Association between birthplace, prevalence, and age of asthma onset in adults: a United States population-based study

Epidemiology of asthma across the ages

In the past 3 decades, the overall prevalence of asthma appears to be plateauing, although large geographic and socioeconomic variation is evident. Overall, asthma prevalence slightly decreased in most age groups, except for school-aged children. Of note, asthma mortality steadily decreased, potentially highlighting improved asthma management strategies. Several epidemiologic studies indicate that a complex interplay between genetic, environmental, and immunologic factors predisposes individuals to asthma inception and persistence across different life stages. Established risk factors for preschool wheezing to asthma persistence comprise a combination of pre- and post-natal parameters including the maternal history of asthma, prematurity, caesarian section, early-life respiratory infections, exposure to air pollution or tobacco smoke, and allergic polysensitization. On the other hand, persistence into adulthood is mainly driven by disease severity, allergic multimorbidity, relevant comorbidities, severe respiratory infections, and tobacco smoke exposure. It is evident that asthma prevention strategies do not fit a "one size fits all" concept and key environmental interventions should be tailored to different regions of the world. Undoubtedly, the heterogeneity of asthma as a disease is at least partly reflected in the reported epidemiologic measures, and continuing, methodologically rigorous studies will allow us to unravel some of the observed discrepancies.

The rising of allergic respiratory diseases in a changing world: from climate change to migration

INTRODUCTION

The rising of allergic respiratory diseases (ARDs) suggests a decisive role of environmental factors, that have dramatically changed in the last decades.

AREAS COVERED

This review addresses various aspects of the external exposome acting on the development, progression, clinical presentation and severity of ARDs. Climate change, air pollution and biodiversity loss act directly and through their complex interactions on atopic risk: reacent foundings on these aspects are discussed herein. The review also focuses on migration studies, underling the possible role of migrant status as an experimental model to study environment effects on atopy onset and progression.

EXPERT OPINION

Future perspective on this topic include prevention and mitigation strategies in regard to pollution and climate change, improvement of environmental monitoring methods, implementation of public health policies, further advances in 'omics' research and knowledge, prospective and immunological research on migrant populations and new policies to face human mobility.

Adult-Onset Atopic Dermatitis: Characteristics and Management

Recent epidemiological studies found the US prevalence of atopic dermatitis in adults to be approximately 7%. In particular, one in four adults with atopic dermatitis report adult onset of their disease. Adult-onset compared to child-onset atopic dermatitis is associated with distinct risk factors, lesional distribution and morphology, associated signs, genetics, and comorbidities. Adult-onset atopic dermatitis is a clinical diagnosis, and must be distinguished from other entities in the differential diagnosis, e.g., allergic contact dermatitis and cutaneous T-cell lymphoma. Further research is necessary to better understand the pathogenesis and optimal treatment approaches in adult-onset/recurrent atopic dermatitis.

Urban/rural residence effect on emergency department visits arising from food-induced anaphylaxis

BACKGROUND

Anaphylaxis is a severe and potentially fatal allergic response. Early-life exposure to rural environments may help protect against allergic reaction. This study assesses urban/rural differences by age and race/ethnicity in emergency department (ED) pediatric visit rates for food-induced anaphylaxis.

METHODS

This observational study examined 2009-2014 inpatient and ED data from New York and Florida, using ICD-9-CM diagnostic code (995.6) to identify food-induced anaphylaxis cases <18 y/o. Primary predictor of interest was urban/rural setting, with race/ethnicity and age also evaluated. Associations between ED visit rates and urban/rural setting were evaluated by multivariable hierarchical negative binomial regression with state and year fixed effects.

RESULTS

ED visit rates (per 100,000) for food-induced anaphylaxis were 12.31 and 4.60 in urban and rural settings, respectively. Rates were highest among Blacks (15.26) younger urban children (17.29) and older rural children (6.99). Compared to rural, urban children had significantly higher anaphalaxis ED visit rates (IRR 2.77).

CONCLUSIONS

Food-induced anaphylaxis ED visit rates were highest among younger urban children and Black children, with a notable contrast in age distribution between urban and rural rates. Higher urban rates may be attributed to Hygiene Hypothesis, though racial, economic and emergency care access disparities may also influence these outcomes.

Prevalence of and factors associated with adult-onset asthma in different ethnic groups: The HELIUS study

Little is known about adult-onset asthma in different ethnic groups. The aim of this study was to examine ethnic differences in the prevalence of adult-onset asthma and factors associated with this phenotype. Cross-sectional data of 23,356 participants of the HELIUS study were used, including Dutch, South-Asian Surinamese, African Surinamese, Moroccan, Turkish and Ghanaian origin participants. Adult-onset asthma was defined as: self-reported asthma symptoms or start of asthma-medication at age ≥18 years combined with a smoking history <10 pack years. The prevalence of adult-onset asthma and its association with potential risk factors were assessed by logistic regression analyses. The adjusted prevalence of adult-onset asthma was higher in the Turkish, Moroccan and South-Asian Surinamese groups (4.9-6.0%) compared to the Dutch, Ghanaian and African Surinamese origin groups (2.4-2.6%). In addition to ethnicity, age, female sex, BMI, and doctors' diagnosis of nasal allergy/hay fever and chronic sinusitis/polyps were independently associated with adult-onset asthma. There are significant differences in the adjusted prevalence of adult-onset asthma among six ethnic groups.

