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Müller A, Wouters EF, Koul P, Welte T, Harrabi I, Rashid A, Loh LC, Al Ghobain M, Elsony A, Ahmed R, Potts J, Mortimer K, Rodrigues F, Paraguas SN, Juvekar S, Agarwal D, Obaseki D, Gislason T, Seemungal T, Nafees AA, Jenkins C, Dias HB, Franssen FME, Studnicka M, Janson C, Cherkaski HH, El Biaze M, Mahesh PA, Cardoso J, Burney P, Hartl S, Janssen DJA, Amaral AFS. Association between lung function and dyspnoea and its variation in the multinational Burden of Obstructive Lung Disease (BOLD) study. Pulmonology 2024:S2531-0437(24)00044-8. [PMID: 38614859 DOI: 10.1016/j.pulmoe.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/14/2024] [Accepted: 03/31/2024] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND Dyspnoea is a common symptom of respiratory disease. However, data on its prevalence in general populations and its association with lung function are limited and are mainly from high-income countries. The aims of this study were to estimate the prevalence of dyspnoea across several world regions, and to investigate the association of dyspnoea with lung function. METHODS Dyspnoea was assessed, and lung function measured in 25,806 adult participants of the multinational Burden of Obstructive Lung Disease study. Dyspnoea was defined as ≥2 on the modified Medical Research Council (mMRC) dyspnoea scale. The prevalence of dyspnoea was estimated for each of the study sites and compared across countries and world regions. Multivariable logistic regression was used to assess the association of dyspnoea with lung function in each site. Results were then pooled using random-effects meta-analysis. RESULTS The prevalence of dyspnoea varied widely across sites without a clear geographical pattern. The mean prevalence of dyspnoea was 13.7 % (SD=8.2 %), ranging from 0 % in Mysore (India) to 28.8 % in Nampicuan-Talugtug (Philippines). Dyspnoea was strongly associated with both spirometry restriction (FVC CONCLUSION The prevalence of dyspnoea varies substantially across the world and is strongly associated with lung function impairment. Using the mMRC scale in epidemiological research should be discussed.
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Affiliation(s)
- A Müller
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria; Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.
| | - E F Wouters
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria; Sigmund Freud University, Faculty of Medicine, Vienna, Austria; Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - P Koul
- Department of Pulmonary Medicine, Sheri Kashmir Institute of Medical Sciences, Srinagar, India
| | - T Welte
- Department of Respiratory Medicine/Infectious Disease, Member of the German Centre for Lung Research, Hannover School of Medicine, Hannover, Germany
| | - I Harrabi
- Faculté de Médecine, Sousse, Tunisia
| | - A Rashid
- RCSI and UCD Malaysia Campus, Penang, Malaysia
| | | | - M Al Ghobain
- King Abdullah International Medical Research Center, King Saud ben Abdulaziz University for Health Science, Riyadh, Saudi Arabia
| | - A Elsony
- The Epidemiological Laboratory, Khartoum, Sudan
| | - R Ahmed
- The Epidemiological Laboratory, Khartoum, Sudan
| | - J Potts
- National Heart and Lung Institute, Imperial College London, London, UK
| | - K Mortimer
- University of Cambridge, Cambridge, UK; Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - F Rodrigues
- Pulmonology Department, Lisbon North Hospital Centre, Lisbon, Portugal; Institute of Environmental Health, Associate Laboratory TERRA, Lisbon Medical School, Lisbon University, Lisbon, Portugal
| | - S N Paraguas
- Philippine College of Chest Physicians, Manila, Philippines
| | - S Juvekar
- KEM Hospital Research Centre, Pune, India
| | - D Agarwal
- KEM Hospital Research Centre, Pune, India
| | - D Obaseki
- Department of Medicine, Obafemi Awolowo University, Nigeria; Faculty of Medicine, University of British Columbia, Canada
| | - T Gislason
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland; Department of Sleep, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - T Seemungal
- Faculty of Medical Sciences, University of West Indies, St Augustine, Trinidad and Tobago
| | | | - C Jenkins
- Woolcock Institute of Medical Research, Sydney, Australia
| | - H B Dias
- Escola Superior de Tecnologia da Saúde de Lisboa, Politecnico de Lisboa, Lisbon, Portugal
| | - F M E Franssen
- Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Research and Development, Ciro, Horn, the Netherlands
| | - M Studnicka
- Department of Pulmonary Medicine, Paracelsus Medical University, Salzburg, Austria
| | - C Janson
- Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - H H Cherkaski
- Faculty of Medicine, University Badji Mokhtar, Annaba, Algeria
| | - M El Biaze
- Department of Respiratory Medicine, Faculty of Medicine, Mohammed Ben Abdellah University, Fes, Morocco
| | - P A Mahesh
- Department of Respiratory Medicine, JSS Medical College and Hospital, Mysore, Karnataka, India
| | - J Cardoso
- Pulmonology Department, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal; NOVA Medical School, Nova University Lisbon, Lisboa, Portugal
| | - P Burney
- National Heart and Lung Institute, Imperial College London, London, UK
| | - S Hartl
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria; Sigmund Freud University, Faculty of Medicine, Vienna, Austria
| | - D J A Janssen
- Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands; Department of Research and Development, Ciro, Horn, the Netherlands
| | - A F S Amaral
- National Heart and Lung Institute, Imperial College London, London, UK; NIHR Imperial Biomedical Research Centre, London, UK
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Ahmed R, Osman R, Nightingale R, Nagem D, Thomson R, Malmborg R, Elmustafa M, Amaral AFS, Patel J, Burney P, El Sony A, Mortimer K. Prevalence and determinants of chronic respiratory diseases in adults in rural Sudan. Int J Tuberc Lung Dis 2023; 27:841-849. [PMID: 37880887 PMCID: PMC10599415 DOI: 10.5588/ijtld.22.0655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 04/19/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND: Chronic respiratory diseases (CRDs) greatly contribute to worldwide mortality. Despite new data emerging from Africa, prevalence estimates and determinants of CRDs in rural settings are limited. This study sought to extend the existing research conducted in urban Sudan by conducting a rural comparison.METHODS: Participants aged ≥18 years (n = 1,850), living in rural Gezira State completed pre-and post-bronchodilator spirometry and a questionnaire. Prevalence of respiratory symptoms and spirometric abnormalities were reported. Regression analyses were used to identify risk factors for CRDs.RESULTS: Prevalence of chronic airflow obstruction (CAO) was 4.1% overall and 5.5% in those aged ≥40 years. Reversibility was seen in 6.4%. Low forced vital capacity (FVC) was seen in 58.5%, and at least one respiratory symptom was present in 40.7% of the participants. CAO was more common among people aged 60-69 years (OR 2.07, 95% CI 1.13-3.82) and less common among highly educated participants (OR 0.50, 95% CI 0.27-0.93). Being underweight was associated with lower FVC (OR 3.07, 95% CI 2.24-4.20).CONCLUSIONS: A substantial burden of CRD exists among adults in rural Sudan. Investment in CRD prevention and management strategies is needed.
