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Laha A, Moitra S, Podder S. A review on aero-allergen induced allergy in India. Clin Exp Allergy 2023. [PMID: 36756731 DOI: 10.1111/cea.14266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 11/25/2022] [Accepted: 12/01/2022] [Indexed: 02/10/2023]
Abstract
Allergic diseases such as bronchial asthma, rhinitis and eczema are an important public health issue globally in 21st century. Their prevalence and impact in India is high, in terms of total numbers of people affected. Due to diverse climate and lifestyle, the Indian population is exposed to a rich and varied range of aerobiological particles. In the last two decades in India, 83 pollens, 34 fungi, six dust mite and 19 insect species were reported as allergenic, often contributing to heavy allergenic exposure in indoor and outdoor environments. There are currently few practitioners who offer allergy diagnosis and treatment in India, but there is active basic and molecular research aiming to improve the health of allergic patients. This review explores the field of aero-allergy in India during the last two decades, with special emphasis on prevalence across various centres and relevant scientific advances such as genetic associations and new therapeutics. This review will be helpful for clinicians to select aero-allergens for sensitisation testing in patients suffering from symptoms in different regions of India, and to support patients undertaking prophylaxis of allergic symptoms in India according to local environmental conditions. This study also helps to define patient selection for allergy testing and the role of test results in guiding allergic disease management in the Indian context. Finally, we summarize genetic findings relevant to aero-allergy in India and discuss the development of novel therapeutics for investigation and management of aero-allergy in India.
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Affiliation(s)
- Arghya Laha
- Ecology and Allergology Lab, Department of Zoology, The University of Burdwan, Bardhaman, West Bengal, India
| | - Saibal Moitra
- Apollo Multispecialty Hospitals, Kolkata, West Bengal, India
| | - Sanjoy Podder
- Ecology and Allergology Lab, Department of Zoology, The University of Burdwan, Bardhaman, West Bengal, India
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2
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Custovic A, de Moira AP, Murray CS, Simpson A. Environmental influences on childhood asthma: Allergens. Pediatr Allergy Immunol 2023; 34:e13915. [PMID: 36825741 DOI: 10.1111/pai.13915] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 01/19/2023] [Indexed: 02/15/2023]
Abstract
Allergen exposure is associated with the development of allergen-specific sensitization, but their relationship is influenced by other contemporaneous exposures (such as microbial exposure) and the genetic predisposition of the host. Clinical outcomes of the primary prevention studies that tested the effectiveness of allergen avoidance in pregnancy and early life on the subsequent development of sensitization and asthma published to date are inconsistent. Therefore, we cannot provide any evidence-based advice on the use of allergen avoidance for the primary prevention of these conditions. The evidence about the impact of allergen exposure among and among sensitized children with asthma is more consistent, and the combination of sensitization and high exposure to sensitizing allergen increases airway inflammation, triggers symptoms, adversely impacts upon disease control, and is associated with poorer lung function in preschool age. However, there are differing opinions about the role of inhalant allergen avoidance in asthma management, and recommendations differ in different guidelines. Evidence from more recent high-quality trials suggests that mite allergen-impermeable bed encasings reduce hospital attendance with asthma attacks and that multifaceted targeted environmental control improves asthma control in children. We therefore suggest a pragmatic approach to allergen avoidance in the management of childhood asthma for clinical practice, including the recommendations to: (1) tailor the intervention to the patient's sensitization and exposure status by using titer of allergen-specific IgE antibodies and/or the size of the skin test as indicators of potential response; (2) use a multifaceted allergen control regime to reduce exposure as much as possible; and (3) start intervention as early as possible upon diagnosis.
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Affiliation(s)
- Adnan Custovic
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | - Clare S Murray
- NIHR Manchester Biomedical Research Unit, Division of Immunology, Immunity to Infection, and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Angela Simpson
- NIHR Manchester Biomedical Research Unit, Division of Immunology, Immunity to Infection, and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK
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3
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Muamba Nkashama L, Kayembe Lubeji D, Mwanza Kasongo JC, Kadima Mutombo T, Nyembue Tshipukane D. Sensitization and Clinical Characteristics of Congolese Children with Vernal Keratoconjunctivitis in Kinshasa. Ocul Immunol Inflamm 2023; 31:15-20. [PMID: 34582304 DOI: 10.1080/09273948.2021.1976217] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Data on the sensitization pattern and clinical characteristics of pediatric vernal keratoconjunctivitis (VKC) are scary in Central Africa. This chronic form of allergic conjunctivitis affects the quality of school life and work productivity. There is no study that shows the breadth of vernal keratoconjunctivitis in our setting. PURPOSE To describe the clinical characteristics of vernal keratoconjunctivitis in Kinshasa, to evaluate the sensitization profile and associated factors. METHODS A total of 400 children with vernal keratoconjunctivitis underwent a clinical examination and a skin prick test (SPT) for 10 allergens. Dermatophagoides pteronyssinus, Blomia tropicalis and cockroach were the most common allergens in 52, 1 %, 18, 8% and 13% respectively among sensitized children and 66, 4% showed polysensitization. RESULTS The main symptoms were itchy eyes 45%, brownish discoloration conjunctiva 17%, red eyes 12, 2%, eyelids rubbing 11, 5%, tearing 8, 7% and photophobia 5, 5%.The limbic form was predominant with 54%, followed by palpebral form 26% and mixed form 20%. The most common complications were superficial punctate keratitis 17, 2%, shield ulcer 1, 5%, corneal plaque 1, 3% and corneal erosion 1%. CONCLUSION This study outlines that 34, 5% of children attending the outpatient Ophthalmology Department in two hospitals of Kinshasa for vernal keratoconjunctivitis disease had a positive skin prick test to at least one allergen, in particular for Dermatophagoides pteronyssinus, Blomia tropicalis and cockroach.
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Affiliation(s)
- Léon Muamba Nkashama
- Ophthalmology Department, University Hospital of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - David Kayembe Lubeji
- Ophthalmology Department, University Hospital of Kinshasa, Kinshasa, Democratic Republic of Congo
| | | | - Théodore Kadima Mutombo
- Masina Ophthalmology Hospital, National Eye Care Program, Kinshasa, Democratic Republic of Congo
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Brandt O, Wegenstein B, Müller I, Smith D, Nqweniso S, Adams L, Müller S, du Randt R, Pühse U, Gerber M, Navarini AA, Utzinger J, Daniel Labhardt N, Schindler C, Walter C. Association between allergic sensitization and intestinal parasite infection in schoolchildren in Gqeberha, South Africa. Clin Exp Allergy 2022; 52:670-683. [PMID: 35073608 PMCID: PMC9310757 DOI: 10.1111/cea.14100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/03/2022] [Accepted: 01/17/2022] [Indexed: 11/30/2022]
Abstract
Background Inconsistent data exist regarding the influence of parasitic infection on the prevalence of allergic sensitization and disorders. Objective To investigate the impact of geohelminth and protozoan infections on sensitization patterns and allergic symptoms of children living in low‐income communities in Gqeberha, South Africa. Methods In a cross‐sectional study, 587 schoolchildren aged 8–12 years were recruited in June 2016 and screened for reactivity to common allergens by skin prick tests (SPTs) and for parasitic infections by stool examination. Additionally, questionnaires were completed to record allergic symptoms the children may have experienced. Results Positive SPTs were found in 237/587 children (40.4%), and about one‐third of whom were polysensitized. Sensitizations were most frequently detected against the house dust mites (HDM) Dermatophagoides spp. (31.9%) and Blomia tropicalis (21.0%). Infections with geohelminths (Ascaris lumbricoides, Trichuris trichiura) were found in 26.8% and protozoan infections (Giardia intestinalis, Cryptosporidia spp.) in 13.9% of study participants. Mixed logistic regression analyses revealed negative associations between parasite infection and sensitization to Blomia tropicalis (OR: 0.54, 95% CI 0.33–0.89) and to Dermatophagoides spp. (OR 0.65, 95% CI 0.43–0.96), and between protozoan infection and allergic sensitization to any aeroallergen, although these associations were not significant when adjusted for false discovery. Geohelminth infection and intensity of geohelminth infection were both associated with reduced risk of polysensitization (OR 0.41, 95% CI 0.21–0.86), and this association remained significant with adjustment for false discovery. Reported respiratory symptoms were associated with HDM sensitization (ORs from 1.54 to 2.48), but not with parasite infection. Conclusions and clinical relevance Our data suggest that geohelminth infection and high geohelminth infection intensity are associated with a reduced risk of polysensitization.
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Affiliation(s)
- Oliver Brandt
- Department of Dermatology, Allergy Unit, University Hospital, University of Basel, Basel, Switzerland.,Department of Dermatology, University Hospital, University of Basel, Basel, Switzerland.,Pediatric Respiratory Medicine, Children's University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Benjamin Wegenstein
- Department of Dermatology, Allergy Unit, University Hospital, University of Basel, Basel, Switzerland.,Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Ivan Müller
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Danielle Smith
- Department of Human Movement Science, Nelson Mandela University, Ggeberha, South Africa
| | - Siphesihle Nqweniso
- Department of Human Movement Science, Nelson Mandela University, Ggeberha, South Africa
| | - Larissa Adams
- Department of Human Movement Science, Nelson Mandela University, Ggeberha, South Africa
| | - Simon Müller
- Department of Dermatology, University Hospital, University of Basel, Basel, Switzerland
| | - Rosa du Randt
- Department of Human Movement Science, Nelson Mandela University, Ggeberha, South Africa
| | - Uwe Pühse
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Markus Gerber
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Alexander A Navarini
- Department of Dermatology, University Hospital, University of Basel, Basel, Switzerland
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | | | | | - Cheryl Walter
- Department of Human Movement Science, Nelson Mandela University, Ggeberha, South Africa
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Raherison-Semjen C, Guilleminault L, Billiart I, Chenivesse C, De Oliveira A, Izadifar A, Lorenzo A, Nocent C, Oster JP, Padovani M, Perez T, Russier M, Steinecker M, Didier A. [Update of the 2021 recommendations for the management and follow-up of adult asthmatic patients under the guidance of the French Society of Pulmonology and the Paediatric Society of Pulmonology and Allergology. Long version]. Rev Mal Respir 2021; 38:1048-1083. [PMID: 34799211 DOI: 10.1016/j.rmr.2021.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 06/17/2021] [Indexed: 11/22/2022]
Affiliation(s)
- C Raherison-Semjen
- Université de Bordeaux, INSERM UMR 1219, Epicene Team, Bordeaux, France.
| | - L Guilleminault
- Pôle des voies respiratoires, CHU de Toulouse, Toulouse, France; Institut toulousain des maladies infectieuses et inflammatoires (Infinity), INSERM, UMR1291, CNRS UMR5051, université Toulouse III, CRISALIS F-CRIN, Toulouse, France
| | | | - C Chenivesse
- CHRU de Lille, service de pneumo-allergologie, 59000 Lille, France
| | - A De Oliveira
- Sorbonne université, département de médecine générale, Paris, France
| | - A Izadifar
- Département de pneumologie, centre cardiologique du Nord, Saint-Denis, France
| | - A Lorenzo
- Sorbonne université, département de médecine générale, Paris, France
| | - C Nocent
- CHG Côte Basque, Bayonne, France
| | - J P Oster
- Service de pneumologie, centre hospitalier Louis-Pasteur, Colmar, France
| | - M Padovani
- Espace Santé Ii, La Seyne-sur-Mer, France
| | - T Perez
- CHRU de Lille, service d'explorations fonctionnelles, 59000 Lille, France
| | - M Russier
- Service de pneumo-allergologie, CHR Orléans, Orléans, France
| | - M Steinecker
- Sorbonne université, département de médecine générale, Paris, France
| | - A Didier
- Université de Bordeaux, INSERM UMR 1219, Epicene Team, Bordeaux, France; Pôle des voies respiratoires, CHU de Toulouse, Toulouse, France
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Aheto JMK, Udofia EA, Kallson E, Mensah G, Nadia M, Nirmala N, Chatterji S, Kowal P, Biritwum R, Yawson AE. Prevalence, socio-demographic and environmental determinants of asthma in 4621 Ghanaian adults: Evidence from Wave 2 of the World Health Organization's study on global AGEing and adult health. PLoS One 2020; 15:e0243642. [PMID: 33296442 PMCID: PMC7725342 DOI: 10.1371/journal.pone.0243642] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 11/24/2020] [Indexed: 12/25/2022] Open
Abstract
Background A previous multi-site study involving lower- and middle-income countries demonstrated that asthma in older adults is associated with long-term exposure to particulate matter, male gender and smoking. However, variations may occur within individual countries, which are relevant to inform health promoting policies as populations live longer. The present study estimates asthma prevalence and examines the sociodemographic characteristics and environmental determinants associated with asthma in older adults in Ghana. Methods This study utilised data from the nationally representative World Health Organization Study on global AGEing and adult health (SAGE) Ghana Wave 2. A final sample of 4621 individuals residing in 3970 households was used in analytical modelling. Factors associated with asthma were investigated using single level and multilevel binary logistic regression models. Results Asthma was reported by 102 (2.2%) respondents. Factors associated with asthma in the univariate model were: those aged 60–69 (OR = 5.22, 95% CI: 1.24, 21.95) and 70 or more (OR = 5.56, 95% CI: 1.33, 23.26) years, Ga-Adangbe dialect group (OR = 1.65, 95% CI: 1.01, 2.71), no religion (OR = 3.59, 95% CI: 1.77, 7.28), having moderate (OR = 1.76, 95% CI: 1.13, 2.75) and bad/very bad (OR = 2.75, 95% CI: 1.58, 4.80) health state, and severe/extreme difficulty with self-care (OR = 3.49, 95% CI: 1.23, 9.88) and non-flush toilet facility (OR = 0.62, 95% CI: 0.39, 0.99). Factors independently associated with asthma in the adjusted models were: those aged 60–69 (OR = 4.49, 95% CI: 1.03, 19.55) years, father with primary education or less (OR = 0.40, 95% CI: 0.17, 0.94), no religion (OR = 2.52, 95% CI: 1.18, 5.41), and households with non-flush toilet facility (OR = 0.58, 95% CI: 0.35, 0.96). Significant residual household-level variation in asthma was observed. Over 40% of variance in asthma episodes could be attributable to residual household-level variations. Conclusion Individual as well as household factors were seen to influence the prevalence of asthma in this national survey. Clinical management of these patients in health facilities should consider household factors in addition to individual level factors.
