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Siegel J, Gill N, Ramanathan M, Patadia M. Unified Airway Disease. Otolaryngol Clin North Am 2023; 56:39-53. [DOI: 10.1016/j.otc.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Dai X, Dharmage SC, Lodge CJ. The relationship of early-life household air pollution with childhood asthma and lung function. Eur Respir Rev 2022; 31:220020. [PMID: 38743526 DOI: 10.1183/16000617.0020-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 06/29/2022] [Indexed: 11/05/2022] Open
Abstract
The increase in childhood asthma over the past few decades has made it an important public health issue. Poor lung function growth associated with some phenotypes of asthma compounds its long-term impact on the individual. Exposure to early-life household risk factors is believed to be linked with respiratory health while infants' lungs are still developing. This review summarises epidemiological studies and mechanistic evidence focusing on the detrimental effects of early-life household air exposures on the respiratory health of children, in particular effects on asthma and lung function. Many early-life household air exposures, including tobacco smoke, gases from heating and cooking, mould/dampness and cleaning products are associated with childhood asthma development and lung function growth. These exposures may alter structural and mechanical characteristics of infants' lungs and contribute to deficits in later life. In addition, some risk factors, including tobacco smoke and cleaning products, can transmit effects across generations to increase the risk of asthma in subsequent generations. This review supports the hypothesis that risks of asthma and accelerated lung ageing are established in early life. The timing of exposure may be critical in the pathogenesis of respiratory diseases, in terms of future risk of asthma and reduced lung function in adults.
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Affiliation(s)
- Xin Dai
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Caroline J Lodge
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
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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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Al-Tamprouri C, Malin B, Bill H, Lennart B, Anna S. Cat and dog ownership during/after the first year of life and risk for sensitization and reported allergy symptoms at age 13. IMMUNITY INFLAMMATION AND DISEASE 2019; 7:250-257. [PMID: 31464382 PMCID: PMC6842813 DOI: 10.1002/iid3.267] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 06/07/2019] [Accepted: 06/10/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND Avoidance of pets as a strategy for preventing atopic diseases has been questioned. This study aimed to identify the risk of sensitization and allergic symptoms at age 13 in relation to dog- and cat-keeping during and after the first year of life. METHODS The study included all children born at Östersund Hospital in Northern Sweden between February 1996 and January 1997 (n = 1231). At inclusion, parents were asked to answer questionnaires about lifestyle, including cat- and dog-keeping. Dog allergy, cat allergy, hay fever, and asthma were diagnosed based on parental reported allergic symptoms at 13 years of age (n = 834). The risks of sensitization or allergy in relation to dog- and cat-keeping during and after the first year of life were analyzed with logistic regression. To adjust for reverse causation, all subjects that had reported avoidance of pets due to allergic symptoms of the child or allergy in the family (n = 177) were excluded. RESULTS Dog- or cat-keeping during the first year of life reduced the risk of sensitization to dog or cat allergens, respectively, and to birch and to at least one of the 10 allergens tested. Cat-keeping, both during and after the first year of life, reduced the risk of cat allergy and hay fever. Having a dog at home during the first year of life reduced the risk of dog and cat allergy, whereas dog-keeping after the first year of life did not affect allergic symptoms. CONCLUSIONS Cat ownership, either during or after the first year of life, may be a strategy for preventing the development of cat allergy and hay fever later in life. Dog ownership reduced the risk of sensitization to dog and birch allergen, and also the risk of cat and dog allergy, but had no effect on hay fever.
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Affiliation(s)
| | - Barman Malin
- Department of Biology and Biological Engineering, Food and Nutrition Science, Chalmers University of Technology, Gothenburg, Sweden
| | - Hesselmar Bill
- Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Bråbäck Lennart
- Section of Sustainable Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Sandin Anna
- Department of Clinical Science, Paediatrics, Umeå University, Umeå, Sweden
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Barman M, Murray F, Bernardi AI, Broberg K, Bölte S, Hesselmar B, Jacobsson B, Jonsson K, Kippler M, Rabe H, Ross AB, Sjöberg F, Strömberg N, Vahter M, Wold AE, Sandberg AS, Sandin A. Nutritional impact on Immunological maturation during Childhood in relation to the Environment (NICE): a prospective birth cohort in northern Sweden. BMJ Open 2018; 8:e022013. [PMID: 30344169 PMCID: PMC6196815 DOI: 10.1136/bmjopen-2018-022013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Prenatal and neonatal environmental factors, such as nutrition, microbes and toxicants, may affect health throughout life. Many diseases, such as allergy and impaired child development, may be programmed already in utero or during early infancy. Birth cohorts are important tools to study associations between early life exposure and disease risk. Here, we describe the study protocol of the prospective birth cohort, 'Nutritional impact on Immunological maturation during Childhood in relation to the Environment' (NICE). The primary aim of the NICE cohort is to clarify the effect of key environmental exposures-diet, microbes and environmental toxicants-during pregnancy and early childhood, on the maturation of the infant's immune system, including initiation of sensitisation and allergy as well as some secondary outcomes: infant growth, obesity, neurological development and oral health. METHODS AND ANALYSIS The NICE cohort will recruit about 650 families during mid-pregnancy. The principal inclusion criterion will be planned birth at the Sunderby Hospital in the north of Sweden, during 2015-2018. Questionnaires data and biological samples will be collected at 10 time-points, from pregnancy until the children reach 4 years of age. Samples will be collected primarily from mothers and children, and from fathers. Biological samples include blood, urine, placenta, breast milk, meconium, faeces, saliva and hair. Information regarding allergic heredity, diet, socioeconomic status, lifestyle including smoking, siblings, pet ownership, etc will be collected using questionnaires. Sensitisation to common allergens will be assessed by skin prick testing and allergic disease will be diagnosed by a paediatrician at 1 and 4 years of age. At 4 years of age, the children will also be examined regarding growth, neurobehavioural and neurophysiological status and oral health. ETHICS AND DISSEMINATION The NICE cohort has been approved by the Regional Ethical Review Board in Umeå, Sweden (2013/18-31M). Results will be disseminated through peer-reviewed journals and communicated on scientific conferences.
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Affiliation(s)
- Malin Barman
- Food and Nutrition Science, Department of Biology and Biological Engineering, Chalmers University of Technology, Göteborg, Sweden
- Department of Obstetrics and Gynaecology, University of Gothenburg, the Sahlgrenska Academy, Institute of Clinical Sciences, Göteborg, Sweden
| | - Fiona Murray
- Sunderby Research Unit, Region Norrbotten, Luleå, Sweden
| | - Angelina I Bernardi
- Department of Infectious Diseases, University of Gothenburg, Institute of Biomedicine, the Sahlgrenska Academy, Göteborg, Sweden
| | - Karin Broberg
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Sven Bölte
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research; Department of Women’s and Children’s Health, Karolinska Institutet & Child and Adolescent Psychiatry, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Bill Hesselmar
- Department of Paediatrics, University of Gothenburg, Institute of Clinical Sciences, Göteborg, Sweden
| | - Bo Jacobsson
- Department of Obstetrics and Gynaecology, University of Gothenburg, the Sahlgrenska Academy, Institute of Clinical Sciences, Göteborg, Sweden
| | - Karin Jonsson
- Food and Nutrition Science, Department of Biology and Biological Engineering, Chalmers University of Technology, Göteborg, Sweden
| | - Maria Kippler
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Hardis Rabe
- Department of Infectious Diseases, University of Gothenburg, Institute of Biomedicine, the Sahlgrenska Academy, Göteborg, Sweden
| | - Alastair B Ross
- Food and Nutrition Science, Department of Biology and Biological Engineering, Chalmers University of Technology, Göteborg, Sweden
| | - Fei Sjöberg
- Department of Infectious Diseases, University of Gothenburg, Institute of Biomedicine, the Sahlgrenska Academy, Göteborg, Sweden
| | | | - Marie Vahter
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Agnes E Wold
- Department of Infectious Diseases, University of Gothenburg, Institute of Biomedicine, the Sahlgrenska Academy, Göteborg, Sweden
| | - Ann-Sofie Sandberg
- Food and Nutrition Science, Department of Biology and Biological Engineering, Chalmers University of Technology, Göteborg, Sweden
| | - Anna Sandin
- Sunderby Research Unit, Region Norrbotten, Luleå, Sweden
- Department of Clinical Sciences, Unit of Pediatrics, Umeå University, Umeå, Sweden
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Sierra-Heredia C, North M, Brook J, Daly C, Ellis AK, Henderson D, Henderson SB, Lavigne É, Takaro TK. Aeroallergens in Canada: Distribution, Public Health Impacts, and Opportunities for Prevention. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E1577. [PMID: 30044421 PMCID: PMC6121311 DOI: 10.3390/ijerph15081577] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 07/04/2018] [Accepted: 07/18/2018] [Indexed: 12/17/2022]
Abstract
Aeroallergens occur naturally in the environment and are widely dispersed across Canada, yet their public health implications are not well-understood. This review intends to provide a scientific and public health-oriented perspective on aeroallergens in Canada: their distribution, health impacts, and new developments including the effects of climate change and the potential role of aeroallergens in the development of allergies and asthma. The review also describes anthropogenic effects on plant distribution and diversity, and how aeroallergens interact with other environmental elements, such as air pollution and weather events. Increased understanding of the relationships between aeroallergens and health will enhance our ability to provide accurate information, improve preventive measures and provide timely treatments for affected populations.
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Affiliation(s)
| | - Michelle North
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 3H7, Canada.
- Department of Biomedical & Molecular Sciences and Division of Allergy & Immunology, Department of Medicine, Queen's University, Kingston, ON K7L 3N6, Canada.