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Affiliation(s)
- R Ahmed
- The Epidemiological Laboratory, Khartoum, Sudan
| | - R Osman
- The Epidemiological Laboratory, Khartoum, Sudan
| | - R Nightingale
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - D Nagem
- The Epidemiological Laboratory, Khartoum, Sudan
| | - R Thomson
- Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - M Elmustafa
- University of Gezira, Wad Medani, Wad Medani College of Medical Sciences and Technology, Wad Medani, Sudan
| | - A F S Amaral
- National Heart and Lung Institute, Imperial College London, London
| | - J Patel
- National Heart and Lung Institute, Imperial College London, London
| | - P Burney
- National Heart and Lung Institute, Imperial College London, London
| | - A El Sony
- The Epidemiological Laboratory, Khartoum, Sudan
| | - K Mortimer
- Liverpool School of Tropical Medicine, Liverpool, UK, National Heart and Lung Institute, Imperial College London, London, Liverpool University Hospitals NHS Foundation Trust, Liverpool, University of Cambridge, Cambridge, UK, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Akhter Z, Razzaq S, Rabbani U, Irfan M, Burney P, Nafees AA. Prevalence of and risk factors for respiratory symptoms in an adult urban population. Int J Tuberc Lung Dis 2021; 25:16-22. [PMID: 33384040 DOI: 10.5588/ijtld.20.0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE: To determine prevalence of and risk factors for respiratory symptoms in an adult urban Pakistani population.METHODS: We conducted a multi-stage, community-based, cross-sectional survey from May 2014 to August 2015, comprising 1629 adults from 75 random clusters in Karachi using questionnaire-based interviews.RESULTS: Around 60% of participants were females and 43% belonged to the >37 years age group. At least one respiratory symptom was reported by 37.5% of participants. Breathlessness was the most common symptom (25.2%, 95%CI 23.1-27.3), followed by acute wheeze (10.1%, 95%CI 8.7-11.7). Multivariable models revealed that males and those aged >37 years were more likely to report acute and chronic phlegm and bronchitis, and breathlessness. Participants with a higher level of education were less likely to report acute and chronic cough. Participants with >5 years pack-years of smoking were more likely to report acute and chronic cough and breathlessness. Other risk factors included passive smoking, regular use of air conditioning and mosquito coils, wet spots and mould in the house, and exposure to dusty jobs.CONCLUSION: We found breathlessness to be the most prevalent respiratory symptom and identified various risk factors for respiratory symptoms.
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Affiliation(s)
- Z Akhter
- York Trials Unit, Department of Health Sciences, University of York, UK
| | - S Razzaq
- Department of Community Medicine, Shalamar Medical and Dental College, Lahore
| | - U Rabbani
- Family Medicine Academy, Qassim Health Cluster, Saudi Arabia
| | - M Irfan
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - P Burney
- Respiratory Epidemiology and Public Health, National Heart & Lung Institute, Imperial College London, London, UK
| | - A A Nafees
- Respiratory Epidemiology and Public Health, National Heart & Lung Institute, Imperial College London, London, UK, Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
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Atassi M, Kava ACF, Nejjari C, Benjelloun MC, El Biaze M, El Kinany K, Patel J, Burney P, El Rhazi K. Association between chronic airflow obstruction and socio-economic position in Morocco: BOLD results. Int J Tuberc Lung Dis 2021; 24:202-206. [PMID: 32127105 DOI: 10.5588/ijtld.19.0170] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: Chronic obstructive lung disease (COPD) is the third most common cause of death in the world. Factors other than smoking, such as socio-economic status, could be involved in the development of COPD.OBJECTIVE: To investigate the association between chronic airflow obstruction and socio-economic status in Morocco.DESIGN: Questionnaires were administered and spirometry tests performed as part of the BOLD (Burden of Obstructive Lung Disease) Study carried out in Fez, Morocco. Socio-economic status was evaluated using a wealth score (0-10) based on household assets. The ratio of forced expiratory volume in 1 s (FEV1) to forced vital capacity (FVC) was used to measure airflow obstruction.RESULTS: A total of 760 subjects were included in the analysis. The mean age was 55.3 years (standard deviation [SD] 10.2); the average wealth score was 7.54 (SD 1.63). After controlling for other factors and potential confounders, FEV1/FVC increased by 0.4% (95%CI 0.01-0.78; P < 0.04) per unit increase in wealth score. Ageing, tobacco smoking, underweight, history of tuberculosis and asthma were also independently associated with a higher risk of airflow obstruction.CONCLUSION: Our findings suggest that airflow obstruction is associated with poverty in Morocco. Further investigations are needed to better understand the mechanisms of this association.
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Affiliation(s)
- M Atassi
- Department of Epidemiology and Public Health, Faculty of Medicine of Fez
| | - A C F Kava
- Department of Epidemiology and Public Health, Faculty of Medicine of Fez
| | - C Nejjari
- Department of Epidemiology and Public Health, Faculty of Medicine of Fez
| | - M C Benjelloun
- Pneumology Service, Centre Hospitalier Hassan II of Fez, University Sidi Mohamed Ben Abdellah, Fez, Morocco
| | - M El Biaze
- Pneumology Service, Centre Hospitalier Hassan II of Fez, University Sidi Mohamed Ben Abdellah, Fez, Morocco
| | - K El Kinany
- Department of Epidemiology and Public Health, Faculty of Medicine of Fez
| | - J Patel
- National Heart & Lung Institute, Imperial College, London, UK
| | - P Burney
- National Heart & Lung Institute, Imperial College, London, UK
| | - K El Rhazi
- Department of Epidemiology and Public Health, Faculty of Medicine of Fez
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Nafees AA, Rabbani U, Razzaq S, Minai K, Khan MA, Naeem S, Fatmi Z, Burney P. Indoor air quality and its relationship with cluster type in urban Pakistani households. Int J Tuberc Lung Dis 2021; 25:113-119. [PMID: 33656422 DOI: 10.5588/ijtld.20.0761] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE: To assess the levels and predictors of formaldehyde, nitrogen dioxide (NO₂), carbon monoxide (CO) and fine particulate matter with diameter less than 2.5 μm (PM2.5) in Karachi, Pakistan.METHODS: A total of 1629 households were selected through multistage cluster sampling in a community-based cross-sectional survey. Formaldehyde, NO₂ and CO levels were measured using YesAir Indoor air monitor and for PM2.5, UCB-PATS (University of California Berkeley Particle and Temperature Sensor) was used. Clusters were classified either as planned (areas of planned housing) or unplanned (informal settlements).RESULTS: We found the median concentrations to be as follows: formaldehyde, 0.03 ppm (IQR 0.00-0.090); CO, 0.00 ppm (IQR 0.00-1.00); NO₂, 0 ppm (IQR 0.00-0.00) and PM2.5, 0.278 mg/m³ (IQR 0.162-0.526). We found a significant association of the upper quartiles of formaldehyde and PM2.5 levels with type of cluster. The risk of obtaining formaldehyde and PM2.5 levels in the upper quartile was higher in unplanned clusters than in planned clusters (adjusted odds ratio [aOR] 33.0, 95% CI 4.02-271.5 and aOR 0.10, 95% CI 0.001-0.16, respectively). No significant association was observed between levels of CO and cluster type (aOR 0.84, 95%CI 0.62-1.14).CONCLUSION: This study reports high levels of indoor air pollutants in Karachi, with considerable variation across planned vs. unplanned clusters.
