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Trikamjee T, Basera W, Botha M, Facey-Thomas HE, Gaunt B, Genuneit J, Gray CL, Hadebe S, Hlela C, Kirstein F, Lunjani N, Mankahla A, Ramjith J, Levin M. Associations between Environmental dust composition and Atopic Dermatitis in urban and rural settings. Pediatr Allergy Immunol 2021; 32:1013-1021. [PMID: 33595127 DOI: 10.1111/pai.13476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 02/12/2021] [Accepted: 02/15/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Environmental exposures are involved in the pathogenesis of the allergic phenotype and in determining which individual triggers a person becomes sensitized to. Atopic dermatitis (AD) may modulate these effects through increased penetration through the skin modifying the immune system and AD may be triggered or intensified by environmental exposures. These exposures and immune-modulating factors may differ in urban and rural environments. OBJECTIVES To compare house dust composition in urban and rural settings and correlate them with AD outcomes. METHODS Dust samples were collected from the beds of 156 children aged 6 months to 3 years. 42% of participants had atopic dermatitis. Samples were analyzed for bacterial endotoxin, fungal (β-1,3-glucan) levels, and house dust mite, cockroach, dog, cat, mouse, and peanut allergen. Exposures were compared in urban and rural environments and in participants with and without AD. RESULTS Endotoxin but not fungal β-glucan exposure is higher in the environment of healthy controls than children with AD in both urban and rural settings. House dust mite allergen exposure is high in urban and rural settings with Dermatophagoides detected in 100% of samples. Cat and dog allergen exposure mirrors pet ownership patterns which differ slightly between groups and environments. Mouse allergen exposure is higher in urban homes. CONCLUSION Environmental endotoxin may be protective against AD in both urban and rural settings. There are marked differences in allergen exposure in urban and rural settings, but these are unlikely to be important protective or risk factors.
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Affiliation(s)
- Thulja Trikamjee
- Allergy and Immunology Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - Wisdom Basera
- School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Burden of Disease Research Unit, South African Medical Research Council, South Africa
| | - Maresa Botha
- Division of Paediatric Allergy, Department of Paediatrics, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Heidi E Facey-Thomas
- Division of Paediatric Allergy, Department of Paediatrics, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Ben Gaunt
- School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Eastern Cape Department of Health, Zithulele Hospital, Mqanduli, South Africa
| | - Jon Genuneit
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.,Pediatric Epidemiology, Department of Pediatrics, Medical Faculty, Leipzig University, Leipzig, Germany
| | - Claudia L Gray
- Division of Paediatric Allergy, Department of Paediatrics, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Sabelo Hadebe
- Division of Immunology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Carol Hlela
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Frank Kirstein
- Division of Immunology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Nonhlanhla Lunjani
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland.,Department of Dermatology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,APC Microbiome Ireland, University College Cork, Cork, Ireland
| | - Avumile Mankahla
- Division of Dermatology, Department of Medicine and Pharmacology, Walter Sisulu University, Mthatha, South Africa
| | - Jordache Ramjith
- Department for Health Evidence, Biostatistics Research Group, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Michael Levin
- Division of Paediatric Allergy, Department of Paediatrics, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,inVIVO Planetary Health, Group of Worldwide Universities Network (WUN)
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Mittermann I, Dzoro S, Gattinger P, Botha M, Basera W, Facey-Thomas HE, Gaunt B, Genuneit J, Gray CL, Hlela C, Flicker S, Lunjani N, Mankahla A, Ramjith J, Valenta R, Levin ME. Molecular IgE sensitization profiles of urban and rural children in South Africa. Pediatr Allergy Immunol 2021; 32:234-241. [PMID: 32969537 DOI: 10.1111/pai.13377] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 09/01/2020] [Accepted: 09/10/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Allergens can act as disease-triggering factors in atopic dermatitis (AD) patients. The aim of the study was to elucidate the molecular IgE sensitization profile in children with and without AD living in urban and rural areas of South Africa. METHODS Specific IgE reactivity was assessed in 166 Black South African children aged 9-38 months using a comprehensive panel of microarrayed allergens. According to clinical characterization children fell in four groups, urban AD cases (n = 32), urban controls (non-AD, n = 40), rural cases (n = 49) and rural controls (non-AD, n = 45). RESULTS IgE reactivity to at least one of the allergens was detected in 94% of urban and 86% of rural AD children. House dust mite (HDM; 81% urban, 74% rural AD) and animal-derived allergens (50% urban, 31% rural AD) were the most frequently recognized respiratory allergens, whereas IgE to pollen allergens was almost absent. Urban AD children showed significantly higher frequency of IgE reactivity (50%) to mouse lipocalin, Mus m 1, than rural AD children (12%). The most frequently recognized food allergens were from egg (63% urban, 43% rural AD), peanut (31% vs 41%), and soybean (22% vs 27%), whereas milk sensitization was rare. α-gal-specific IgE almost exclusively occurred in rural children (AD: 14%, non-AD: 49%). CONCLUSION Molecular allergy diagnosis detects frequent IgE sensitization to HDM, animal but not pollen allergens and to egg, peanut, and soy, but not milk allergens in African AD children. Urban AD children reacted more often to Mus m 1, whereas α-gal sensitization is more common in rural children likely due to parasite exposure.