- Allergy Research Unit, Kingston General Hospital, Kingston, ON K7L 2V7, Canada.
| | - Jeff Brook
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M3H 5T4, Canada.
| | - Christina Daly
- Air Quality Health Index, Health Canada, Ottawa, ON K1A 0K9, Canada.
| | - Anne K Ellis
- Department of Biomedical & Molecular Sciences and Division of Allergy & Immunology, Department of Medicine, Queen's University, Kingston, ON K7L 3N6, Canada.
- Allergy Research Unit, Kingston General Hospital, Kingston, ON K7L 2V7, Canada.
| | - Dave Henderson
- Health and Air Quality Services, Environment and Climate Change Canada, Gatineau, QC K1A 0H3, Canada.
| | - Sarah B Henderson
- Environmental Health Services, BC Centre for Disease Control, Vancouver, BC V5Z 4R4, Canada.
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada.
| | - Éric Lavigne
- Air Health Science Division, Health Canada, Ottawa, ON K1A 0K9, Canada.
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1G 5Z3, Canada.
| | - Tim K Takaro
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada.
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Hu LW, Qian Z, Dharmage SC, Liu E, Howard SW, Vaughn MG, Perret J, Lodge CC, Zeng XW, Yang BY, Xu SL, Zhang C, Dong GH. Pre-natal and post-natal exposure to pet ownership and lung function in children: The Seven Northeastern Cities Study. INDOOR AIR 2017; 27:1177-1189. [PMID: 28613428 DOI: 10.1111/ina.12401] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 06/07/2017] [Indexed: 06/07/2023]
Abstract
To evaluate the association between pre-natal and post-natal exposure to pet ownership and lung function in children, a cross-sectional study named Seven Northeastern Cities (SNEC) study was conducted. In this study, children's lung function including the forced expiratory volume in 1 second (FEV1 ), forced vital capacity (FVC), maximal mid-expiratory flow (MMEF), and peak expiratory flow (PEF) were measured by spirometers, and pet ownership situations were collected by questionnaire. Analyzed by multiple logistic regression and generalized linear modeling, we found that for all subjects, pet exposure in the first 2 years of life was significantly associated with lung function impairment of FVC<85% predicted (adjusted odds ratio [aOR]=1.28; 95% confidence interval [CI]: 1.01, 1.63). For current pet exposure, the increased odds of lung function impairment ranged from 35% (aOR=1.35; 95%CI: 1.12, 1.62) for FVC<85% predicted to 57% (aOR=1.57; 95%CI: 1.29, 1.93) for FEV1 <85% predicted. The in utero exposure was not related to lung function impairment. Compared with other pets, higher odds were observed among children with dogs. When stratified by gender, girls with current pet exposure were more likely to have lung function impairment than boys. It implies self-reported exposures to pets were negatively associated with lung function among the children under study.
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Affiliation(s)
- L-W Hu
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Z Qian
- Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO, USA
| | - S C Dharmage
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia
| | - E Liu
- Department of Health Management & Policy, College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO, USA
| | - S W Howard
- Department of Health Management & Policy, College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO, USA
| | - M G Vaughn
- School of Social Work, College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO, USA
| | - J Perret
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia
| | - C C Lodge
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia
| | - X-W Zeng
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - B-Y Yang
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - S-L Xu
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - C Zhang
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - G-H Dong
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, China
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Wold A. Why is there still confusion about the impact of breast-feeding on the risk of allergy development? SCANDINAVIAN JOURNAL OF FOOD & NUTRITION 2016. [DOI: 10.1080/11026480600617774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Agnes Wold
- Department of Clinical Bacteriology, Go¨ teborg University, Sweden
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Wegienka G, Havstad S, Kim H, Zoratti E, Ownby D, Woodcroft KJ, Johnson CC. Subgroup differences in the associations between dog exposure during the first year of life and early life allergic outcomes. Clin Exp Allergy 2016; 47:97-105. [PMID: 27562398 DOI: 10.1111/cea.12804] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Revised: 08/12/2016] [Accepted: 08/15/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND The effect of dog exposure on the risk of children developing allergic disease remains controversial. Many analyses have not considered that associations may vary within population subgroups. OBJECTIVE To examine whether associations between living with a dog in the first year of life and allergic outcomes vary within subgroups selected a priori (race, gender and delivery mode). METHODS Black (n = 496) and White (n = 196) children enrolled in the WHEALS birth cohort study had a clinical examination at age 2 years to assess eczema and allergen-specific IgE (sIgE) and perform skin prick testing (SPT). Whether the child lived with an indoor dog in the first year of life was assessed through interview, as was doctor diagnosis of asthma at ages 3-6 years. RESULTS Living with a dog was associated with decreased odds of having ≥ 1 positive SPT (OR = 0.56, 95% CI: 0.34, 0.91) and having eczema (OR = 0.34, 95% CI: 0.20, 0.60). The association with SPT was stronger in those children born via caesarean section (c-section) vs. vaginally (OR = 0.29, 95% CI: 0.12, 0.74 vs. OR = 0.76, 95% CI: 0.43, 1.37, respectively, interaction P = 0.087) and in those who were firstborn vs. not (OR = 0.27, 95% CI: 0.11, 0.67 vs. OR = 0.82, 95% CI: 0.45, 1.47, respectively, interaction P = 0.044). The association with eczema was stronger in children born vaginally compared with those born via caesarean section (OR = 0.17, 95% CI: 0.06, 0.43 vs. OR = 0.65, 95% CI: 0.31, 1.35, respectively, interaction P = 0.025) and was stronger in Black vs. White children (OR = 0.30, 95% CI: 0.15, 0.61 vs. OR = 0.78, 95% CI: 0.29, 2.11, respectively, interaction P = 0.12). Dog keeping was not significantly inversely associated with having ≥ 1 elevated sIgE and only approached statistical significance with asthma. CONCLUSIONS AND CLINICAL RELEVANCE Results likely vary between studies due to variability of specific exposure-outcome associations in subgroups defined by other factors as well as the relative distributions of those subgroups. Important allergic disorder associations will be missed without subgroup analyses.
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Affiliation(s)
- G Wegienka
- Department of Public Health Sciences, Henry Ford Hospital, Detroit, MI, USA
| | - S Havstad
- Department of Public Health Sciences, Henry Ford Hospital, Detroit, MI, USA
| | - H Kim
- Division of Allergy and Clinical Immunology, Henry Ford Hospital, Detroit, MI, USA
| | - E Zoratti
- Division of Allergy and Clinical Immunology, Henry Ford Hospital, Detroit, MI, USA
| | - D Ownby
- Department of Pediatrics, Georgia Regents University, Augusta, GA, USA
| | - K J Woodcroft
- Department of Public Health Sciences, Henry Ford Hospital, Detroit, MI, USA
| | - C C Johnson
- Department of Public Health Sciences, Henry Ford Hospital, Detroit, MI, USA
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Apfelbacher C, Frew E, Xiang A, Apfel A, Smith H. Assessment of pet exposure by self-report in epidemiological studies of allergy and asthma: a systematic review. J Asthma 2016; 53:363-73. [PMID: 26539692 DOI: 10.3109/02770903.2015.1099161] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE In epidemiological studies that aim to investigate the relationship between pet exposure and allergy/asthma, pet exposure is often ascertained by means of a questionnaire, but it is unclear which questionnaire items are used. The objective of this study was to systematically review self-reported pet exposure assessment in questionnaires used in epidemiological studies which explore the associations between pets and allergy/asthma. METHODS A systematic literature search was conducted in PubMed and papers were selected according to pre-specified eligibility criteria. The pet exposure questions used were classified within a framework including direct pet contact, indirect pet contact (e.g. through carers or grandparents) and avoidance behaviour. Authors were contacted when the questions used were not reported in detail. RESULTS Ninety-six full text papers were systematically reviewed. All studies assessed direct pet contact, but less than half (45%) explicitly assessed whether pets were allowed indoors. The vast majority of studies assessed both pet exposures during the first year of life and after the first year of life. The minority (13%) assessed whether pet(s) were kept at places regularly visited by the child and pet exposure in utero (15%). Even fewer studies assessed indirect contact to pets (n = 8) and avoidance behaviour (n = 10). CONCLUSIONS In epidemiological studies, the ascertainment of pet exposure through questionnaires appears to vary greatly. This variation might partly explain the inconsistent and contradictory results of the effects of pet exposure on the development of allergy and asthma.
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Affiliation(s)
- Christian Apfelbacher
- a Division of Public Health and Primary Care , Brighton and Sussex Medical School , Brighton , UK and.,b Department of Medical Sociology , Institute of Epidemiology and Preventive Medicine, University of Regensburg , Regensburg , Germany
| | - Edward Frew
- a Division of Public Health and Primary Care , Brighton and Sussex Medical School , Brighton , UK and
| | - Ally Xiang
- a Division of Public Health and Primary Care , Brighton and Sussex Medical School , Brighton , UK and
| | - Alex Apfel
- a Division of Public Health and Primary Care , Brighton and Sussex Medical School , Brighton , UK and
| | - Helen Smith
- a Division of Public Health and Primary Care , Brighton and Sussex Medical School , Brighton , UK and
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Collin SM, Granell R, Westgarth C, Murray J, Paul ES, Sterne JAC, Henderson AJ. Associations of Pet Ownership with Wheezing and Lung Function in Childhood: Findings from a UK Birth Cohort. PLoS One 2015; 10:e0127756. [PMID: 26061067 PMCID: PMC4465326 DOI: 10.1371/journal.pone.0127756] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 04/19/2015] [Indexed: 01/04/2023] Open
Abstract
Background Asthma is a heterogeneous condition and differential effects of pet ownership on non-atopic versus atopic asthma have been reported. The aim of this study was to investigate whether pet ownership during pregnancy and early childhood was associated with wheezing from birth to age 7 years and with lung function at age 8 years in a UK population-based birth cohort. Methods Data from the Avon Longitudinal Study of Parents and Children (ALSPAC) were used to investigate associations of pet ownership at six time-points from pregnancy to age 7 years with concurrent episodes of wheezing, wheezing trajectories (phenotypes) and lung function at age 8 years using logistic regression models adjusted for child’s sex, maternal history of asthma/atopy, maternal smoking during pregnancy, and family adversity. Results 4,706 children had complete data on pet ownership and wheezing. From birth to age 7 years, cat ownership was associated with an overall 6% lower odds of wheezing (OR=0.94 (0.89-0.99)). Rabbit and rodent ownership was associated with 21% (OR=1.21 (1.12-1.31)) and 11% (OR=1.11 (1.02–1.21)) higher odds of wheezing, respectively, with strongest effects evident during infancy. Rabbit and rodent ownership was positively associated with a ‘persistent wheeze’ phenotype. Pet ownership was not associated with lung function at age 8 years, with the exception of positive associations of rodent and bird ownership with better lung function. Conclusions Cat ownership was associated with reduced risk, and rabbit and rodent ownership with increased risk, of wheezing during childhood. The mechanisms behind these differential effects warrant further investigation.
