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Balla J, Rathore APS, St. John AL. Maternal IgE Influence on Fetal and Infant Health. Immunol Rev 2025; 331:e70029. [PMID: 40281548 PMCID: PMC12032057 DOI: 10.1111/imr.70029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2025] [Accepted: 04/07/2025] [Indexed: 04/29/2025]
Abstract
Immunoglobulin E (IgE) is the most recently discovered and evolved mammalian antibody type, best known for interacting with mast cells (MCs) as immune effectors. IgE-mediated antigen sensing by MC provides protection from parasites, venomous animals, bacteria, and other insults to barrier tissues exposed to the environment. IgE and MCs act as inflammation amplifiers and immune response adjuvants. Thus, IgE production and memory formation are greatly constrained and require specific licensing. Failure of regulation gives rise to allergic disease, one of the top causes of chronic illness. Increasing evidence suggests allergy development often starts early in life, including prenatally, with maternal influence being central in shaping the offspring's immune system. Although IgE often exists before birth, an endogenous source of IgE-producing B cells has not been identified. This review discusses the mechanisms of maternal IgE transfer into the offspring, its interactions with offspring MCs and antigen-presenting cells, and the consequences for allergic inflammation and allergen sensitization development. We discuss the multifaceted effects of pre-existing IgG, IgE, and their glycosylation on maternal IgE transfer and functionality in the progeny. Understanding the IgE-mediated mechanisms predisposing for early life allergy development may allow their targeting with existing therapeutics and guide the development of new ones.
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Affiliation(s)
- Jozef Balla
- Programme in Emerging Infectious DiseasesDuke‐National University of Singapore Medical SchoolSingaporeSingapore
| | - Abhay P. S. Rathore
- Programme in Emerging Infectious DiseasesDuke‐National University of Singapore Medical SchoolSingaporeSingapore
- Department of PathologyDuke University Medical CenterDurhamNorth CarolinaUSA
| | - Ashley L. St. John
- Programme in Emerging Infectious DiseasesDuke‐National University of Singapore Medical SchoolSingaporeSingapore
- Department of PathologyDuke University Medical CenterDurhamNorth CarolinaUSA
- Department of Microbiology and Immunology, Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
- SingHealth Duke‐NUS Global Health InstituteSingaporeSingapore
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De Troeyer K, Grosso A, Heyvaert S, Somers B, Mendoza H, Bentouhami H, Hagendorens M, De Soomer K, Oostveen E, Verstraeten WW, Delcloo A, Aerts R, Casas L. Residential greenness and pollen exposure across gestational trimesters in relation to preschool wheezing: Results for the PIPO birth cohort. ENVIRONMENTAL RESEARCH 2025; 267:120646. [PMID: 39710235 DOI: 10.1016/j.envres.2024.120646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2024] [Revised: 11/30/2024] [Accepted: 12/15/2024] [Indexed: 12/24/2024]
Abstract
INTRODUCTION Previous studies on prenatal green space exposure and early respiratory health show inconsistent results. This may reflect stage-specific in utero effects and pollen influence. We examine associations of surrounding greenness and pollen exposure during pregnancy (overall and by trimester) with preschool wheezing, and assess potential mediation by pollen. METHODS We used data from the PIPO birth cohort (n = 860). Wheezing was reported biannually between 18 and 48 months of age. Residential greenness was measured with Normalized Difference Vegetation Index (NDVI) in 100 and 250 m buffer. Cumulative grass and birch pollen was estimated using modelled airborne pollen counts and categorized per trimester into no, low and high. All exposures were assessed for the overall pregnancy and per trimester. We used Generalized Estimated Equations to obtain odds ratios (OR) and 95% confidence intervals (CI). To assess mediation by pollen we used a data duplication algorithm with a generalized estimation approach. RESULTS Approximately 10% of participants wheezed. During pregnancy, greenness (OR = 1.07, CI: 1.05-1.08) and grass pollen exposure (OR = 1.09, CI: 1.03-1.15) increased the odds of wheezing, while birch pollen decreased it (OR = 0.86, CI:0.87-1.00). Per trimester, more greenness during the 2nd trimester increased the odds (OR = 1.21, CI: 1.16-1.26), whereas third-trimester greenness decreased it (OR = 0.87, CI: 0.84-0.91). Grass pollen exposure in the 1st and 3rd trimesters increased the odds of wheezing (OR = 1.23, CI: 1.12-1.34 and OR = 1.13, CI: 1.00-1.27, respectively), while birch pollen exposure in the 1st and 2nd trimesters decreased the odds (OR = 0.88, CI: 0.77-1.00 and OR = 0.83, CI: 0.73-0.95, respectively). No significant associations were found for greenness in the 1st trimester, grass pollen in the 2nd trimester, and birch pollen in the 1st and 3rd trimester. Mediation analysis showed large uncertainty. DISCUSSION Surrounding greenness and pollen exposure during pregnancy may impact the likelihood of preschool wheezing differently depending on the timing of exposure and the pollen type.