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Affiliation(s)
- Irene Mittermann
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Sheron Dzoro
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Pia Gattinger
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Maresa Botha
- Division of Paediatric Allergy, Department of Paediatrics, University of Cape Town, Cape Town, South Africa
| | - Wisdom Basera
- School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Heidi E Facey-Thomas
- Division of Paediatric Allergy, Department of Paediatrics, University of Cape Town, Cape Town, South Africa
| | - Ben Gaunt
- Eastern Cape Department of Health, Zithulele Hospital, Mqanduli, South Africa.,Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Jon Genuneit
- Pediatric Epidemiology, Department of Pediatrics, Medical Faculty, Leipzig University, Leipzig, Germany
| | - Claudia L Gray
- School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Carol Hlela
- Department of Dermatology, University of Cape Town, Cape Town, South Africa
| | - Sabine Flicker
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Nonhlanhla Lunjani
- Division of Paediatric Allergy, Department of Paediatrics, University of Cape Town, Cape Town, South Africa
| | - Avumile Mankahla
- Eastern Cape Department of Health, Zithulele Hospital, Mqanduli, South Africa
| | - Jordache Ramjith
- Department for Health Evidence, Biostatistics Research Group, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Rudolf Valenta
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria.,NRC Institute of Immunology FMBA of Russia, Moscow, Russia.,Laboratory of Immunopathology, Department of Clinical Immunology and Allergy, Sechenov First Moscow State Medical University, Moscow, Russia.,Karl Landsteiner University for Health Sciences, Krems, Austria
| | - Michael E Levin
- Division of Paediatric Allergy, Department of Paediatrics, University of Cape Town, Cape Town, South Africa.,INVIVO Planetary Health Network, Research subgroup of the Worldwide Universities Network
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De Waal PJ, Levin ME, Facey-Thomas HE. Environmental factors associated with allergy in urban and rural children from the South African Food Allergy (SAFFA) cohort. World Allergy Organ J 2020. [DOI: 10.1016/j.waojou.2020.100306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Levin ME, Botha M, Basera W, Facey-Thomas HE, Gaunt B, Gray CL, Kiragu W, Ramjith J, Watkins A, Genuneit J. Environmental factors associated with allergy in urban and rural children from the South African Food Allergy (SAFFA) cohort. J Allergy Clin Immunol 2019; 145:415-426. [PMID: 31606483 DOI: 10.1016/j.jaci.2019.07.048] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/21/2019] [Accepted: 07/02/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND The prevalence of allergic diseases differs in urban and rural populations. OBJECTIVE We sought to assess associations between environmental and dietary factors with allergic diseases in urban and rural South African children. METHODS Toddlers aged 12 to 36 months were assessed for food allergen and aeroallergen sensitization, atopic dermatitis, allergic rhinitis, asthma, and challenge-proved food allergy. Information was collected on family history of allergic diseases, household size, socioeconomic status, delivery mode, antibiotic and probiotic use, exposure to fermented and unpasteurized milk, antihelminth treatment, sunlight exposure, pet and farm animal exposure, cigarette smoke, and household cooking and heating fuels. Antenatal exposures to pets, livestock, and cigarette smoke were assessed. A subsection completed questions on consumption of fruits and vegetables, fast foods, soft drinks/fruit juices, and fried/microwaved meat. RESULTS Risk and protective factors differed between urban and rural settings. Exposure to farm animals in infants and their mothers during pregnancy was protective against allergic outcomes in the rural population. Consumption of unpasteurized milk is uncommon in this group of rural children and is unlikely to be an important factor in rural protection. In urban children birth by cesarean section is associated with food allergy, and consumption of fermented milk products is associated with reduced asthma and atopic dermatitis. In both cohorts antenatal maternal smoking and environmental smoking exposure were predominantly associated with asthma, and consumption of fast foods and fried meats were associated with allergy. CONCLUSION In this rural environment exposure to livestock is the strongest protective factor. In urban communities, where animal contact is rare, risk factors include cesarian section, and protective factors include consumption of fermented milk products. Modifiable risk factors urgently require interventions to prevent increasing allergy rates in countries undergoing rapid urbanization.