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Affiliation(s)
- Simon M. Collin
- Centre for Child & Adolescent Health, University of Bristol, Bristol, United Kingdom
- School of Social & Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Raquel Granell
- School of Social & Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Carri Westgarth
- Department of Epidemiology & Population Health, University of Liverpool, Liverpool, United Kingdom
- School of Veterinary Science, University of Liverpool, Liverpool, United Kingdom
| | - Jane Murray
- School of Veterinary Sciences, University of Bristol, Bristol, United Kingdom
| | - Elizabeth S. Paul
- School of Veterinary Sciences, University of Bristol, Bristol, United Kingdom
| | - Jonathan A. C. Sterne
- School of Social & Community Medicine, University of Bristol, Bristol, United Kingdom
| | - A. John Henderson
- School of Social & Community Medicine, University of Bristol, Bristol, United Kingdom
- * E-mail:
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Dick S, Friend A, Dynes K, AlKandari F, Doust E, Cowie H, Ayres JG, Turner SW. A systematic review of associations between environmental exposures and development of asthma in children aged up to 9 years. BMJ Open 2014; 4:e006554. [PMID: 25421340 PMCID: PMC4244417 DOI: 10.1136/bmjopen-2014-006554] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES Childhood asthma is a complex condition where many environmental factors are implicated in causation. The aim of this study was to complete a systematic review of the literature describing associations between environmental exposures and the development of asthma in young children. SETTING A systematic review of the literature up to November 2013 was conducted using key words agreed by the research team. Abstracts were screened and potentially eligible papers reviewed. Papers describing associations between exposures and exacerbation of pre-existing asthma were not included. Papers were placed into the following predefined categories: secondhand smoke (SHS), inhaled chemicals, damp housing/mould, inhaled allergens, air pollution, domestic combustion, dietary exposures, respiratory virus infection and medications. PARTICIPANTS Children aged up to 9 years. PRIMARY OUTCOMES Diagnosed asthma and wheeze. RESULTS 14,691 abstracts were identified, 207 papers reviewed and 135 included in the present review of which 15 were systematic reviews, 6 were meta-analyses and 14 were intervention studies. There was consistent evidence linking exposures to SHS, inhaled chemicals, mould, ambient air pollutants, some deficiencies in maternal diet and respiratory viruses to an increased risk for asthma (OR typically increased by 1.5-2.0). There was less consistent evidence linking exposures to pets, breast feeding and infant dietary exposures to asthma risk, and although there were consistent associations between exposures to antibiotics and paracetamol in early life, these associations might reflect reverse causation. There was good evidence that exposures to house dust mites (in isolation) was not associated with asthma risk. Evidence from observational and intervention studies suggest that interactions between exposures were important to asthma causation, where the effect size was typically 1.5-3.0. CONCLUSIONS There are many publications reporting associations between environmental exposures and modest changes in risk for asthma in young children, and this review highlights the complex interactions between exposures that further increase risk.
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Affiliation(s)
- S Dick
- Occupational and Environmental Medicine, University of Aberdeen, Aberdeen, UK
| | - A Friend
- Department of Child Health, University of Aberdeen, Aberdeen, UK
| | - K Dynes
- Department of Child Health, University of Aberdeen, Aberdeen, UK
| | - F AlKandari
- Department of Child Health, University of Aberdeen, Aberdeen, UK
| | - E Doust
- Institute of Occupational Medicine, Edinburgh, UK
| | - H Cowie
- Institute of Occupational Medicine, Edinburgh, UK
| | - J G Ayres
- Occupational and Environmental Medicine, University of Aberdeen, Aberdeen, UK
- Environmental and Respiratory Medicine, University of Birmingham, Birmingham, UK
| | - S W Turner
- Department of Child Health, University of Aberdeen, Aberdeen, UK
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Barman M, Jonsson K, Sandin A, Wold AE, Sandberg AS. Serum fatty acid profile does not reflect seafood intake in adolescents with atopic eczema. Acta Paediatr 2014; 103:968-76. [PMID: 24837739 PMCID: PMC4225477 DOI: 10.1111/apa.12690] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 04/23/2014] [Accepted: 05/13/2014] [Indexed: 01/15/2023]
Abstract
AIM Long-chain polyunsaturated fatty acids (LCPUFAs) are immunomodulatory, but their role in allergy development is controversial. We investigated whether proportions of LCPUFAs in serum phospholipids were related to allergic diagnosis, seafood intake and LCPUFA proportions in cord blood. METHODS Serum was obtained from 148 birth cohort children at 13 years of age. Forty had atopic eczema, 53 had respiratory allergy, and 55 were nonallergic. Proportions of LCPUFAs were determined in serum phospholipids; cord blood from 128 of the individuals was previously analysed. Seafood intake was estimated using questionnaires. RESULTS Allergic and nonallergic individuals did not differ significantly regarding individual LCPUFAs. However, arachidonic acid over docosahexaenoic acid (DHA) ratio was higher in allergic, compared with nonallergic, adolescents. In nonallergic individuals, LCPUFA proportions in cord serum and adolescent serum correlated weakly. In individuals with atopic eczema and respiratory allergy, these correlations were weak or absent. A moderate correlation between seafood intake and serum DHA was seen in nonallergic individuals and those with respiratory allergy, but not in those with atopic eczema. CONCLUSION Serum LCPUFA pattern was similar in allergic and nonallergic adolescents. Fatty acid metabolism may be altered in atopic eczema subjects, suggested by poor correlations between fatty acid intake and serum levels.
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Affiliation(s)
- Malin Barman
- Food Science, Department of Chemical and Biological Engineering, Chalmers University of Technology, Göteborg, Sweden
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Barman M, Johansson S, Hesselmar B, Wold AE, Sandberg AS, Sandin A. High levels of both n-3 and n-6 long-chain polyunsaturated fatty acids in cord serum phospholipids predict allergy development. PLoS One 2013; 8:e67920. [PMID: 23874467 PMCID: PMC3707846 DOI: 10.1371/journal.pone.0067920] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 05/22/2013] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Long-chain polyunsaturated fatty acids (LCPUFAs) reduce T-cell activation and dampen inflammation. They might thereby counteract the neonatal immune activation and hamper normal tolerance development to harmless environmental antigens. We investigated whether fatty acid composition of cord serum phospholipids affects allergy development up to age 13 years. METHODS From a population-based birth-cohort born in 1996/7 and followed until 13 years of age (n = 794), we selected cases with atopic eczema (n = 37) or respiratory allergy (n = 44), as well as non-allergic non-sensitized controls (n = 48) based on diagnosis at 13 years of age. Cord and maternal sera obtained at delivery from cases and controls were analysed for proportions of saturated, monounsaturated and polyunsaturated fatty acids among serum phospholipids. RESULTS The cord serum phospholipids from subject who later developed either respiratory allergy or atopic eczema had significantly higher proportions of 5/8 LCPUFA species, as well as total n-3 LCPUFA, total n-6 LCPUFA and total LCPUFA compared to cord serum phospholipids from controls who did not develop allergy (P<0.001 for all comparisons). Conversely, individuals later developing allergy had lower proportion of the monounsaturated fatty acid 18∶1n-9 as well as total MUFA (p<0.001) among cord serum phospholipids. The risk of respiratory allergy at age 13 increased linearly with the proportion of n-3 LCPUFA (Ptrend<0.001), n-6 LCPUFA (Ptrend = 0.001), and total LCPUFA (Ptrend<0.001) and decreased linearly with the proportions of total MUFA (Ptrend = 0.025) in cord serum phospholipids. Furthermore, Kaplan-Meier estimates of allergy development demonstrated that total LCPUFA proportion in cord serum phospholipids was significantly associated with respiratory allergy (P = 0.008) and sensitization (P = 0.002), after control for sex and parental allergy. CONCLUSION A high proportion of long-chain PUFAs among cord serum phospholipids may predispose to allergy development. The mechanism is unknown, but may involve dampening of the physiologic immune activation in infancy needed for proper maturation of the infant's immune system.
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Affiliation(s)
- Malin Barman
- Food Science, Department of Chemical and Biological Engineering, Chalmers University of Technology, Gothenburg, Sweden.