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Affiliation(s)
- Katrien De Troeyer
- Social Epidemiology and Health Policy, Department of Family Medicine and Population Health, University of Antwerp, Doornstraat 331, BE-2610, Wilrijk, Belgium.
| | - Alessandro Grosso
- Social Epidemiology and Health Policy, Department of Family Medicine and Population Health, University of Antwerp, Doornstraat 331, BE-2610, Wilrijk, Belgium
| | - Seppe Heyvaert
- Division Forest Nature and Landscape, University of Leuven (KU Leuven), Celestijnenlaan 200E, BE-3001, Leuven, Belgium
| | - Ben Somers
- Division Forest Nature and Landscape, University of Leuven (KU Leuven), Celestijnenlaan 200E, BE-3001, Leuven, Belgium
| | - Hilbert Mendoza
- Social Epidemiology and Health Policy, Department of Family Medicine and Population Health, University of Antwerp, Doornstraat 331, BE-2610, Wilrijk, Belgium
| | - Hayat Bentouhami
- Social Epidemiology and Health Policy, Department of Family Medicine and Population Health, University of Antwerp, Doornstraat 331, BE-2610, Wilrijk, Belgium
| | - Margo Hagendorens
- Department of Pediatrics, University Hospital Antwerp, Drie Eikenstraat 655, BE-2650, Edegem, Belgium
| | - Kevin De Soomer
- Department of Respiratory Medicine, Antwerp University Hospital, Drie Eikenstraat 655, BE-2650, Edegem, Belgium
| | - Ellie Oostveen
- Department of Respiratory Medicine, Antwerp University Hospital, Drie Eikenstraat 655, BE-2650, Edegem, Belgium
| | | | - Andy Delcloo
- Royal Meteorological Institute of Belgium, Ringlaan 3, BE-1180, Ukkel, Belgium; Department of Physics and Astronomy, Ghent University, Krijgslaan 281, BE-9000, Gent, Belgium
| | - Raf Aerts
- Division Ecology, Evolution and Biodiversity Conservation, University of Leuven (KU Leuven), Kasteelpark Arenberg 31-2435, BE-3001, Leuven, Belgium; Risk and Health Impact Assessment, Sciensano (Belgian Institute of Health), Rue Juliette Wytsmanstraat 14, BE-1050, Brussels, Belgium
| | - Lidia Casas
- Social Epidemiology and Health Policy, Department of Family Medicine and Population Health, University of Antwerp, Doornstraat 331, BE-2610, Wilrijk, Belgium; Institute for Environment and Sustainable Development (IMDO), Groenenborgerlaan 171, BE-2020, Antwerpen, Belgium; Laboratory of Applied Microbiology and Biotechnology (LAMB), Department of Bioscience Engineering, University of Antwerp, Groenenborgerlaan 171, BE-2020, Antwerpen, Belgium
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Lin YC, Wang LH, Wen HJ, Yang CY, Lee YL, Lee CC, Tsai EM, Huang SK, Leon Guo YL. Association of the AhR, ARNT, and AhRR gene polymorphisms and cord blood AhR levels with elevated cord blood IgE susceptibility in Taiwan mother-infant pairs: a nested case-control study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2024; 34:4150-4160. [PMID: 38590026 DOI: 10.1080/09603123.2024.2338896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 04/01/2024] [Indexed: 04/10/2024]
Abstract
The roles of aryl hydrocarbon receptor (AhR), AhR-nuclear translocator (ARNT), and AhR repressor (AhRR) genes in the elevation of cord blood IgE (CbIgE) remained unclear. Our aims were to determine the polymorphisms of AhR, ARNT, and AhRR genes, cord blood AhR (CBAhR) level, and susceptibility to elevation of CbIgE. 206 infant-mother pairs with CbIgE>=0.35 IU/ml and 421 randomly selected controls recruited from our previous study. Genotyping was determined using TaqMan assays. Statistical analysis showed AhR rs2066853 (GG vs. AA+AG: adjusted OR (AOR)=1.5, 95%CI=1.10-2.31 and AOR=1.60, 95%CI=1.06-2.43, respectively) and the combination of AhR rs2066853 and maternal total IgE (mtIgE)>=100 IU/ml were significantly correlated with CbIgE>=0.35 IU/ml or CbIgE>=0.5 IU/ml. CBAhR in a random subsample and CbIgE levels were significantly higher in infants with rs2066853GG genotype. We suggest that infant AhR rs2066853 and their interactions with mtIgE>=100 IU/ml significantly correlate with elevated CbIgE, but AhRR and ARNT polymorphisms do not.
