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Ozkaya E, Sogut A, Küçükkoç M, Eres M, Acemoglu H, Yuksel H, Murat N. Sensitization pattern of inhalant allergens in children with asthma who are living different altitudes in Turkey. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2015; 59:1685-1690. [PMID: 25732843 DOI: 10.1007/s00484-015-0975-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 02/10/2015] [Accepted: 02/11/2015] [Indexed: 06/04/2023]
Abstract
Variability in children's allergic sensitization has been detected not only among different countries but also among cities within the same nation but yet different climatic areas. The aim of this study was to investigate the sensitization pattern of asthmatic children who lived in different altitude areas: the two largest Turkish cities, Istanbul (sea level) and Erzurum (high altitude). Five hundred and twelve asthmatic children (6-15 years old) from Istanbul (western Turkey, at sea level) and 609 from Erzurum (eastern Turkey, at an altitude of 1800 m) were included in the study. All participants underwent skin testing with common inhalant allergens, spirometry, total IgE level, and clinical examination. The positive sensitization ratio to aeroallergens in children with asthma living at sea level was statistically higher than that in children living in the high altitude group [p = 0.001, OR (odds ratio) 4.9 (confidence interval (CI) 3.67-6.459)]. However, pollen sensitization in asthmatic children living in high altitudes was significantly higher than that in children living at sea level [p = 0.00, OR 2.6 (CI 1.79-3.87)]. Children with asthma who live at high altitudes are characterized by higher pollen but lower mite sensitization rates than those living at sea level in Turkey. Different climatic conditions and altitudes may affect aeroallergen sensitization in children with asthma.
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Affiliation(s)
- Emin Ozkaya
- Division of Pediatric Allergy, Department of Pediatrics, Bezmialem Vakif University, Fatih, Istanbul, Turkey.
| | - Ayhan Sogut
- Division of Pediatric Allergy, Department of Pediatrics, Erzurum Regional Education and Research Hospital, Erzurum, Turkey
| | - Mehmet Küçükkoç
- Department of Pediatrics, Bezmialem Vakif University, Istanbul, Turkey
| | - Mustafa Eres
- Division of Pediatric Allergy, Department of Pediatrics, Erzurum Regional Education and Research Hospital, Erzurum, Turkey
| | - Hamit Acemoglu
- Department of Medical Education, Atatürk University School of Medicine, Erzurum, Turkey
| | - Hasan Yuksel
- Department of Pediatric Allergy and Pulmonology Unit, Celal Bayar University School of Medicine, Maniza, Turkey
| | - Naci Murat
- Faculty of Engineering, Department of Industry of Engineering, Ondokuz Mayıs University, Samsun, Turkey
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Abstract
Activation of receptors of the innate immune system is a critical step in the initiation of immune responses. It has been shown that dominant allergens have properties that could allow them to interact with toll-like and C-type lectin receptors to favour Th2-biased responses and many bind lipids and glycans that could associate with ligands to mimic pathogen-associated microbial patterns. In accord with the proposed allergen-specific innate interactions it has been shown that the immune responses to different allergens and antigens from the same source are not necessarily coordinately regulated.
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Affiliation(s)
- W R Thomas
- Centre for Child Health Research, University of Western Australia, Telethon Institute for Child Health Research, Subiaco, Western Australia, Australia.
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Riiser A, Hovland V, Carlsen KH, Mowinckel P, Lødrup Carlsen KC. Does bronchial hyperresponsiveness in childhood predict active asthma in adolescence? Am J Respir Crit Care Med 2012; 186:493-500. [PMID: 22798318 DOI: 10.1164/rccm.201112-2235oc] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
RATIONALE Bronchial hyperresponsiveness (BHR) is an important, but not specific, asthma characteristic. OBJECTIVES We aimed to assess the predictive value of BHR tested by methacholine and exercise challenge at age 10 years for active asthma 6 years later. METHODS From a Norwegian birth cohort, 530 children underwent methacholine challenge and exercise-induced bronchoconstriction (EIB) test (n = 478) at 10 years and structured interview and clinical examination at age 16 years. The methacholine dose causing 20% reduction in FEV(1) (PD(20)) and the reduction in FEV(1) (%) after a standardized treadmill test were used for BHR assessment. Active asthma was defined with at least two criteria positive: doctor's diagnosis of asthma, symptoms of asthma, and/or treatment for asthma in the last year. MEASUREMENTS AND MAIN RESULTS PD(20) and EIB at 10 years of age increased the risk of asthma (β = 0.94 [95% confidence interval (CI), 0.92-0.96] per μmol methacholine and β = 1.10 [95% CI, 1.06-1.15] per %, respectively). Separately the tests explained 10 and 7%, respectively, and together 14% of the variation in active asthma 6 years later. The predicted probability for active asthma at the age of 16 years increased with decreasing PD(20) and increasing EIB. The area under the curve (receiver operating characteristic curves) was larger for PD(20) (0.69; 95% CI, 0.62-0.75) than for EIB (0.60; 95% CI, 0.53-0.67). CONCLUSIONS BHR at 10 years was a significant but modest predictor of active asthma 6 years later, with methacholine challenge being superior to exercise test.