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15
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Collins SA, Pike KC, Inskip HM, Godfrey KM, Roberts G, Holloway JW, Lucas JSA. Validation of novel wheeze phenotypes using longitudinal airway function and atopic sensitization data in the first 6 years of life: evidence from the Southampton Women's survey. Pediatr Pulmonol 2013; 48:683-92. [PMID: 23401430 PMCID: PMC3689612 DOI: 10.1002/ppul.22766] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 11/09/2012] [Accepted: 11/09/2012] [Indexed: 12/16/2022]
Abstract
BACKGROUND In 1995 the Tucson Children's Respiratory Study (TCRS) identified clinically distinct phenotypes amongst early wheezers; the Avon Longitudinal Study of Parents And Children (ALSPAC) has recently re-examined these. OBJECTIVES To validate statistically derived ALSPAC phenotypes in the Southampton Women's Survey (SWS) using infant and 6-year lung function, and allergic sensitization at 1, 3, and 6 years, comparing these with TCRS phenotypes. METHODS Complete 6-year follow-up data were available for 926 children, selected from 1,973 infants born to 12,579 women characterized pre-conception. Ninety-five children had V'maxFRC and FEV0.4 measured age 5-14 weeks using rapid compression/raised volume techniques. At 6 years we performed spirometry (n = 791), fractional exhaled nitric oxide (FeNO, n = 589) and methacholine challenge (n = 234). Skin prick testing was performed at 12m, 3 and 6 years (n = 1,494, 1,255, 699, respectively). Using wheeze status questionnaire data at 6m, 12m, 2, 3 and 6 years we classified children into TCRS (never, transient early, persistent, late-onset) and ALSPAC based groups (never, early, transient, intermediate-onset, late-onset, persistent). RESULTS Amongst ALSPAC groups, persistent and late-onset wheeze were associated with atopy at 3 and 6 years, whilst intermediate-onset wheeze showed earlier atopic association at 1 year; all three were associated with FeNO at 6 years. Persistent wheezers had lower infant (V'maxFRC P < 0.05) and 6-year lung function (FEV1, FEV1/FVC, and FEF(25-75), P < 0.05), whilst late and intermediate-onset wheezers showed no lung function deficits. Transient wheezers were non-atopic but showed persistent lung function deficits (V'maxFRC in infancy, FEV1 and FEF(25-75) at 6 years, all P < 0.05). Those who wheezed only in the first year (early phenotype) showed no lung function deficits. No associations were seen with 6 years bronchial hyper-responsiveness or infancy FEV0.4. CONCLUSION SWS cohort data validates the statistically derived ALSPAC six-class model. In particular, lung function and atopy successfully differentiate persistent, late-onset and intermediate-onset wheeze, whilst the Tucson "transient early" wheeze phenotype can be sub-classified into groups that reflect early lung function. Since the 4-class model fails to adequately differentiate phenotypes based on lung function and atopy, we propose that strong consideration be given to using the 6-class paradigm for longitudinal outcome work in wheezing with onset in early life.
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Affiliation(s)
- Samuel A Collins
- Clinical and Experimental Sciences, University of Southampton Faculty of Medicine, Southampton, UK
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Stoltz DJ, Jackson DJ, Evans MD, Gangnon RE, Tisler CJ, Gern JE, Lemanske RF. Specific patterns of allergic sensitization in early childhood and asthma & rhinitis risk. Clin Exp Allergy 2013; 43:233-41. [PMID: 23331564 DOI: 10.1111/cea.12050] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Revised: 09/06/2012] [Accepted: 10/01/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Specific patterns of allergic sensitization as well as quantification of the in vitro IgE response in early life may provide relevant clinical insight into future rhinitis and asthma risk. OBJECTIVE To define relationships among established sensitization to particular aeroallergens, quantitative analyses of allergen-specific IgE levels, pet exposure and sensitization, and asthma and rhinitis risk. METHODS Children at high-risk for the development of asthma and allergic diseases were enrolled at birth into the Childhood Origins of ASThma (COAST) study. Allergen-specific IgE was assessed at ages 1, 3, 6, and 9 years by fluoroenzyme immunoassay (Unicap(®) 100; Pharmacia Diagnostics). Current asthma and rhinitis were diagnosed at age 6 and 8 years. RESULTS Sensitization to dog was strongly associated with increased asthma risk (P < 0.0001). Sensitization to perennial compared with seasonal allergens was more strongly associated with asthma risk, while sensitization to seasonal allergens was more closely associated with rhinitis risk. Increased levels of specific IgE to perennial allergens were associated with an increased asthma risk (P = 0.05), while any detectable level of IgE to seasonal allergens was associated with increased rhinitis risk (P = 0.0009). While dog and cat sensitization were both independently associated with increased asthma and rhinitis risk, dog exposure at birth was associated with a reduced risk of asthma, regardless of dog sensitization status during the first 6 years of life (P = 0.05). CONCLUSIONS AND CLINICAL RELEVANCE Analysing specific patterns of an individual's allergic sensitization profile reveals additional relevant associations with asthma and rhinitis risk as opposed to the information gained from characterizing an individual as 'atopic' by the presence of any demonstrable sensitization alone. Furthermore, protective mechanisms of dog exposure with regards to asthma risk appear to be unrelated to the prevention of sensitization.
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Affiliation(s)
- D J Stoltz
- University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA
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Lodge CJ, Lowe AJ, Gurrin LC, Matheson MC, Balloch A, Axelrad C, Hill DJ, Hosking CS, Rodrigues S, Svanes C, Abramson MJ, Allen KJ, Dharmage SC. Pets at birth do not increase allergic disease in at-risk children. Clin Exp Allergy 2013; 42:1377-85. [PMID: 22925324 DOI: 10.1111/j.1365-2222.2012.04032.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The literature is contradictory concerning pet exposure and risk of allergic disease in childhood especially among those with a family history of allergy. OBJECTIVE To investigate the relationship between cat and dog exposure at birth and allergic outcomes over the first 12 years in a birth cohort selected for familial allergy. METHODS A prospective birth cohort of 620 infants with a family history of allergic diseases was recruited. Data on pet keeping, family demographics and cord blood samples were collected at birth. Information on childhood wheeze, eczema and hay fever was collected 18 times in the first 2 years, at 7 years and at 12 years. Skin prick tests were conducted at 2, 7 and 12 years, and in parents. Regression analyses were used to investigate the relevant associations while adjusting for potential confounders. RESULTS Exposure to cats or dogs at birth showed a moderate reduction in risk of wheeze (aOR = 0.76; 95% CI 0.53, 1.09) and hay fever (aOR = 0.71; 0.49, 1.02) after 7 years of age. Protective effects were stronger in children of non-sensitized fathers (aOR wheeze 0.55; 0.31, 0.98; aOR hay fever 0.33; 0.15, 0.77 on exposure to cats alone, or cats or dogs at birth). Pet keeping was not related to cord blood IgE or sensitization from 2 to 12 years. CONCLUSIONS AND CLINICAL RELEVANCE Pets at birth either decreased or had no effect on allergic disease up to age 12. We found no evidence that exposure to cats or dogs at birth increases the risk of allergic disease in high-risk children.
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Affiliation(s)
- C J Lodge
- Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, School of Population Health, University of Melbourne, Melbourne, Vic., Australia.
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18
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Lødrup Carlsen KC, Roll S, Carlsen KH, Mowinckel P, Wijga AH, Brunekreef B, Torrent M, Roberts G, Arshad SH, Kull I, Krämer U, von Berg A, Eller E, Høst A, Kuehni C, Spycher B, Sunyer J, Chen CM, Reich A, Asarnoj A, Puig C, Herbarth O, Mahachie John JM, Van Steen K, Willich SN, Wahn U, Lau S, Keil T. Does pet ownership in infancy lead to asthma or allergy at school age? Pooled analysis of individual participant data from 11 European birth cohorts. PLoS One 2012; 7:e43214. [PMID: 22952649 PMCID: PMC3430634 DOI: 10.1371/journal.pone.0043214] [Citation(s) in RCA: 165] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Accepted: 07/20/2012] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To examine the associations between pet keeping in early childhood and asthma and allergies in children aged 6-10 years. DESIGN Pooled analysis of individual participant data of 11 prospective European birth cohorts that recruited a total of over 22,000 children in the 1990s. EXPOSURE DEFINITION: Ownership of only cats, dogs, birds, rodents, or cats/dogs combined during the first 2 years of life. OUTCOME DEFINITION: Current asthma (primary outcome), allergic asthma, allergic rhinitis and allergic sensitization during 6-10 years of age. DATA SYNTHESIS Three-step approach: (i) Common definition of outcome and exposure variables across cohorts; (ii) calculation of adjusted effect estimates for each cohort; (iii) pooling of effect estimates by using random effects meta-analysis models. RESULTS We found no association between furry and feathered pet keeping early in life and asthma in school age. For example, the odds ratio for asthma comparing cat ownership with "no pets" (10 studies, 11489 participants) was 1.00 (95% confidence interval 0.78 to 1.28) (I(2) = 9%; p = 0.36). The odds ratio for asthma comparing dog ownership with "no pets" (9 studies, 11433 participants) was 0.77 (0.58 to 1.03) (I(2) = 0%, p = 0.89). Owning both cat(s) and dog(s) compared to "no pets" resulted in an odds ratio of 1.04 (0.59 to 1.84) (I(2) = 33%, p = 0.18). Similarly, for allergic asthma and for allergic rhinitis we did not find associations regarding any type of pet ownership early in life. However, we found some evidence for an association between ownership of furry pets during the first 2 years of life and reduced likelihood of becoming sensitized to aero-allergens. CONCLUSIONS Pet ownership in early life did not appear to either increase or reduce the risk of asthma or allergic rhinitis symptoms in children aged 6-10. Advice from health care practitioners to avoid or to specifically acquire pets for primary prevention of asthma or allergic rhinitis in children should not be given.