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Affiliation(s)
- Justice Moses K. Aheto
- Department of Biostatistics, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
- * E-mail: ,
| | - Emilia A. Udofia
- Department of Community Health, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Eugene Kallson
- Deloitte Consulting, West Africa Deloitte & Touche, Accra, Ghana
| | - George Mensah
- Department of Community Health, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Minicuci Nadia
- National Research Council, Institute of Neuroscience, Padova, Italy
| | - Naidoo Nirmala
- World Health Organization HIS/HIS/MCS, Geneva, Switzerland
| | | | - Paul Kowal
- World Health Organization HIS/HIS/MCS, Geneva, Switzerland
- University of Newcastle Research Centre for Gender, Health and Ageing, Newcastle, Australia
| | - Richard Biritwum
- Department of Community Health, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Alfred E. Yawson
- Department of Biostatistics, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
- Department of Community Health, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
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Thiakane M, Bodilis H, Nakoulima A, Kane KF, Scheinmann P, Christophe D, Lezmi G. Allergic rhinitis in children with asthma in Dakar, Senegal: A descriptive study based on a doctor's diagnosis. Pediatr Pulmonol 2020; 55:2196-2197. [PMID: 32589790 DOI: 10.1002/ppul.24902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 06/10/2020] [Indexed: 11/08/2022]
Affiliation(s)
- Michel Thiakane
- Service de Pédiatrie Pneumologie et Allergologie, Hôpital Principal de Dakar, Dakar, Sénégal
| | - Hélène Bodilis
- AP-HP, Hôpital Necker-Enfants Malades, Service de Pneumologie et Allergologie Pédiatriques, Paris, France
| | - Aminata Nakoulima
- Service de Pédiatrie Pneumologie et Allergologie, Hôpital Principal de Dakar, Dakar, Sénégal
| | - Khadija Fall Kane
- Service de Pédiatrie Pneumologie et Allergologie, Hôpital Principal de Dakar, Dakar, Sénégal
| | - Pierre Scheinmann
- AP-HP, Hôpital Necker-Enfants Malades, Service de Pneumologie et Allergologie Pédiatriques, Paris, France
| | - Delacourt Christophe
- AP-HP, Hôpital Necker-Enfants Malades, Service de Pneumologie et Allergologie Pédiatriques, Paris, France.,Faculté de Médecine, Université de Paris, Paris, France
| | - Guillaume Lezmi
- AP-HP, Hôpital Necker-Enfants Malades, Service de Pneumologie et Allergologie Pédiatriques, Paris, France.,Faculté de Médecine, Université de Paris, Paris, France
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8
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Skin prick reactivity among asthmatics in East Africa. World Allergy Organ J 2020; 13:100130. [PMID: 32612738 PMCID: PMC7322185 DOI: 10.1016/j.waojou.2020.100130] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 05/06/2020] [Accepted: 05/14/2020] [Indexed: 12/17/2022] Open
Abstract
Background The burden of asthma in Africa is high, and yet the disease is not universally prioritised. Data on allergic asthma and its impact on asthma morbidity are limited in Africa. Our aim was to describe the distribution of skin prick positivity among asthmatics in Eastern Africa. Methods From August 2016 to May 2018, 1671 asthmatic patients were enrolled from Uganda, Kenya, and Ethiopia as part of the African Severe Asthma Program clinical study. Skin prick testing was performed at baseline using a panel of 12 allergens, and factors associated with skin prick reactivity determined. Results Of the 1, 671 patients recruited, 71% were female with a median age of 40 years, 93.6% were aged >15 years and the patterns of asthma symptom frequency was intermittent in 2.9%, mild persistent in 19.9%, moderate persistent in 42.6% and severe persistent in 34.6% at baseline. Self-reported triggers, were dust (92%), cold weather (89%), upper respiratory infections (84%), strong smells (79%) and exposure to tobacco (78%). The majority (90%) of the participants had at least 1 positive allergen reaction, with 0.9% participants reacting to all the 12 allergens. Participants commonly reacted to house dust mites (66%), Blomia tropicalis (62%), and the German cockroach (52%). Patients sensitized to more allergens (>2) had significantly reduced lung function (FEV ≤ 80%; p = 0.001) and were more likely to visit the emergency department due to asthma (p = 0.012). There was no significant relationship between number of allergens and measures of asthma control, quality of life, and other clinical outcomes. Only the country of origin was independently associated with atopy among African asthmatics. Conclusion There is a high prevalence of skin prick positivity among East African patients with asthma, with the commonest allergen being house dust mite. Skin reactivity did not correlate well with asthma severity and poor asthma control. The relation between atopy, measured through skin prick testing, and measures of asthma control among asthma patients in Eastern Africa is unclear and needs further study. Trial registration The ASAP study was registered prospectively. ClinicalTrials.gov Identifier: NCT03065920; Registration date: February 28, 2017; Last verified: February 28, 2017.
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Key Words
- A. fumigatus, Aspergillus fumigatus
- ACT, Asthma control test
- AQLQ, Asthma Quality of Life Questionnaire
- ASAP, African Severe Asthma Project
- Africa
- Allergy
- Asthma
- Atopy
- COPD, Chronic obstructive pulmonary disease
- East Africa
- FEV, Forced Expiratory Volume
- HIV, Human immunodeficiency virus
- IQR, Interquartile range
- Ig, Immunoglobulin
- SPT
- SPT, Skin prick testing
- TB, Tuberculosis
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Gao X, Yin M, Yang P, Li X, Di L, Wang W, Cui H, Yan X, Liu J. Effect of Exposure to Cats and Dogs on the Risk of Asthma and Allergic Rhinitis: A Systematic Review and Meta-analysis. Am J Rhinol Allergy 2020; 34:703-714. [PMID: 32564683 DOI: 10.1177/1945892420932487] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Controversies persist regarding whether exposure to cat or dog increases the risk of asthma and allergic rhinitis. OBJECTIVE This meta-analysis aimed to assess the associations between exposure to cats or dogs and the development of asthma and allergic rhinitis. METHODS A systematic review was performed to identify case-control and cohort studies before May 2019, evaluating the association between exposure to cats and dogs and the risk of asthma and rhinitis. The risk of bias was assessed using the Newcastle-Ottawa Scale. The odds ratios (ORs) and risk ratios (RRs) were pooled for case-control and cohort studies, respectively. Subgroup analyses were performed on prespecified study-level characteristics. RESULTS The meta-analysis of 34 cohort studies showed a protective role of exposure to cats [RR: 0.88, 95% confidence interval (CI): 0.77-0.99] or dogs (RR: 0.85, 95% CI: 0.73-0.97) in the development of asthma. The subgroup analysis of birth cohort (RR: 0.74, 95% CI: 0.56-0.93) and children population (RR: 0.83, 95% CI: 0.70-0.96) also suggested a favorable role of exposure to dogs in the development of asthma. Pooled evidence from 13 case-control studies indicated no significant impact of cats (OR: 1.66, 95% CI: 0.39-2.94) and dogs (OR: 1.22, 95% CI: 0.92-1.52) on the development of asthma. A pooled analysis of five cohort studies showed a favorable effect of exposure to cats (RR: 0.60, 95% CI: 0.33-0.86) or dogs (RR: 0.68, 95% CI 0.44-0.90) on the development of allergic rhinitis. CONCLUSION The findings indicated a protective effect of exposure to cats and dogs, especially ownership, on the development of asthma and allergic rhinitis.
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Affiliation(s)
- Xiaoping Gao
- Department of Otorhinolaryngology Head and Neck Surgery, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Mei Yin
- Department of Respiratory and Critical Care Medicine, the Cardiovascular and Cerebrovascular Disease, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Pei Yang
- Department of Otorhinolaryngology Head and Neck Surgery, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Xia Li
- Department of Otolaryngology, The Third People's Hospital of Yinchuan, Yinchuan, China
| | - Lingling Di
- Department of Otorhinolaryngology Head and Neck Surgery, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Wei Wang
- Department of Otorhinolaryngology Head and Neck Surgery, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Hua Cui
- Department of Respiratory and Critical Care Medicine, the Cardiovascular and Cerebrovascular Disease, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Xiaohui Yan
- Department of Otorhinolaryngology Head and Neck Surgery, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Jing Liu
- Department of Otorhinolaryngology Head and Neck Surgery, General Hospital of Ningxia Medical University, Yinchuan, China
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10
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Arrais M, Lulua O, Quifica F, Rosado-Pinto J, Gama JM, Brito M, Taborda-Barata L. Sensitisation to aeroallergens in relation to asthma and other allergic diseases in Angolan children: a cross-sectional study. Allergol Immunopathol (Madr) 2020; 48:281-289. [PMID: 32035729 DOI: 10.1016/j.aller.2019.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 10/06/2019] [Accepted: 10/17/2019] [Indexed: 02/05/2023]
Abstract
INTRODUCTION AND OBJECTIVES In Africa, few studies of sensitisation profiles have been performed in children or adolescents and, in Angola, there are none. The objectives of the present study were to assess the sensitisation profile of Angolan schoolchildren and to determine the relationship between that pattern, sociodemographic factors, asthma and other allergic diseases. MATERIALS AND METHODS Cross-sectional, observational study in 5-14-year-old children, performed between September and November 2017, in the Province of Bengo, Angola. Five schools (15%) were randomly selected in the geographical area of the study: three from an urban area, and two from a rural area. Data were collected using the Portuguese versions of the ISAAC questionnaires for children and adolescents, regarding asthma, rhinitis and eczema. Skin prick tests (SPT) were performed with a battery of 12 aeroallergens. Stools were assessed for the presence of helminths. Descriptive statistics were used, as well as univariate calculation of odds ratios. RESULTS Sensitisation to aeroallergens was low (8%) and most sensitised children were asymptomatic. Most frequent sensitisations involved house dust mites, cockroach or fungi, and a high proportion of children (78.1%) were monosensitised. No relationship was detected between sensitisations and asthma, rhinitis or eczema. Place of residence, gender, age or helminthic infection did not affect the probability of having positive SPTs. CONCLUSIONS The most frequent sensitisations in children from Bengo Province in Angola involve house dust mites, followed by cockroach and fungi. No relationship was found between atopic sensitisation and asthma or other allergic diseases.
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11
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Turkalj M, Drkulec V, Haider S, Plavec D, Banić I, Malev O, Erceg D, Woodcock A, Nogalo B, Custovic A. Association of bacterial load in drinking water and allergic diseases in childhood. Clin Exp Allergy 2020; 50:733-740. [PMID: 32270527 DOI: 10.1111/cea.13605] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 03/11/2020] [Accepted: 03/22/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Treatment of drinking water may decrease microbial exposure. OBJECTIVE To investigate whether bacterial load in drinking water is associated with altered risk of allergic diseases. METHODS We recruited 1,110 schoolchildren aged 6-16 years between 2011 and 2013 in Požega-Slavonia County in Croatia, where we capitalized on a natural experiment whereby individuals receive drinking water through public mains supply or individual wells. We obtained data on microbial content of drinking water for all participants; 585 children were randomly selected for more detailed assessments, including skin prick testing. Since water supply was highly correlated with rural residence, we compared clinical outcomes across four groups (Rural/Individual, Rural/Public, Urban/Individual and Urban/Public). For each child, we derived quantitative index of microbial exposure (bacterial load in the drinking water measured during the child's first year of life). RESULTS Cumulative bacterial load in drinking water was higher (median [IQR]: 6390 [4190-9550] vs 0 [0-0]; P < .0001), and lifetime prevalence of allergic diseases was significantly lower among children with individual supply (5.5% vs 2.3%, P = .01; 14.4% vs 6.7%, P < .001; 25.2% vs 15.1%, P < .001; asthma, atopic dermatitis [AD] and rhinitis, respectively). Compared with the reference group (Urban/Public), there was a significant reduction in the risk of ever asthma, AD and rhinitis amongst rural children with individual supply: OR [95% CI]: 0.14 [0.03,0.67], P = .013; 0.20 [0.09,0.43], P < .001; 0.17 [0.10,0.32], P < .001. Protection was also observed in the Rural/Public group, but the effect was consistently highest among Rural/Individual children. In the quantitative analysis, the risk of allergic diseases decreased significantly with increasing bacterial load in drinking water in the first year of life (0.79 [0.70,0.88], P < .001; 0.90 [0.83,0.99], P = .025; 0.80 [0.74,0.86], P < .001; current wheeze, AD and rhinitis). CONCLUSIONS AND CLINICAL RELEVANCE High commensal bacterial content in drinking water may protect against allergic diseases.