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Affiliation(s)
- Michael E Levin
- Division of Paediatric Allergy, Department of Paediatrics, University of Cape Town, Cape Town, South Africa; inVIVO Planetary Health Group of the Worldwide Universities Network (WUN).
| | - Maresa Botha
- Division of Paediatric Allergy, Department of Paediatrics, University of Cape Town, Cape Town, South Africa
| | - Wisdom Basera
- School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Heidi E Facey-Thomas
- Division of Paediatric Allergy, Department of Paediatrics, University of Cape Town, Cape Town, South Africa
| | - Ben Gaunt
- Zithulele Hospital, Eastern Cape Department of Health, Bisho, South Africa; Division of Primary Health Care, Health Sciences Faculty, University of Cape Town, Cape Town, South Africa
| | - Claudia L Gray
- Division of Paediatric Allergy, Department of Paediatrics, University of Cape Town, Cape Town, South Africa
| | - Wanjiku Kiragu
- Department of Paediatrics, Aga Khan University Hospital, Nairobi, Kenya
| | - Jordache Ramjith
- Department for Health Evidence, Biostatistics Research Group, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands; Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Alexandra Watkins
- Division of Paediatric Allergy, Department of Paediatrics, University of Cape Town, Cape Town, South Africa
| | - Jon Genuneit
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany; Center for Pediatric Research Leipzig, Hospital for Children and Adolescents, University of Leipzig Medical Center, Leipzig, Germany
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Botha M, Basera W, Facey-Thomas HE, Gaunt B, Genuneit J, Gray CL, Kiragu W, Ramjith J, Watkins A, Levin ME. Nutrition and allergic diseases in urban and rural communities from the South African Food Allergy cohort. Pediatr Allergy Immunol 2019; 30:511-521. [PMID: 30945339 DOI: 10.1111/pai.13058] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 03/05/2019] [Accepted: 03/18/2019] [Indexed: 11/30/2022]
Abstract
UNLABELLED This study describes and compares allergic diseases and sensitization in urban and rural children in the SAFFA study cohort as well as infant feeding patterns and nutritional status. We assessed the relationship between nutritional status, breastfeeding, complementary feeding patterns, and atopic diseases including aeroallergen and food allergen sensitization, self-reported atopic dermatitis, allergic rhinitis, asthma, and challenge-proven food allergy (FA). METHODOLOGY A total of 1185 urban and 398 rural toddlers aged 12-36 months were screened for food sensitization (FS) and FA using skin prick testing and oral food challenges. Of these, 535 and 347, respectively, were additionally screened for aeroallergen sensitization. Information was collected on infant feeding practices, and anthropometric measurements and clinical signs for atopy were documented. RESULTS Markedly higher rates of allergy (asthma 9.0% vs 1.0%, eczema 25.6% vs 2.0%, rhinitis 25.3% vs 3.3%, and FA 2.5% vs 0.5%) exist in urban vs rural children. 13.1% unselected urban South African children were sensitized to aeroallergens compared to 3.8% of their rural counterparts and 9.0% to any food compared to 0.5%. Exclusive breastfeeding duration was longer, and there was a later introduction of allergenic foods in rural communities. Obesity rates were similar between the two groups, but rural children were more likely to be stunted. Being overweight was associated with asthma in urban but not rural settings. In the urban cohort, children with FS and allergy were thinner than their peers. CONCLUSION Allergy and sensitization rates are significantly higher in unselected urban South African toddlers than their rural counterparts. Risk and protective factors for allergy and atopy may differ between urban and rural settings.
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Affiliation(s)
- Maresa Botha
- Division of Paediatric Allergy, Department of Paediatrics, University of Cape Town, Cape Town, South Africa
| | - Wisdom Basera
- School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Heidi E Facey-Thomas
- Division of Paediatric Allergy, Department of Paediatrics, University of Cape Town, Cape Town, South Africa
| | - Ben Gaunt
- Eastern Cape Department of Health, Zithulele Hospital, Zithulele, South Africa.,Division of Primary Health Care, Health Sciences Faculty, University of Cape Town, Cape Town, South Africa
| | - Jon Genuneit
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.,Center for Pediatric Research Leipzig, Hospital for Children and Adolescents, University of Leipzig Medical Center, Leipzig, Germany
| | - Claudia L Gray
- Division of Paediatric Allergy, Department of Paediatrics, University of Cape Town, Cape Town, South Africa
| | - Wanjiku Kiragu
- Department of Paediatrics, Aga Khan University Hospital, Nairobi, Kenya
| | - Jordache Ramjith
- Department for Health Evidence, Biostatistics Research Group, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Alexandra Watkins
- Division of Paediatric Allergy, Department of Paediatrics, University of Cape Town, Cape Town, South Africa
| | - Michael E Levin
- Division of Paediatric Allergy, Department of Paediatrics, University of Cape Town, Cape Town, South Africa.,Group of the Worldwide Universities Network (WUN), inVIVO Planetary Health
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Botha M, Basera W, Facey-Thomas HE, Gaunt B, Gray CL, Ramjith J, Watkins A, Levin ME. Rural and urban food allergy prevalence from the South African Food Allergy (SAFFA) study. J Allergy Clin Immunol 2019; 143:662-668.e2. [DOI: 10.1016/j.jaci.2018.07.023] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 06/12/2018] [Accepted: 07/12/2018] [Indexed: 10/28/2022]
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