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Affiliation(s)
- Karin C. Lødrup Carlsen
- Department of Paediatrics, Oslo University Hospital, Ullevål, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Stephanie Roll
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany
- * E-mail:
| | - Kai-Håkon Carlsen
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Voksentoppen, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Petter Mowinckel
- Department of Paediatrics, Oslo University Hospital, Ullevål, Norway
| | - Alet H. Wijga
- Centre for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Bert Brunekreef
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands
| | - Maties Torrent
- Ib-salut Menorca Health Area and Fundacio Caubet-Cimera, Menorca, Spain
| | - Graham Roberts
- The David Hide Asthma and Allergy Research Centre, Isle of Wight and University of Southampton, Southampton, United Kingdom
| | - S. Hasan Arshad
- The David Hide Asthma and Allergy Research Centre, Isle of Wight and University of Southampton, Southampton, United Kingdom
| | - Inger Kull
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ursula Krämer
- Institut für Umweltmedizinische Forschung, University of Düsseldorf, Düsseldorf, Germany
| | - Andrea von Berg
- Department of Pediatrics, Marien-Hospital Wesel, Wesel, Germany
| | - Esben Eller
- Allergycenter, Department of Dermatology, Odense University Hospital, Odense, Denmark
| | - Arne Høst
- Department of Pediatrics, Odense University Hospital, Odense, Denmark
| | - Claudia Kuehni
- Institute for Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Ben Spycher
- Institute for Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Jordi Sunyer
- Environmental Epidemiology Research Centre and Institut Municipal d'Investigacio Medica, Barcelona, Spain
| | - Chih-Mei Chen
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg, Germany
| | - Andreas Reich
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Anna Asarnoj
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Astrid Lindgrens' Children's Hospital, Karolinska University Hospital, Solna, Sweden
| | - Carmen Puig
- Unitat recerca infancia i entorn, Institut Municipal d'Investigacio Medica - Hospital del Mar, Barcelona, Spain
| | - Olf Herbarth
- Faculty of Medicine, University of Leipzig and Department of Human Exposure Research and Epidemiology, UFZ - Centre for Environmental Research Leipzig, Leipzig, Germany
| | - Jestinah M. Mahachie John
- Dept. of Oto-Rhino-Laryngology, University of Ghent, Ghent, Belgium
- Systems and Modeling Unit, Montefiore Institute, University of Liège, Liège, Belgium
- Bioinformatics and Modeling, GIGA-R, University of Liège, Liège, Belgium
| | - Kristel Van Steen
- Dept. of Oto-Rhino-Laryngology, University of Ghent, Ghent, Belgium
- Systems and Modeling Unit, Montefiore Institute, University of Liège, Liège, Belgium
- Bioinformatics and Modeling, GIGA-R, University of Liège, Liège, Belgium
| | - Stefan N. Willich
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ulrich Wahn
- Dept. for Paediatric Pneumology and Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Susanne Lau
- Dept. for Paediatric Pneumology and Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Keil
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - GA2LEN WP 1.5 ‘Birth Cohorts’ working groupWickmanMagnusSachs' Children's HospitalHallnerEvaInstitute of Environmental MedicineAlmJohanInstitute of Environmental MedicineAlmqvistCatarinaDept. of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, SwedenWennergrenGöranDept. of Pediatrics, Queen Silvia Children's Hospital, University of Gothenburg, SwedenAlmBerntDept. of Pediatrics, Queen Silvia Children's Hospital, University of Gothenburg, SwedenHeinrichJoachimInstitute of Epidemiology, Helmholtz-Zentrum München, German Research Centre for Environmetal Health, Munich, GermanySmitHenriette A.Center for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven, The NetherlandsThijsCarelMommersMoniqueSchool of Public Health and Primary Care, Maastricht University, Maastricht, The NetherlandsBindslev-JensenCarstenDept. of DermatologyHalkenSusanneDept. of Pediatrics, Odense University Hospital, DenmarkFantiniMaria PiaDept. of Public Health, Alma Mater Studiorum, University of Bologna, ItalyBraviFrancescaDept. of Public Health, Alma Mater Studiorum, University of Bologna, ItalyPortaDanielaDipartimento di Epidemiologia ASL Rm E, Rome, ItalyForastiereFrancescoDipartimento di Epidemiologia ASL Rm E, Rome, ItalyCustovicAdnanWythenshawe Hospital, University of Manchester, UKDubakieneRutaAllergy Center, Vilnius University, LithuaniaMahachieJestinahDept. of Oto-Rhino-Laryngology, University of Ghent, Belgium
- Global Allergy and Asthma European Network (GALEN)-Work Package 1.5 ‘Birth Cohorts’
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Sandin A, Björkstén B, Böttcher MF, Englund E, Jenmalm MC, Bråbäck L. High salivary secretory IgA antibody levels are associated with less late-onset wheezing in IgE-sensitized infants. Pediatr Allergy Immunol 2011; 22:477-81. [PMID: 21332801 DOI: 10.1111/j.1399-3038.2010.01106.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Low levels of secretory IgA (SIgA) and transient IgA deficiency have been associated with an increased risk for allergy, but data are conflicting. The aim was to assess the relationship between salivary SIgA antibody levels at 1 yr and wheezing at age four in a birth cohort, in particular the possible protective role of salivary SIgA in sensitized children. Saliva samples were obtained from all children (n=67) with a positive skin prick test (SPT) at 1 yr and 212 children with a negative SPT. In all, 200 of these children responded to questionnaires at 4 yrs and 183 were skin prick tested at that age. The levels of salivary SIgA and salivary IgA antibodies to the most common food allergen egg and inhalant allergen cat were analyzed by ELISA. Serum was analyzed for IgE antibodies to egg and cat. Development of late-onset wheezing was associated with low SIgA levels in children with positive SPT to at least one allergen both at 1 and 4 yrs of age (p=0.04), as well as in children with circulating IgE antibodies to egg or cat at 1 yr (p=0.02). None of nine persistently sensitized children with SIgA levels in the upper quartile developed wheezing, when compared to 10/20 children with lower levels (p=0.01). Older siblings, more than three infections during infancy, at least one smoking parent, and male gender, were all associated with SIgA in the upper quartile. In conclusion, high levels of SIgA antibodies in sensitized infants were associated with significantly less late-onset wheezing, supporting a protective role against development of asthmatic symptoms. Recurrent infections and other factors supporting an increased microbial pressure during infancy were associated with high levels of salivary SIgA.
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Affiliation(s)
- Anna Sandin
- Department of Clinical Science, Pediatrics, Umeå University, Umeå, Sweden.
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Jartti T, Gern JE. Rhinovirus-associated wheeze during infancy and asthma development. CURRENT RESPIRATORY MEDICINE REVIEWS 2011; 7:160-166. [PMID: 23066381 DOI: 10.2174/157339811795589423] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Rhinovirus is commonly associated with bronchiolitis - only second to RSV during the first year life. The prevalence of HRV-bronchiolitis may be very high in predisposed infants. HRV diagnosis is almost exclusively based on PCR, which detects respiratory infections with or without symptoms. Two immunologic factors, interferon responses and atopy, have been associated with susceptibility to HRV-bronchiolitis in multiple studies. The current data supports the hypothesis that susceptibility to HRV-bronchiolitis is likely to be an early manifestation of biased immune responses, which are linked to both decreased viral defence and atopic airway inflammation. Prospective studies have consistently shown that early wheezing associated with HRV infection is closely associated with recurrent wheezing and the development of asthma in children. Collectively, these studies suggest that HRV infection in wheezing children could serve as a clinically useful marker for early identification of asthma prone children. The findings to date provide the rationale for future studies to incorporate rhinovirus illnesses into asthma risk indices.
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Affiliation(s)
- Tuomas Jartti
- Department of Pediatrics, Turku University Hospital, Turku, Finland
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21
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Savenije OE, Granell R, Caudri D, Koppelman GH, Smit HA, Wijga A, de Jongste JC, Brunekreef B, Sterne JA, Postma DS, Henderson J, Kerkhof M. Comparison of childhood wheezing phenotypes in 2 birth cohorts: ALSPAC and PIAMA. J Allergy Clin Immunol 2011; 127:1505-12.e14. [DOI: 10.1016/j.jaci.2011.02.002] [Citation(s) in RCA: 259] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2010] [Revised: 02/02/2011] [Accepted: 02/03/2011] [Indexed: 11/26/2022]
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Pyrhönen K, Hiltunen L, Kaila M, Näyhä S, Läärä E. Heredity of food allergies in an unselected child population: an epidemiological survey from Finland. Pediatr Allergy Immunol 2011; 22:e124-32. [PMID: 20961338 DOI: 10.1111/j.1399-3038.2010.01095.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The heredity of food allergies (FA) has not previously been addressed in a large unselected child population. Our target population comprised all children born from April 2001 to March 2006 resident in one province of South-East Finland (n c. 6000), as identified from the national population register. In a questionnaire survey conducted in 2005-2006, data were obtained on allergic manifestations (FA symptoms, atopic rash, allergic asthma, hay fever/pollen allergy, or animal allergy) in the biologic parents of 3800 children (64% of the total). Concurrently with the survey but independently of it, results of specific immunoglobulin E antibodies (sIgE), skin prick tests (SPT), and open food challenges (OFC) in the offspring were collected from patient records throughout the province. Up to the age of 4 yr, the incidences of any positive FA test, a positive SPT or sIgE for food items, and a positive OFC in these children were threefold higher if both parents reported having an allergic manifestation and twofold higher if either mother or father had such a manifestation when compared with children whose parents did not report any of these conditions. The estimated risk of any positive FA test increased by a factor of 1.3 (95% CI 1.2-1.4) for each additional allergic manifestation in the parents. Positive FA tests in the offspring were relatively strongly associated with the reports of allergic phenotypes and the number of these phenotypes in their biologic parents.
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Affiliation(s)
- Kaisa Pyrhönen
- South Karelia District of Social and Health Services, Lappeenranta, Finland.