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Affiliation(s)
- Mirjana Turkalj
- Children's Hospital Srebrnjak, Zagreb, Croatia.,Faculty of Medicine, J. J. Strossmayer University of Osijek, Osijek, Croatia.,Croatian Catholic University, Zagreb, Croatia
| | | | - Sadia Haider
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Davor Plavec
- Children's Hospital Srebrnjak, Zagreb, Croatia.,Faculty of Medicine, J. J. Strossmayer University of Osijek, Osijek, Croatia
| | - Ivana Banić
- Children's Hospital Srebrnjak, Zagreb, Croatia
| | - Olga Malev
- Children's Hospital Srebrnjak, Zagreb, Croatia.,Division of Zoology, Department of Biology, Faculty of Science, University of Zagreb, Zagreb, Croatia
| | - Damir Erceg
- Children's Hospital Srebrnjak, Zagreb, Croatia.,Faculty of Medicine, J. J. Strossmayer University of Osijek, Osijek, Croatia.,Croatian Catholic University, Zagreb, Croatia
| | - Ashley Woodcock
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, University of Manchester and University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
| | - Boro Nogalo
- Children's Hospital Srebrnjak, Zagreb, Croatia.,Faculty of Medicine, J. J. Strossmayer University of Osijek, Osijek, Croatia
| | - Adnan Custovic
- National Heart and Lung Institute, Imperial College London, London, UK
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12
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Sookrung N, Tungtrongchitr A, Chaicumpa W. Cockroaches: Allergens, Component-Resolved Diagnosis (CRD) and Component-Resolved Immunotherapy. Curr Protein Pept Sci 2020; 21:124-141. [DOI: 10.2174/1389203720666190731144043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 06/18/2019] [Accepted: 06/21/2019] [Indexed: 12/27/2022]
Abstract
Allergic diseases are assuming increasing trend of prevalence worldwide. The diseases confer increasing demand on medical and healthcare facilities. Patients with allergies have poor quality of life and impaired cognition. Adult patients have subpar working efficiency while afflicted children are less effective at school, often have school absenteeism and need more attention of their caregivers. All of them lead to negative socio-economic impact. This narrative review focuses on cockroach allergy including currently recognized cockroach allergens, pathogenic mechanisms of allergy, componentresolved diagnosis and allergen-specific immunotherapy, particularly the component-resolved immunotherapy and the molecular mechanisms that bring about resolution of the chronic airway inflammation.
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Affiliation(s)
- Nitat Sookrung
- Center of Research Excellence on Therapeutic Proteins and Antibody Engineering, Department of Parasitology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Anchalee Tungtrongchitr
- Center of Research Excellence on Therapeutic Proteins and Antibody Engineering, Department of Parasitology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Wanpen Chaicumpa
- Center of Research Excellence on Therapeutic Proteins and Antibody Engineering, Department of Parasitology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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13
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Mpairwe H, Namutebi M, Nkurunungi G, Tumwesige P, Nambuya I, Mukasa M, Onen C, Nnaluwooza M, Apule B, Katongole T, Oduru G, Kahwa J, Webb EL, Lubyayi L, Pearce N, Elliott AM. Risk factors for asthma among schoolchildren who participated in a case-control study in urban Uganda. eLife 2019; 8:49496. [PMID: 31729315 PMCID: PMC6914334 DOI: 10.7554/elife.49496] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 11/13/2019] [Indexed: 12/20/2022] Open
Abstract
Data on asthma aetiology in Africa are scarce. We investigated the risk factors for asthma among schoolchildren (5–17 years) in urban Uganda. We conducted a case-control study, among 555 cases and 1115 controls. Asthma was diagnosed by study clinicians. The main risk factors for asthma were tertiary education for fathers (adjusted OR (95% CI); 2.32 (1.71–3.16)) and mothers (1.85 (1.38–2.48)); area of residence at birth, with children born in a small town or in the city having an increased asthma risk compared to schoolchildren born in rural areas (2.16 (1.60–2.92)) and (2.79 (1.79–4.35)), respectively; father’s and mother’s history of asthma; children’s own allergic conditions; atopy; and cooking on gas/electricity. In conclusion, asthma was associated with a strong rural-town-city risk gradient, higher parental socio-economic status and urbanicity. This work provides the basis for future studies to identify specific environmental/lifestyle factors responsible for increasing asthma risk among children in urban areas in LMICs. Asthma is a chronic disease of the airways that leads to breathing difficulty and sometimes death: the condition affects about 235 million people worldwide, especially children. Scientists still do not know exactly what causes asthma, but studies in Europe and North America suggest that individuals born or raised in rural areas are less likely to be affected. However, few studies have examined asthma in African countries, where urbanization is often quickly increasing. Examining the factors associated with the disease as more people move to cities may provide new clues about how asthma emerges, and how to prevent it. To this end, Mpairwe et al. conducted a study with over 1,670 schoolchildren in Uganda. Those born or raised in rural areas were least likely to have asthma, but the risk doubled among children from small towns, and tripled in those born or who grew up in the city. Children whose parents had a higher education and socioeconomic status had the highest asthma risk, but more work is required to understand why this is the case. The study by Mpairwe et al. is the first step towards identifying environmental and lifestyle factors associated with increased asthma risk in Africa. Further studies may help scientists to understand how beginning life in a more urban area plays a role in the development of the disease.
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Affiliation(s)
- Harriet Mpairwe
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Milly Namutebi
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Gyaviira Nkurunungi
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Pius Tumwesige
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Irene Nambuya
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Mike Mukasa
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Caroline Onen
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Marble Nnaluwooza
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Barbara Apule
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Tonny Katongole
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Gloria Oduru
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Joseph Kahwa
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Emily L Webb
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Lawrence Lubyayi
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Neil Pearce
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Alison M Elliott
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda.,London School of Hygiene and Tropical Medicine, London, United Kingdom
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14
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Alaazi DA, Aganah GAM. Understanding the slum-health conundrum in sub-Saharan Africa: a proposal for a rights-based approach to health promotion in slums. Glob Health Promot 2019; 27:65-72. [PMID: 31375057 DOI: 10.1177/1757975919856273] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Sub-Saharan Africa is the world's least urbanized region but is ironically also the region with the largest proportion of urban slum dwellers. However, there exists limited understanding of the impact of slums on health in the region. To address this knowledge gap, we conducted a systematic search in PubMed, Google, and Google Scholar to identify and review studies examining the slum-health relationship in sub-Saharan African cities. Subsequently, we performed thematic analysis of 40 studies to identify themes that explain the health impact of slums in the region. The majority of studies characterize slums as health-damaging settings, where poverty and unfavorable environmental conditions pose threats to public health and safety. Only a handful of studies suggest a beneficial relationship between slums and health, in such areas as affordable housing provision, employment generation, and community cohesion. We argue that the literature's overwhelming emphasis on the environmental risks of slums feeds into a neoliberal urban agenda that seeks to clear slums at the expense of their beneficial contributions to health. Accordingly, we advocate a shift in policy discourse, from static characterization of slums as health risks to a health-promotion agenda that emphasizes the housing and service rights of slum populations.
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Affiliation(s)
- Dominic A Alaazi
- School of Public Health, University of Alberta, Edmonton, Canada
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15
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Dey D, Saha GK, Podder S. A review of house dust mite allergy in India. EXPERIMENTAL & APPLIED ACAROLOGY 2019; 78:1-14. [PMID: 31115731 DOI: 10.1007/s10493-019-00366-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 05/03/2019] [Indexed: 06/09/2023]
Abstract
House dust mites (HDMs) are extensively reported as potent allergens worldwide with India being in the top row. HDM sensitization is hugely reported from India and has led to the concern of implementing proper guidelines for treatment of the sufferers. Climatic conditions and a rapid shift of life style toward a more indoor and urbanised pattern are denoted as the probable causes of increased HDM exposure and sensitization. On the contrary, the varying rate of HDM allergy from similar climate and urbanised areas throughout the world suggest the influence of genetic predisposition. At present, in India, avoidance of HDM exposure is recommended as the baseline defence. Allergen immunotherapy (AIT) guidelines are proposed in India to maintain uniformity in the diagnosis techniques and management strategies throughout the country. Considering the genetic susceptibility toward allergic diseases, the concept of 'personalised medicine' is preferred over the 'mass targeted treatment'. From the Indian perspective, the present problem is Dermatophagoides pteronyssinus and D. farinae allergens are not well characterised at the molecular level. As a consequence, India is still reliant on less standardised allergen extracts. The proper identification, purification, and molecular characterization of HDM allergens can combat this problem. In this review, we aimed to portray a complete account of HDM allergy in India with respect to prevalence, probable triggers, diagnosis and therapy. We have attempted to present the current ambiguities along with the likely deciphering that would pave the way to solve HDM allergy-related queries in India.
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Affiliation(s)
- Debarati Dey
- Department of Zoology, University of Calcutta, 35, BC Road, Kolkata, West Bengal, 700019, India
| | - Goutam Kumar Saha
- Department of Zoology, University of Calcutta, 35, BC Road, Kolkata, West Bengal, 700019, India
| | - Sanjoy Podder
- Allergology and Medical Entomology Research Laboratory, Post Graduate Department of Zoology, Barasat Government College, 10, KNC Road, Kolkata, West Bengal, 700124, India.
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16
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Arasi S, Porcaro F, Cutrera R, Fiocchi AG. Severe Asthma and Allergy: A Pediatric Perspective. Front Pediatr 2019; 7:28. [PMID: 30805326 PMCID: PMC6378301 DOI: 10.3389/fped.2019.00028] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 01/23/2019] [Indexed: 12/17/2022] Open
Abstract
Severe asthma in children is associated with significant morbidity and lung function decline. It represents a highly heterogeneous disorder with multiple clinical phenotypes. As its management is demanding, the social and economic burden are impressive. Several co-morbidities may contribute to worsen asthma control and complicate diagnostic and therapeutic management of severe asthmatic patients. Allergen sensitization and/or allergy symptoms may predict asthma onset and severity. A better framing of "allergen sensitization" and understanding of mechanisms underlying progression of atopic march could improve the management and the long-term outcomes of pediatric severe asthma. This review focuses on the current knowledge about interactions between severe asthma and allergies.
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Affiliation(s)
- Stefania Arasi
- Pediatric Allergology Unit, Bambino Gesù Hospital (IRCCS), Rome, Italy
| | - Federica Porcaro
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Department of Pediatrics, Bambino Gesù Children's Hospital, Rome, Italy
| | - Renato Cutrera
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Department of Pediatrics, Bambino Gesù Children's Hospital, Rome, Italy
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17
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Han H, Roan F, Ziegler SF. The atopic march: current insights into skin barrier dysfunction and epithelial cell-derived cytokines. Immunol Rev 2018; 278:116-130. [PMID: 28658558 DOI: 10.1111/imr.12546] [Citation(s) in RCA: 179] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Atopic dermatitis often precedes the development of other atopic diseases. The atopic march describes this temporal relationship in the natural history of atopic diseases. Although the pathophysiological mechanisms that underlie this relationship are poorly understood, epidemiological and genetic data have suggested that the skin might be an important route of sensitization to allergens. Animal models have begun to elucidate how skin barrier defects can lead to systemic allergen sensitization. Emerging data now suggest that epithelial cell-derived cytokines such as thymic stromal lymphopoietin (TSLP), IL-33, and IL-25 may drive the progression from atopic dermatitis to asthma and food allergy. This review focuses on current concepts of the role of skin barrier defects and epithelial cell-derived cytokines in the initiation and maintenance of allergic inflammation and the atopic march.
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Affiliation(s)
- Hongwei Han
- Immunology Program, Benaroya Research Institute, Seattle, WA, USA
| | - Florence Roan
- Immunology Program, Benaroya Research Institute, Seattle, WA, USA
| | - Steven F Ziegler
- Immunology Program, Benaroya Research Institute, Seattle, WA, USA.,Department of Immunology, University of Washington School of Medicine, Seattle, WA, USA
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18
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Del Giacco SR, Bakirtas A, Bel E, Custovic A, Diamant Z, Hamelmann E, Heffler E, Kalayci Ö, Saglani S, Sergejeva S, Seys S, Simpson A, Bjermer L. Allergy in severe asthma. Allergy 2017; 72:207-220. [PMID: 27775836 DOI: 10.1111/all.13072] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2016] [Indexed: 12/20/2022]
Abstract
It is well recognized that atopic sensitization is an important risk factor for asthma, both in adults and in children. However, the role of allergy in severe asthma is still under debate. The term 'Severe Asthma' encompasses a highly heterogeneous group of patients who require treatment on steps 4-5 of GINA guidelines to prevent their asthma from becoming 'uncontrolled', or whose disease remains 'uncontrolled' despite this therapy. Epidemiological studies on emergency room visits and hospital admissions for asthma suggest the important role of allergy in asthma exacerbations. In addition, allergic asthma in childhood is often associated with severe asthma in adulthood. A strong association exists between asthma exacerbations and respiratory viral infections, and interaction between viruses and allergy further increases the risk of asthma exacerbations. Furthermore, fungal allergy has been shown to play an important role in severe asthma. Other contributing factors include smoking, pollution and work-related exposures. The 'Allergy and Asthma Severity' EAACI Task Force examined the current evidence and produced this position document on the role of allergy in severe asthma.