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Affiliation(s)
- A A Nafees
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan, National Heart and Lung Institute (NHLI), Imperial College London, London, UK
| | - U Rabbani
- Family Medicine Academy, Qassim Health Cluster, Kingdom of Saudi Arabia
| | - S Razzaq
- Department of Community Medicine, Jinnah Medical and Dental College, Karachi, Pakistan
| | - K Minai
- Universal Quality Solutions Inc, Mississauga, ON, Canada
| | - M A Khan
- Department of Community Health Sciences, Aga Khan University, Karachi
| | - S Naeem
- CMH Institute of Medical Sciences, Bahawalpur
| | - Z Fatmi
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - P Burney
- National Heart & Lung Institute, Imperial College London, London, UK
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Abstract
BACKGROUND Epidemiological studies have reported associations between pesticide exposure and respiratory health effects, but the quantitative impact on lung function is unclear. To fill this gap, we undertook a systematic review of the available literature on the association between pesticide exposure and pulmonary function. AIMS To examine all available literature regarding the relationship between occupational and environmental exposure to pesticides and lung function. METHODS We searched MEDLINE, EMBASE and Web of Science databases to 1 October 2017 without any date or language restrictions using a combination of MeSH terms and free text for 'pesticide exposure' and 'lung function'. We included studies that met the criteria of our research protocol registered in PROSPERO, and we assessed their quality using a modified Newcastle-Ottawa scale. RESULTS Of 2356 articles retrieved, 56 articles were included in the systematic review and pooled in meta-analyses for forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC), FVC and FEV1. There was tentative evidence that exposure to cholinesterase (ChE) inhibiting pesticides reduced FEV1/FVC and no evidence that paraquat exposure affected lung function in farmers. CONCLUSIONS Respiratory surveillance should be enhanced in those exposed to ChE-inhibiting pesticides which reduced FEV1/FVC according to the meta-analysis. Our study is limited by heterogeneity between studies due to different types of exposure assessment to pesticides and potential confounders. Further studies with a more accurate exposure assessment are suggested.
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Affiliation(s)
- J Ratanachina
- National Heart and Lung Institute, Imperial College London, London, UK.,King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Thailand.,Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Thailand
| | - S De Matteis
- National Heart and Lung Institute, Imperial College London, London, UK
| | - P Cullinan
- National Heart and Lung Institute, Imperial College London, London, UK
| | - P Burney
- National Heart and Lung Institute, Imperial College London, London, UK
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Conyette L, Lutchmansingh F, Sakhamuri S, Simeon D, Ivey MA, Burney P, Seemungal T. Prevalence and risk factors of airflow obstruction in a Caribbean population. Int J Tuberc Lung Dis 2020; 24:512-519. [PMID: 32398201 DOI: 10.5588/ijtld.19.0578] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING: The prevalence of airflow obstruction (AO) in the Caribbean population is unknown.OBJECTIVE: To measure the prevalence of and risk factors for AO (post-bronchodilator ratio of forced expiratory volume in 1 sec to forced vital capacity of <0.7) in the Trinidad and Tobago general population using the Burden of Obstructive Lung Disease methodology.DESIGN: National cross-sectional, stratified, cluster sampling of adults aged ≥40 years.RESULTS: AO prevalence was 9.5% among 1104 participants, most of whom were unaware of this. Compared to those aged 40-49 years, the adjusted odds ratio of AO by age group was 2.73 (60-69 years) and 3.30 (≥70 years). Risk factors for AO were unemployment (OR 4.31), being retired (OR 2.17), smoking ≥20 pack-years (OR 1.88) and exposure to dusty jobs for more than 1 year (OR 2.06). Related symptoms were history of wheezing, unscheduled visits to the doctor or admission to hospital for breathing problems and in subjects with at least one respiratory symptom (OR 1.90), at least one risk factor (OR 2.81), either symptoms or risk factors (OR 3.71) and both symptoms and risk factors (OR 5.78) (P < 0.05 in all cases).CONCLUSION: AO prevalence in the general population of Trinidad and Tobago aged ≥40 years was 9.5%, almost all of which was undiagnosed. AO was associated with smoking, age >59 years, lack of employment and working in a dusty job.
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Affiliation(s)
- L Conyette
- South-West Regional Health Authority, San Fernando, Trinidad and Tobago
| | - F Lutchmansingh
- Faculty of Medical Sciences, The University of the West Indies, St Augustine Campus, Trinidad and Tobago
| | - S Sakhamuri
- Faculty of Medical Sciences, The University of the West Indies, St Augustine Campus, Trinidad and Tobago
| | - D Simeon
- Faculty of Medical Sciences, The University of the West Indies, St Augustine Campus, Trinidad and Tobago
| | - M A Ivey
- Faculty of Medical Sciences, The University of the West Indies, St Augustine Campus, Trinidad and Tobago
| | - P Burney
- National Heart and Lung Institute, Imperial College, London, UK
| | - T Seemungal
- Faculty of Medical Sciences, The University of the West Indies, St Augustine Campus, Trinidad and Tobago
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Harries AD, Ade S, Burney P, Hoa NB, Schluger NW, Castro JL. Successfully treated but not fit for purpose: paying attention to chronic lung impairment after TB treatment. Int J Tuberc Lung Dis 2018; 20:1010-4. [PMID: 27393532 DOI: 10.5588/ijtld.16.0277] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
In 2013, 86% of patients with newly diagnosed tuberculosis (TB) successfully completed treatment and were discharged from care. However, long-term studies in industrialised and resource-poor countries all point to a higher risk of death in TB survivors than in the general population. The likely explanation is chronic restrictive and obstructive lung disease consequent to TB. We call for better linkages between TB control programmes and respiratory medicine services, a better understanding of the burden of respiratory disability at the end of anti-tuberculosis treatment, and political, programmatic, clinical and research action to improve the quality of life of affected patients.