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Bertelsen RJ, Carlsen KCL, Granum B, Carlsen KH, Håland G, Devulapalli CS, Munthe-Kaas MC, Mowinckel P, Løvik M. Do allergic families avoid keeping furry pets? INDOOR AIR 2010; 20:187-195. [PMID: 20158528 DOI: 10.1111/j.1600-0668.2009.00640.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
UNLABELLED Studies addressing the relationship between pet keeping and development of asthma and allergies may be influenced by pet avoidance in families with a history of allergic disease. Following a cohort of 1019 children in Oslo till 10 years of age, we studied the association of pet keeping with socio-economic factors and allergic disease in the family. A family history of asthma and rhinoconjunctivitis was not significantly associated with pet ownership at birth or with pet removal by 10 years. Acquiring cats and dogs was less likely if the child had allergic rhinoconjunctivitis, whereas no association was seen with asthma (in any family member). Single parenthood increased the likelihood of acquiring a cat, smoking parents more often had cats or dogs, and having older siblings was associated with keeping dogs and other furry pets. Among 319 families reporting pet avoidance, 70% never had pets, 8% had given up pets, and 22% avoided a particular type of pet only. Twenty-four per cent of the parents failed to retrospectively report pet keeping during the child's first year of life. Overall, allergic rhinitis, but not asthma was associated with actual pet avoidance, whereas the strongest predictors for keeping pets were found to be socio-economic factors. PRACTICAL IMPLICATIONS Allergic disease in a child most often does not lead to the removal of the family's furry pet. Pet avoidance is associated with allergic symptoms, but not asthma. Socio-economic factors like parental education, single parenthood and smoking affects the families' decisions on pet keeping, including the type of pets the families will avoid or acquire. The large recall error demonstrated points to the need for prospective data regarding pet keeping.
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Affiliation(s)
- R J Bertelsen
- Department of Environmental Immunology, Division of Environmental Medicine, Norwegian Institute of Public Health, Nydalen, Oslo, Norway.
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Lim RH, Kobzik L, Dahl M. Risk for asthma in offspring of asthmatic mothers versus fathers: a meta-analysis. PLoS One 2010; 5:e10134. [PMID: 20405032 PMCID: PMC2853568 DOI: 10.1371/journal.pone.0010134] [Citation(s) in RCA: 157] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2009] [Accepted: 03/13/2010] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Many human epidemiologic studies demonstrate that maternal asthma confers greater risk of asthma to offspring than does paternal disease. However, a handful have shown the opposite. Given this disparity, a meta-analysis is necessary to determine the veracity and magnitude of the "maternal effect." METHODOLOGY/PRINCIPAL FINDINGS We screened the medical literature from 1966 to 2009 and performed a meta-analysis to compare the effect of maternal asthma vs. paternal asthma on offspring asthma susceptibility. Aggregating data from 33 studies, the odds ratio for asthma in children of asthmatic mothers compared with non-asthmatic mothers was significantly increased at 3.04 (95% confidence interval: 2.59-3.56). The corresponding odds ratio for asthma in children of asthmatic fathers was increased at 2.44 (2.14-2.79). When comparing the odds ratios, maternal asthma conferred greater risk of disease than did paternal asthma (3.04 vs. 2.44, p = 0.037). When analyzing the studies in which asthma was diagnosed by a physician the odds ratios were attenuated and no significant differences were observed (2.85 vs. 2.48, N = 18, p = 0.37). Similarly, no significant differences were observed between maternal and paternal odds ratios when analyzing the studies in which the patient population was 5 years or older (3.15 vs. 2.60, p = 0.14). However, in all cases the trend remained the same, that maternal asthma was a greater risk factor for asthma than paternal. CONCLUSIONS/SIGNIFICANCE The results show that maternal asthma increases offspring disease risk to a greater extent than paternal disease.
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Affiliation(s)
- Robert H. Lim
- Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, United States of America
- Department of Pulmonary Medicine, Children's Hospital Boston, Boston, Massachusetts, United States of America
| | - Lester Kobzik
- Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, United States of America
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, United States of America
| | - Morten Dahl
- Department of Clinical Biochemistry, Copenhagen University Hospital Herlev, Copenhagen, Denmark
- * E-mail:
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Apfelbacher CJ, Ollert M, Ring J, Behrendt H, Krämer U. Contact to cat or dog, allergies and parental education. Pediatr Allergy Immunol 2010; 21:284-91. [PMID: 19594863 DOI: 10.1111/j.1399-3038.2009.00893.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Whether or not associations between animal contact and allergy/atopy are homogeneous across social strata has not yet been investigated. The aim of this study was to estimate the association between animal contact (cat, dog) and allergy/atopy in 6-yr-old school beginners, stratified by parental educational level. A total of 30794, 6-yr old children participated in cross-sectional studies between 1991 and 2000 in Germany. Allergic sensitization to common aeroallergens and symptoms and diagnoses of atopic diseases (asthma, eczema, hay fever) were the dependent variables. Contact with dog/cat were the independent variables. Logistic regression was used to adjust for confounding. Analyses were stratified for parental education. Prevalences of hay fever, eczema, specific sensitization to pollen and house dust mite increased, while the prevalence of contact to cat and dog decreased with parental educational level. Globally significant positive associations between cat contact and sensitization to cat (interaction significant) and between dog contact and wheezing remained significant in the highest and medium/highest educational strata respectively. A globally significant inverse association between cat contact and hay fever remained significant in the highest educational stratum only. The inverse association of contact to dog with eczema was globally significant, but not in the strata. When estimating the associations between animal contact and allergy/atopy in children, effect modification by social status should be considered. Cat contact seems to increase the odds of sensitization to cat only in children whose parents have a high level of education.
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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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Kjaer HF, Eller E, Andersen KE, Høst A, Bindslev-Jensen C. The association between early sensitization patterns and subsequent allergic disease. The DARC birth cohort study. Pediatr Allergy Immunol 2009; 20:726-34. [PMID: 19744222 DOI: 10.1111/j.1399-3038.2009.00862.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Prevention of allergic diseases depends on early identification of clinical markers preceding such disorders. This study describes the natural course of sensitization as measured by skin prick test (SPT) and specific immunoglobulin E (S-IgE) and analyses the association between early sensitization patterns and subsequent allergic disease at 6 yr of age. In an ongoing population-based birth cohort study of 562 children, follow-up visits were performed at 0, 3, 6, 9, 12, 18, 36, and 72 months. Visits included an interview, physical examination, SPTs, and S-IgE measurements for 12 food and inhalant allergens. The frequency of S-IgE sensitization to > or = 1 inhalant allergen was constant from 0 to 6 months (9-10%), decreased at 12-18 months before increasing from 36 months onwards. S-IgE sensitization to at least one food allergen remained constant from 0 to 6 yr. SPT sensitization to food and inhalant allergens appeared from 3 and 12 months, respectively. Early food sensitization (S-IgE) between 3 and 18 months was found to be significantly (p < 0.05) associated with atopic dermatitis (OR: 4.0 [1.6-9.9]) and asthma (OR 4.0 [1.1-12.5]) at the age of 6 yr. Children with atopic dermatitis, asthma, or rhinoconjunctivitis, and sensitization at 6 yr, were sensitized to food allergens to a large extent (53%, 42%, and 47%, respectively) already at 6 months. Early inhalant sensitization (S-IgE) did not increase the risk of later allergic disease. Early atopic dermatitis (0-18 months) was also highly associated with subsequent allergic disease. Children with early food sensitization and/or atopic dermatitis would be a proper target group for future interventional studies.
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Affiliation(s)
- Henrik Fomsgaard Kjaer
- Allergy Centre, Department of Dermatology, Odense University Hospital, 5000 Odense C, Denmark.
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Hagen EW, Sadek-Badawi M, Palta M. Daycare attendance and risk for respiratory morbidity among young very low birth weight children. Pediatr Pulmonol 2009; 44:1093-9. [PMID: 19824048 PMCID: PMC2783181 DOI: 10.1002/ppul.21104] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Daycare attendance and very low birth weight (VLBW, < or =1,500 g) are associated with respiratory morbidity during childhood. The objective of this study was to evaluate whether daycare attendance is associated with even higher risk for respiratory problems among VLBW children. We hypothesized that VLBW children attending daycare, in a private home or daycare center, are at higher risk for respiratory problems than VLBW children not attending daycare. We also investigated whether the effect of daycare is independent or synergistic with respiratory risk resulting from being VLBW, as indicated by having bronchopulmonary dysplasia (BPD) as a neonate. We conducted a prospective study of VLBW children followed from birth to age 2-3 (N = 715). Logistic regression was used to evaluate the relationship between daycare attendance and respiratory problems, adjusting for known neonatal risk factors for poor respiratory outcomes. Attending daycare in either a private home or in a daycare center was significantly associated with higher risk of lower respiratory infections than never attending. Attending a daycare center was also associated with higher risk for wheezy chest, cough without a cold, and respiratory medication use. While having BPD was associated with increased risk for respiratory problems, daycare attendance and BPD were not found to be synergistic risk factors for respiratory problems among VLBW children, but acted independently to increase risk. This implies that the increase in risk for respiratory problems associated with daycare attendance may be similar among VLBW children and those of normal birth weight.
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Affiliation(s)
- Erika W Hagen
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin 53726, USA.
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Kerkhof M, Wijga AH, Brunekreef B, Smit HA, de Jongste JC, Aalberse RC, Hoekstra MO, Gerritsen J, Postma DS. Effects of pets on asthma development up to 8 years of age: the PIAMA study. Allergy 2009; 64:1202-8. [PMID: 19245426 DOI: 10.1111/j.1398-9995.2009.02016.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Recall bias may provide discrepant relationships of pet exposure with sensitization and asthma development. We studied prospectively effects of pets at home on development of sensitization, asthma and respiratory symptoms from birth up to age 8 years. METHODS Event history analysis was performed on annually registered data of 2951 children, participating in the PIAMA birth cohort study. RESULTS Children with a cat or dog at home at 3 months of age had a significantly lower prevalence of sensitization to inhalant allergens at age 8, but not of asthma. A cat decreased the risk of house dust mite sensitization at age 8 [odds ratio (OR) = 0.68, 95% confidence interval (CI) 0.49-0.95], a dog of pollen sensitization (OR = 0.49, 95% CI: 0.29-0.83). A cat or dog at home did not significantly affect asthma incidence in each subsequent year. From 2 years of age onwards, the incidence of wheeze (OR = 1.52, 95% CI: 1.12-2.05) and a dry cough at night (OR = 1.28, 95% CI: 1.05-1.57) was higher in children with a dog, whereas removal of a dog increased the risk of developing asthma symptoms. Comparing analyses using prospectively and retrospectively collected data on diagnosed asthma showed important recall bias. CONCLUSIONS Our prospective study shows a protective effect of early presence of pets at home on sensitization to inhalant allergens, but no prevention of asthma development. Furthermore, children with pets had more frequent transient or intermittent asthma symptoms. Parental report of asthma by recall may provide spurious results of these associations.