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Affiliation(s)
- S. R. Del Giacco
- Department of Medical Sciences and Public Health; University of Cagliari; Cagliari Italy
| | - A. Bakirtas
- Department of Pediatric Allergy and Asthma; School of Medicine; Gazi University; Ankara Turkey
| | - E. Bel
- Department of Respiratory Medicine; Academic Medical Centre; University of Amsterdam; Amsterdam The Netherlands
| | - A. Custovic
- Department of Paediatrics; Imperial College London; London UK
| | - Z. Diamant
- Department of General Practice and Department of Clinical Pharmacy & Pharmacology; University Medical Centre Groningen; University of Groningen; Groningen The Netherlands
- Department of Respiratory Medicine and Allergology; Lund University; Lund Sweden
| | - E. Hamelmann
- Klinik für Kinder and Jugendmedizin Kinderzentrum; Bethel Evangelisches Krankenhaus; Allergy Center; Ruhr University Bochum; Bielefeld Germany
| | - E. Heffler
- Respiratory Medicine and Allergology - Department of Experimental and Clinical Medicine; University of Catania; Catania Italy
| | - Ö. Kalayci
- School of Medicine; Hacettepe University; Ankara Turkey
| | - S. Saglani
- National Heart & Lung Institute; Imperial College London; London UK
| | - S. Sergejeva
- Institute of Technology; University of Tartu; Tartu Estonia
| | - S. Seys
- Department of Microbiology and Immunology; Laboratory of Clinical Immunology; KU Leuven Belgium
| | - A. Simpson
- Centre Lead for Respiratory Medicine and Allergy; University Hospital of South Manchester; Education and Research Centre; University of Manchester; Manchester UK
| | - L. Bjermer
- Department of Respiratory Medicine and Allergology; Lund University; Lund Sweden
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19
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Caraballo L, Zakzuk J, Lee BW, Acevedo N, Soh JY, Sánchez-Borges M, Hossny E, García E, Rosario N, Ansotegui I, Puerta L, Sánchez J, Cardona V. Particularities of allergy in the Tropics. World Allergy Organ J 2016; 9:20. [PMID: 27386040 PMCID: PMC4924335 DOI: 10.1186/s40413-016-0110-7] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 05/25/2016] [Indexed: 12/27/2022] Open
Abstract
Allergic diseases are distributed worldwide and their risk factors and triggers vary according to geographical and socioeconomic conditions. Allergies are frequent in the Tropics but aspects of their prevalence, natural history, risk factors, sensitizers and triggers are not well defined and some are expected to be different from those in temperate zone countries. The aim of this review is to investigate if allergic diseases in the Tropics have particularities that deserve special attention for research and clinical practice. Such information will help to form a better understanding of the pathogenesis, diagnosis and management of allergic diseases in the Tropics. As expected, we found particularities in the Tropics that merit further study because they strongly affect the natural history of common allergic diseases; most of them related to climate conditions that favor permanent exposure to mite allergens, helminth infections and stinging insects. In addition, we detected several unmet needs in important areas which should be investigated and solved by collaborative efforts led by the emergent research groups on allergy from tropical countries.
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Affiliation(s)
- Luis Caraballo
- />Institute for Immunological Research, University of Cartagena, Cra. 5 # 7-77, Cartagena, Colombia
| | - Josefina Zakzuk
- />Institute for Immunological Research, University of Cartagena, Cra. 5 # 7-77, Cartagena, Colombia
| | - Bee Wah Lee
- />Khoo Teck Puat- National University Children’s Medical Institute, National University Health System, Singapore, Singapore
- />Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Nathalie Acevedo
- />Department of Medicine Solna, Karolinska Institutet, Translational Immunology Unit, Stockholm, Sweden
| | - Jian Yi Soh
- />Khoo Teck Puat- National University Children’s Medical Institute, National University Health System, Singapore, Singapore
- />Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Mario Sánchez-Borges
- />Allergy and Clinical Immunology Department, Centro Médico- Docente La Trinidad and Clínica El Avila, Caracas, Venezuela
| | - Elham Hossny
- />Pediatric Allergy and Immunology Unit, Children’s Hospital, Ain Shams University, Cairo, Egypt
| | - Elizabeth García
- />Allergy Section, Fundación Santa Fe de Bogotá, Faculty of Medicine, Universidad de los Andes, Bogotá, Colombia
| | - Nelson Rosario
- />Federal University of Parana, Rua General Carneiro, Curitiba, Brazil
| | - Ignacio Ansotegui
- />Department of Allergy and Immunology, Hospital Quirón Bizkaia, Bilbao, Spain
| | - Leonardo Puerta
- />Institute for Immunological Research, University of Cartagena, Cra. 5 # 7-77, Cartagena, Colombia
| | - Jorge Sánchez
- />Department of Pediatrics, Graduate Program on Allergology, University of Antioquia, Medellín, Colombia
| | - Victoria Cardona
- />Allergy Section, Department of Internal Medicine, Hospital Vall d’Hebron, Barcelona, Spain
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20
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Mohammad HR, Belgrave D, Kopec Harding K, Murray CS, Simpson A, Custovic A. Age, sex and the association between skin test responses and IgE titres with asthma. Pediatr Allergy Immunol 2016; 27:313-9. [PMID: 26766520 DOI: 10.1111/pai.12534] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/09/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Skin prick tests (SPTs) and allergen-specific serum IgE (sIgE) measurements are the main diagnostic tools for confirming atopic sensitization. Results are usually reported as 'positive' or 'negative', using the same arbitrary cut-offs (SPT>3 mm, sIgE>0.35 kUA /l) across different ages and sexes. We investigated the influence of age and sex on the interpretation of allergy test in the context of childhood asthma. METHODS In a population-based birth cohort (n = 1051), we ascertained the information on asthma/wheeze (validated questionnaires) and performed SPTs and sIgE measurement to inhalant allergens (dust mite, cat, dog) at follow-ups between ages three and 11 years. We investigated the association between quantitative sensitization (sum of SPT mean wheal diameters [MWD] and sIgE titres to the three allergens) and current wheeze and asthma across ages and sexes. RESULTS We observed a significant association between the SPT MWD and sIgE titres and wheeze/asthma at most ages and for both sexes. However, the strength of this association was age- and sex-dependent. For SPTs, the strength of the association between MWD and asthma increased with increasing age; we observed the opposite pattern for sIgE titre. For any given SPT MWD/sIgE titre, boys were significantly more likely to express clinical symptoms, particularly in early life; this difference between males and females diminished with age and was no longer significant by age 11 years. CONCLUSIONS Age and sex should be taken into account when interpreting the results of skin tests and sIgE measurement, and age- and sex-specific normative data are needed for these allergy tests.
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Affiliation(s)
- Hasan Raza Mohammad
- Centre for Respiratory Medicine and Allergy, Institute of Inflammation and Repair, Manchester Academic Health Science Centre, University of Manchester & University Hospital of South Manchester, Manchester, UK
| | | | - Kamilla Kopec Harding
- Centre for Respiratory Medicine and Allergy, Institute of Inflammation and Repair, Manchester Academic Health Science Centre, University of Manchester & University Hospital of South Manchester, Manchester, UK
| | - Clare S Murray
- Centre for Respiratory Medicine and Allergy, Institute of Inflammation and Repair, Manchester Academic Health Science Centre, University of Manchester & University Hospital of South Manchester, Manchester, UK
| | - Angela Simpson
- Centre for Respiratory Medicine and Allergy, Institute of Inflammation and Repair, Manchester Academic Health Science Centre, University of Manchester & University Hospital of South Manchester, Manchester, UK
| | - Adnan Custovic
- Department of Paediatrics, Imperial College London, London, UK
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21
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Mbatchou Ngahane BH, Noah D, Nganda Motto M, Mapoure Njankouo Y, Njock LR. Sensitization to common aeroallergens in a population of young adults in a sub-Saharan Africa setting: a cross-sectional study. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2016; 12:1. [PMID: 26734065 PMCID: PMC4700563 DOI: 10.1186/s13223-015-0107-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Accepted: 12/17/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND Sensitization to aeroallergens increases the risk of developing asthma or allergic rhinitis. Data on sensitization to airborne allergens in the general population in sub-Saharan Africa are lacking. The aim of this study was to determine the prevalence and determinants of sensitization to common aeroallergens in a population of young adults. METHODS A cross-sectional study was conducted among students of the Faculty of Medicine and Pharmaceutical Sciences of the University of Douala between 1st February and 30th April 2014. We consecutively recruited all the students present in class or in hospital during our visit. They filled an anonymous questionnaire and underwent skin prick tests with common aeroallergens. A logistic regression model of the SPSS.20 software was used to investigate factors associated with sensitization to common aeroallergens. RESULTS Of the 600 students included in the study, 305 (50.8 %) were female. The mean age of participants was 22.6 ± 2.7 years. The prevalence of sensitization to aeroallergens was 42.8 % (95 % CI 38.8-46.8). Dermatophagoides pteronyssimus (24.2 %), Dermatophagoides farinae (22.8 %), Blomia tropicalis (23.3 %) and Blatella germanica (15.2 %) were the most common allergens found. Allergic rhinitis, asthma symptoms and family atopy were independently associated to sensitization to common aeroallergens. CONCLUSION A significant proportion of young adults are sensitized to common aeroallergens. Dust mites and cockroach should be included in the panel of aeroallergens in Cameroon.
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Affiliation(s)
- Bertrand Hugo Mbatchou Ngahane
- />Department of Internal Medicine, Douala General Hospital, PO Box 4856, Douala, Cameroon
- />Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Diane Noah
- />Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Malea Nganda Motto
- />Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Yacouba Mapoure Njankouo
- />Department of Internal Medicine, Douala General Hospital, PO Box 4856, Douala, Cameroon
- />Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Louis Richard Njock
- />Department of Ear Nose and Throat, Douala General Hospital, Douala, Cameroon
- />Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon
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Custovic A. To what extent is allergen exposure a risk factor for the development of allergic disease? Clin Exp Allergy 2015; 45:54-62. [PMID: 25381695 DOI: 10.1111/cea.12450] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The role of allergen exposure in the development of allergic disease has been a matter of considerable debate, and our understanding of the importance of allergens has evolved over the last 25 years. Several observational and primary prevention studies have investigated these relationships, and different studies reported inconsistent, and sometimes opposite findings. It has to be emphasized that a clear understanding of how aeroallergen exposure occurs, and accurate and reproducible measurement of exposure are essential prerequisites for understanding the role of exposure. However, our current understanding of how we get exposed to allergens is not based on solid evidence, but on a number of assumptions, and we urgently need to develop better proxy measures (or indices) of exposure. In addition, the relative importance of the timing of exposure (e.g. early compared to exposure in later life) is unknown. It is also unclear which route of exposure is the most relevant (e.g. inhaled vs. oral vs. transcutaneous). Available data suggest that the dose-response relationship between allergen exposure and allergic disease may differ between different allergens, dose ranges and exposure patterns, and these relationships may further differ between different populations and geographical areas. It is increasingly clear that childhood asthma and atopy are not single phenotypes, and it is likely that allergen exposure has different effect on distinct subgroups under the umbrella terms of 'sensitization' and 'asthma'. Susceptibility to allergen exposure, other environmental exposures and their interactions may also differ between individuals with different genetic predispositions. However, the precise nature of these complex relationships is unclear. We need a holistic approach offered by systems biology, with integration of information on the standardized and reliable measures of exposures (including allergens and other relevant exposures) with genetic and biological data to fully understand the role of allergens in the development of allergic disease.
