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Herzig van Wees S, Abunnaja K, Mounier-Jack S. Understanding and explaining the link between anthroposophy and vaccine hesitancy: a systematic review. BMC Public Health 2023; 23:2238. [PMID: 37957574 PMCID: PMC10644591 DOI: 10.1186/s12889-023-17081-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 10/27/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Due to low vaccination uptake and measles outbreaks across Europe, public health authorities have paid increasing attention to anthroposophic communities. Public media outlets have further described these communities as vaccine refusers or "anti-vaxxers". The aim of this review was to understand the scope of the problem and explore assumptions about vaccination beliefs in anthroposophic communities. For the purpose of this review, we define anthroposophic communities as people following some/certain views more or less loosely connected to the philosophies of anthroposophy. The systematic review addresses three research questions and (1) collates evidence documenting outbreaks linked to anthroposophic communities, (2) literature on vaccination coverage in anthroposophic communities, and (3) lastly describes literature that summarizes theories and factors influencing vaccine decision-making in anthroposophic communities. METHODS This is a systematic review using the following databases: Medline, Web of Science, Psycinfo, and CINAHL. Double-blinded article screening was conducted by two researchers. Data was summarized to address the research questions. For the qualitative research question the data was analysed using thematic analysis with the assistance of Nvivo12.0. RESULTS There were 12 articles documenting 18 measles outbreaks linked to anthroposophic communities between the years 2000 and 2012. Seven articles describe lower vaccination uptake in anthroposophic communities than in other communities, although one article describes that vaccination coverage in low-income communities with a migrant background was lower than in the anthroposophic community they studied. We found eight articles examining factors and theories influencing vaccine decision making in anthroposophic communities. The qualitative analysis revealed four common themes. Firstly, there was a very broad spectrum of vaccine beliefs among the anthroposophic communities. Secondly, there was a consistent narrative about problems or concerns with vaccines, including toxicity and lack of trust in the system. Thirdly, there was a strong notion of the importance of making individual and well-informed choices as opposed to simply following the masses. Lastly, making vaccine choices different from public health guidelines was highly stigmatized by those outside of the anthroposophic community but also those within the community. CONCLUSION Continuing to further knowledge of vaccine beliefs in anthroposophic communities is particularly important in view of increasing measles rates and potential sudden reliance on vaccines for emerging diseases. However, popular assumptions about vaccine beliefs in anthroposophic communities are challenged by the data presented in this systematic review.
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Affiliation(s)
| | - Khadija Abunnaja
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Sandra Mounier-Jack
- Department of Global Health and Development, London School of Hygiene and Tropical, London, UK
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Wrenger J, Martin DD, Jenetzky E. Infants' immunisations, their timing and the risk of allergic diseases (INITIAL): an observational prospective cohort study protocol. BMJ Open 2023; 13:e072722. [PMID: 37355269 PMCID: PMC10314580 DOI: 10.1136/bmjopen-2023-072722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 06/11/2023] [Indexed: 06/26/2023] Open
Abstract
INTRODUCTION Vaccinations are considered to have a large impact on disease control, hence a multitude of vaccines in infancy is recommended. Retrospective studies suggest a possible relation between timing, kind or number of vaccines given in the first year of life and the subsequent incidence of allergic diseases. It must be clarified whether a causal relationship exists to ensure safety and reduce vaccine hesitancy. METHODS AND ANALYSIS Due to the high recommendation rate of vaccines, a long-term randomised controlled trial is not considered as ethically acceptable. Therefore, this study aims to observe prospectively the allergic incidence at the age of 5 years after various vaccine interventions in the early months of life.Parents of infants up to the age of 4-6 weeks will be recruited before the first recommended vaccination. Relevant prognostic factors for allergies, status of immunisation and general health will be evaluated up to the age of 5.Allergic symptoms will be assessed by the International Study of Asthma and Allergies in Childhood-questionnaire and a medical confirmation of the allergy is mandatory.The main objective is to compare the incidence of asthma, atopic dermatitis, rhinoconjunctivitis, food allergy or any of these atopies at the age of 5 between infants who were not vaccinated or were vaccinated according to recommendations in the first year of life.The sample size calculation with about 4000 participants can prove a 5% difference to the basic prevalence with about 80% power and global 5% alpha error for the five primary endpoints adjusting according to Bonferroni-Holm and assuming a rate of 10% not early vaccinated infants. ETHICS AND DISSEMINATION The study was registered (DRKS00029677) and has received approval by the ethics committee of Universität Witten/Herdecke (no. 113/2022). The results will be published.