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Affiliation(s)
- Amund Riiser
- Department of Paediatrics, Oslo University Hospital, NO-0407 Oslo, Norway.
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Bakken HN, Nafstad P, Bolle R, Nystad W. Skin sensitization in school children in northern and southern Norway. J Asthma 2007; 44:23-7. [PMID: 17365200 DOI: 10.1080/02770900601034353] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
It has been suggested that environmental exposures and living conditions can explain some of the worldwide variation in atopic disorders. Norway has large environmental contrasts within the country. We compared skin prick sensitization rates among school children living in the southern subarctic and in the northern arctic part of Norway. Approximately one quarter of the children were sensitized, mostly against pollen and animal dander, while mite and mould sensitization seemed to be a minor problem. Sensitization rates and profiles were similar in the north and south despite differences in living conditions and environmental exposures.
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Affiliation(s)
- Heidi Nygaard Bakken
- Division of Epidemiology, The Norwegian Institute of Public Health, Oslo, Norway
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Kiechl-Kohlendorfer U, Horak E, Mueller W, Strobl R, Haberland C, Fink FM, Schwaiger M, Gutenberger KH, Reich H, Meraner D, Kiechl S. Living at high altitude and risk of hospitalisation for atopic asthma in children: results from a large prospective birth-cohort study. Arch Dis Child 2007; 92:339-42. [PMID: 17376940 PMCID: PMC2083677 DOI: 10.1136/adc.2006.106278] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Asthma is among the most common chronic diseases in childhood and is steadily increasing in prevalence. Better characterisation of factors that determine the risk of hospitalisation for atopic asthma in childhood may help design prevention programmes and improve our understanding of disease pathobiology. This study will focus on the altitude of residence. METHODS This is an ongoing prospective birth-cohort study that enrolled all live-born infants in the Tyrol. Between 1994 and 1999, baseline data were collected for 33 808 infants. From 2000 to 2005, all children hospitalised for atopic asthma at the age of > or =6 years (n = 305) were identified by a careful search of hospital databases. Disease status was ascertained from the typical medical history, a thorough examination and proof of atopy. RESULTS Living at higher altitude was associated with an enhanced risk of hospitalisation for atopic asthma (multivariate RRs (95% confidence interval 2.08 (1.45 to 2.98) and 1.49 (1.05 to 2.11) for a comparison between altitude categories > or =1200 m and 900-1199 m versus <900 m; p<0.001). This finding applied equally to hospital admissions in spring, summer, autumn and winter. When altitude of residence was analysed as a continuous variable, the risk for asthma hospitalisation increased by 7% for each 100-m increase in altitude (p = 0.013). CONCLUSIONS This large prospective study shows a significant association between the risk of hospitalisation for atopic asthma and altitude of residence between 450 and 1800 m. The underlying mechanisms remain to be elucidated, but it is tempting to speculate about a role for altitude characteristics such as the decline in outdoor temperature and air humidity and increase in ozone levels, which may trigger airway hyper-responsiveness and attenuate lung function.
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Affiliation(s)
- U Kiechl-Kohlendorfer
- Department of Paediatrics, Division of Neonatology, Innsbruck Medical University, Innsbruck, Austria.
