarding infant feeding and childhood wheezing may result from insufficient differentiation among various feeding modes.

OBJECTIVES

We conducted prospective analyses of associations between the repeated ascertainment of feeding mode and wheezing in infancy.

METHODS

The Infant Feeding Practices Study II (2833 infants) provided data on coughing/wheezing episodes (CWEs) at 8 time points and feeding modes at 9 time points from months 1 to 12. Feeding modes were defined as direct breastfeeding, indirect breastfeeding (IBF, bottled breast milk), formula feeding (FF), and their combinations. In concurrent and delayed models using repeated measurements, the relative risks (RR) and their 95% confidence intervals (95% CI) of different feeding modes for CWEs were estimated. In the delayed models, only infants without symptoms were considered at risk for consequent CWE.

RESULTS

In a model with a 1-month delay, compared to direct breastfeeding, any other feeding mode showed a statistically significant risk for CWEs (IBF: RR = 1.69, 95% CI [1.05, 2.72]; FF: RR = 1.26, 95% CI [1.08, 1.47]; mixed breast feeding plus FF: RR = 1.25, 95% CI [1.01, 1.55]; and FF and direct breastfeeding: RR = 1.38, 95% CI [1.14, 1.68]). In a concurrent effect model, FF, the combination of FF and IBF, and mixed breastfeeding plus formula were risk factors (RR = 1.38, 95% CI [1.19, 1.59], RR = 1.83, 95% CI [1.27, 2.63], and RR=1.35, 95% CI [1.11, 1.65]; respectively).

CONCLUSIONS

Any mode of feeding that includes formula or bottled breast milk seems to be a moderate risk for cough or wheezing episodes in the first 12 months of life.

Understanding the evidence for and against the role of breastfeeding in allergy prevention

The relationship between breastfeeding and allergic disease risk has been controversial. This article reviews the current evidence for the role of breastfeeding in the prevention of allergic disease. We found considerable methodological limitations inherent in most studies evaluating the effect of breastfeeding in allergic disease. Nevertheless, since randomized control trials in breast feeding research would be considered unethical, the evidence remains limited to poorer quality observational studies where participation and recall bias can severely affect the objectivity of the data collected. Furthermore, reporting of type of breastfeeding (exclusive, full or partial) may be biased by a participant's inherent belief system of what they think they should be doing. Current evidence is inconclusive regarding the effect of breastfeeding on the development of eczema, with the most recent systemic review reporting no protective effect. There is insufficient data regarding the effects of breastfeeding on objective measures of food allergy at any age. Studies show a paradoxical effect of breastfeeding on the prevention of asthma, with an apparent protective effect against early wheezing illness in the first years of life yet an increased risk of asthma in later life; however, these findings must be interpreted with caution. Existing studies fail to adequately adjust for confounders, including the critical issues of protection against early life respiratory illnesses and reverse causation. Therefore, it is possible that the effect of breastfeeding on early wheezing illness reflects protection against respiratory infection, the predominant trigger of wheezing in early childhood, rather than a true reduction in risk of asthma. In summary, future research that takes into account the potential contribution of confounding factors and effect modifiers is needed to clarify the role of breastfeeding in development of allergic disease and to inform current clinical guidelines on the prevention of allergic disease.

The Role of Intraoperative Fluid Optimization Using the Esophageal Doppler in Advanced Gynecological Cancer: Early Postoperative Recovery and Fitness for Discharge

Objective

To determine the effect of fluid optimization using esophageal Doppler monitoring (EDM) when compared to standard fluid management in women who undergo major gynecological cancer surgery and whether its use is associated with reduced postoperative morbidity.

Methods

From January 2009 to December 2010, women undergoing laparotomy for pelvic masses or uterine cancer had either fluid optimization using intraoperative EDM or standard fluid replacement without using EDM. Cases were selected from 2 surgeons to control for variability in surgical practice. Demographic and surgical details were collected prospectively. Univariate and multivariate analyses were performed to quantify the association between the use of EDM with “early postoperative recovery” and “early fitness for discharge.”

Results

A total of 198 women were operated by the 2 prespecified surgeons; 79 women had fluid optimization with EDM, whereas 119 women had standard anesthetic care. The use of ODM was associated with earlier postoperative recovery (adjusted odds ratio, 2.83; 95% confidence interval, 1.20–6.68; P = 0.02) and earlier fitness for discharge (adjusted odds ratio, 2.81; 95% confidence interval, 1.01–7.78; P = 0.05). Women with advanced-stage disease in the “EDM” group resumed oral diet earlier than women in the “no EDM” group (median, 1 day vs 2 days; P = 0.02). These benefits with EDM did not extend to women with early-stage disease/benign/borderline tumors. No significant difference in postoperative complications was noted.