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Affiliation(s)
- A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France; Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - S Ade
- International Union Against Tuberculosis and Lung Disease, Paris, France, National Tuberculosis Programme, Cotonou, Benin
| | - P Burney
- National Heart and Lung Institute, Imperial College, London, UK
| | - N B Hoa
- International Union Against Tuberculosis and Lung Disease, Paris, France; National Tuberculosis Control Programme, Hanoi, Viet Nam
| | - N W Schluger
- Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Medical Center, New York, Vital Strategies, New York, New York, USA
| | - J L Castro
- International Union Against Tuberculosis and Lung Disease, Paris, France, Vital Strategies, New York, New York, USA
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Fedorova OS, Janse JJ, Ogorodova LM, Fedotova MM, Achterberg RA, Verweij JJ, Fernández-Rivas M, Versteeg SA, Potts J, Minelli C, van Ree R, Burney P, Yazdanbakhsh M. Opisthorchis felineus negatively associates with skin test reactivity in Russia-EuroPrevall-International Cooperation study. Allergy 2017; 72:1096-1104. [PMID: 28032359 DOI: 10.1111/all.13120] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND Most studies on the relationship between helminth infections and atopic disorders have been conducted in (sub)tropical developing countries where exposure to multiple parasites and lifestyle can confound the relationship. We aimed to study the relationship between infection with the fish-borne helminth Opishorchis felineus and specific IgE, skin prick testing, and atopic symptoms in Western Siberia, with lifestyle and hygiene standards of a developed country. METHODS Schoolchildren aged 7-11 years were sampled from one urban and two rural regions. Skin prick tests (SPT) and specific IgE (sIgE) against food and aeroallergens were measured, and data on allergic symptoms and on demographic and socioeconomic factors were collected by questionnaire. Diagnosis of opisthorchiasis was based on PCR performed on stool samples. RESULTS Of the 732 children included, 34.9% had opisthorchiasis. The sensitization to any allergen when estimated by positive SPT was 12.8%, while much higher, 24.0%, when measured by sIgE. Atopic symptoms in the past year (flexural eczema and/or rhinoconjunctivitis) were reported in 12.4% of the children. SPT was positively related to flexural eczema and rhinoconjunctivitis, but not to wheezing. Opisthorchiasis showed association with lower SPT response, as well as borderline association with low IgE reactivity to any allergen. However, the effect of opisthorchiasis on SPT response was not mediated by IgE, suggesting that opisthorchiasis influences SPT response through another mechanism. Opisthorchiasis also showed borderline association with lower atopic symptoms. CONCLUSIONS There is a negative association between a chronic helminth infection and skin prick test reactivity even in a developed country.
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Affiliation(s)
- O. S. Fedorova
- Department of Faculty Pediatrics; Siberian State Medical University; Tomsk Russian Federation
| | - J. J. Janse
- Department of Parasitology; Leiden University Medical Center; Leiden The Netherlands
| | - L. M. Ogorodova
- Department of Faculty Pediatrics; Siberian State Medical University; Tomsk Russian Federation
| | - M. M. Fedotova
- Department of Faculty Pediatrics; Siberian State Medical University; Tomsk Russian Federation
| | - R. A. Achterberg
- Department of Parasitology; Leiden University Medical Center; Leiden The Netherlands
| | - J. J. Verweij
- Department of Parasitology; Leiden University Medical Center; Leiden The Netherlands
| | | | - S. A. Versteeg
- Department of Experimental Immunology; Academic Medical Center; Amsterdam The Netherlands
| | - J. Potts
- Department of Respiratory Epidemiology and Public Health; National Heart and Lung Institute; Imperial College London; London UK
| | - C. Minelli
- Department of Respiratory Epidemiology and Public Health; National Heart and Lung Institute; Imperial College London; London UK
| | - R. van Ree
- Department of Experimental Immunology; Academic Medical Center; Amsterdam The Netherlands
- Department of Otorhinolaryngology; Academic Medical Center; Amsterdam The Netherlands
| | - P. Burney
- Department of Respiratory Epidemiology and Public Health; National Heart and Lung Institute; Imperial College London; London UK
| | - M. Yazdanbakhsh
- Department of Parasitology; Leiden University Medical Center; Leiden The Netherlands
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Makowska JS, Burney P, Jarvis D, Keil T, Tomassen P, Bislimovska J, Brozek G, Bachert C, Baelum J, Bindslev-Jensen C, Bousquet J, Bousquet PJ, Kai-Håkon C, Dahlen SE, Dahlen B, Fokkens WJ, Forsberg B, Gjomarkaj M, Howarth P, Salagean E, Janson C, Kasper L, Kraemer U, Louiro C, Lundback B, Minov J, Nizankowska-Mogilnicka E, Papadopoulos N, Sakellariou AG, Todo-Bom A, Toskala E, Zejda JE, Zuberbier T, Kowalski ML. Respiratory hypersensitivity reactions to NSAIDs in Europe: the global allergy and asthma network (GA 2 LEN) survey. Allergy 2016; 71:1603-1611. [PMID: 27230252 DOI: 10.1111/all.12941] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most prevalent drugs inducing hypersensitivity reactions. The aim of this analysis was to estimate the prevalence of NSAID-induced respiratory symptoms in population across Europe and to assess its association with upper and lower respiratory tract disorders. METHODS The GA2 LEN survey was conducted in 22 centers in 15 European countries. Each of 19 centers selected random samples of 5000 adults aged 15-74 from their general population, and in three centers (Athens, Munich, Oslo), a younger population was sampled. Questionnaires including questions about age, gender, presence of symptoms of asthma, allergic rhinitis, chronic rhinosinusitis, smoking status, and history of NSAID-induced hypersensitivity reactions were sent to participants by mail. Totally, 62 737 participants completed the questionnaires. RESULTS The mean prevalence of NSAID-induced dyspnea was 1.9% and was highest in the three Polish centers [Katowice (4.9%), Krakow (4.8%), and Lodz (4.4%)] and lowest in Skopje, (0.9%), Amsterdam (1.1%), and Umea (1.2%). In multivariate analysis, the prevalence of respiratory reactions to NSAIDs was higher in participants with chronic rhinosinusitis symptoms (Odds Ratio 2.12; 95%CI 1.78-2.74), asthma symptoms in last 12 months (2.7; 2.18-3.35), hospitalization due to asthma (1.53; 1.22-1.99), and adults vs children (1.53; 1.24-1.89), but was not associated with allergic rhinitis. CONCLUSION Our study documented significant variation between European countries in the prevalence of NSAID-induced respiratory hypersensitivity reactions, and association with chronic airway diseases, but also with environmental factors.