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Joyner BL, Fiorino EK, Matta-Arroyo E, Needleman JP. Cardiopulmonary exercise testing in children and adolescents with asthma who report symptoms of exercise-induced bronchoconstriction. J Asthma 2007; 43:675-8. [PMID: 17092848 DOI: 10.1080/02770900600925460] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Patients with asthma often report symptoms of exercise-induced bronchoconstriction. We performed cardiopulmonary exercise testing to establish the cause of exercise limitation in patients with asthma, under treatment, who reported symptoms of exercise-induced bronchoconstriction. Ten of the 42 patients meeting criteria for inclusion in our study (24%) developed exercise-induced bronchoconstriction. Exercise limitation without exercise-induced bronchoconstriction was found in both obese and non-obese patients, suggesting that poor fitness is a problem independent of body habitus. Including cardiopulmonary exercise testing in the management of children with suspected exercise-induced bronchoconstriction would provide a better understanding of the etiology of their symptoms and facilitate more appropriate treatment.
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Affiliation(s)
- Benny L Joyner
- Division of Pediatric Respiratory and Sleep Medicine, Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York, USA.
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Lødrup Carlsen KC, Håland G, Devulapalli CS, Munthe-Kaas M, Pettersen M, Granum B, Løvik M, Carlsen KH. Asthma in every fifth child in Oslo, Norway: a 10-year follow up of a birth cohort study. Allergy 2006; 61:454-60. [PMID: 16512808 DOI: 10.1111/j.1398-9995.2005.00938.x] [Citation(s) in RCA: 127] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The western world's increase in childhood asthma is suggested to level off. We aimed to investigate asthma prevalence in 10-year-old children within the prospective birth cohort Environment and Childhood Asthma (ECA) Study in Oslo established in 1992/1993. SUBJECTS AND METHODS Six hundred and sixteen (77%) of 803 children (mean age 10.9 +/- 0.9 (SD) years) with lung function measurements at birth were reinvestigated at age 10 years. At birth they corresponded to the entire birth cohort (n = 3754) regarding gender, socio-demographic factors, parental allergic diseases, pet keeping and maternal smoking. Results from structured parental interview, spirometry, and skin prick test for inhalant and food allergens are presented. Asthma definition required minimum two positive criteria, (i) doctor's diagnosis of asthma, (ii) wheeze and/or chest tightness, (iii) use of anti-asthmatic treatment. Current asthma required asthma definition plus either (ii) and/or (iii) in the last 12 months, and/or > or = 10% fall in forced expired volume in 1 s after treadmill running. RESULTS Lifetime prevalence of asthma was 20.2%; current asthma 11.1%, doctor diagnosis of asthma 16.1% and wheezes ever 30.3%. Allergic sensitization (29.3% overall) was more common among children with current (56.3%) compared to asymptomatic (last 12 months) (26.0%) or no asthma (27.6%) (P < 0.001). Boys more often than girls had current asthma (14.4 vs 7.1%, P = 0.004), wheeze ever (36.9 vs 22.5%, P = 0.002) and allergic sensitization (36.2 vs 22.1%, respectively, P < 0.001). CONCLUSION Childhood asthma apparently continues to increase in Oslo, having affected every fifth 10-year-old child.
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Affiliation(s)
- K C Lødrup Carlsen
- Department of Paediatrics, Woman/child division, Ullevål University Hospital, Oslo, Norway
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Halász A, Cserháti E. The prognosis of bronchial asthma in childhood in Hungary: a long-term follow-up. J Asthma 2002; 39:693-9. [PMID: 12507189 DOI: 10.1081/jas-120015792] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The aim of this study was to determine the prognosis of bronchial asthma in childhood in Hungary. One hundred and forty five adults (96 men and 49 women) with a clinical history of childhood bronchial asthma were examined at the age of 28 years or above (mean age 37.6, SD 5.9 years). The patients completed questionnaires concerning their asthmatic and accompanying allergic symptoms in childhood, at the age of 18 and at present. They were all prick-tested with 12 inhalant allergens. The results showed that 42.8% of the patients had become symptom-free, but 57.2% still had intermittent or persisting asthmatic symptoms in adulthood. More patients had intermittent day-time (59%) and night-time (67%) asthmatic symptoms than persistent symptoms (41% and 33%). Accompanying allergic diseases (rhinitis, conjunctivitis, dermal and gastrointestinal diseases, and drug andfood allergies) in childhood did not definitely affect the prognosis of the bronchial asthma. The proportion of females with allergic diseases increased, and among patients with skin diseases it was significantly higher than the proportion of affected males. At the age of 18, allergic rhinitis was more frequent than in childhood. The frequencies of other allergic disorders did not change significantly. In the patients with asthmatic symptoms, molds and cat-hair allergies were more frequent than in the symptom-free group. The long-term prognosis of bronchial asthma in childhood in Hungary is relatively good, but fewer than half of the patients became symptom-free. The complaints of most of the patients were mild, but one in seven of all the adults suffered from moderate or serious bronchial asthma. Household allergens may contribute to the persistence of asthmatic symptoms.