Conclusions

Intraoperative fluid optimization with EDM in women with advanced gynecological cancer may be associated with improved postoperative recovery and early fitness for discharge. Studies with adequate power are needed to investigate its role in reducing postoperative complications.

Food allergy and the development of asthma symptoms

Allergies are multifactorial diseases the onset of which depends also on genetic and environmental factors in early life. Thus, environmental factors can affect the immune response and modify lung development, thereby leading to asthma. The role of the factors used to date to predict asthma development is modest, and clinical criteria should always be considered in association with familiarity for atopy. The aim of this study is to evaluate the risk of asthma in a population with positive skin prick test (SPT) (which is a reliable marker of atopy) to food allergens, regardless of clinical manifestations in the early years of life. The cohort of children enrolled in our study who had a positive SPT to food in the first three years of life had a prevalence of asthma after 7-14 years, double that of the general pediatric population. This prevalence increased significantly in patients with SPT positivity for food and inhalant allergens. We identified a correlation between the sensitization profile in children under the age of 36 months and the development of asthma during a period of 7-14 years. This study confirms that early sensitization is an important risk factor for the development of asthma, particularly in association with sensitization to inhalants, and that the persistence of food sensitization in school-age children and adolescents is associated to more severe asthma.

Primary prevention of allergic disease through nutritional interventions

With the rising prevalence of atopic disease, primary prevention may play a role in reducing its burden, especially in high-risk infants. With this in mind, the Adverse Reactions to Foods Committee of the American Academy of Allergy, Asthma & Immunology was charged with the task of developing recommendations for primary care physicians and specialists about the primary prevention of allergic disease through nutritional interventions according to current available literature and expert opinion. Recommendations that are supported by data are as follows. Avoidance diets during pregnancy and lactation are not recommended at this time, but more research is necessary for peanut. Exclusive breast-feeding for at least 4 and up to 6 months is endorsed. For high-risk infants who cannot be exclusively breast-fed, hydrolyzed formula appears to offer advantages to prevent allergic disease and cow's milk allergy. Complementary foods can be introduced between 4 and 6 months of age. Because no formal recommendations have been previously provided about how and when to introduce the main allergenic foods (cow's milk, egg, soy, wheat, peanut, tree nuts, fish, shellfish), these are now provided, and reasons to consider allergy consultation for development of a personalized plan for food introduction are also presented.

The 'Hygiene hypothesis' and the sharp gradient in the incidence of autoimmune and allergic diseases between Russian Karelia and Finland

Autoimmune and allergic diseases have become a major health problem in the Western world during past decades. The hygiene hypothesis suggests that decreased microbial exposure in childhood leads to increasing prevalence of these diseases. This review summarizes epidemiological evidence and current immunological knowledge concerning the hygiene hypothesis. Recent results from Russian Karelia and Finland imply that environmental factors have greatly contributed to the increasing prevalence of immune-mediated disorders. Infections, or lack of them, may indeed be strongly involved in the development of both autoimmune and allergic diseases.

Interaction between IL13 genotype and environmental factors in the risk for allergic rhinitis in Korean children

BACKGROUND

The prevalence of allergic rhinitis (AR) is increasing worldwide. Allergic diseases develop in susceptible subjects when they are exposed to specific environmental factors.

OBJECTIVE

We analyzed changes in the prevalence of AR and identified genetic and environmental factors in early childhood that affect risk.

METHODS

We used the International Study of Asthma and Allergies in Childhood questionnaire to collect data on AR, allergies, and environmental exposures from 4554 elementary school students from 5 areas of Seoul, Korea, in 2008. We also obtained DNA from 1050 subjects from 1 area of Seoul for genotype analysis of IL13.

RESULTS

We identified genetic and environmental factors during infancy and early childhood that increased the risk for current AR (resulting in a diagnosis of AR and AR symptoms in the past 12 months) in elementary school-aged children. These included allergic disease in parents and antibiotic use in infants, allergic disease in parents and exposure of infants to mold, and allergic disease in parents and moving an infant to a newly built house. The risk of current AR also increased in subjects with GA or AA at nucleotide 2044 in IL13 who had been exposed to mold in the home during infancy (adjusted odds ratio, 3.27; 95% CI, 1.75-6.11) compared with subjects who had GG at this position and had not been exposed to mold (adjusted odds ratio, 3.27; 95% CI, 1.75-6.11).