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Affiliation(s)
- M Kerkhof
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, PO Box 30.001, Groningen 9700 RB, The Netherlands
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Schäfer T, Stieger B, Polzius R, Krauspe A. Associations between cat keeping, allergen exposure, allergic sensitization and atopic diseases: results from the Children of Lübeck Allergy and Environment Study (KLAUS). Pediatr Allergy Immunol 2009; 20:353-7. [PMID: 19538356 DOI: 10.1111/j.1399-3038.2008.00806.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The role of cat keeping on the promotion of allergies is discussed controversially. We investigated the associations between cat keeping, allergen exposure, allergic sensitization and atopic diseases in pre-school children. A total of 606 children (5- to 6-yr old) were studied in the course of the mandatory school entrance examination. Information on doctor diagnosed asthma and allergic rhinitis, pet keeping and confounders was obtained by questionnaire. The prevalence of atopic eczema was determined by dermatological examination, allergic sensitization was assessed by skin prick test, and the allergen exposure to cat allergen Fel d 1 was measured by a commercial wipe test. Cats were present in 16% of the households and results of the exposure categories (0-III) on cat allergen were 47.2%, 25.5%, 24.3% and 3.0% respectively. The prevalence of cat keeping increased significantly with exposure categories from 0.5% to 61.5% (p(trend) < 0.001). Children (6.3%) were sensitized to cat allergen and sensitization rates increased also significantly with exposure categories from 3.0% to 15.4% (p(trend) < 0.001). Children (9.3%) were diagnosed with atopic eczema and a positive history of asthma/rhinitis was given in 3.6% and 3.9% respectively. Sensitization to cat was associated with atopic eczema (23.3% vs. 7.4%; OR(adj.)= 3.8, CI: 1.4-10.8), asthma (12.5% vs. 3.7%; OR(adj.)= 4.9, CI: 1.1-21.2), allergic rhinitis (6.9% vs. 2.7%; OR(adj.)= 3.1, CI: 0.7-15.2) and any atopic disease (43.5% vs. 16.3%; OR(adj.)= 3.8, CI: 1.5-9.5). The data suggest a promoting effect of cat keeping for atopic diseases.
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Affiliation(s)
- Torsten Schäfer
- Institute of Social Medicine, Medical University Lübeck, Lübeck, Germany.
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Abstract
AIM To investigate whether functional changes of the gut flora over time were related to sensitization and allergic symptoms at four years of age. METHODS The levels of short chain fatty acids (SCFAs) in faecal samples at one (n = 139) and four (n = 53) years of age were related to the development of positive skin prick tests (SPT) and allergic symptoms during the first four years of life. RESULTS Faecal acetic (p < 0.01) and propionic (p < 0.01) acids decreased from one to four years of age, while valeric acid (p < 0.001) increased. Low levels of i-butyric (p = 0.01), i-valeric (p = 0.03) and valeric acids (p = 0.02) at one year were associated with questionnaire-reported symptoms of food allergy at four years. Positive SPTs and allergic symptoms at four years were associated with low faecal levels of i-butyric, i-valeric and valeric acids. At one year of age, infants with, as compared to without older siblings had higher median levels of valeric acid. CONCLUSION A slow functional maturation of the gut microflora, as measured by faecal levels of SCFAs is associated with allergy both at one and four years. The findings lend further support to an association between allergy and the development of microbial diversity.
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Affiliation(s)
- Anna Sandin
- Department of Clinical Science, Pediatrics, Umeå University, Umeå, Sweden.
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Bråbäck L, Forsberg B. Does traffic exhaust contribute to the development of asthma and allergic sensitization in children: findings from recent cohort studies. Environ Health 2009; 8:17. [PMID: 19371435 PMCID: PMC2674435 DOI: 10.1186/1476-069x-8-17] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2008] [Accepted: 04/16/2009] [Indexed: 04/14/2023]
Abstract
The aim of this review was to assess the evidence from recent prospective studies that long-term traffic pollution could contribute to the development of asthma-like symptoms and allergic sensitization in children. We have reviewed cohort studies published since 2002 and found in PubMed in Oct 2008. In all, 13 papers based on data from 9 cohorts have evaluated the relationship between traffic exposure and respiratory health. All surveys reported associations with at least some of the studied respiratory symptoms. The outcome varied, however, according to the age of the child. Nevertheless, the consistency in the results indicates that traffic exhaust contributes to the development of respiratory symptoms in healthy children. Potential effects of traffic exhaust on the development of allergic sensitization were only assessed in the four European birth cohorts. Long-term exposure to outdoor air pollutants had no association with sensitization in ten-year-old schoolchildren in Norway. In contrast, German, Dutch and Swedish preschool children had an increased risk of sensitization related to traffic exhaust despite fairly similar levels of outdoor air pollution as in Norway. Traffic-related effects on sensitization could be restricted to individuals with a specific genetic polymorphism. Assessment of gene-environment interactions on sensitization has so far only been carried out in a subgroup of the Swedish birth cohort. Further genetic association studies are required and may identify individuals vulnerable to adverse effects from traffic-related pollutants. Future studies should also evaluate effects of traffic exhaust on the development and long term outcome of different phenotypes of asthma and wheezing symptoms.
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Affiliation(s)
- Lennart Bråbäck
- Occupational & Environmental Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- Department of Public Health and Research, Sundsvall Hospital, Sundsvall, Sweden
| | - Bertil Forsberg
- Occupational & Environmental Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Korppi M, Hyvärinen M, Kotaniemi-Syrjänen A, Piippo-Savolainen E, Reijonen T. Early exposure and sensitization to cat and dog: different effects on asthma risk after wheezing in infancy. Pediatr Allergy Immunol 2008; 19:696-701. [PMID: 19076565 DOI: 10.1111/j.1399-3038.2008.00758.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Birth cohort studies have suggested that early exposure to furred pets protects from later asthma and allergy. The aim of the present study was to evaluate the association between exposure or sensitization to cat or dog in infancy, and later asthma and allergy assessed at the median ages of 4.0, 7.2 and 12.3 yr, in children who have wheezed at <24 months of age. Exposure to cat and dog in infancy was assessed by interviewing the parents. The child was considered as sensitized, if the allergen-specific IgE to cat or to dog was >or=0.35 kU/l, or if there was a positive skin test response. When the 20 children with persistent childhood asthma (doctor-diagnosed asthma at all three control visits) were compared with the other 61 children, an early exposure to dog (OR = 0.14, p = 0.034)) decreased the asthma risk and an early sensitization to cat (OR = 5.92, p = 0.008) and dog (OR = 9.33, p = 0.001) increased the asthma risk. There were less cat and dog keeping in atopic families and the effect of sensitization was, but the effect of exposure was not, robust to adjustments in multivariate analyses. The present study demonstrates, in a long-term follow-up after early wheezing, that early sensitization to cat and dog increases the risk of later asthma but early exposure to cat or dog has no such effect. Dog keeping was less frequent in atopic families, which may explain that the protective effect of early exposure to dog was lost in multivariate analyses.
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Affiliation(s)
- Matti Korppi
- Pediatric Research Center, Tampere University and University Hospital, Tampere, Finland.
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Naydenov K, Popov T, Mustakov T, Melikov A, Bornehag CG, Sundell J. The association of pet keeping at home with symptoms in airways, nose and skin among Bulgarian children. Pediatr Allergy Immunol 2008; 19:702-8. [PMID: 18266829 DOI: 10.1111/j.1399-3038.2008.00721.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The role of pet exposure in early childhood for allergy/ asthma later in life is still controversial. Recently it was shown that 'avoidance behaviour' is an important factor for the pet distribution in the population. The aim of the present work is to study the association between self-reported pet keeping at home and symptoms in airways, nose and skin among children 2-7 years of age, in a country where primary prevention strategies regarding allergies are not common. A cross-sectional survey on the association between allergy and asthma symptoms and home environmental factors was conducted in two towns in Bulgaria in spring 2004 (the ALLHOME-1 study). Data for 4479 out of 12982 children was obtained. 21.3% of the parents reported having pets at the time of the questionnaire, and 23.3% for pet keeping at index child's birth. Parents of 3.3% of the children got rid of some of the pets and 10.6% refrained from having pets, due in both cases to allergic illness in the family. Keeping dogs or cats at the time of the survey or during the child's first years was associated with most of the symptoms (aOR 1.1-2.2).
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Morass B, Kiechl-Kohlendorfer U, Horak E. The impact of early lifestyle factors on wheezing and asthma in Austrian preschool children. Acta Paediatr 2008; 97:337-41. [PMID: 18241290 DOI: 10.1111/j.1651-2227.2007.00633.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIM This study investigated the influence of early lifestyle factors on the prevalence of asthma and wheezing in preschool children in Tyrol, Austria. METHODS A cross-sectional questionnaire survey was performed in 1761 preschool children to obtain information on wheezing and asthma in the light of early lifestyle factors. RESULTS Factors independently associated with an increased risk for wheezing in the past 12 months included high parental education (OR: 1.5, 95% CI: 1.1-2.1) and parental hay fever (OR: 1.5, 95%CI: 1.1-2.2). Risk factors for doctor-diagnosed asthma (DDA) were early pet contact (OR: 2.2, 95% CI: 1.1-4.8) and parental asthma (OR: 3.0, 95%CI: 1.0-9.1), whereas breastfeeding decreased the risk (OR: 0.5, 95% CI: 0.2-1.0). Boiling the pacifier/sucker daily increased the risk for wheezing in the past 12 months (OR: 1.4, 95%CI: 1.0-2.0) and revealed a tendency towards DDA (OR: 1.9, 95% CI: 0.9-4.0). CONCLUSION In preschool children, we established an independent association between wheezing in the past 12 months, DDA and boiling frequency of the pacifier/bottle sucker during infancy. The impact of pacifier boiling frequency on atopic diseases on the basis of the hygiene hypothesis needs further investigation.