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Affiliation(s)
- Jennifer Wrenger
- Faculty of Health/School of Medicine, Witten/Herdecke University, Witten, Germany
| | - David D Martin
- Faculty of Health/School of Medicine, Witten/Herdecke University, Witten, Germany
- University Children's Hospital, Tübingen University, Tübingen, Germany
| | - Ekkehart Jenetzky
- Faculty of Health/School of Medicine, Witten/Herdecke University, Witten, Germany
- Department for Child and Adolescent Psychiatry and Psychotherapy, Johannes Gutenberg University Mainz, Mainz, Germany
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Olin A, Acevedo N, Lakshmikanth T, Chen Y, Johansson C, Alm J, Scheynius A, Brodin P. Longitudinal analyses of development of the immune system during the first five years of life in relation to lifestyle. Allergy 2022; 77:1583-1595. [PMID: 35094423 DOI: 10.1111/all.15232] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 11/24/2021] [Accepted: 12/22/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Changes in immune cell composition during the immunological window within the first years after birth are not fully understood, especially the effect that different lifestyles might have on immune cell functionality. METHODS Peripheral blood mononuclear cells from mothers and their children at birth and at two anvd five years were analyzed by mass cytometry. Immune cell composition and functionality was analyzed according to family lifestyle (anthroposophic and non-anthroposophic). RESULTS We found no significant differences in the proportions of major immune lineages between anthroposophic and non-anthroposophic children at each time point, but there were clear changes over time in the proportions of mononuclear leukocytes, especially in B-cells and T lymphocytes. Phenotypic distances between cord blood and maternal blood were high at birth but decreased sharply the first two years, indicating strong phenotypic convergence with maternal cells. We found that children exhibited similar stimulation responses at birth, but subsequently segregated into two discrete functional trajectories. Trajectory 1 was associated with a decrease in tumor necrosis factor alpha (TNFa) production by CD4+ T- and NK-cells, while Trajectory 2 depicted an increase in the production of IL-2 and interferon gamma (INFg) by T-cells. In both trajectories, there was an increase in IL-17A production by T-cells resulting in prominent differences at five years of age. CONCLUSIONS This exploratory study suggests that leukocyte frequencies and cell phenotypes change with age in the same way across all children, while functional development follows one of two discrete trajectories that largely segregate by family lifestyle, supporting the hypothesis that early environmental exposures imprint immune cell function which may contribute to IgE sensitization. Our results also support that the first two years are critical for the environmental exposures to imprint the immune cells. Further studies with larger sample sizes are required to validate our findings.
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Affiliation(s)
- Axel Olin
- Science for Life Laboratory Department of Women’s and Children's Health Karolinska Institutet Stockholm Sweden
| | - Nathalie Acevedo
- Department of Clinical Science and Education Karolinska Institutet Stockholm Sweden
- Sachs' Children and Youth Hospital Södersjukhuset Stockholm Sweden
- Institute for Immunological Research University of Cartagena Cartagena Colombia
| | - Tadepally Lakshmikanth
- Science for Life Laboratory Department of Women’s and Children's Health Karolinska Institutet Stockholm Sweden
| | - Yang Chen
- Science for Life Laboratory Department of Women’s and Children's Health Karolinska Institutet Stockholm Sweden
| | - Catharina Johansson
- Department of Clinical Science and Education Karolinska Institutet Stockholm Sweden
- Sachs' Children and Youth Hospital Södersjukhuset Stockholm Sweden
| | - Johan Alm
- Department of Clinical Science and Education Karolinska Institutet Stockholm Sweden
- Sachs' Children and Youth Hospital Södersjukhuset Stockholm Sweden
| | - Annika Scheynius
- Department of Clinical Science and Education Karolinska Institutet Stockholm Sweden
- Sachs' Children and Youth Hospital Södersjukhuset Stockholm Sweden
- Science for Life Laboratory Karolinska Institutet Stockholm Sweden
| | - Petter Brodin
- Science for Life Laboratory Department of Women’s and Children's Health Karolinska Institutet Stockholm Sweden
- Department of Newborn Medicine Karolinska University Hospital Stockholm Sweden