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Burney P. COPD, inflammation and co-morbidities. Pneumologie 2016. [DOI: 10.1055/s-0036-1584661] [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: 10/19/2022]
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12
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Mahesh PA, Wong GWK, Ogorodova L, Potts J, Leung TF, Fedorova O, Holla AD, Fernandez-Rivas M, Clare Mills EN, Kummeling I, Versteeg SA, van Ree R, Yazdanbakhsh M, Burney P. Prevalence of food sensitization and probable food allergy among adults in India: the EuroPrevall INCO study. Allergy 2016; 71:1010-9. [PMID: 27297800 DOI: 10.1111/all.12868] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2016] [Indexed: 01/21/2023]
Abstract
BACKGROUND Data are lacking regarding the prevalence of food sensitization and probable food allergy among general population in India. We report the prevalence of sensitization and probable food allergy to 24 common foods among adults from general population in Karnataka, South India. METHODOLOGY The study was conducted in two stages: a screening study and a case-control study. A total of 11 791 adults in age group 20-54 were randomly sampled from general population in South India and answered a screening questionnaire. A total of 588 subjects (236 cases and 352 controls) participated in the case-control study involving a detailed questionnaire and specific IgE estimation for 24 common foods. RESULTS A high level of sensitization (26.5%) was observed for most of the foods in the general population, higher than that observed among adults in Europe, except for those foods that cross-react with birch pollen. Most of the sensitization was observed in subjects who had total IgE above the median IgE level. A high level of cross-reactivity was observed among different pollens and foods and among foods. The prevalence of probable food allergy (self-reports of adverse symptoms after the consumption of food and specific IgE to the same food) was 1.2%, which was mainly accounted for cow's milk (0.5%) and apple (0.5%). CONCLUSION Very high levels of sensitization were observed for most foods, including those not commonly consumed in the general population. For the levels of sensitization, the prevalence of probable food allergy was low. This disassociation needs to be further explored in future studies.
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Affiliation(s)
- P. A. Mahesh
- Department of Allergy; Allergy Asthma Associates; Mysore Karnataka India
- Department of TB and Respiratory Medicine; JSS Medical College and Hospital; JSS University, Mysore Karnataka India
| | - Gary W. K. Wong
- Department of Pediatrics and School of Public Health; Chinese University of Hong Kong; Shatin, NT Hong Kong China
| | - L. Ogorodova
- Department of Faculty Pediatrics; Siberian State Medical University; Tomsk Russia
| | - J. Potts
- Department of Respiratory Epidemiology and Public Health; National Heart and Lung Institute; Imperial College London London UK
| | - T. F. Leung
- Department of Pediatrics and School of Public Health; Chinese University of Hong Kong; Shatin, NT Hong Kong China
| | - O. Fedorova
- Department of Faculty Pediatrics; Siberian State Medical University; Tomsk Russia
| | - Amrutha D. Holla
- Department of Allergy; Allergy Asthma Associates; Mysore Karnataka India
| | | | - E. N. Clare Mills
- Respiratory and Allergy Centre; Institute of Inflammation and Repair; Manchester Institute of Biotechnology; The University of Manchester Manchester UK
| | - I. Kummeling
- Department of Respiratory Epidemiology and Public Health; National Heart and Lung Institute; Imperial College London London UK
| | - S. A. Versteeg
- Department of Experimental Immunology and Department of Otorhinolaryngology; Academic Medical Center; Amsterdam the Netherlands
| | - R. van Ree
- Department of Experimental Immunology and Department of Otorhinolaryngology; Academic Medical Center; Amsterdam the Netherlands
| | - M. Yazdanbakhsh
- Department of Parasitology; Leiden University Medical Center; Leiden the Netherlands
| | - P. Burney
- Department of Respiratory Epidemiology and Public Health; National Heart and Lung Institute; Imperial College London London UK
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Abstract
With an aging global population, chronic respiratory diseases are becoming a more prominent cause of death and disability. Age-standardised death rates from chronic obstructive pulmonary disease (COPD) are highest in low-income regions of the world, particularly South Asia and sub-Saharan Africa, although airflow obstruction is relatively uncommon in these areas. Airflow obstruction is, by contrast, more common in regions with a high prevalence of cigarette smoking. COPD mortality is much more closely related to the prevalence of a low forced vital capacity which is, in turn, associated with poverty. Mortality from asthma is less common than mortality from COPD, but it is also relatively more common in poorer areas, particularly Oceania, South and South-East Asia, the Middle East and Africa. Again this contrasts with the asthma prevalence among adults, which is highest in high-income regions. In high-income areas, mortality due to asthma, which is predominantly an adult problem, has fallen substantially in recent decades with the spread of new guidelines for treatment that emphasise the use of inhaled steroids to control the disease. Although mortality rates have been falling, the prevalence of atopy has been increasing between generations in Western Europe. Changes in the prevalence of wheeze among adults has been more varied and may have been influenced by the reduction in smoking and the increase in the use of inhaled steroids.