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Affiliation(s)
- Ying-Chu Lin
- School of Dentistry, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Li-Hsuan Wang
- Division of Molecular Diagnosis, Department of Clinical Laboratory, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Hui-Ju Wen
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli County, Taiwan
| | - Chiu-Yueh Yang
- Department of Health Business Administration, Hungkuang University, Taichung, Taiwan
| | - Yung-Ling Lee
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Ching-Chang Lee
- Department of Environmental and Occupational Health, National Cheng Kung University, Tainan, Taiwan
| | - Eing-Mei Tsai
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shau-Ku Huang
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli County, Taiwan
| | - Yue-Liang Leon Guo
- Department of Environmental and Occupational Medicine, College of Medicine, National Taiwan University (NTU) and NTU Hospital, Taipei, Taiwan
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Lukkarinen M, Kirjavainen PV, Backman K, Gonzales-Inca C, Hickman B, Kallio S, Karlsson H, Karlsson L, Keski-Nisula L, Korhonen LS, Korpela K, Kuitunen M, Kukkonen AK, Käyhkö N, Lagström H, Lukkarinen H, Peltola V, Pentti J, Salonen A, Savilahti E, Tuoresmäki P, Täubel M, Vahtera J, de Vos WM, Pekkanen J, Karvonen AM. Early-life environment and the risk of eczema at 2 years-Meta-analyses of six Finnish birth cohorts. Pediatr Allergy Immunol 2023; 34:e13945. [PMID: 37102387 DOI: 10.1111/pai.13945] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 01/28/2023] [Accepted: 03/07/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND Urban-related nature exposures are suggested to contribute to the rising prevalence of allergic diseases despite little supporting evidence. Our aim was to evaluate the impact of 12 land cover classes and two greenness indices around homes at birth on the development of doctor-diagnosed eczema by the age of 2 years, and the influence of birth season. METHODS Data from 5085 children were obtained from six Finnish birth cohorts. Exposures were provided by the Coordination of Information on the Environment in three predefined grid sizes. Adjusted logistic regression was run in each cohort, and pooled effects across cohorts were estimated using fixed or random effect meta-analyses. RESULTS In meta-analyses, neither greenness indices (NDVI or VCDI, 250 m × 250 m grid size) nor residential or industrial/commercial areas were associated with eczema by age of 2 years. Coniferous forest (adjusted odds ratio 1.19; 95% confidence interval 1.01-1.39 for the middle and 1.16; 0.98-1.28 for the highest vs. lowest tertile) and mixed forest (1.21; 1.02-1.42 middle vs. lowest tertile) were associated with elevated eczema risk. Higher coverage with agricultural areas tended to associate with elevated eczema risk (1.20; 0.98-1.48 vs. none). In contrast, transport infrastructure was inversely associated with eczema (0.77; 0.65-0.91 highest vs. lowest tertile). CONCLUSION Greenness around the home during early childhood does not seem to protect from eczema. In contrast, nearby coniferous and mixed forests may increase eczema risk, as well as being born in spring close to forest or high-green areas.