CONCLUSION

The prevalence of AR is increasing in Korean children. Children with a family history of allergic disease and exposure to specific environmental risk factors during infancy are more likely to have AR. Children with GA or AA at IL13(+2044) are at increased risk for AR when exposed to mold in the home during the first year of life.

Soluble trail as a marker of efficacy of allergen-specific immunotherapy in patients with allergic rhinoconjunctivitis

BACKGROUND

Allergic rhinitis is a common health problem affecting the immune system. The homeostasis of the immune system is regulated by apoptosis. In this study, serum circulating soluble TRAIL levels of allergic rhinoconjunctivitis patients before and after allergen-specific immunotherapy were evaluated.

MATERIAL/METHODS

The sTRAIL levels of pre- and post-treated allergic rhinoconjunctivitis patients (n=25) were compared to age- and sex-matched healthy individuals (n=25). sTRAIL levels were measured by ELISA. The skin prick test (SPT) results were recorded before and after treatment.

RESULTS

The sTRAIL levels between the pre-treated and control groups were significantly different (p<0.0001). However, there was no significant difference between the post-treated group and healthy individuals (p=0,801). SPT was a statistically significant difference between the values of the research group before and after immunotherapy (grasses mixture, barley mixture, Oleaauropeae, D. Pteronyssinus, D. farinae).

CONCLUSIONS

The sTRAIL levels were decreased after allergen-specific immunotherapy to healthy levels and may be of use as a marker of efficacy of immunotherapy in allergic rhinoconjunctivitis patients.

Does eczema in infancy cause hay fever, asthma, or both in childhood? Insights from a novel regression model of sibling data

BACKGROUND

The atopic march hypothesis proposes that eczema precedes the development of asthma and allergic rhinitis.

OBJECTIVE

We sought to assess the evidence for a causal effect of infantile eczema on childhood hay fever, asthma, or both.

METHODS

We used parental reports on infantile eczema and childhood asthma and hay fever for 3778 pairs of 7-year-olds matched to their sibling closest in age within 2 years from the Tasmanian Longitudinal Health Study. We analyzed paired sibling data using a logistic regression model that allowed inference about a causal effect of a familial predictor on a child's outcome by examining the change in association with their cosibling's predictor after adjusting for their own predictor status.

RESULTS

Siblings were concordant for infantile eczema (tetrachoric correlation, 0.40). For having both hay fever and asthma by age 7 years, the association with cosibling's eczema was an odds ratio (OR) of 1.98 (95% CI, 1.37-2.86), which reduced after adjusting for own eczema to an OR of 1.65 (95% CI, 1.17-2.34). For having hay fever only, the association with cosibling's eczema was an OR of 1.68 (95% CI, 1.22-2.31) before and an OR of 1.59 (95% CI, 1.19-2.14) after adjusting for own eczema. There was no association between having asthma only and cosibling's eczema (OR, 1.00; 95% CI, 0.77-1.30).

CONCLUSIONS

Eczema in infancy might have a causal effect on hay fever in children with and perhaps without asthma. The association of infantile eczema on asthma in children without hay fever, which might be early transient wheeze, is unlikely to be causal or familial. These findings have implications for hay fever prevention.

The effect of parental allergy on childhood allergic diseases depends on the sex of the child

BACKGROUND

The parent-of-origin effect is important in understanding the genetic basis of childhood allergic diseases and improving our ability to identify high-risk children.

OBJECTIVE

We sought to investigate the parent-of-origin effect in childhood allergic diseases.

METHODS

The Isle of Wight Birth Cohort (n= 1456) has been examined at 1, 2, 4, 10, and 18 years of age. Information on the prevalence of asthma, eczema, rhinitis, and environmental factors was obtained by using validated questionnaires. Skin prick tests were carried out at ages 4, 10, and 18 years, and total IgE measurement was carried out at 10 and 18 years. Parental history of allergic disease was assessed soon after the birth of the child, when maternal IgE levels were also measured. Prevalence ratios (PRs) and their 95% CIs were estimated, applying log-linear models adjusted for confounding variables.