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Korbely C, Weinberger A, Kutzora S, Huß J, Hendrowarsito L, Nennstiel U, Heißenhuber A, Herr C, Heinze S. Atopic diseases and airway-related symptoms in Bavarian pre-schoolers: determinants and association with immunization. Eur J Public Health 2021; 31:770-775. [PMID: 34436561 DOI: 10.1093/eurpub/ckab123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Atopic diseases are among the most common chronic conditions in childhood. Causes of allergies are manifold. The aim of this paper is to evaluate risk factors for atopic diseases and unremitting wheeze and to examine if there is an association between measles, mumps and rubella (MMR) vaccination and atopic dermatitis, asthma and unremitting wheeze in Bavarian pre-schoolers. METHODS Parents filled out a questionnaire on children's health and environmental and socioeconomic factors. The questionnaire was administered within the Health Monitoring Units in a cross-sectional study in Bavaria, Germany (2014/2015). Data on vaccinations were obtained via the School Entrance Examination, a mandatory examination for pre-school children in Bavaria. Rates of influential factors of atopic diseases and wheeze, MMR and DTP (diphtheria, pertussis and tetanus) vaccination were calculated for all children stratified by health outcomes. To examine if there is an association between MMR vaccination and health outcomes, a multiple logistic regression analysis was performed. RESULTS Data were available for 3237 individuals. Symptoms and diseases were more frequent in boys. Higher parental education was associated with a higher prevalence of atopic dermatitis. There were no significant associations between any of the health outcome groups and MMR vaccination in the multiple logistic regression models with adjustment for potential confounders. CONCLUSIONS The present study is in line with the current state of research that MMR vaccination is not associated with atopic diseases.
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Affiliation(s)
- Christine Korbely
- Institute for Medical Informatics, Biometry and Epidemiology (IBE) at the Ludwig-Maximilians-Universität München, Munich, Germany.,Pettenkofer School of Public Health, Munich, Germany.,Department of Occupational and Environmental Health/Epidemiology, Bavarian Health and Food Safety Authority, Munich, Germany
| | - Alisa Weinberger
- Department of Occupational and Environmental Health/Epidemiology, Bavarian Health and Food Safety Authority, Munich, Germany
| | - Susanne Kutzora
- Department of Occupational and Environmental Health/Epidemiology, Bavarian Health and Food Safety Authority, Munich, Germany
| | - Jonas Huß
- Department of Occupational and Environmental Health/Epidemiology, Bavarian Health and Food Safety Authority, Munich, Germany
| | - Lana Hendrowarsito
- Department of Occupational and Environmental Health/Epidemiology, Bavarian Health and Food Safety Authority, Munich, Germany
| | - Uta Nennstiel
- Bavarian Health and Food Safety Authority (LGL), Oberschleißheim, Germany
| | | | - Caroline Herr
- Department of Occupational and Environmental Health/Epidemiology, Bavarian Health and Food Safety Authority, Munich, Germany.,Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Hospital of the University of Munich, Munich, Germany
| | - Stefanie Heinze
- Department of Occupational and Environmental Health/Epidemiology, Bavarian Health and Food Safety Authority, Munich, Germany.,Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Hospital of the University of Munich, Munich, Germany
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Perez Chacon G, Ramsay J, Brennan-Jones CG, Estcourt MJ, Richmond P, Holt P, Snelling T. Whole-cell pertussis vaccine in early infancy for the prevention of allergy in children. Cochrane Database Syst Rev 2021; 9:CD013682. [PMID: 34693993 PMCID: PMC8543786 DOI: 10.1002/14651858.cd013682.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Atopic diseases are the most common chronic conditions of childhood. The apparent rise in food anaphylaxis in young children over the past three decades is of particular concern, owing to the lack of proven prevention strategies other than the timely introduction of peanut and egg. Due to reported in vitro differences in the immune response of young infants primed with whole-cell pertussis (wP) versus acellular pertussis (aP) vaccine, we systematically appraised and synthesised evidence on the safety and the potential allergy preventive benefits of wP, to inform recommendation for future practice and research. OBJECTIVES To assess the efficacy and safety of wP vaccinations in comparison to aP vaccinations in early infancy for the prevention of atopic diseases in children. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials, Ovid MEDLINE, Embase, and grey literature. The date of the search was 7 September 2020. SELECTION CRITERIA We included randomised controlled trials (RCTs) and non-randomised studies of interventions (NRSIs) that reported the occurrence of atopic diseases, and RCTs only to assess safety outcomes. To be included studies had to have at least six months follow-up, and involve children under 18 years old, who received a first dose of either wP (experimental intervention) or aP (comparator) before six months of age. DATA COLLECTION AND ANALYSIS Two review authors independently screened studies for eligibility, extracted the data, and assessed risk of bias using standard Cochrane methods. We assessed the certainty of the evidence using GRADE. Our primary outcomes were diagnosis of IgE-mediated food allergy and all-cause