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Affiliation(s)
- Adrienne Halász
- 1st Department of Paediatrics, Semmelweis University, Budapest, Hungary.
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Gourgoulianis KI, Brelas N, Hatziparasides G, Papayianni M, Molyvdas PA. The influence of altitude in bronchial asthma. Arch Med Res 2001; 32:429-31. [PMID: 11578758 DOI: 10.1016/s0188-4409(01)00302-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Some asthmatic children living in mountain areas experience significant improvement in daily symptoms and in the degree of bronchial obstruction. The aim of this study is to investigate the effect of altitude on the prevalence and morbidity of childhood bronchial asthma. METHODS A questionnaire regarding the history and symptoms of asthma was distributed to 874 children aged 6-12 years, to be completed by their parents with the help of their pediatrician. A total of 583 children lived at sea level, 180 at an altitude between 501 and 800 meters, and 111 at an altitude between 801 and 1,200 meters. All children with recurrent cough, shortness of breath, wheezing, and a history of bronchial asthma were considered to have bronchial asthma. RESULTS The prevalence of childhood bronchial asthma in the mountains (800-1,200 meters) was twice as low as that at sea level (15.8% of children) (p <0.01). Parental smoking was more frequent in children who lived at sea level than in the mountains. Additionally, consumption of fish and oranges was more frequent at sea level. Children with asthma who lived in the mountains were absent fewer days from school per year (0.2) and had fewer nights with dyspnea per year (0.5) than asthmatic children who lived at sea level (1.6 days and 25 nights, respectively). CONCLUSIONS Bronchial asthma in children who live at high altitudes is characterized by low prevalence and low morbidity.
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Affiliation(s)
- K I Gourgoulianis
- Pulmonary Department, Medical University of Thessaly, Larissa, Greece.
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Nja F, Røksund OD, Carlsen KH. Eosinophil cationic protein (ECP) in school children living in a mountainous area of Norway: a population-based study of ECP as a tool for diagnosing asthma in children with reference values. Allergy 2001; 56:138-44. [PMID: 11167374 DOI: 10.1034/j.1398-9995.2001.056002138.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Most previous studies on eosinophil cationic protein (ECP) have been performed on carefully selected groups of asthmatic patients. Few studies based upon population cohorts have been reported. The primary objective of the present study was to assess the usefulness of serum eosinophil cationic protein (s-ECP) in the diagnosis of asthma in schoolchildren and determine reference values based on measurements in healthy children. METHODS The population consisted of 216 schoolchildren (aged 7-16 years) who in a previous questionnaire had reported asthma or asthma-like symptoms and a control group. The questionnaire study comprised the entire population of schoolchildren in Upper Hallingdal. After clinical assessment, blood samples, and skin prick tests, these subjects were then reclassified into four groups: atopic and nonatopic asthmatic and nonasthmatics. S-ECP was assessed in relation to atopy, asthma severity, allergen exposure, and sex. RESULTS The asthma group (n = 105) had significantly higher mean s-ECP level than the nonasthma group (n = 111) (13.3 vs 8.3 microg/l, P < 0.001), with no significant difference between atopic asthmatics and atopic nonasthmatics. Mean s-ECP levels in children with mild, moderate, or severe asthma were 12.1, 18.5, and 12.2 microg/l, respectively. The children with animal dander allergy demonstrated higher levels of s-ECP than children without this allergy (12.9 vs 9.1 microg/l, P = 0.001). The upper reference limit (determined as the 95th percentile in healthy children) of 19.1 microg/l, showed low sensitivity (24%) and high specificity (93%) for the diagnosis of asthma. The positive and negative likelihood ratios for the asthma diagnosis were found to be 3.2 and 0.83, respectively. CONCLUSIONS The highest s-ECP values were found among children with moderate asthma. Animal dander allergy resulted in elevated s-ECP. However, mean values were still below the reference value of 19.1 microg/l, and the sensitivity was low, suggesting that s-ECP is not a useful parameter for diagnosing asthma in population-based studies.
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Affiliation(s)
- F Nja
- Geilomo Children's Hospital for Asthma and Allergy, Geilo and Sandvika, Norway
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