RESULTS

When stratified for sex of the child, maternal asthma was associated with asthma in girls (PR, 1.91; 95% CI, 1.34-2.72; P= .0003) but not in boys (PR, 1.29; 95% CI, 0.85-1.96; P= .23), whereas paternal asthma was associated with asthma in boys (PR, 1.99; 95% CI, 1.42-2.79; P< .0001) but not in girls (PR, 1.03; 95% CI, 0.59-1.80; P= .92). Maternal eczema increased the risk of eczema in girls (PR, 1.92; 95% CI, 1.37-2.68; P= .0001) only, whereas paternal eczema did the same for boys (PR, 2.07; 95% CI, 1.32-3.25; P = .002). Similar trends were observed when the effect of maternal and paternal allergic disease was assessed for childhood atopy and when maternal total IgE levels were related to total IgE levels in children at ages 10 and 18 years.

CONCLUSIONS

The current study indicates a sex-dependent association of parental allergic conditions with childhood allergies, with maternal allergy increasing the risk in girls and paternal allergy increasing the risk in boys. This has implications for childhood allergy prediction and prevention.

Development and comorbidity of eczema, asthma and rhinitis to age 12: data from the BAMSE birth cohort

BACKGROUND

Allergy-related diseases are a public health issue, but knowledge on development and comorbidity among children is scarce. The aim was to study the development of eczema, asthma and rhinitis in relation to sex and parental allergy, in a population-based cohort, during childhood.

METHODS

At 1, 2, 4, 8 and 12 years, parental questionnaires were used to obtain data on allergy-related diseases. Complete data for all five follow-up occasions were available from 2916 children. Odds ratios for the risk of any allergy-related disease in relation to heredity and sex were calculated using generalized estimating equations.

RESULTS

At 12 years, 58% of the children had had eczema, asthma and/or rhinitis at some time. Disease turnover was high for all three diseases throughout the study. Comorbidity increased with age, and at 12 years, 7.5% of all the children were affected by at least two allergy-related diseases. Parental allergy was associated with increased comorbidity and more persistent disease and increased the risk of having any allergy-related disease (adjusted OR 1.76; 95% CI 1.57-1.97) up to 12 years. Male sex was associated with an increased risk throughout childhood. Boys and girls did not differ in disease persistence, and for comorbidity, the differences were minor.

CONCLUSIONS

Allergy-related diseases may affect a majority of children. Eczema, asthma and rhinitis develop dynamically throughout childhood, and allergic comorbidity is common. These findings indicate that allergy-related diseases should be neither seen nor studied as isolated entities.

Prenatal and passive smoke exposure and incidence of asthma and wheeze: systematic review and meta-analysis

OBJECTIVES

Exposure to passive smoke is a common and avoidable risk factor for wheeze and asthma in children. Substantial growth in the prospective cohort study evidence base provides an opportunity to generate new and more detailed estimates of the magnitude of the effect. A systematic review and meta-analysis was conducted to provide estimates of the prospective effect of smoking by parents or household members on the risk of wheeze and asthma at different stages of childhood.

METHODS

We systematically searched Medline, Embase, and conference abstracts to identify cohort studies of the incidence of asthma or wheeze in relation to exposure to prenatal or postnatal maternal, paternal, or household smoking in subjects aged up to 18 years old. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were estimated by using random effects model.

RESULTS

We identified 79 prospective studies. Exposure to pre- or postnatal passive smoke exposure was associated with a 30% to 70% increased risk of incident wheezing (strongest effect from postnatal maternal smoking on wheeze in children aged ≤2 years, OR = 1.70, 95% CI = 1.24-2.35, 4 studies) and a 21% to 85% increase in incident asthma (strongest effect from prenatal maternal smoking on asthma in children aged ≤2 years, OR = 1.85, 95% CI = 1.35-2.53, 5 studies).

CONCLUSIONS

Building upon previous findings, exposure to passive smoking increases the incidence of wheeze and asthma in children and young people by at least 20%. Preventing parental smoking is crucially important to the prevention of asthma.

Validating childhood symptoms with physician-diagnosed allergic rhinitis

BACKGROUND

Multiple population-based and high-risk cohort studies use parental questionnaire responses to define allergic rhinitis (AR) in children. Individual questionnaire items have not been validated by comparison with physician-diagnosed AR (PDAR).

OBJECTIVE

To identify routine clinical questions that best agree with a physician diagnosis of AR and can be used for early case identification.

METHODS

Children participating in a longitudinal birth cohort study were evaluated at ages 1 through 4 and at age 7 (n = 531) using questionnaires, physical examinations, and skin prick tests (SPT) with 15 aeroallergens (AG). Parents answered 3 stem questions pertaining to their child, including presence of nasal symptoms absent a cold/flu (ISAAC-validated question), presence of hayfever, and ocular itch. Substem questions were answered with details regarding seasonality, nasal triggers, and ocular seasonality. A global assessment of allergic diseases, including AR, was performed by a specialty-trained clinician. Percent agreement, sensitivity, specificity, and positive predictive values were assessed for individual stem and substem questions.