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Affiliation(s)
- A Custovic
- Centre for Respiratory Medicine and Allergy, Institute of Inflammation and Repair, University of Manchester & University Hospital of South Manchester, Manchester, UK
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D'Amato G, Holgate ST, Pawankar R, Ledford DK, Cecchi L, Al-Ahmad M, Al-Enezi F, Al-Muhsen S, Ansotegui I, Baena-Cagnani CE, Baker DJ, Bayram H, Bergmann KC, Boulet LP, Buters JTM, D'Amato M, Dorsano S, Douwes J, Finlay SE, Garrasi D, Gómez M, Haahtela T, Halwani R, Hassani Y, Mahboub B, Marks G, Michelozzi P, Montagni M, Nunes C, Oh JJW, Popov TA, Portnoy J, Ridolo E, Rosário N, Rottem M, Sánchez-Borges M, Sibanda E, Sienra-Monge JJ, Vitale C, Annesi-Maesano I. Meteorological conditions, climate change, new emerging factors, and asthma and related allergic disorders. A statement of the World Allergy Organization. World Allergy Organ J 2015; 8:25. [PMID: 26207160 PMCID: PMC4499913 DOI: 10.1186/s40413-015-0073-0] [Citation(s) in RCA: 244] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 05/29/2015] [Indexed: 01/08/2023] Open
Abstract
The prevalence of allergic airway diseases such as asthma and rhinitis has increased dramatically to epidemic proportions worldwide. Besides air pollution from industry derived emissions and motor vehicles, the rising trend can only be explained by gross changes in the environments where we live. The world economy has been transformed over the last 25 years with developing countries being at the core of these changes. Around the planet, in both developed and developing countries, environments are undergoing profound changes. Many of these changes are considered to have negative effects on respiratory health and to enhance the frequency and severity of respiratory diseases such as asthma in the general population. Increased concentrations of greenhouse gases, and especially carbon dioxide (CO2), in the atmosphere have already warmed the planet substantially, causing more severe and prolonged heat waves, variability in temperature, increased air pollution, forest fires, droughts, and floods – all of which can put the respiratory health of the public at risk. These changes in climate and air quality have a measurable impact not only on the morbidity but also the mortality of patients with asthma and other respiratory diseases. The massive increase in emissions of air pollutants due to economic and industrial growth in the last century has made air quality an environmental problem of the first order in a large number of regions of the world. A body of evidence suggests that major changes to our world are occurring and involve the atmosphere and its associated climate. These changes, including global warming induced by human activity, have an impact on the biosphere, biodiversity, and the human environment. Mitigating this huge health impact and reversing the effects of these changes are major challenges. This statement of the World Allergy Organization (WAO) raises the importance of this health hazard and highlights the facts on climate-related health impacts, including: deaths and acute morbidity due to heat waves and extreme meteorological events; increased frequency of acute cardio-respiratory events due to higher concentrations of ground level ozone; changes in the frequency of respiratory diseases due to trans-boundary particle pollution; altered spatial and temporal distribution of allergens (pollens, molds, and mites); and some infectious disease vectors. According to this report, these impacts will not only affect those with current asthma but also increase the incidence and prevalence of allergic respiratory conditions and of asthma. The effects of climate change on respiratory allergy are still not well defined, and more studies addressing this topic are needed. Global warming is expected to affect the start, duration, and intensity of the pollen season on the one hand, and the rate of asthma exacerbations due to air pollution, respiratory infections, and/or cold air inhalation, and other conditions on the other hand.
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Affiliation(s)
- Gennaro D'Amato
- Department of Respiratory Diseases, Division of Pneumology and Allergology, High Specialty Hospital "A. Cardarelli" Napoli, Italy, University of Naples Medical School, Via Rione Sirignano, 10, 80121 Napoli, Italy
| | - Stephen T Holgate
- Southampton General Hospital, Clinical and Experimental Sciences, University of Southampton, Hampshire, UK
| | - Ruby Pawankar
- Department of Pediatrics, Nippon Medical School, Tokyo, Japan
| | - Dennis K Ledford
- Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Lorenzo Cecchi
- Interdepartmental Centre of Bioclimatology, University of Florence Allergy and Clinical Immunology Section, Azienda Sanitaria di Prato, Italy
| | - Mona Al-Ahmad
- Department of Allergy, Al-Rashid Center, Ministry of Health, Khobar, Kuwait
| | - Fatma Al-Enezi
- Al-Rashid Allergy and Respiratory Center, Khobar, Kuwait
| | - Saleh Al-Muhsen
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ignacio Ansotegui
- Department of Allergy and Immunology, Hospital Quirón Bizkaia, Erandio, Spain
| | - Carlos E Baena-Cagnani
- Centre for Research in Respiratory Medicine, Faculty of Medicine, Catholic University of Córdoba, Córdoba, Argentina
| | - David J Baker
- Emeritus Consultant Anaesthesiologist, SAMU de Paris, Hôpital Necker - Enfants Malades, Paris, France
| | - Hasan Bayram
- Department of Chest Diseases, Respiratory Research Laboratory, Allergy Division, School of Medicine, University of Gaziantep, Şehitkamil/Gaziantep, 27310 Turkey
| | | | - Louis-Philippe Boulet
- Quebec Heart and Lung Institute, Laval University, 2725 chemin Sainte-Foy, Quebec City, G1V 4G5 Canada
| | - Jeroen T M Buters
- ZAUM - Center of Allergy and Environment, Helmholtz Zentrum München/Technische Universität München, Munich, Germany
| | - Maria D'Amato
- University of Naples, Institute of Respiratory Diseases, Naples, Italy
| | - Sofia Dorsano
- World Allergy Organization, Milwaukee, Wisconsin United States
| | - Jeroen Douwes
- Centre for Public Health Research, Massey University, Wellington, New Zealand
| | - Sarah Elise Finlay
- Consultant in Emergency Medicine, Chelsea and Westminster Hospital, London, UK
| | - Donata Garrasi
- Development Assistance Committee, Organisation of Economic Cooperation and Development, Paris, France
| | | | - Tari Haahtela
- Skin and Allergy Hospital, Helsinki University Hospital, Helsinki, Finland
| | - Rabih Halwani
- Prince Naif Center for Immunology Research, College of Medicine, King Saud University, P.O.Box 2925, Postal Code 11461 Riyadh, Saudi Arabia
| | - Youssouf Hassani
- Epidemiology of Respiratory and Allergic Disease Department, UMR-S, Institute Pierre Louis of Epidemiology and Public Health, INSERM Medical School Saint-Antoine, UPMC Sorbonne Universités, Paris, France
| | - Basam Mahboub
- University of Sharjah, and, Rashid Hospital DHA, Abu Dhabi, United Arab Emirates
| | - Guy Marks
- South Western Sydney Clinical School, UNSW, Australia and Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia
| | - Paola Michelozzi
- Dipartimento Epidemiologia Regione Lazio, UOC Epidemiologia Ambientale, Roma, Italy
| | - Marcello Montagni
- Department of Clinical and Experimental Medicine, University of Parma, Via Gramsci 14, 43100 Parma, Italy
| | - Carlos Nunes
- Center of Allergy of Algarve, Hospital Particular do Algarve, Particular do Algarve, Brasil
| | - Jay Jae-Won Oh
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, Korea
| | - Todor A Popov
- Clinic of Allergy and Asthma, Medical University in Sofia, Sofia, Bulgaria
| | - Jay Portnoy
- Children's Mercy Hospitals & Clinics, Kansas City, Missouri USA
| | - Erminia Ridolo
- Department of Clinical and Experimental Medicine, University of Parma, Via Gramsci 14, 43100 Parma, Italy
| | - Nelson Rosário
- Division of Pediatric Respiratory Medicine, Hospital de Clínicas, Federal University of Parana, Rua Tte. João Gomes da Silva 226, 80810-100 Curitiba, PR Brazil
| | - Menachem Rottem
- Allergy Asthma and Immunology, Emek Medical Center, Afula, and the Rappaport Faculty of Medicine Technion, Israel Institute of Technology, Haifa, Israel
| | | | - Elopy Sibanda
- Asthma, Allergy and Immune Dysfunction Clinic, Harare, Zimbabwe
| | - Juan José Sienra-Monge
- Allergy and Immunology Department, Hospital Infantil de México Federico Gómez, SSA, México City, Mexico
| | - Carolina Vitale
- University of Naples, Institute of Respiratory Diseases, Naples, Italy
| | - Isabella Annesi-Maesano
- Epidemiology of Respiratory and Allergic Disease Department (EPAR), Institute Pierre Louis of Epidemiology and Public Health, UMR-S 1136, INSERM, Paris, France ; UPMC, Sorbonne Universités, Medical School Saint-Antoine, 803-804-806, 8 etage/Floor 27, Rue Chaligny, CEDEX 12, 75571 Paris, France
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Pefura-Yone EW, Mbele-Onana CL, Balkissou AD, Kenmegne-Noumsi EC, Boulleys-Nana JR, Kolontchang-Yomi BL, Theubo-Kamgang BJ, Ndjeutcheu-Moualeu PI, Ebouki ER, Kengne AP. Perennial aeroallergens sensitisation and risk of asthma in African children and adolescents: a case-control study. J Asthma 2015; 52:571-5. [PMID: 25494554 DOI: 10.3109/02770903.2014.995306] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The distribution and impact of various aeroallergens on asthma occurrence vary across regions. We investigated the association between sensitisation to perennial aeroallergens and asthma risk in children and adolescents in Yaounde, Cameroon. METHODS This was a case-control study involving children and adolescents with asthma (cases) vs. non-allergic counterparts (controls). Children/adolescents with doctor-diagnosed asthma were included over a period of 30 months, and controls were selected from the community through random sampling. Logistic regression models were used to relate perennial aeroallergens sensitisation with asthma. RESULTS The asthma and control groups included, respectively, 151 and 372 participants, with no sex ratio difference. The mean age (standard deviation) was 11.9 (4.4) years in cases and 11.3 (3.7) years in controls. The prevalence of sensitisation to any aeroallergen (cases vs. controls) was 76.8% (116/151) and 32.3% (120/372), p < 0.001. Sensitisation to mites was found in 104 (68.9%) cases vs. 56 (15.1%) controls, p < 0.001. In multivariable analysis, sensitisation to Alternaria alternata, Blattella germanica and dander (cat and dog) was not associated with asthma. However, sensitisation to mites was significantly associated with asthma. Odds ratios (95% CI) for sensitisation to Dermatophagoides pteronyssinus, Dermatophagoides farinae and Blomia tropicalis in relation with asthma were 7.28 (3.75-14.15), 2.65 (1.27-5.45) and 3.23 (1.68-6.21), respectively. CONCLUSIONS Sensitisation to mites was the main perennial allergenic factor associated with asthma in children and adolescents in this setting. This has application for the selection of patients with asthma who could benefit from the control of exposure to mites and specific immunotherapy.
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Affiliation(s)
- Eric Walter Pefura-Yone
- a Department of Internal Medicine and Subspecialties, Faculty of Medicine and Biomedical Sciences , University of Yaounde I , Yaounde , Cameroon
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Kariya S, Okano M, Nishizaki K. Relationship between chronic rhinosinusitis and lower airway diseases: An extensive review. World J Otorhinolaryngol 2015; 5:44-52. [DOI: 10.5319/wjo.v5.i2.44] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Revised: 12/04/2014] [Accepted: 03/05/2015] [Indexed: 02/06/2023] Open
Abstract
Significant links between allergic rhinitis and asthma have been reported, and the united airway disease hypothesis is supported by numerous findings in epidemiologic, physiologic, pathologic, and immunologic studies. The impact of allergic rhinitis on asthma has been established. On the other hand, the relationship between chronic rhinosinusitis and lung diseases has been under investigation. Chronic rhinosinusitis is a common disease, and the high prevalence of chronic rhinosinusitis in some kinds of lung diseases has been reported. Recent studies suggest that the treatment of chronic rhinosinusitis has beneficial effects in the management of asthma. Here, we present an overview of the current research on the relationship between chronic rhinosinusitis and lower airway diseases including asthma, chronic obstructive pulmonary disease, cystic fibrosis, diffuse panbronchiolitis, primary ciliary dyskinesia, idiopathic bronchiectasis, and allergic bronchopulmonary aspergillosis.
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Abstract
PURPOSE OF REVIEW There is ongoing controversy about the relationship between atopy and asthma. RECENT FINDINGS In clinical practice, specific IgE and skin test results should not be reported as 'positive' or 'negative', but as the level of IgE and the size of skin test wheal diameter. In assessment of children with severe asthma, these tests are not mutually exclusive but complementary, and both should be carried out and quantified. In the near future, their diagnostic accuracy in children with wheezing may be improved by the measurement of allergen-specific IgG. It is becoming increasingly clear that asthma is not a single disease, but a collection of several diseases with similar/same symptoms. These distinct disease entities (endotypes) may share similar observable characteristics (phenotypes), but arise via different pathophysiological mechanisms. Observable phenotypic features (e.g. sputum inflammatory phenotypes) are not stable in children with asthma. The discovery of novel, latent endotypes of asthma will require integration of a time component to take into account the phenotype instability and longitudinal changes. Not only asthma, but also 'atopy' encompasses a number of different endotypes which differ in their association with asthma. SUMMARY Novel endotypes of atopy and asthma which better reflect the unique pathophysiological processes underlying different diseases in the atopy and asthma syndromes can be defined through the fusion of computational thinking and novel mathematical approaches with biomedical science. These novel endotypes may be more relevant for epidemiological, genetic and therapeutic studies.