serious adverse events (SAEs). Secondary outcomes included: diagnosis of not vaccine-associated anaphylaxis or urticaria, diagnosis of asthma, diagnosis of allergic rhinitis, diagnosis of atopic dermatitis and diagnosis of encephalopathy. Due to paucity of RCTs reporting on the atopic outcomes of interest, we assessed a broader outcome domain (cumulative incidence of atopic disease) as specified in our protocol. We summarised effect estimates as risk ratios (RR) and 95% confidence intervals (CI). Where appropriate, we pooled safety data in meta-analyses using fixed-effect Mantel-Haenszel methods, without zero-cell corrections for dichotomous outcomes. MAIN RESULTS We identified four eligible studies reporting on atopic outcomes, representing 7333 children. Based on a single trial, there was uncertain evidence on whether wP vaccines affected the risk of overall atopic disease (RR 0.85, 95% CI 0.62 to 1.17) or asthma only (RR 1.04, 95% CI 0.59 to 1.82; 497 children) by 2.5 years old.Three NRSIs were judged to be at serious or critical risk of bias due to confounding, missing data, or both, and were ineligible for inclusion in a narrative synthesis. We identified 21 eligible studies (137,281 children) that reported the safety outcomes of interest. We judged seven studies to be at high risk of bias and those remaining, at unclear risk. The pooled RR was 0.94 for all-cause SAEs (95% CI 0.78 to 1.15; I2 = 0%; 15 studies, 38,072 children). For every 1000 children primed with a first dose of wP, 11 had an SAE. The corresponding risk with aP was 12 children (95% CI 9 to 13). The 95% CI around the risk difference ranged from three fewer to two more events per 1000 children, and the certainty of the evidence was judged as moderate (downgraded one level for imprecision). No diagnoses of encephalopathy following vaccination were reported (95% CI around the risk difference - 5 to 12 per 100,000 children; seven primary series studies; 115,271 children). The certainty of the evidence was judged as low, since this is a serious condition, and we could not exclude a clinically meaningful difference. AUTHORS' CONCLUSIONS There is very low-certainty evidence that a first dose of wP given early in infancy, compared to a first dose of aP, affects the risk of atopic diseases in children. The incidence of all-cause SAEs in wP and aP vaccinees was low, and no cases of encephalopathy were reported. The certainty of the evidence was judged as moderate for all-cause SAEs, and low for encephalopathy. Future studies should use sensitive and specific endpoints of clinical relevance, and should be conducted in settings with high prevalence of IgE-mediated food allergy. Safety endpoints should prioritise common vaccine reactions, parental acceptability, SAEs and their potential relatedness to the dose administered.
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Affiliation(s)
- Gladymar Perez Chacon
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia
- School of Public Health, Curtin University, Perth, Australia
| | - Jessica Ramsay
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia
| | | | - Marie J Estcourt
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Peter Richmond
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia
- Division of Paediatrics, The University of Western Australia, Perth, Australia
| | - Patrick Holt
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Tom Snelling
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
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Mikus M, Järnbert-Pettersson H, Johansson C, Nilsson P, Scheynius A, Alm J. Protein profiles in plasma: Development from infancy to 5 years of age. Proteomics Clin Appl 2021; 15:e2000038. [PMID: 33830667 DOI: 10.1002/prca.202000038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 03/31/2021] [Accepted: 04/01/2021] [Indexed: 11/10/2022]
Abstract
PURPOSE Little is known about the longitudinal development of different plasma protein levels during early childhood and particularly in relation to lifestyle factors. This study aimed to monitor the plasma proteome early in life and the influence of different lifestyles. EXPERIMENTAL DESIGN A multiplex bead-based immunoassay was used to analyze plasma levels of 97 proteins in 280 blood samples longitudinally collected in children at 6, 12, 24, and 60 months of age living in families with an anthroposophic (n = 15), partly anthroposophic (n = 27), or non-anthroposophic (n = 28) lifestyle. RESULTS A total of 68 proteins (70%) showed significantly altered plasma levels between 6 months and 5 years of age. In lifestyle stratified analysis, 59 of 97 (61%) proteins were altered over time within one or more of the three lifestyle groups. Nearly half of these proteins (28 out of 59) changed irrespective of lifestyle. The temporal changes represented four longitudinal trends of the plasma proteins during development, also following stratification of lifestyle. CONCLUSIONS AND CLINICAL RELEVANCE Our findings contribute to understand the development of the plasma proteome under the influence of lifestyle exposures in early childhood.