RESULTS

Positive response to having hayfever and presence of ocular symptoms had the highest specificity (84% and 69%, respectively) and the highest percent agreement (74% and 68%) with PDAR. Identification of triggers for nasal and ocular symptoms had the highest sensitivity (89%). Positive predictive values ranged from 31 to 39%. Combining 2 responses with highest agreement increased specificity for PDAR to 91%.

CONCLUSION

Responses to hayfever and ocular symptoms had better specificity and percent agreement with PDAR than the ISAAC-validated questionnaire item. Combining 2 rhinitis questions sharply increases specificity and may improve diagnostic accuracy of clinical questions.

Characterisation of asthma that develops during adolescence; findings from the Isle of Wight Birth Cohort

BACKGROUND

Understanding of adolescent-onset asthma remains limited. We sought to characterise this state and identify associated factors within a longitudinal birth cohort study.

METHODS

The Isle of Wight Whole Population Birth Cohort was recruited in 1989 (N=1456) and characterised at 1, 2, 4, 10 and 18-years. "Adolescent-onset asthma" was defined as asthma at age 18 without prior history of asthma, "persistent-adolescent asthma" as asthma at both 10 and 18 and "never-asthma" as those without asthma at any assessment.

RESULTS

Adolescent-onset asthma accounted for 28.3% of asthma at 18-years and was of similar severity to persistent-adolescent asthma. Adolescent-onset asthmatics showed elevated bronchial hyper-responsiveness (BHR) and atopy at 10 and 18 years. BHR in this group at 10 was intermediate to that of never-asthmatics and persistent-adolescent asthma. By 18 their BHR, bronchodilator reversibility and sputum eosinophilia was greater than never-asthmatics and comparable to persistent-adolescent asthma. At 10, males who later developed adolescent-onset asthma had reduced FEV(1) and FEF(25-75), while females had normal lung function but then developed impaired FEV(1) and FEF(25-75) in parallel with adolescent asthma. Factors independently associated with adolescent-onset asthma included atopy at 10 (OR=2.35; 95% CI=1.08-5.09), BHR at 10 (3.42; 1.55-7.59), rhinitis at 10 (2.35; 1.11-5.01) and paracetamol use at 18-years (1.10; 1.01-1.19).

CONCLUSIONS

Adolescent-onset asthma is associated with significant morbidity. Predisposing factors are atopy, rhinitis and BHR at age 10 while adolescent paracetamol use is also associated with this state. Awareness of potentially modifiable influences may offer avenues for mitigating this disease state.

[Clinical manifestations of atopy in children up to two years of age]

BACKGROUND/AIM

Atopic diseases such as atopic dermatitis, allergic rhinitis and asthma have had increased prevalence during the past decade and nowadays occur in every third child in developed countries. The aim of the study was to determine frequency and type of atopic diseases at the age of two, as well as the importance the total IgE antibodies concentrations have in diagnosis and prognosis of the disease.

METHODS

The study involved 175 children up to two years of age. Allergy-like symptoms were found after surveying their parents and pediatric medical records. Using the fluorescence immunossay (FIA) method, total IgE antibodies concentrations and specific IgE antibodies (Phadiatop infant) were determined on an Immunocap 100 Dyagnostic System.

RESULTS

One or more allergy-like symptoms accounted for 57.7% of findings in children under the age of two, whilst in 19.4% the existence of IgE-related allergic diseases was found. Atopic diseases usually have clinical manifestations of atopic dermatitis (11.4%), IgE-bound wheezing/asthma (10.8%) and food allergies (7.4%), and to much lesser extent those of allergic rhinitis (3.4%) and urticaria (1.7%). The significantly higher total IgE antibodies concentrations were found in children with allergy-like symptoms (p < 0.0005) (cut-off 15.15 kU/L, sensitivity 76.5% specificity 71.6%).

CONCLUSION

Almost 20% of two-year-old children have any of clinically manifested allergic diseases, with atopic dermatitis and IgE wheeze/asthma being predominant. The higher total IgE antibodies concentration is a good marker for sensitization in children with allergy-like symptoms.