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Oluwole O, Arinola OG, Falade GA, Ige MO, Falusi GA, Aderemi T, Huo D, Olopade IO, Olopade CO. Allergy sensitization and asthma among 13-14 year old school children in Nigeria. Afr Health Sci 2013; 13:144-53. [PMID: 23658581 DOI: 10.4314/ahs.v13i1.20] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The prevalence of asthma and role of atopy in asthma among children has not been clearly defined in Nigeria. OBJECTIVE To determine the prevalence of asthma and investigate risk factors related to allergy sensitization among urban and rural school children in southwest Nigeria. METHODS Validated ISAAC questionnaire was administered to 1736 high school children in randomly selected schools in rural and urban communities. Identified asthma cases were matched to controls. Allergy skin tests, blood eosinophil count, serum IgE and stool examination for parasites were performed. Dust samples from homes were also collected and analyzed for allergens. RESULTS The prevalence of asthma was 7.5% (95% CI 6.0 to 9.2%) and 8% (95% CI 6.0-10.4%) in the rural and urban communities respectively . Risk factors for asthma included cigarette-smoking, cats in the home and family size. Eosinophil count (109/L) was elevated in asthmatics [0.70 (95% CI 0.48-1.11) vs. 0.32 (95% CI 0.19-0.69); p<0.01], but IgE levels were similar between the two groups (298±229 IU/mL vs. 288±257; p=0.97). Positive skin tests to cat hair, cockroach, mango blossom and mouse epithelium were more frequent in asthmatics than in healthy controls, especially in the rural communities. There was no correlation between allergens in dust collected from homes and skin test reactivity. CONCLUSION Asthma prevalence is similar in rural and urban children in Southwest Nigeria and atopy with elevated IgE was not observed to be a major factor for asthma in our cohort of children in both communities.
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Affiliation(s)
- O Oluwole
- The Center for Global Health Initiative, University of Chicago, Chicago, IL, USA
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Jafta N, Batterman SA, Gqaleni N, Naidoo RN, Robins TG. Characterization of allergens and airborne fungi in low and middle-income homes of primary school children in Durban, South Africa. Am J Ind Med 2012; 55:1110-21. [PMID: 22674665 DOI: 10.1002/ajim.22081] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2012] [Indexed: 11/06/2022]
Abstract
BACKGROUND The South Durban Health Study (SDHS) is a population-based study that examined the relationship between exposure to ambient air pollutants and respiratory disease among school children with high prevalence of asthma who resided in two purposely selected communities in north and south Durban, KwaZulu-Natal, South Africa. METHODS From the SDHS participants, a subgroup of 135 families was selected for investigation of household characteristics potentially related to respiratory health. In these households, a walkthrough investigation was conducted, and settled dust and air samples were collected for allergen and fungal measurements using standardized techniques. RESULTS Asp f1 allergen was detected in all homes, and Bla g1 allergen was detected in half of the homes. House dust allergens, Der f1 and Der p1 exceeded concentrations associated with risk of sensitization and exacerbation of asthma in 3% and 13%, respectively, of the sampled homes, while Bla g1 exceeded guidance values in 13% of the homes. Although airborne fungal concentrations in sleep areas and indoors were lower than outdoor concentrations, they exceeded 1,000 CFU/m(3) in 29% of the homes. Multivariate analyses identified several home characteristics that were predictors of airborne fungal concentrations, including moisture, ventilation, floor type, and bedding type. Airborne fungal concentrations were similar indoors and outdoors, which likely reduced the significance of housing and indoor factors as determinants of indoor concentrations. CONCLUSION Allergen concentrations were highly variable in homes, and a portion of the variability can be attributed to easily recognized conditions.
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Affiliation(s)
- Nkosana Jafta
- Discipline of Occupational and Environmental Health, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
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Wang JY. The innate immune response in house dust mite-induced allergic inflammation. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2012; 5:68-74. [PMID: 23450108 PMCID: PMC3579094 DOI: 10.4168/aair.2013.5.2.68] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Accepted: 06/04/2012] [Indexed: 12/05/2022]
Abstract
Hypersensitivity to house dust mite (HDM; Dermatophagoides sp.) allergens is one of the most common allergic responses, affecting up to 85% of asthmatics. Sensitization to indoor allergens is the strongest independent risk factor associated with asthma. Additionally, >50% of children and adolescents with asthma are sensitized to HDM. Although allergen-specific CD4+ Th2 cells orchestrate the HDM allergic response through induction of IgE directed toward mite allergens, activation of innate immunity also plays a critical role in HDM-induced allergic inflammation. This review highlights the HDM components that lead to activation of the innate immune response. Activation may due to HDM proteases. Proteases may be recognized by protease-activation receptors (PARs), Toll-like receptors (TLRs), or C-type lectin receptors (CTRs), or act as a molecular mimic for PAMP activation signaling pathways. Understanding the role of mite allergen-induced innate immunity will facilitate the development of therapeutic strategies that exploit innate immunity receptors and associated signaling pathways for the treatment of allergic asthma.
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Affiliation(s)
- Jiu-Yao Wang
- Division of Allergy and Clinical Immunology, Department of Pediatrics, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Wolff PT, Arison L, Rahajamiakatra A, Raserijaona F, Niggemann B. High asthma prevalence and associated factors in urban malagasy schoolchildren. J Asthma 2012; 49:575-80. [PMID: 22793524 DOI: 10.3109/02770903.2012.696170] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Studies about bronchial asthma in Africa are impeded by the dearth of reliable data for the vast majority of countries on the continent. This study was conducted to establish the first epidemiological data concerning bronchial asthma in urban Malagasy schoolchildren. METHODS From three public and five private schools 1236 students aged 7-14 years were recruited and examined using a modified International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. In a subgroup of 111 schoolchildren from two schools, lung function tests were conducted together with bronchodilator response (BDR) to establish reversible obstruction (change in FEV1 ≥ 12%). RESULTS The overall prevalence of wheezing in schoolchildren was 25.2%, with strikingly more wheezing in children attending private schools than public schools (p = .0012). The risk was diminished in students with older siblings (p < .03), but was not affected by other variables like smoking habits at home, body mass index, or cooking fuel. In the schools where BDR was performed, we found a point prevalence for reversible bronchial obstruction of 9% through lung function tests. CONCLUSION Bronchial asthma is of great relevance for schoolchildren living in urban Madagascar. Socioeconomic factors and air pollution seem to have a major impact in addition to the number of older siblings.
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Affiliation(s)
- P T Wolff
- Pediatric Allergology and Pneumology, Practice Am Stadtsee, Am Stadtweiher 9, Pfullendorf, Germany.
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Nyembue TD, Ntumba W, Omadjela LA, Muyunga C, Hellings PW, Jorissen M. Sensitization rate and clinical profile of Congolese patients with rhinitis. ALLERGY & RHINOLOGY 2012; 3:e16-24. [PMID: 22852125 PMCID: PMC3404473 DOI: 10.2500/ar.2012.3.0023] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
In the African continent, the sensitization pattern and clinical profile are unknown in patients with rhinitis/rhinosinusitis attending the outpatient ear, nose, and throat (ENT) clinics. We therefore aimed to analyze the clinical characteristics of rhinitis/rhinosinusitis patients in Democratic Republic of Congo (DRC), classify allergic rhinitis (AR) according to the Allergic Rhinitis and Its Impact on Asthma criteria, and evaluate the sensitization profile and its associated factors. From January to May 2009, 423 patients with rhinitis symptoms attending the Outpatient ENT clinic of the University Hospital and Saint Joseph Hospital of Kinshasa were evaluated for allergy symptoms, severity, and duration of symptoms and underwent skin-prick tests (SPTs) for a panel of 15 allergens. Of 423 patients 35.2% had positive SPT results, with 40.9% showing polysensitization. Dermatophagoides pteronyssinus (DPT) (68.5%) and cockroach (36.2%) were the most common allergens among sensitized patients. Patients with rhinitis/rhinosinusitis mainly presented in decreasing order with sneezing, facial pain/pressure, nasal obstruction, postnasal discharge, nose itching, clear nasal discharge, and eye itching. Persistent and moderate/severe AR represented 61.4 and 69.3%, respectively. Sensitization was independently associated with younger age, rhinoconjunctivitis, and reaction to nonspecific trigger factors. In conclusion, 35.2% of patients attending the ENT Outpatient Clinic in DRC for rhinitis problems had a positive SPT to at least one allergen, with mainly DPT and cockroach allergens being involved; and a substantial portion showed persistent and moderate/severe AR. Therefore, allergy should not be neglected as an etiologic factor in rhinologic disease in the African continent.
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Ige OM, Falade AG, Arinola OG. Atopy is a risk factor for adult asthma in urban community of Southwestern Nigeria. Lung India 2012; 29:114-9. [PMID: 22628923 PMCID: PMC3354482 DOI: 10.4103/0970-2113.95301] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
RATIONALE Factors affecting asthma course are not clearly elucidated in urban communities in developing countries. Furthermore, the interaction between factors such as atopy, environmental exposure, urbanization, and helminthic infections in modulating asthma have not been well investigated. OBJECTIVES To determine factors, which affect asthma in adults being evaluated at urban tertiary health center of Southwestern part of Nigeria. MATERIALS AND METHODS A random sample of 24 (12 males, 12 females) consecutive asthmatics seen in the Outpatient Pulmonary Clinic of University College Hospital of Ibadan and 27 (13 males, 14 females) age and gender-matched controls underwent evaluation, which included blood tests for eosinophils, serum IgE, allergy skin tests to eight common environmental allergens, and spirometry. The modified version of the questionnaire of the International study of Asthma and Allergies in Children (ISAAC) Phase III used by the same study group of researchers in Nigeria was used to assess the asthma symptoms. Wilcoxon sign-rank tests were used to compare eosinophil counts, percentage eosinophils, and allergic skin test between the two groups, while paired t test was used to compare spirometry variables. RESULTS Asthmatics had significantly more positive skin reaction to house dust mite and mould than controls (P<0.05). Total serum IgE was also significantly higher in asthmatics than in controls (mean 210 vs 60 IU/mL; P=0.003). However, no significant differences were observed in total eosinophil counts. No significant difference in the degree of intestinal helminthes infection in the two groups, which means stool parasitism was similar. FEV(1) % was significantly lower in asthmatics (P=0.02) but FEV(1) was similar between the two groups (P=0.02). CONCLUSION The elevated levels of IgE and positive skin reactions to some of the common environmental allergens suggests an important role of atopy in the expression of asthma in this developing country's urban setting. Intestinal parasites were seen in both, control and asthma subjects, but appear not to play any role in the course of asthma, so also is the blood group, genotype and G6PD status.
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Affiliation(s)
- O. M. Ige
- Department of Medicine, Pulmonary Unit (Adult), College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - A. G. Falade
- Department of Paediatrics, Pulmonary Unit, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - O. G. Arinola
- Department of Chemical Pathology, Immunology Unit, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Ige OM, Arinola OG, Oluwole O, Falade AG, Falusi AG, Aderemi T, Huo D, Olopade OI, Olopade CO. Atopy is associated with asthma in adults living in rural and urban southwestern Nigeria. J Asthma 2011; 48:894-900. [PMID: 21861770 DOI: 10.3109/02770903.2011.608458] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
RATIONALE Factors affecting the course of asthma are not clearly understood in rural and urban communities within low-resource countries. Furthermore, the interactions between atopy, environmental exposure, and helminthic infections in modulating asthma have not been well investigated. OBJECTIVES To conduct a feasibility study to examine the relationship between atopy and asthma in adults at two rural Health Centers and urban university college hospital in southwestern Nigeria. METHODS A convenient sample of 55 consecutive patients with stable physician-diagnosed asthma and 55 age-matched nonasthmatic controls seen at the outpatient clinics in two rural Health Centers and an urban university hospital were enrolled. All subjects underwent blood test, allergy skin test, and stool examination for ova and parasites. Wilcoxon sign-rank tests were used to compare serum eosinophilia and allergy skin test between the two groups. RESULTS Asthmatics in both urban and rural settings had significantly more positive skin reactions to house dust mite, cockroach, mold, and mouse epithelium than nonasthmatic controls (p < .05). Mean total serum IgE was also significantly higher in asthmatics than in nonasthmatic controls (360 vs. 90 IU/L, p <.001). Stool parasitemia was infrequent in both groups and not statistically significant. CONCLUSION Atopy is associated with adult asthma in southwest Nigeria. Larger studies to confirm the nature of this association and to examine the role of helminthic infection and other environmental factors on the expression of asthma are needed.
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Affiliation(s)
- O M Ige
- College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
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Stevens W, Addo-Yobo E, Roper J, Woodcock A, James H, Platts-Mills T, Custovic A. Differences in both prevalence and titre of specific immunoglobulin E among children with asthma in affluent and poor communities within a large town in Ghana. Clin Exp Allergy 2011; 41:1587-94. [PMID: 21810123 PMCID: PMC3505371 DOI: 10.1111/j.1365-2222.2011.03832.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Reports from several African countries have noted an increasing prevalence of asthma in areas of extensive urbanization. OBJECTIVE To investigate the relevance of allergen-specific sensitization and body mass index (BMI) to asthma/wheezing and exercise-induced bronchospasm (EIB) among children from affluent and poorer communities within a large town in Ghana. METHODS Children with physician-diagnosed asthma and/or current wheezing aged 9-16 years (n=99; cases) from three schools with differing socio-economic backgrounds [urban affluent (UA), urban poor (UP) or suburban/rural (SR)] were recruited from a cross-sectional study (n=1848) in Kumasi, Ghana, and matched according to age, sex and area of residence with non-asthmatic/non-wheezy controls. We assayed sera for IgE antibodies to mite, cat, dog, cockroach, Ascaris and galactose-α-1,3-galactose. RESULTS Children from the UA school had the lowest total serum IgE. However, cases from the UA school had a higher prevalence and mean titre of sIgE to mite (71.4%, 21.2 IU/mL) when compared with controls (14.3%, 0.8 IU/mL) or cases from UP (30%, 0.8 IU/mL) and SR community (47.8%, 1.6 IU/mL). While similar findings were observed with EIB in the whole population, among cases there was no difference in IgE antibody prevalence or titre between children with or without EIB. BMI was higher among UA children with and without asthma; in UP and SR communities, children with EIB (n=14) had a significantly higher BMI compared with children with asthma/wheezing without EIB (n=38) (18.2 vs. 16.4, respectively, P<0.01). CONCLUSIONS AND CLINICAL RELEVANCE In the relatively affluent school, asthma/wheezing and EIB were associated with high titre IgE antibodies to mite, decreased total IgE, and increased BMI. This contrasted with children in the urban poor school and suggests that changes relevant to a Western model of childhood asthma can occur within a short geographical distance within a large city in Africa.