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Affiliation(s)
- P Burney
- National Heart and Lung Institute, Imperial College, London, UK
| | - D Jarvis
- National Heart and Lung Institute, Imperial College, London, UK
| | - R Perez-Padilla
- Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
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14
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Saleh-Langenberg J, Goossens NJ, Flokstra-de Blok BMJ, Kollen BJ, van der Meulen GN, Le TM, Knulst AC, Jedrzejczak-Czechowicz M, Kowalski ML, Rokicka E, Starosta P, de la Hoz Caballer B, Vazquez-Cortés S, Cerecedo I, Barreales L, Asero R, Clausen M, DunnGalvin A, Hourihane JOB, Purohit A, Papadopoulos NG, Fernandéz-Rivas M, Frewer L, Burney P, Duiverman EJ, Dubois AEJ. Predictors of health-related quality of life of European food-allergic patients. Allergy 2015; 70:616-24. [PMID: 25627424 DOI: 10.1111/all.12582] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although food allergy has universally been found to impair HRQL, studies have found significant differences in HRQL between countries, even when corrected for differences in perceived disease severity. However, little is known about factors other than disease severity which may contribute to HRQL in food-allergic patients. Therefore, the aim of this study was to identify factors which may predict HRQL of food-allergic patients and also to investigate the specific impact of having experienced anaphylaxis and being prescribed an EAI on HRQL. METHODS A total of 648 European food-allergic patients (404 adults, 244 children) completed an age-specific questionnaire package including descriptive questions. Multivariable regression analyses were performed to develop models for predicting HRQL of these patients. RESULTS For adults, the prediction model accounted for 62% of the variance in HRQL and included perceived disease severity, type of symptoms, having a fish or milk allergy, and gender. For children, the prediction model accounted for 28% of the variance in HRQL and included perceived disease severity, having a peanut or soy allergy, and country of origin. For both adults and children, neither experiencing anaphylaxis nor being prescribed an epinephrine auto-injector (EAI) contributed to impairment of HRQL. CONCLUSIONS In this study, food allergy-related HRQL may be predicted to a greater extent in adults than in children. Allergy to certain foods may cause greater HRQL impairment than others. Country of origin may affect HRQL, at least in children. Experiencing anaphylaxis or being prescribed an EAI has no impact on HRQL in either adults or children.
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Affiliation(s)
- J. Saleh-Langenberg
- Department of Pediatric Pulmonology and Pediatric Allergy; University of Groningen; University Medical Centre Groningen; Groningen the Netherlands
- University of Groningen; University Medical Centre Groningen; GRIAC Research Institute; Groningen the Netherlands
| | - N. J. Goossens
- Department of Pediatric Pulmonology and Pediatric Allergy; University of Groningen; University Medical Centre Groningen; Groningen the Netherlands
- University of Groningen; University Medical Centre Groningen; GRIAC Research Institute; Groningen the Netherlands
| | - B. M. J. Flokstra-de Blok
- University of Groningen; University Medical Centre Groningen; GRIAC Research Institute; Groningen the Netherlands
- Department of General Practice; University of Groningen; University Medical Centre Groningen; Groningen the Netherlands
| | - B. J. Kollen
- University of Groningen; University Medical Centre Groningen; GRIAC Research Institute; Groningen the Netherlands
| | - G. N. van der Meulen
- Department of Pediatric Pulmonology and Pediatric Allergy; University of Groningen; University Medical Centre Groningen; Groningen the Netherlands
- Department of Paediatric Allergy; Martini Hospital; Utrecht the Netherlands
| | - T. M. Le
- Department of Dermatology/Allergology; University Medical Center Utrecht; Utrecht the Netherlands
| | - A. C. Knulst
- Department of Dermatology/Allergology; University Medical Center Utrecht; Utrecht the Netherlands
| | | | - M. L. Kowalski
- Department of Immunology, Rheumatology and Allergy; Medical University of Lodz; Lodz Poland
| | - E. Rokicka
- Faculty of Economics and Sociology; Lodz University; Lodz Poland
| | - P. Starosta
- Faculty of Economics and Sociology; Lodz University; Lodz Poland
| | | | - S. Vazquez-Cortés
- Department of Allergy; Hospital Clinico San Carlos; IdISSC; Madrid Spain
| | - I. Cerecedo
- Department of Allergy; University Hospital Ramón y Cajal; IRICYS; Madrid Spain
| | - L. Barreales
- Department of Preventive Medicine; Research Unit; Hospital Clínico San Carlos; IdISSC; Madrid Spain
| | - R. Asero
- Ambulatorio di Allergologia; Clinica San Carlo; Paderno Dugnano Italy
| | - M. Clausen
- Department of Allergy; Landspitali; University Hospital; Reykjavík Iceland
| | - A. DunnGalvin
- Department of Paediatrics and Child Health; Clinical Investigation Unit; Cork University Hospital; University College; Cork Ireland
| | - J. O'. B. Hourihane
- Department of Paediatrics and Child Health; Clinical Investigation Unit; Cork University Hospital; University College; Cork Ireland
| | - A. Purohit
- Division of Allergy; Department of Chest Diseases; University Hospitals; University of Strasbourg; Strasbourg France
| | - N. G. Papadopoulos
- Allergy Department; 2nd Pediatric Clinic; University of Athens; Athens Greece
- Center for Pediatrics and Child Health; Institute of Human Development; University of Manchester; Manchester UK
| | - M. Fernandéz-Rivas
- Department of Allergy; Hospital Clinico San Carlos; IdISSC; Madrid Spain
| | - L. Frewer
- Food Safety and Consumer Behaviour; Marketing and Consumer Behaviour Group; Wageningen the Netherlands
- Food and Society Group; School of Agriculture; Food and Rural Development; Newcastle University; Newcastle UK
| | - P. Burney
- Department of Respiratory Epidemiology and Public Health; National Heart and Lung Institute; Imperial College London; London UK
| | - E. J. Duiverman
- Department of Pediatric Pulmonology and Pediatric Allergy; University of Groningen; University Medical Centre Groningen; Groningen the Netherlands
- University of Groningen; University Medical Centre Groningen; GRIAC Research Institute; Groningen the Netherlands
| | - A. E. J. Dubois
- Department of Pediatric Pulmonology and Pediatric Allergy; University of Groningen; University Medical Centre Groningen; Groningen the Netherlands
- University of Groningen; University Medical Centre Groningen; GRIAC Research Institute; Groningen the Netherlands
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15
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Gupta RP, Perez-Padilla R, Marks G, Vollmer W, Menezes A, Burney P. Summarising published results from spirometric surveys of COPD: the problem of inconsistent definitions. Int J Tuberc Lung Dis 2015; 18:998-1003. [PMID: 25199020 DOI: 10.5588/ijtld.13.0910] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING The use of different spirometric definitions for chronic obstructive pulmonary disease (COPD) has made an informative review of the available prevalence surveys impossible. OBJECTIVE To derive adjustment factors that allow the comparison of studies using different spirometric criteria. METHODS Pre- and post-bronchodilator one-second forced expiratory volume (FEV1) and forced vital capacity (FVC) values were taken from the Burden of Obstructive Lung Disease (BOLD) survey in 16 centres. Using a post-bronchodilator FEV1/FVC ratio less than the lower limit of normal (LLN) as our reference prevalence, we calculated simple multiplicative adjustments to transform other reported prevalence estimates to reference values. These adjustments were then tested on independent data sets from six further BOLD centres and five centres from the PLATINO study, a Latin American survey on obstructive lung disease. RESULTS Prevalence estimates based on pre-bronchodilator fixed-ratio measurements were 5-25% higher than reference values, and were strongly positively biased with age and prevalence level. Applying simple adjustments provided prevalence estimates that were almost unbiased and within 5% of the reference values. CONCLUSIONS Using the BOLD data, we have been able to estimate COPD prevalences based on post-bronchodilator FEV1/FVC < LLN by adjusting estimates based on other common definitions, enabling more meaningful comparisons of published findings.