Does allergic rhinitis exist in infancy? Findings from the PARIS birth cohort

BACKGROUND

  Early onset of allergic rhinitis (AR) is poorly described, and rhinitis symptoms are often attributed to infections. This study analyses the relations between AR-like symptoms and atopy in infancy in the PARIS (Pollution and Asthma Risk: an Infant Study) birth cohort.

METHODS

  Data on AR-like symptoms (runny nose, blocked nose, sneezing apart from a cold) were collected using a standardized questionnaire administered during the health examination at age 18 months included in the follow-up of the PARIS birth cohort. Parental history of allergy and children's atopy blood markers (blood eosinophilia ≥470 eosinophils/mm(3) , total immunoglobulin E ≥45 U/ml and presence of allergen-specific IgE) were assessed. Associations were studied using multivariate logistic regression models adjusted for potential confounders.

RESULTS

  Prevalence of AR-like symptoms in the past year was 9.1% of the 1850 toddlers of the study cohort. AR-like symptoms and dry cough apart from a cold were frequent comorbid conditions. Parental history of AR in both parents increased the risk of suffering from AR-like symptoms with an OR 2.09 (P=0.036). Significant associations were found with the presence of concurrent biological markers of atopy, especially blood eosinophilia and sensitization to house dust mite (OR 1.54, P=0.046 and OR 2.91, P=0.042) whereas there was no relation with sensitization to food.

CONCLUSIONS

  These results support the hypothesis that AR could begin as early as 18 months of life. Suspicion of AR should be reinforced in infants with parental history of AR or biological evidence of atopy, particularly blood eosinophilia and sensitization to inhalant allergens.

Can sensitization to aeroallergens disappear over time in children with allergic disease?

BACKGROUND

Remittance of aeroallergen sensitization has been shown in population-based studies, but there is a common perception that sensitization to aeroallergens rarely if ever disappears in children with allergic disease.

METHODS

We retrospectively reviewed all specific IgE tests carried out in children aged 0-18 years at our hospital laboratory over a 14-year period. Of 3115 children sensitized to one or more aeroallergens, 244 (7.8%) were retested after a mean (SD) period of 45 (28) months at their physician's discretion.

RESULTS

Disappearance of sensitization to individual aeroallergens did occur, with remittance rates ranging from 3.1% for house dust mite to 17.5% for cat. However, complete remittance of aeroallergen sensitization was found in only one subject. In up to 35% of cases, remittance of sensitization was offset by the appearance of one or more new aeroallergen sensitizations. Remittance was only observed in children sensitized to multiple allergens (with a median of 3 aeroallergen sensitizations), and their median degree of sensitization was low (median 2.1 kU/L).

CONCLUSION

Aeroallergen sensitization can disappear in children with allergic disease, but only in polysensitized individuals. Complete remittance of sensitization to aeroallergens is rare in symptomatic children.

What are the risks associated with formula feeding? A re-analysis and review

BACKGROUND

Most infant feeding studies present infant formula use as "standard" practice, supporting perceptions of formula feeding as normative and hindering translation of current research into counseling messages supportive of exclusive breastfeeding. To promote optimal counseling, and to challenge researchers to use exclusive breastfeeding as the standard, we have reviewed the scientific literature on exclusive breastfeeding and converted reported odds ratios to allow discussion of the "risks" of any formula use.

METHODS

Studies indexed in PubMed that investigated the association between exclusive breastfeeding and otitis media, asthma, types 1 and 2 diabetes, atopic dermatitis, and infant hospitalization secondary to lower respiratory tract diseases were reviewed. Findings were reconstructed with exclusive breastfeeding as the standard, and levels of significance calculated.

RESULTS

When exclusive breastfeeding is set as the normative standard, the re-calculated odds ratios communicate the risks of any formula use. For example, any formula use in the first 6 months is significantly associated with increased incidence of otitis media (OR: 1.78, 95% CI: 1.19, 2.70 and OR: 4.55, 95% CI: 1.64, 12.50 in the available studies; pooled OR for any formula in the first 3 mo: 2.00, 95% CI: 1.40, 2.78). Only shorter durations of exclusive breastfeeding are available to use as standards for calculating the effect of "any formula use" for type 1 diabetes, asthma, atopic dermatitis, and hospitalization secondary to lower respiratory tract infections.

CONCLUSIONS

Exclusive breastfeeding is an optimal practice, compared with which other infant feeding practices carry risks. Further studies on the influence of presenting exclusive breastfeeding as the standard in research studies and counseling messages are recommended.