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Affiliation(s)
- W Stevens
- University of Virginia Asthma and Allergic Diseases Center, Charlottesville, VA, USA
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High body mass index is not associated with atopy in schoolchildren living in rural and urban areas of Ghana. BMC Public Health 2011; 11:469. [PMID: 21669010 PMCID: PMC3141453 DOI: 10.1186/1471-2458-11-469] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Accepted: 06/14/2011] [Indexed: 11/26/2022] Open
Abstract
Background Factors which determine the development of atopy and the observed rural-urban gradient in its prevalence are not fully understood. High body mass index (BMI) has been associated with asthma and potentially atopy in industrialized countries. In developing countries, the transition from rural to urban areas has been associated with lifestyle changes and an increased prevalence of high BMI; however, the effect of high BMI on atopy remains unknown in this population. We therefore investigated the association between high BMI and atopy among schoolchildren living in rural and urban areas of Ghana. Methods Data on skin prick testing, anthropometric, parasitological, demographic and lifestyle information for 1,482 schoolchildren aged 6-15 years was collected. Atopy was defined as sensitization to at least one tested allergen whilst the Centres for Disease Control and Prevention (CDC, Atlanta) growth reference charts were used in defining high BMI as BMI ≥ the 85th percentile. Logistic regression was performed to investigate the association between high BMI and atopy whilst adjusting for potential confounding factors. Results The following prevalences were observed for high BMI [Rural: 16%, Urban: 10.8%, p < 0.001] and atopy [Rural: 25.1%, Urban: 17.8%, p < 0.001]. High BMI was not associated with atopy; but an inverse association was observed between underweight and atopy [OR: 0.57, 95% CI: 0.33-0.99]. Significant associations were also observed with male sex [Rural: OR: 1.49, 95% CI: 1.06-2.08; Urban: OR: 1.90, 95% CI: 1.30-2.79], and in the urban site with older age [OR: 1.76, 95% CI: 1.00-3.07], family history of asthma [OR: 1.58, 95% CI: 1.01-2.47] and occupational status of parent [OR: 0.33, 95% CI: 0.12-0.93]; whilst co-infection with intestinal parasites [OR: 2.47, 95% CI: 1.01-6.04] was associated with atopy in the rural site. After multivariate adjustment, male sex, older age and family history of asthma remained significant. Conclusions In Ghanaian schoolchildren, high BMI was not associated with atopy. Further studies are warranted to clarify the relationship between body weight and atopy in children subjected to rapid life-style changes associated with urbanization of their environments.
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Simpson A. Effect of household pet ownership on infant immune response and subsequent sensitization. J Asthma Allergy 2010; 3:131-7. [PMID: 21437047 PMCID: PMC3047904 DOI: 10.2147/jaa.s6958] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2010] [Indexed: 11/23/2022] Open
Abstract
Sensitization to pets is a major risk factor for asthma. There are many reports on the relationship between household pets, sensitization to the pet, and sensitization to other allergens, often with conflicting results. Pet ownership is not random, and household pets are associated with exposures other than pet allergens. We will review some of the evidence regarding the effects of household pets on infant immune responses, focusing on data from birth cohort studies. It remains unclear precisely why some children develop specific sensitizations to pets whilst others do not in the face of equivalent exposures, but it is likely to be due to gene-environment interactions. Further long-term follow-up of children in whom neonatal and infant immune responses have been measured is necessary to understand how these events occur and how they relate to subsequent disease.
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Affiliation(s)
- Angela Simpson
- Manchester Academic Health Science Centre, NIHR Translational Research Facility in Respiratory Medicine, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
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Whitrow MJ, Harding S. Asthma in Black African, Black Caribbean and South Asian adolescents in the MRC DASH study: a cross sectional analysis. BMC Pediatr 2010; 10:18. [PMID: 20334698 PMCID: PMC2851680 DOI: 10.1186/1471-2431-10-18] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2009] [Accepted: 03/25/2010] [Indexed: 11/10/2022] Open
Abstract
Background Ethnic differences in the prevalence of asthma among children in the UK are under-researched. We aimed to determine the ethnic differences in the prevalence of asthma and atopic asthma in children from the main UK ethnic groups, and whether differences are associated with differential distributions in social and psychosocial risk factors. Methods 6,643 pupils aged 11-13 years, 80% ethnic minorities. Outcomes were asthma/wheeze with (atopic) and without hay fever/eczema. Risk factors examined were family history of asthma, length of residence in the UK, socioeconomic disadvantage, tobacco exposure, psychological well-being, and body mass index (BMI). Results There was a pattern of lower prevalence of asthma in Black African boys and girls, and Indian and Bangladeshi girls compared to White UK. The overall prevalence was higher in Mixed Black Caribbean/White boys, with more atopic asthma in Black Caribbean boys and Mixed Black Caribbean/White boys due to more hayfever. Poor psychological well-being and family history of asthma were associated with an increased risk of asthma within each ethnic group. UK residence for ≤ 5 years was protective for Black Caribbeans and Black Africans. Increased BMI was associated with an increased reporting of asthma for Black Africans. Adjustments for all variables did not remove the excess asthma reported by Black Caribbean boys (atopic) or Mixed Black Caribbean/White boys. Conclusion The protective effect of being born abroad accounted for ethnic differences in some groups, signalling a role for socio-environmental factors in patterning ethnic differences in asthma in adolescence.
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Affiliation(s)
- Melissa J Whitrow
- Social and Public Health Sciences Unit, Medical Research Council, Glasgow, UK.
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Chen CM, Tischer C, Schnappinger M, Heinrich J. The role of cats and dogs in asthma and allergy--a systematic review. Int J Hyg Environ Health 2010; 213:1-31. [PMID: 20053584 DOI: 10.1016/j.ijheh.2009.12.003] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Revised: 12/07/2009] [Accepted: 12/07/2009] [Indexed: 10/20/2022]
Abstract
Studies have reported contradictory effects of cat and dog exposure on allergy, resulting in inconsistent recommendations on animal avoidance. We conducted a systematic review of observational studies published in English from 2000 to January 2009. It shows in this review that the reported exposure-response relationships are contradictory. A total of 17 and 13 birth cohort studies on cat and dog exposure, respectively, are included in the review. Most of the birth cohort studies found that cat or dog exposure in early life had no effect on the development of asthma or wheezing symptoms and dog exposure during infancy was found to protect children from developing sensitization against aeroallergens. A total of 7 and 6 prospective studies in school-age children or adults on cat and dog exposure, respectively, are included in this review and most of these studies suggested an inverse association between cat exposure and asthma and wheezing symptoms. As for cross-sectional studies, 26 and 21 studies on cat and dog exposure, respectively, are included in this review, which cover a broad range of age groups and geographical areas, and reported inconsistent results. The evidence summarised in this systematic review needs to be interpreted with caution, the inconsistent study results may be due to study design, exposure assessment, and avoidance measure. The exposure-response relationships may also alter in geographical areas where the community prevalence of cats and dogs are significantly different. However, as the evidence of the effects of pet keeping on subsequent development of asthma or allergic diseases presented in this review are not overwhelmingly strong, the decision of whether to keep a cat or a dog in the family should be based on arguments other than the concern of developing asthma and allergy.
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Affiliation(s)
- Chih-Mei Chen
- Helmholtz Zentrum München, German Research Centre for Environmental Health, Institute of Epidemiology, Neuherberg, Germany.
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Takkouche B, González-Barcala FJ, Etminan M, Fitzgerald M. Exposure to furry pets and the risk of asthma and allergic rhinitis: a meta-analysis. Allergy 2008; 63:857-64. [PMID: 18588551 DOI: 10.1111/j.1398-9995.2008.01732.x] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Exposure to pets has been implicated as a risk factor for asthma. However, this relation has been difficult to assess in individual studies because of the large potential of selection bias. We sought to examine the association between exposure to furry pets and asthma and allergic rhinitis by means of a meta-analysis. METHODS We retrieved studies published in any language by searching systematically Medline (1966-March 2007), Embase, LILACS and ISI Proceedings computerized databases, and by examining manually the references of the original articles and reviews retrieved. We included cohort and case-control studies reporting relative risk estimates and confidence intervals of exposure to cats, dogs and unspecified furry animals and subsequent asthma and allergic rhinitis. We excluded cross-sectional studies and those studies that did not measure exposure but rather sensitization to pets. RESULTS Thirty-two studies were included. For asthma, the pooled relative risk related to dog exposure was 1.14 (95% CI 1.01-1.29), that related to exposure to any furry pet was 1.39 (95% CI 1.00-1.95). Among cohort studies, exposure to cats yielded a relative risk of 0.72 (95% CI 0.55-0.93). For rhinitis, the pooled relative risk of exposure to any furry pet was 0.79 (95% CI 0.68-0.93). CONCLUSIONS Exposure to cats exerts a slight preventive effect on asthma, an effect that is more pronounced in cohort studies. On the contrary, exposure to dogs increases slightly the risk of asthma. Exposure to furry pets of undermined type is not conclusive. More studies with exact measurement of exposure are needed to elucidate the role of pet exposures in atopic diseases.
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Affiliation(s)
- B Takkouche
- Department of Preventive Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
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Abstract
Identification and characterization of risk and protective factors for allergy is important for developing strategies for prevention or treatment. The prevalence of allergy is clearly higher in affluent countries than in developing countries like, e.g. Africa. Especially in urban areas of developing countries, allergy is however on the increase. In Africa, we have the unique opportunity to investigate risk and protective factors and the influence of urbanization and westernization, i.e. almost to take a look at Europe, Australia or the USA as they were before their allergy epidemics. Moreover, migrants from developing to affluent countries experiencing an increased burden of allergy provide new insights into risk and protective factors. Allergen exposure, diet and infections are the major exogenous influences playing a role as risk and protective factors. Depending on the nature, timing, chronicity and level of exposure, each of them can promote or inhibit allergy. Perhaps with the exception of infections, availability of data from Africa on their role in the development of allergy is limited. Detailed epidemiological studies in rural and urban Africa combined with basic immunological research are needed to unravel mechanisms of increase in allergy and of protection. The maturation of the immune system at young age under influence of exogenous factors results in differences in T-cell-skewing (Th1/Th2/Treg) and humoral responses. It is essential to perform studies from a 'non-Eurocentric' angle (e.g. local allergens, locally validated questionnaires and diagnostic procedures). Such studies will provide the affluent countries with new leads to combat the allergy epidemic and more importantly help prevent it in Africa.
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Affiliation(s)
- R van Ree
- Department of Experimental Immunology, Academic Medical Center, Amsterdam, the Netherlands
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Addo-Yobo EOD, Woodcock A, Allotey A, Baffoe-Bonnie B, Strachan D, Custovic A. Exercise-induced bronchospasm and atopy in Ghana: two surveys ten years apart. PLoS Med 2007; 4:e70. [PMID: 17326711 PMCID: PMC1808098 DOI: 10.1371/journal.pmed.0040070] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2006] [Accepted: 01/04/2007] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Asthma and allergic diseases have increased in the developed countries. It is important to determine whether the same trends are occurring in the developing countries in Africa. We aimed to determine the time trend in the prevalence of exercise-induced bronchospasm (EIB) and atopic sensitisation over a ten-year period in Ghanaian schoolchildren. METHODS AND FINDINGS Two surveys conducted using the same methodology ten years apart (1993 and 2003) among schoolchildren aged 9-16 years attending urban rich (UR), urban poor (UP), and rural (R) schools. Exercise provocation consisted of free running for six minutes. Children were skin tested to mite, cat, and dog allergen. 1,095 children were exercised in 1993 and 1,848 in 2003; 916 were skin tested in 1993 and 1,861 in 2003. The prevalence of EIB increased from 3.1% (95% CI 2.2%-4.3%) to 5.2% (4.3%-6.3%); absolute percentage increase 2.1% (95% CI 0.6%-3.5%, p < 0.01); among UR, UP, and R children EIB had approximately doubled from 4.2%, 1.4%, and 2.2% to 8.3%, 3.0% and 3.9% respectively. The prevalence of sensitisation had also doubled from 10.6%, 4.7%, and 4.4% to 20.2%, 10.3%, and 9.9% (UR, UP, and R respectively). Mite sensitisation remained unchanged (5.6% versus 6.4%), but sensitisation to cat and dog increased considerably from 0.7% and 0.3% to 4.6% and 3.1%, respectively. In the multiple logistic regression analysis, sensitisation (odds ratio [OR] 1.77, 95% CI 1.12-2.81), age (OR 0.88, 95% CI 0.79-0.98), school (the risk being was significantly lower in UP and R schools: OR 0.40, 95% CI 0.23-0.68 and OR 0.54, 95% CI 0.34-0.86, respectively) and year of the study (OR 1.73, 95% CI 1.13-2.66) remained significant and independent associates of EIB. CONCLUSIONS The prevalence of both EIB and sensitisation has approximately doubled over the ten-year period amongst 9- to 16-year-old Ghanaian children irrespective of location, with both EIB and atopy being more common among the UR than the UP and R children.