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Affiliation(s)
- Minna Lukkarinen
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland
- Department of Paediatrics and Adolescent Medicine, University of Turku and Turku University Hospital, Turku, Finland
| | - Pirkka V Kirjavainen
- Department of Health Security, Finnish Institute for Health and Welfare, Kuopio, Finland
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Katri Backman
- Kuopio Birth Cohort (KuBiCo), University of Eastern Finland, Kuopio, Finland
- Department of Paediatrics, Kuopio University Hospital, Kuopio, Finland
| | | | - Brandon Hickman
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Sampo Kallio
- FLORA: New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Hasse Karlsson
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
- Department of Psychiatry, University of Turku and Turku University Hospital, Turku, Finland
| | - Linnea Karlsson
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland
- Department of Paediatrics and Adolescent Medicine, University of Turku and Turku University Hospital, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Leea Keski-Nisula
- Kuopio Birth Cohort (KuBiCo), University of Eastern Finland, Kuopio, Finland
- Department of Obstetrics and Gynaecology, Kuopio University Hospital, Kuopio, Finland
| | - Laura S Korhonen
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland
- Department of Paediatrics and Adolescent Medicine, University of Turku and Turku University Hospital, Turku, Finland
| | - Katri Korpela
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Mikael Kuitunen
- FLORA: New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anna Kaarina Kukkonen
- FLORA: New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Niina Käyhkö
- Department of Geography and Geology, University of Turku, Turku, Finland
| | - Hanna Lagström
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Heikki Lukkarinen
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland
- Department of Paediatrics and Adolescent Medicine, University of Turku and Turku University Hospital, Turku, Finland
| | - Ville Peltola
- Department of Paediatrics and Adolescent Medicine, University of Turku and Turku University Hospital, Turku, Finland
| | - Jaana Pentti
- Department of Public Health, University of Turku, Turku, Finland
- Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Anne Salonen
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Erkki Savilahti
- FLORA: New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Pauli Tuoresmäki
- Department of Health Security, Finnish Institute for Health and Welfare, Kuopio, Finland
| | - Martin Täubel
- Department of Health Security, Finnish Institute for Health and Welfare, Kuopio, Finland
| | - Jussi Vahtera
- Department of Public Health, University of Turku, Turku, Finland
| | - Willem M de Vos
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Juha Pekkanen
- Department of Health Security, Finnish Institute for Health and Welfare, Kuopio, Finland
- Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Anne M Karvonen
- Department of Health Security, Finnish Institute for Health and Welfare, Kuopio, Finland
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Kojima R, Shinohara R, Kushima M, Horiuchi S, Otawa S, Miyake K, Yokomichi H, Akiyama Y, Ooka T, Yamagata Z. Effect of birth season on allergic rhinitis and cedar pollinosis considering allergen and vitamin D exposure: The Japan Environment and Children's study (JECS). Allergol Int 2023:S1323-8930(23)00003-5. [PMID: 36725444 DOI: 10.1016/j.alit.2023.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 12/01/2022] [Accepted: 12/27/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The relationship between the season of birth, allergen sensitization, and allergic rhinitis have been inconsistent, and there are no studies that simultaneously consider vitamin D and allergen exposure. This study aimed to determine the associations between the season of birth, house dust mite (HDM) and Japanese cedar pollen (JCP) sensitization, and allergic rhinitis and pollinosis, while taking vitamin D levels and allergen exposure into account. METHODS This study included 4323 participants in the Sub-Cohort Study of the Japan Environment and Children's Study. A logistic regression model was used to analyze the association between the season of birth and sensitization to JCP or HDM (judged by specific immunoglobulin E) at age 2 and allergic rhinitis or pollinosis at age 3, adjusted for HDM or JCP exposure and vitamin D levels with potential confounders. RESULTS Participants born in spring or summer were more likely to have pollinosis than were those born in winter (adjusted odds ratio [aOR]: 2.08, 95% confidence interval [CI]: 1.13-3.82 for spring; aOR: 1.89, 95% CI: 1.03-3.47 for summer). Participants born in summer were more likely to have HDM sensitization than were those born in winter (Der p 1, aOR: 1.53, 95% CI: 1.10-2.15; Der f 1, aOR: 1.44, 95% CI: 1.03-2.01). Exposure to JCP and HDM were associated with pollinosis and HDM sensitization, respectively. CONCLUSIONS Spring and summer births were associated with the development of pollinosis, and summer birth was associated with HDM sensitization, even when vitamin D and allergen exposure were considered. Further studies on mechanisms other than vitamin D and allergen exposure are required.