Development of atopic dermatitis in the DARC birth cohort

The aim was to describe the relapsing pattern, sensitization and prognosis of atopic dermatitis (AD) in the first 6 yr in a population-based, prospective birth cohort. The DARC cohort includes 562 children with clinical examinations, specific-IgE and skin prick test at all follow-ups. All children were examined for the development of AD using Hanifin-Rajka criteria and for food hypersensitivity by oral challenges. Severity of AD was measured by objective SCORing Atopic Dermatitis (SCORAD). Point-prevalence of AD peaked at 18 months of age (10%) and decreased at 36 and 72 months to slightly below 7%. The 6-yr cumulative incidence was 22.8% and sensitization was found in 43% of children with AD. It was predominately sensitization to foods, however shifting toward inhalant allergens with age. Sensitization at >or=2 follow-ups affected severity, whereas short-term sensitization at one follow-up does not. Children with early, non-IgE mediated (intrinsic) AD outgrew more often their eczema; however if they develop persistent AD, they remain intrinsic. Early long-term sensitization worsens the prognosis, but 38% of all children have a debut later than 18 months of age. Boys had earlier onset of AD than girls. The large number of follow-ups gives a detailed picture of the relapsing pattern and shows that the relapses occur independently of time of onset. We could not establish any clear correlation between elimination diets and AD duration nor severity.

High prevalence of sensitization to aeroallergens in children 4 yrs of age or younger with symptoms of allergic disease

The assumption that sensitization to aeroallergens is rare in preschool children is based on population studies in which most subjects have little or no symptoms of atopic disease. We assessed the prevalence of atopic sensitization in children 0 to 4 yr of age presenting with symptoms of allergic disease by reviewing results of all specific immunoglobulin (IgE) tests performed in our hospital laboratory in children 4 yr of age or younger between 1985 and 2003. Tests were ordered by general practitioners or hospital-based pediatricians in children presenting with symptoms of allergic disease. Specific IgE tests to a panel of common food and inhalant allergens were performed in 2946 children; a specific IgE concentration >0.35 kU/l was considered positive. Overall, 505 (17%) tests were positive to aeroallergens: 346 (12%) for house dust mite, 257 (9%) for dog dander, 240 (8%) for cat dander, and 197 (7%) for grass pollen. Positive tests were more common in boys (19.2%) than in girls (14.2%, p < 0.01), irrespective of age. Although sensitization to food allergens was more common in 0-<3 yr olds, aeroallergen and food allergen showed comparable prevalence rates in 3-<5 yr olds. Sensitization to aeroallergens is common in preschool children with symptoms of allergic disease, and more common in boys than in girls. Screening tests for allergy in infants and toddlers should include inhalant allergens.

Neonatal sepsis and later development of atopy

BACKGROUND

The role of infections on the development of atopy is still widely debated. We aimed to evaluate the effects of neonatal severe sepsis and consequent antibiotic treatment on the development of atopy and allergic diseases.

MATERIAL AND METHODS

A retrospective enrollment at school age of children with a clear history of neonatal sepsis (NS) was performed from registers of neonatal intensive care units. A normal control was assigned to each patient with sepsis. Thirty six cases with sepsis (18 males, 18 females) and 36 controls (21 males, 15 females) were selected (8.5+/-3.6 yrs). Physical examination and lung function evaluation were performed. Atopic status was verified by blood eosinophil count, total IgE serum level and skin prick tests (SPT).

RESULTS

SPT positivity for at least one allergen was present in 30% of subjects in both groups. No difference for all investigated parameters between groups and no influence by other factors such as familiarity or gender was observed. No correlation was associated to NS history.

CONCLUSIONS

Neonatal sepsis, even if clinically severe and dramatic, could represent an event too limited and really precocious in life to influence the development of immune response. Furthermore, other factors, besides infections, may influence the atopic future of newborns.

Infant feeding and allergy prevention: a review of current knowledge and recommendations. A EuroPrevall state of the art paper

The relationship between infant feeding patterns and the later development of food allergies has been the focus of much debate and research over the last decade. National recommendations have been made by many countries on how to feed infants to reduce the risk of food allergy but due to the lack of firm evidence the recommendations differ widely. This review has been developed as part of EuroPrevall, a European multicentre research project funded by the European Union, to document the differing feeding recommendations made across Europe, to investigate the current evidence base for any allergy prevention feeding recommendations and to identify areas where further research is needed. This review will also provide information which, when combined with the infant feeding data collected as part of EuroPrevall, will give an indication of compliance to national feeding guidelines which can be utilised to assess the effectiveness of current dissemination and implementation strategies.