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Affiliation(s)
- Bernhard Morass
- Division of Paediatric Cardiology and Pulmonology, Department of Paediatrics and Adolescents, Innsbruck Medical University, 6020 Innsbruck, Austria
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Piippo-Savolainen E, Korppi M. Wheezy babies--wheezy adults? Review on long-term outcome until adulthood after early childhood wheezing. Acta Paediatr 2008; 97:5-11. [PMID: 18052998 DOI: 10.1111/j.1651-2227.2007.00558.x] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
UNLABELLED Population-based birth cohort studies have documented that about 30% of children suffer from wheezing during respiratory infection before their third birthday. Recurrent wheezing is common in early childhood, but most patients outgrow their symptoms by school age. However, recent long-term postbronchiolitis follow-up studies from Sweden and Finland have revealed that asthma is present in about 40% of young adults and over half of the cases are relapses after many symptom-free years. In population studies, the principal predictors for later asthma have been parental asthma, recurrent wheezing, atopy and eosinophilia. In the Swedish postbronchiolitis study, atopic diathesis through the development of clinical atopy, and early passive smoking through bronchial hyper-reactivity or later active smoking led to adult asthma. The Finnish postbronchiolitis follow-up stressed early recurrence of wheezing, wheezing induced by less invasive viruses than respiratory syncytial virus (RSV), early-life atopy and eosinophilia and parental asthma as predictors for adult asthma. CONCLUSION The majority of wheezing infants and children outgrow their symptoms by school age, but based on recent long-term follow-up studies, asthma relapses are common in young adults. These studies have highlighted parental asthma, maternal smoking and wheezing induced by other viruses than RSV as predictive factors for later asthma.
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Affiliation(s)
- Eija Piippo-Savolainen
- Department of Paediatrics, Kuopio University and University Hospital, FIN-70210 Kuopio, Finland.
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Tanaka K, Miyake Y, Kiyohara C. Environmental factors and allergic disorders. Allergol Int 2007; 56:363-96. [PMID: 17965579 DOI: 10.2332/allergolint.r-07-143] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2007] [Indexed: 12/19/2022] Open
Abstract
Despite numerous studies on possible associations between environmental exposure and allergic disorders, any conclusions made remain a matter of controversy. We conducted a review of evidence in relation to environmental and nutritional determinants and wheeze, asthma, atopic dermatitis, and allergic rhinitis. Identified were 263 articles for analysis after consideration of 1093 papers that were published since 2000 and selected by electronic search of the PubMed database using keywords relevant to epidemiological studies. Most were cross-sectional and case-control studies. Several prospective cohort studies revealed inconsistent associations between various environmental factors and the risk of any allergic disorder. Therefore, the evidence was inadequate to infer the presence or absence of a causal relationship between various environmental exposures and allergic diseases. However, evidence is suggestive of positive associations of allergies with heredity. Because almost all the studies were performed in Western countries, the application of these findings to people in other countries, including Japan, may not be appropriate. Further epidemiological information gained from population-based prospective cohort studies, in particular among Japanese together with other Asians, is needed to assess causal relationships between various environmental factors and allergic diseases.
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Affiliation(s)
- Keiko Tanaka
- Department of Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
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Abstract
Although pet exposure is known to trigger or worsen allergy symptoms and asthma in patients sensitized to pets, data from recent years has shown that pet exposure in early childhood may actually prevent the development of allergic sensitization and allergic diseases including allergic rhinitis, asthma, and atopic dermatitis. The concept of a protective pet effect remains controversial because these findings have not been duplicated in all studies. Moreover, some studies suggest that pet exposure promotes allergic disease. The protective pet effect may be influenced by multiple factors including type of pet; timing, duration, and intensity of exposure; and genetic factors. The mechanisms behind the protective pet effect remain under investigation but may include alterations in immune development, pet-specific tolerance, and exposure to innate immune stimuli.
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Affiliation(s)
- Jeremy D Bufford
- University of Wisconsin Hospital and Clinics, 600 Highland Avenue, K4/918, CSC Box 9988, Madison, WI 53792, USA
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Dean T, Venter C, Pereira B, Arshad SH, Grundy J, Clayton CB, Higgins B. Patterns of sensitization to food and aeroallergens in the first 3 years of life. J Allergy Clin Immunol 2007; 120:1166-71. [PMID: 17825888 DOI: 10.1016/j.jaci.2007.06.042] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2007] [Revised: 06/28/2007] [Accepted: 06/28/2007] [Indexed: 11/22/2022]
Abstract
BACKGROUND There is a paucity of longitudinal studies of allergen sensitization in childhood. OBJECTIVE To investigate the pattern of sensitization in early childhood. METHODS A nested cohort of children (n = 543) were followed up from birth and given a skin prick test (SPT) at 1, 2, and 3 years of age. A detailed clinical history was obtained. RESULTS The prevalences of sensitization to aeroallergens were 1.3%, 6.4%, and 10.7% at 1, 2, and 3 years of age. The figures for food allergens were 2.8%, 3.9%, and 3.7%. There was a statistically significant increase in the prevalence of sensitization to >or=1 allergen between years 1 and 2 (P < .001) and years 2 and 3 (P = .032). Among those with a positive SPT at 1 year, 29% tested positive to additional allergens at 2 years (P = .0054). Sensitization to milk or egg at 1 year was a predictor for increased sensitization to peanut at 3 years (odds ratio, 34.8; P < .0001). Sensitization to egg at 1 year was associated with increased sensitization to aeroallergens at 3 years (odds ratios, house dust mite, 27.1, P < .001; cat, 8.9, P < .01; grass, 11.8, P = .005). For peanut and cat allergens, wheal size increases with the age of the child (P = .009 and P = .017, respectively). CONCLUSION Sensitization to allergens as demonstrated by positive SPT tends to increase with age, and this change can be detected in the first 3 years of life. CLINICAL IMPLICATIONS The high predictive value for early sensitization and a linear increase in SPT reactivity provide an opportunity for early intervention.
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Affiliation(s)
- Taraneh Dean
- David Hide Asthma and Allergy Research Center, St Mary's Hospital, Newport, Isle of Wight, UK.
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LeMasters GK, Wilson K, Levin L, Biagini J, Ryan P, Lockey JE, Stanforth S, Maier S, Yang J, Burkle J, Villareal M, Khurana Hershey GK, Bernstein DI. High prevalence of aeroallergen sensitization among infants of atopic parents. J Pediatr 2006; 149:505-11. [PMID: 17011322 PMCID: PMC2233934 DOI: 10.1016/j.jpeds.2006.06.035] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2006] [Revised: 04/24/2006] [Accepted: 06/19/2006] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To present methodology to identify atopic parents and determine the prevalence of sensitization to 15 aeroallergens in their infant offspring. STUDY DESIGN A birth cohort of infants was identified from birth records; an infant was enrolled if 1 of the parents reported allergy respiratory symptoms and had a positive skin prick test (SPT) to a common aeroallergen. At age 1 year, these infants were tested to the same aeroallergens. RESULTS Of the 680 enrolled infants, 28.4% were SPT+ to 1 or more aeroallergens and/or food, and 18.0% were positive to 1 or more aeroallergens. By category of allergens, 9.7% were sensitized to pollens, 7.5% to molds, 4.3% to house dust mite and/or cockroach, and 3.4% to dog and/or cat. Of the infants who were positive to an aeroallergen, 65.7% remained positive at age 2 years. CONCLUSIONS Infants born to atopic parents with percutaneous sensitization to aeroallergens are at increased risk for aeroallergen sensitization during infancy, which persists to age 2 years. These findings suggest that current clinical practices, which generally avoid skin testing before age 2 years, be reassessed in this population of high-risk children.
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Affiliation(s)
- Grace K LeMasters
- Department of Environmental Health, Division of Epidemiology, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA.
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Current World Literature. Curr Opin Allergy Clin Immunol 2005. [DOI: 10.1097/01.all.0000168798.22110.c9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Allergic diseases such as allergic rhinitis represent a global health problem, affecting 10%-25% of the world population. There is clear evidence to support the concept that allergic diseases are influenced by genetic predisposition and environmental exposure. Polymorphisms of candidate genes have been associated with clinical expression of these diseases. However, characterization of these susceptibility markers in discriminating an "allergic individual" from the general population has not yet been achieved, and the value of how this genetic insight leading to recognition of specific subtypes of these disorders still needs to be confirmed. Environmental factors (eg, air pollution and bacterial/viral infection) also play an important role in the development of the diseases. A number of epidemiologic studies have supported the "hygiene hypothesis", which is based on the observations that Th1 responses induced by microbial stimulation can counterbalance allergen-induced Th2 responses. Future studies are needed to identify the key genes or their haplotypes for atopic phenotypes and to investigate the interactions between genetic and environmental factors that influence the complex trait of allergic diseases. This will help us to further understand the etiology of the diseases and develop new avenues for genetically oriented diagnosis and more effective measures of prevention and intervention.
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Affiliation(s)
- De-Yun Wang
- Department of Otolaryngology, Faculty of Medicine, National University of Singapore Singapore
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Current World Literature. Curr Opin Allergy Clin Immunol 2005. [DOI: 10.1097/01.all.0000162314.10050.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Ponvert C. Quoi de neuf en allergologie pédiatrique en 2004 ? Partie 1 : épidémiologie, diagnostic précoce et prévention (une revue de la littérature internationale d'octobre 2003 à septembre 2004). ACTA ACUST UNITED AC 2005. [DOI: 10.1016/j.allerg.2004.10.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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