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Affiliation(s)
- R P Gupta
- Respiratory Epidemiology and Public Health, National Heart and Lung Institute, Imperial College, London, UK
| | - R Perez-Padilla
- Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | - G Marks
- Woolcock Institute of Medical Research, Sydney, New South Wales, Australia
| | - W Vollmer
- Kaiser-Permanente Center for Health Research, Portland, Oregon, USA
| | - A Menezes
- Post-Graduate Programme in Epidemiology, Federal University of Pelotas, Capão do Leão, Rio Grande do Sul, Brazil
| | - P Burney
- Respiratory Epidemiology and Public Health, National Heart and Lung Institute, Imperial College, London, UK
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16
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Fernández-Rivas M, Barreales L, Mackie AR, Fritsche P, Vázquez-Cortés S, Jedrzejczak-Czechowicz M, Kowalski ML, Clausen M, Gislason D, Sinaniotis A, Kompoti E, Le TM, Knulst AC, Purohit A, de Blay F, Kralimarkova T, Popov T, Asero R, Belohlavkova S, Seneviratne SL, Dubakiene R, Lidholm J, Hoffmann-Sommergruber K, Burney P, Crevel R, Brill M, Fernández-Pérez C, Vieths S, Clare Mills EN, van Ree R, Ballmer-Weber BK. The EuroPrevall outpatient clinic study on food allergy: background and methodology. Allergy 2015; 70:576-84. [PMID: 25640688 DOI: 10.1111/all.12585] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2015] [Indexed: 01/22/2023]
Abstract
BACKGROUND The EuroPrevall project aimed to develop effective management strategies in food allergy through a suite of interconnected studies and a multidisciplinary integrated approach. To address some of the gaps in food allergy diagnosis, allergen risk management and socio-economic impact and to complement the EuroPrevall population-based surveys, a cross-sectional study in 12 outpatient clinics across Europe was conducted. We describe the study protocol. METHODS Patients referred for immediate food adverse reactions underwent a consistent and standardized allergy work-up that comprised collection of medical history; assessment of sensitization to 24 foods, 14 inhalant allergens and 55 allergenic molecules; and confirmation of clinical reactivity and food thresholds by standardized double-blind placebo-controlled food challenges (DBPCFCs) to milk, egg, fish, shrimp, peanut, hazelnut, celeriac, apple and peach. RESULTS A standardized methodology for a comprehensive evaluation of food allergy was developed and implemented in 12 outpatient clinics across Europe. A total of 2121 patients (22.6% <14 years) reporting 8257 reactions to foods were studied, and 516 DBPCFCs were performed. CONCLUSIONS This is the largest multicentre European case series in food allergy, in which subjects underwent a comprehensive, uniform and standardized evaluation including DBPCFC, by a methodology which is made available for further studies in food allergy. The analysis of this population will provide information on the different phenotypes of food allergy across Europe, will allow to validate novel in vitro diagnostic tests, to establish threshold values for major allergenic foods and to analyse the socio-economic impact of food allergy.
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Affiliation(s)
| | - L. Barreales
- Clinical Epidemilogy Unit; Preventive Medicine Department; Hospital Clínico San Carlos; IdISSC; Madrid Spain
| | - A. R. Mackie
- Institute of Food Research; Norwich Research Park; Colney Norwich UK
| | - P. Fritsche
- Allergy Unit; Department of Dermatology; University Hospital Zürich; Zürich Switzerland
| | - S. Vázquez-Cortés
- Allergy Department; Hospital Clínico San Carlos; IdISSC; Madrid Spain
| | | | - M. L. Kowalski
- Department of Immunology, Rheumatology and Allergy; Medical University of Lodz; Lodz Poland
| | - M. Clausen
- Department of Allergy, Respiratory Medicine and Sleep; Landspitali University Hospital; Reykjavik Iceland
| | - D. Gislason
- Department of Allergy, Respiratory Medicine and Sleep; Landspitali University Hospital; Reykjavik Iceland
| | - A. Sinaniotis
- Allergy Department; Laiko General Hospital; Athens Greece
| | - E. Kompoti
- Allergy Department; Laiko General Hospital; Athens Greece
| | - T.-M. Le
- Department of Dermatology/Allergology; University Medical Center Utrecht; Utrecht The Netherlands
| | - A. C. Knulst
- Department of Dermatology/Allergology; University Medical Center Utrecht; Utrecht The Netherlands
| | - A. Purohit
- Division of Asthma and Allergy; Department of Chest Diseases; University Hospital; Strasbourg France
| | - F. de Blay
- Division of Asthma and Allergy; Department of Chest Diseases; University Hospital; Strasbourg France
| | - T. Kralimarkova
- Clinical Centre of Allergology and Asthma; Medical University Sofia; Sofia Bulgaria
| | - T. Popov
- Clinical Centre of Allergology and Asthma; Medical University Sofia; Sofia Bulgaria
| | - R. Asero
- Ambulatorio di Allergologia; Clinica San Carlo; Paderno Dugnano Milano Italy
| | - S. Belohlavkova
- Department of Pediatrics; Faculty Hospital Bulovka; Charles University; Prague Czech Republic
| | - S. L. Seneviratne
- Department of Clinical Immunology and Allergy; Central Manchester and Manchester Children's University Hospitals NHS Trust; Manchester UK
| | - R. Dubakiene
- Allergy Centre; Vilnius University; Vilnius Lithuania
| | - J. Lidholm
- Thermo Fisher Scientific; Uppsala Sweden
| | - K. Hoffmann-Sommergruber
- Department of Pathophysiology and Allergy Research; Medical University of Vienna; Vienna Austria
| | - P. Burney
- Department of Respiratory Epidemiology and Public Health; National Heart and Lung Institute; Imperial College London; London UK
| | - R. Crevel
- Unilever Safety and Environmental Assurance Centre; Colworth Science Park; Sharnbrook Bedfordshire UK
| | - M. Brill
- Thermo Fisher Scientific; Uppsala Sweden
- VBC Genomics Biosciences Research GmbH; Vienna Austria
| | - C. Fernández-Pérez
- Clinical Epidemilogy Unit; Preventive Medicine Department; Hospital Clínico San Carlos; IdISSC; Madrid Spain
| | - S. Vieths
- Division of Allergologie; Paul Ehrlich Institute; Langen Germany
| | - E. N. Clare Mills
- Institute of Food Research; Norwich Research Park; Colney Norwich UK
- Institute of Inflammation and Repair; Manchester Academic Health Science Centre; Manchester Institute of Biotechnology; The University of Manchester; Manchester UK
| | - R. van Ree
- Department of Experimental Immunology; Academic Medical Center; University of Amsterdam; Amsterdam The Netherlands