Major increase in allergic sensitization in schoolchildren from 1996 to 2006 in northern Sweden

BACKGROUND

Time trends for allergic sensitization are poorly known.

OBJECTIVE

To compare the trends in prevalence of allergic sensitization and associated risk factors in children.

METHODS

Two cohorts of children (age 7-8 years) were invited for skin prick tests (SPTs) 10 years apart, 1996 and 2006. The participation rates were 2148 (88%) and 1700 (90%), respectively. The methods were identical, and 10 common airborne allergens were used. An expanded International Study of Allergy and Asthma in Children questionnaire about symptoms and possible risk factors for allergic conditions was completed by the parents.

RESULTS

The prevalence of any positive SPT increased from 21% in 1996 to 30% in 2006 (P < .001). The pattern of sensitization remained similar, and sensitization to cat was most common both years, 13% and 19%, respectively. Sensitization to mites and mold was uncommon in both surveys. A family history of allergy was a significant risk factor for a positive SPT both years (odds ratio, 1.7). Factors that in 1996 had a protective effect, such as rural living and having several siblings, had lost this effect in 2006. The prevalence of most risk factors remained similar, but respiratory infections and smoking among parents decreased significantly. During the same period, there was no significant increase in the prevalence of current wheeze (11.9% to 12.4%, P = .636) or symptoms of rhinitis or eczema.

CONCLUSION

The prevalence of allergic sensitization increased significantly from 1996 to 2006, whereas no increase in clinical symptoms was found. The parallel decrease in parental smoking and respiratory infections indicate a different influence of environmental factors on allergic sensitization and clinical symptoms, respectively.

Occurrence of parent-reported food hypersensitivities and food allergies among children aged 1-4 yr

Food allergies (FAs) and hypersensitivities (FHSs) have rarely been studied in large unselected child populations. This population-based cross-sectional survey estimated the occurrence of FHS as perceived by parents and that of FA diagnosed by a physician among children aged 1-4 yr in south-eastern Finland. Before the scheduled annual follow-up visit to the local child health clinic, the parents of children who were born between 1 April, 2001 and 31 March, 2005, and living in the Province of South Karelia (data from Finnish Population Register) were mailed a questionnaire containing items on the child's background, physician-diagnosed FAs and FHSs perceived by the parents. The questionnaires were returned during the visit. Three thousand three hundred and eight (69%) out of the 4779 questionnaires were returned. The lifetime prevalence of physician-diagnosed FAs was 9%. In an additional 21%, FHSs were perceived by the parents only. In a further 19% at least one food item had been eliminated from the diet without any perception of symptoms, this proportion having a downward trend by age. Physician-diagnosed FAs were more common in boys than in girls. Cow's milk was the most commonly reported cause of food-associated symptoms (13% of all children). One-third of the children aged 1-4 yr suffered from food-associated symptoms, and in an additional fifth at least one food item had been eliminated from their diet, implying that every other child had possibly been subjected to some form of elimination diet.

Trends in the epidemiology and prescribing of medication for eczema in England

BACKGROUND

The prevalence of eczema, particularly in younger children, increased substantially over the second half of the 20th century. Analysis of primary healthcare data-sets offers the possibility to advance understanding about the changing epidemiology of eczema.

AIM

To investigate recent trends in the recorded incidence, lifetime prevalence, prescribing and consulting behaviour of patients with eczema in England.

METHODS

QRESEARCH is one of the world's largest national aggregated health databases containing the records of over nine million patients. We extracted data on all patients with a recorded diagnosis of eczema and calculated annual age-sex standardized incidence and lifetime period prevalence rates for each year from 2001-2005. We also analysed the consulting behaviour of these patients when compared with the rest of the QRESEARCH database population. The number of eczema prescriptions issued to people in England was also estimated.

RESULTS

The age-sex standardized incidence of eczema was 9.58 per 1000 person-years in 2001 and increased to 13.58 per 1000 patients in 2005 (p<0.001). By 2005, eczema affected an estimated 5,773,700 (95% confidence intervals [CI] 5,754,100-5,793,400) individuals in England, who, on average, consulted a general practitioner 4.02 (95% CI 4.01-4.03) times a year. During the study period, the number of eczema related prescriptions increased by 56.6% (95% CI 56.6-56.7), so by 2005 an estimated 13,690,300 (95% CI 13,643,200-13,737,600) prescriptions were issued.

CONCLUSIONS

Recorded incidence and lifetime prevalence of eczema in England continue to increase. Similar increases have also been observed in the estimated number of eczema prescriptions issued to the English population.