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Affiliation(s)
- Maria Mikus
- Department of Protein Science, Division of Affinity Proteomics, SciLifeLab, KTH Royal Institute of Technology, Stockholm, Sweden.,Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Hans Järnbert-Pettersson
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Catharina Johansson
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Peter Nilsson
- Department of Protein Science, Division of Affinity Proteomics, SciLifeLab, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Annika Scheynius
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,SciLifeLab, Karolinska Institutet, Stockholm, Sweden.,Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Johan Alm
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
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Boolchandani H, Horwitz R, Soffer G. An integrative medicine review of primary prevention of allergy in pediatrics. Complement Ther Med 2021; 58:102695. [PMID: 33636296 DOI: 10.1016/j.ctim.2021.102695] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 02/06/2021] [Accepted: 02/20/2021] [Indexed: 11/18/2022] Open
Abstract
The prevalence of allergic disease has been rapidly increasing in the developed world for over fifty years. The prevention of allergic disease remains one of the most elusive topics in medicine. Integrative medicine emphasizes prevention of disease and utilizes many interventions to help modify long-term outcomes of health. Primary prevention refers to the arrest of manifestations of a disease before they present clinically. Preventing allergy is not simply about preventing sensitization, but also about developing tolerance. This narrative review article will discuss integrative medicine approaches that may help to prevent atopic disease in the pediatric population. It is organized chronologically to aid in counseling patients: 1) prevention during pregnancy and 2) prevention after birth. While research into allergy prevention is in its infancy, Integrative Medicine is well-suited to provide many insights into the prevention and mitigation of atopic disease.
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Affiliation(s)
- Henna Boolchandani
- Yale University School of Medicine, Department of Pediatrics, New Haven, CT, United States.
| | - Randy Horwitz
- University of Arizona, Andrew Weil Center for Integrative Medicine, Tucson, AZ, United States
| | - Gary Soffer
- Yale University School of Medicine, Department of Pediatric Pulmonology, Allergy, Immunology and Sleep Medicine, New Haven, CT, United States
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Bayerl C, Herbst M. Impfung. AKTUELLE DERMATOLOGIE 2020. [DOI: 10.1055/a-1154-2597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- C. Bayerl
- Klinik für Dermatologie und Allergologie Wiesbaden, Helios, Dr. Horst Schmidt Kliniken, Hauttumorzentrum Wiesbaden
| | - M. Herbst
- Dr. med. Matthias Herbst & Kollegen, Hautärzte im Merckhaus, Darmstadt
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Abstract
The diagnosis of asthma can be particularly difficult in young children, in whom wheezing is not always synonym with asthma. It is also difficult to predict which preschool children with wheeze will go on to be true asthmatics. In this chapter, we will characterize preschool wheezing and asthma and discuss early risk factors for the development of severe asthma. We will also review risk factors for severe acute wheezing in young children. Finally, we will describe the natural history and prognosis of wheezing and some of the attempts at early identification of children who will develop severe asthma.
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Affiliation(s)
- Erick Forno
- Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA USA
| | - Sejal Saglani
- Imperial College London, National Heart & Lung Institute, London, UK
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10
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Nilsson LJ. No increased sensitization from early vaccination of infants: a prospective study of infant vaccination in anthroposophical families. EClinicalMedicine 2018; 4-5:8-9. [PMID: 31193625 PMCID: PMC6537531 DOI: 10.1016/j.eclinm.2018.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 11/16/2018] [Indexed: 11/26/2022] Open
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