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Affiliation(s)
| | - Ashley Woodcock
- North West Lung Centre, Wythenshawe Hospital, University of Manchester, Manchester, United Kingdom
| | - Adorkor Allotey
- Department of Child Health, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | - David Strachan
- Department of Public Health Sciences, St George's Hospital Medical School, London, United Kingdom
| | - Adnan Custovic
- North West Lung Centre, Wythenshawe Hospital, University of Manchester, Manchester, United Kingdom
- * To whom correspondence should be addressed. E-mail:
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Nicolaou N, Yiallouros P, Pipis S, Ioannou P, Simpson A, Custovic A. Domestic allergen and endotoxin exposure and allergic sensitization in Cyprus. Pediatr Allergy Immunol 2006; 17:17-21. [PMID: 16426250 DOI: 10.1111/j.1399-3038.2005.00352.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We investigated the relationship between domestic allergen and endotoxin exposure and allergic sensitization among children in Cyprus. We skin prick tested 128 children aged 15-16 yr (random samples of 85 children with self-reported asthma and 43 healthy controls) and measured their domestic exposure to endotoxin and allergens (mite, cat, and dog). We analyzed the data using multivariate logistic regression (adjusting for gender, area of residence and parental history) and presented the outcomes as odds ratios (OR) and 95% confidence intervals (CI). Among this selected population, 19% of children were sensitized to mite, 15% to cat and 7% to dog. Male gender (OR 2.74, 95% CI 1.18-6.38, p = 0.02), maternal history of allergic disease (OR 3.53, 95% CI 1.13-11.00, p = 0.03), increasing endotoxin (OR 1.58, 95% CI 1.00-2.49, p = 0.05) and residence in the district of Nicosia (OR 2.48, 95% CI 1.01-6.08, p = 0.05) were independent associates of allergic sensitization. Factors associated with mite sensitization were increasing Der p 1 and endotoxin exposure (OR 1.28, 95% CI 1.01-1.62, p = 0.04 and OR 1.76, 95% CI 1.01-3.08, p = 0.05, respectively) and living in an urban area (OR 6.80, 95% CI 1.37-33.67, p = 0.02). Sensitization to domestic pets was associated only with paternal allergic disease (cat: OR 5.68, 95% CI 1.57-23.56, p = 0.02; dog: OR 13.5, 95% CI 1.79-101.73, p = 0.01), but not with pet ownership or specific allergen or endotoxin exposure. In conclusion, mite allergen exposure was associated with sensitization to mite, but there was no association between cat and dog allergen exposure and specific sensitizations. Surprisingly, in this area, increasing endotoxin exposure was associated with an increased risk of sensitization.
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Affiliation(s)
- Nicolaos Nicolaou
- Paediatric Respiratory Research Unit, Hospital Archbishop Makarios III, Nicosia, Cyprus.
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Uzel A, Capan N, Canbakan S, Yurdakul AS, Dursun B. Evaluation of the relationship between cockroach sensitivity and house-dust-mite sensitivity in Turkish asthmatic patients. Respir Med 2006; 99:1032-7. [PMID: 15950145 DOI: 10.1016/j.rmed.2004.12.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2004] [Indexed: 10/25/2022]
Abstract
Exposure to cockroach has been identified as an important source of indoor allergens in patients with asthma and allergic rhinitis. We evaluated the relationship between cockroach sensitivity and other allergens in patients with asthma. A total of 114 patients, defined asthma according to GINA, were enrolled in this study. A questionnaire including age, sex, duration of asthma, history of cockroach presence at home, and total IgE, blood eosinophil count, pulmonary function tests, standard skin prick test additional cockroach and shrimp allergen were performed. There were 84 (73.7%) female and 30 (26.3%) male patients with a mean age of 38.1+10.1 years. The average duration of asthma was 7.7+7.2 years. Sixty five (57%) patients were determined atopic and 49 (43%) nonatopic. Pollen allergen was the most common allergen in 59 (51.8%) patients with asthma, and second common allergen was mite allergen in 43 (37.7%) patients. Cockroach sensitivity were detected in 23 (20.2%) of 114 all asthmatics and 23 (35%) of atopic asthmatics. High rates of house-dust-mite allergy (73.9%) was determined in patients with cockroach sensitivity (P<0.05), while we found no relationship with other allergens. There was no difference for cockroach sensitivity between rural and urban population. Cockroach sensitivity was more common in mild bronchial asthmatics and a female predominance was observed. In addition, there was no association between shrimp and cockroach sensitivity. As a result, a high rate of cockroach sensitivity alone or with mite sensitivity was seen in patients with bronchial asthma in Turkish population. Because of cross-reactivity between mites and cockroach, cockroach sensitivity should be investigated in patients with house-dust-mite allergy. In addition, a high rate of cockroach sensitivity, in terms of IgE sensitization, may be important for the development of new sensitizations.
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Affiliation(s)
- Azize Uzel
- Atatürk Chest Disease and Thoracic Surgery Education and Research Hospital, Ankara, Turkey
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Smith W, Butler AJL, Hazell LA, Chapman MD, Pomés A, Nickels DG, Thomas WR. Fel d 4, a cat lipocalin allergen. Clin Exp Allergy 2005; 34:1732-8. [PMID: 15544598 DOI: 10.1111/j.1365-2222.2004.02090.x] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Cat allergy is unique among allergy to mammals in that the major allergen Fel d 1 is a uteroglobin-like protein and not a lipocalin. The biochemical spectrum of the cat allergens is thus uncertain, particularly with regard to the role that a cat lipocalin protein may play in sensitization to cats in allergic individuals. OBJECTIVE To analyse cDNA encoding a lipocalin allergen and the corresponding recombinant allergen at both the molecular and immunological levels. METHODS A submandibular salivary gland cDNA expression library was constructed and screened for clones producing IgE-binding polypeptides. cDNA encoding a lipocalin allergen and its corresponding recombinant allergen were analysed. RESULTS An IgE binding molecule with high sequence identity to the boar salivary lipocalin and the horse lipocalin Equ c 1 allergen was isolated and designated, Fel d 4. Serum from 62.96% of cat-allergic subjects examined had measurable IgE antibody to Fel d 4 but typically at low levels. Despite this in 47% of sera the anti-Fel d 4 IgE titres were higher than the anti-Fel d 1 titres. IgE binding to the lipocalin allergen could be blocked by an allergen extract from cow and to a lesser degree by extracts from horse and dog. CONCLUSION Fel d 4 is a lipocalin allergen produced by the cat, which binds IgE at relatively high frequency in cat-sensitive individuals. The allergen provides not only a means for investigating differences in the immune response to lipocalin allergens from that found for other mammalian species but also an important reagent for the diagnosis of cat allergy.
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Affiliation(s)
- W Smith
- Telethon Institute for Child Health Research and Centre for Child Health Research, University of Western Australia, West Perth, WA, Australia.
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Dennis R, Caraballo L, García E, Caballero A, Aristizabal G, Córdoba H, Rodriguez MN, Rojas MX, Orduz C, Cardona R, Blanco A, Egea E, Verbel C, Cala LL. Asthma and other allergic conditions in Colombia: a study in 6 cities. Ann Allergy Asthma Immunol 2005; 93:568-74. [PMID: 15609767 DOI: 10.1016/s1081-1206(10)61265-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND No detailed information is available on the burden and impact of allergic diseases simultaneously for adults and children in Colombia and most Latin American countries. OBJECTIVES To investigate the prevalence of asthma, allergic rhinitis, and atopic dermatitis symptoms in 6 cities in Colombia; to measure patient expenses and school days and workdays lost; to describe disease severity; and to determine levels of total and specific IgE in asthmatic subjects. METHODS A multistage stratified random sample selection of schools with subjects aged 5 to 18 years in each city was used. Guardian subjects selected were contacted, and home visits were arranged. Subjects aged 1 to 4 years and older than 19 years were also selected randomly by systematic sampling based on the addresses of the subjects aged 5 to 18 years. Subjects with asthma symptoms were invited to provide a blood sample. RESULTS Information was obtained from 6,507 subjects. The prevalence of asthma, rhinitis, and atopic dermatitis symptoms in the past 12 months was 10.4% (95% confidence interval [CI], 9.7%-11.1%), 22.6% (95% CI, 21.6%-23.6%), and 3.9% (95% CI, 3.4%-4.4%), respectively. Thirty-eight percent of asthmatic subjects had visited the emergency department or have been hospitalized, and 50% reported lost school days and workdays. Seventy-six percent of sampled asthmatic patients were considered to be atopic. CONCLUSIONS The burden of disease and societal consequences of allergic entities in urban settings in countries such as Colombia are of concern but are largely ignored, perhaps because of the misconception that these diseases are of public health importance only in industrialized nations.
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Affiliation(s)
- Rodolfo Dennis
- Clinical Epidemiology and Biostatistics Unit, Pontificia Universidad Javeriana, Bogotá, Colombia
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47
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Mavale-Manuel S, Duarte N, Alexandre F, Albuquerque O, Scheinmann P, Poisson-Salomon AS, de Blic J. Knowledge, attitudes, and behavior of the parents of asthmatic children in Maputo. J Asthma 2004; 41:533-8. [PMID: 15360061 DOI: 10.1081/jas-120037653] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Asthma is increasing in frequency worldwide. The education of affected children and their parents is fundamental for the management of the disease. The aim of our study was to describe the knowledge, attitudes, and behavior of the parents of asthmatic children. We studied 152 adults accompanying asthmatic children to consultations in the pediatrics department of Maputo Central Hospital (Mozambique). In general, knowledge about asthma was poor: 11% of the adults thought that asthma was contagious and transmitted from person to person, and 4% thought that it was transmitted by contaminated food. More than half the parents thought that the child could not lead a normal life even during the periods between attacks. A large proportion of the parents thought that asthma could be cured by medical treatment in 7% of cases and by alternative treatment in 43% of cases. The precipitating factors were well identified by the adults, but they had an inaccurate perception of the symptoms of an asthma attack. The actions of the various classes of drugs used were poorly understood. Education programs for both the children and their parents should be developed to improve the management of asthmatic children. Surveys of this type facilitate the targeting of such programs.
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Affiliation(s)
- S Mavale-Manuel
- Department of Pediatrics, Maputo Central Hospital, Maputo, Mozambique
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48
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Affiliation(s)
- J Rosado-Pinto
- Immunology Department, Doña Estefania Hospital, R. Jacinto Marto, 1100 Lisbon, Portugal.
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49
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Mavale-Manuel S, Alexandre F, Duarte N, Albuquerque O, Scheinmann P, Poisson-Salomon AS, de Blic J. Risk factors for asthma among children in Maputo (Mozambique). Allergy 2004; 59:388-93. [PMID: 15005761 DOI: 10.1046/j.1398-9995.2003.00333.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Few studies have looked at risk factors for asthma in African children. We aimed to identify the risk factors associated with childhood asthma in Maputo (Mozambique). METHODS This case-control study included 199 age-matched children (100 asthmatic and 99 nonasthmatic) who attended Maputo Central Hospital between January 1999 and July 2000. We collected information concerning their familial history of atopy, birth weight, environment and breast-feeding. Detailed information about morbidity and treatment was obtained for each asthmatic child. RESULTS The children were aged between 18 months and 8 years; 60% were male. The asthmatic children were hospitalized more frequently than the nonasthmatic children (P < 0.0001). Most of the asthmatic children lived in the urban area of Maputo [odd ratio (OR) = 6.73, CI = 3.1-14.0, P < 0.0001], had a parental history of asthma (OR = 26.8, CI = 10.8-68.2, P < 0.0001) or rhinitis (OR = 4, CI = 1.2-13.3, P = 0.005), had at least parent who smoked and were weaned earlier than the nonasthmatic children (OR = 2.4, CI = 1.3-4.4, P < 0.001). CONCLUSION Childhood asthma was strongly associated with a family history of asthma and rhinitis, the place of residence, having smokers as parents and early weaning from maternal breast milk. These results highlight the need to reassess the management of asthmatic children in Maputo.
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Affiliation(s)
- S Mavale-Manuel
- Department of Pediatrics, Maputo Central Hospital, Maputo, Mozambique
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Bousquet J, Ndiaye M, Aït-Khaled N, Annesi-Maesano I, Vignola AM. Management of chronic respiratory and allergic diseases in developing countries. Focus on sub-Saharan Africa. Allergy 2003; 58:265-83. [PMID: 12708972 DOI: 10.1034/j.1398-9995.2003.02005.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- J Bousquet
- Service des Maladies Respiratoires and INSERM U454, CHU Montpellier; Centre d'Allergologie, Institut Pasteur, Paris, France
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