Phenotypical Differences of Childhood- and Adult-Onset Atopic Dermatitis

BACKGROUND

Little is known about adult-onset atopic dermatitis (AD).

OBJECTIVE

To determine the associations and clinical characteristics of adult-onset AD.

METHODS

A prospective study of 356 adults with AD (age ≥18 years) was performed using standardized questionnaires and examination. AD severity was assessed using the Patient-Oriented Eczema Measure, Eczema Area and Severity Index, Scoring Atopic Dermatitis, body surface area, and numeric rating scale for itch and sleeplessness. Latent class analysis was used to determine dominant clinical phenotypes. Multivariate logistic regression was used to determine the relationship between adult-onset AD and distinct phenotypes.

RESULTS

One hundred forty-nine adults (41.9%) reported onset of AD during adulthood, with 87 (24.4%) after the age of 50 years. Adult- versus childhood-onset AD was associated with birthplace outside the United States (χ2, P = .0008), but not sex, race/ethnicity, current smoking status, or alcohol consumption (P ≥ .11); and decreased personal history of asthma, hay fever, and food allergy and family history of asthma and food allergy (P ≤ .0001 for all). There was no significant difference in the Eczema Area and Severity Index, Scoring Atopic Dermatitis, body surface area, numeric rating scale for itch and sleeplessness, or Patient-Oriented Eczema Measure between adult- and childhood-onset AD (Mann-Whitney U test, P ≥ .10). Latent class analysis identified 3 classes: (1) high probability of flexural dermatitis and xerosis with intermediate to high probabilities of head, neck, and hand dermatitis; (2) high probability of flexural dermatitis and xerosis, but low probabilities of head, neck, and hand dermatitis; and (3) lower probability of flexural dermatitis, but the highest probabilities of virtually all other signs and symptoms. Adult-onset AD was significantly associated with class 1 (multivariate logistic regression; adjusted odds ratio, 5.54; 95% CI, 1.59-19.28) and class 3 (adjusted odds ratio, 14.03; 95% CI, 2.33-85.50).

CONCLUSIONS

Self-reported adult-onset AD is common and has distinct phenotypes with lesional predilection for the hands and/or head/neck.

The Influence of Asthma and/or Hay Fever on Pregnancy: Data from the 1995 National Survey of Family Growth

BACKGROUND

Asthma is associated with adverse pregnancy outcomes. At the same time there is a worldwide increase in asthma and hay fever.

OBJECTIVE

This study addresses whether asthma and/or hay fever adversely influence pregnancy outcomes.

METHODS

Data from the 1995 National Survey of Family Growth that include a history of diagnosed asthma, hay fever, and adverse pregnancy outcomes in 10,847 women representative of the US population aged 15 to 44 years were analyzed.

RESULTS

Women with the allergic phenotypes asthma and hay fever and hay fever only had no significant increase in adverse pregnancy outcomes (spontaneous pregnancy loss, preterm birth, infant low birth weight), whereas women with the nonatopic phenotype asthma only (without hay fever) did. The study did not evaluate endotypes.

CONCLUSIONS

This study provides new data that the allergic phenotypes, asthma and hay fever and hay fever only, are compatible with healthy pregnancy, whereas the nonatopic asthma phenotype, asthma only, adversely impacts pregnancy.

Outdoor Environment and Pediatric Asthma: An Update on the Evidence from North America

Introduction. The evidence about the association between asthma and outdoor environmental factors has been inadequate for certain allergens. Even less is known about how these associations vary across seasons and climate regions. We reviewed recent literature from North America for research related to outdoor environmental factors and pediatric asthma, with attention to spatial-temporal variations of these associations. Method. We included indexed literature between years 2010 and 2015 on outdoor environmental factors and pediatric asthma, by searching PubMed. Results. Our search resulted in 33 manuscripts. Studies about the link between pediatric asthma and traffic-related air pollutants (TRAP) consistently confirmed the correlation between TRAP and asthma. For general air pollution, the roles of PM_2.5 and CO were consistent across studies. The link between asthma and O₃ varied across seasons. Regional variation exists in the role of SO₂. The impact of pollen was consistent across seasons, whereas the role of polycyclic aromatic hydrocarbon was less consistent. Discussion. Recent studies strengthened the evidence about the roles of PM_2.5, TRAP, CO, and pollen in asthma, while the evidence for roles of PM_10-2.5, PM₁₀, O₃, NO₂, SO₂, and polycyclic aromatic hydrocarbon in asthma was less consistent. Spatial-temporal details of the environment are needed in future studies of asthma and environment.