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Affiliation(s)
- Reiji Kojima
- Department of Health Sciences, School of Medicine, University of Yamanashi, Yamanashi, Japan.
| | - Ryoji Shinohara
- Center for Birth Cohort Studies, University of Yamanashi, Yamanashi, Japan
| | - Megumi Kushima
- Center for Birth Cohort Studies, University of Yamanashi, Yamanashi, Japan
| | - Sayaka Horiuchi
- Center for Birth Cohort Studies, University of Yamanashi, Yamanashi, Japan
| | - Sanae Otawa
- Center for Birth Cohort Studies, University of Yamanashi, Yamanashi, Japan
| | - Kunio Miyake
- Department of Health Sciences, School of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Hiroshi Yokomichi
- Department of Health Sciences, School of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Yuka Akiyama
- Department of Health Sciences, School of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Tadao Ooka
- Department of Health Sciences, School of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Zentaro Yamagata
- Department of Health Sciences, School of Medicine, University of Yamanashi, Yamanashi, Japan; Center for Birth Cohort Studies, University of Yamanashi, Yamanashi, Japan
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Susanto NH, Lowe AJ, Salim A, Koplin JJ, Tang MLK, Suaini NHA, Ponsonby AL, Allen KJ, Dharmage SC, Erbas B. Associations between grass pollen exposures in utero and in early life with food allergy in 12-month-old infants. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2022; 32:712-722. [PMID: 32677468 DOI: 10.1080/09603123.2020.1793920] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 07/06/2020] [Indexed: 06/11/2023]
Abstract
Birth during pollen seasons may influence food allergy risk but no study has assessed pollen exposure. Using the HealthNuts population-based cohort of 5276 infants, we assessed grass pollen exposures, in utero and up to the first 6 months of life, on hen's egg, sesame and peanut allergy outcomes at 12 months. Cumulative pollen exposure in the first 7 days of life increased risk of peanut sensitization aMOR (adjusted multinomial odds ratio) = 1.21 (95% CI: 1.01-1.44). Exposure between first 4-6 months of life increased risk of hen's egg aMOR = 1.02 (95% CI: 1.004-1.04) and sensitization to all foods aMOR = 1.02 (95% CI: 1.003-1.04). Grass pollen exposure was associated with food challenge diagnosed food allergy, but only among infants with a maternal history of food allergy. Exposure to grass pollen in the intrauterine period and infancy may be important but more studies are needed to replicate these findings.
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Affiliation(s)
- Nugroho Harry Susanto
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
- Indonesia Research Partnership on Infectious Diseases (INA-RESPOND), Jakarta, Indonesia
| | - Adrian J Lowe
- Allergy and Lung Health Unit, School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Agus Salim
- Department of Mathematics and Statistics, La Trobe University, Melbourne, Australia
| | - Jennifer J Koplin
- Allergy and Lung Health Unit, School of Population and Global Health, The University of Melbourne, Melbourne, Australia
- The Murdoch Children's Research Institute, Parkville, Australia
| | - Mimi L K Tang
- The Murdoch Children's Research Institute, Parkville, Australia
- The Department of Paediatrics, University of Melbourne, Parkville, Australia
- The Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Australia
| | - Noor H A Suaini
- The Murdoch Children's Research Institute, Parkville, Australia
| | - Anne-Louise Ponsonby
- Allergy and Lung Health Unit, School of Population and Global Health, The University of Melbourne, Melbourne, Australia
- The Murdoch Children's Research Institute, Parkville, Australia
| | - Katrina J Allen
- The Murdoch Children's Research Institute, Parkville, Australia
- The Department of Paediatrics, University of Melbourne, Parkville, Australia
- The Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Australia
- The Institute of Inflammation and Repair, University of Manchester, Manchester, UK
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Bircan Erbas
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
- Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
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