- Department of Otorhinolaryngology; Academic Medical Center; University of Amsterdam; Amsterdam The Netherlands
| | - B. K. Ballmer-Weber
- Allergy Unit; Department of Dermatology; University Hospital Zürich; Zürich Switzerland
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Newson RB, Jones M, Forsberg B, Janson C, Bossios A, Dahlen SE, Toskala EM, Al-Kalemji A, Kowalski ML, Rymarczyk B, Salagean EM, van Drunen CM, Bachert C, Wehrend T, Krämer U, Mota-Pinto A, Burney P, Leynaert B, Jarvis D. The association of asthma, nasal allergies, and positive skin prick tests with obesity, leptin, and adiponectin. Clin Exp Allergy 2014; 44:250-60. [PMID: 24147569 DOI: 10.1111/cea.12221] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 08/07/2013] [Accepted: 08/14/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cross-sectional and longitudinal reports show that obese adults have more asthma than non-obese adults. A proposed mechanism is via effects of adipokines (leptin and adiponectin) on the immune system. OBJECTIVE We wished to measure the associations of asthma and other atopic diseases with serum adipokine levels and to find whether the associations with asthma were strong enough to rule out the possibility that they are secondary to the association of fatness measures with asthma. METHODS The Global Asthma and Allergy Network of Excellence (GA(2) LEN) clinical follow-up survey is a clinical survey, embedded in a larger multi-centre cross-sectional postal survey, involving, with a case/control design, enrichment of the sample with subjects with asthma and chronic rhinosinusitis (CRS). We recorded serum leptin or adiponectin in 845 men and 1110 women in 15 centres and also anthropometric measures of fatness including body mass index and waist/hip ratio, current asthma, and specific skin prick and IgE sensitisation. We used inverse sampling-probability-weighted rank and regression statistics to measure population associations of disease outcomes with adipokines in males and females, adjusting for confounders (area, age, smoking history, and number of elder siblings) and also mutually adjusting associations with adipokines and fatness measures. RESULTS One thousand nine hundred and fifty-five subjects aged 16-77 years had information on leptin or adiponectin levels. Leptin and leptin/adiponectin ratio were positively associated with the level of asthma, especially in females (Somers' D of leptin by asthma score, 0.20; 95% CI, 0.08-0.30; P = 0.00079). These associations were attenuated after adjusting for confounders and became non-significant after additionally adjusting for fatness measures and multiple comparisons. CONCLUSIONS AND CLINICAL RELEVANCE Asthma levels are positively associated with serum leptin. However, we cannot rule out the possibility that this association is secondary to associations of both with fatness measures.
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Affiliation(s)
- R B Newson
- Respiratory Epidemiology and Public Health Group, Imperial College London, National Heart and Lung Institute, London, UK
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18
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Obaseki D, Potts J, Joos G, Baelum J, Haahtela T, Ahlström M, Matricardi P, Kramer U, Gjomarkaj M, Fokkens W, Makowska J, Todo‐Bom A, Toren K, Janson C, Dahlen S, Forsberg B, Jarvis D, Howarth P, Brozek G, Minov J, Bachert C, Burney P. The relation of airway obstruction to asthma, chronic rhinosinusitis and age: results from a population survey of adults. Allergy 2014; 69:1205-14. [PMID: 24841074 PMCID: PMC4233404 DOI: 10.1111/all.12447] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2014] [Indexed: 11/27/2022]
Abstract
RATIONALE There is conflicting evidence on whether patients with asthma experience an accelerated decline in lung function with age. We examined the association between postbronchodilator lung function, asthma, chronic rhinosinusitis (CRS), and atopy with age using a large European sample. METHODS In 17 centers in 11 European countries, case-control studies were nested within representative cross-sectional surveys of adults aged less than 75 years. Representative samples of participants with asthma, CRS or both and controls were assessed for postbronchodilator ventilatory function, smoking history, atopy, and treatment. Multiple regression was used to assess the interactive effects of age and diagnostic group on decline in postbronchodilator ventilatory function. RESULTS A total of 3337 participants provided adequate data (778 with asthma, 399 with CRS, 244 with both asthma and CRS and 1916 controls who had neither asthma nor CRS). Participants with asthma had lower FEV1 /FVC (-4.09% (95% CI: -5.02, -3.15, P < 0.001) and a steeper slope of FEV1 /FVC against age (-0.14%/annum [95%CI: -0.19, -0.08]) equivalent to smoking 1-2 packs of cigarettes per day. Those with atopy had a slope equivalent to controls. CONCLUSIONS People with asthma have a steeper decline in postbronchodilator lung function with age, but neither CRS nor atopy alone were associated with such decline.
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Affiliation(s)
- D. Obaseki
- Department of Medicine Obafemi Awolowo University Ile‐Ife Nigeria
- Respiratory Epidemiology and Public Health Group National Heart and Lung Institute Imperial College London London UK
| | - J. Potts
- Respiratory Epidemiology and Public Health Group National Heart and Lung Institute Imperial College London London UK
| | - G. Joos
- Department of Respiratory Medicine Ghent University Hospital Ghent Belgium
| | - J. Baelum
- Odense University Hospital Odense University Odense Denmark
| | - T. Haahtela
- Skin and Allergy Hospital Helsinki University Helsinki Finland
| | - M. Ahlström
- Skin and Allergy Hospital Helsinki University Helsinki Finland
| | - P. Matricardi
- Department of Pediatric Pneumonology and Immunology Charité‐Universitätsmedizin Berlin Berlin Germany
| | - U. Kramer
- IUF – Leibniz Research Institute for Environmental Medicine Düsseldorf Germany
- Department of Dermatology and Allergy am Biederstein Technical University Munich Munich Germany
| | - M. Gjomarkaj
- Institute of Biomedicine and Molecular Immunology National Research Council Palermo Italy
| | - W. Fokkens
- Department of Otorhinolaryngology Academic Medical Center Amsterdam the Netherlands
| | - J. Makowska
- Department of Immunology Rheumatology and Allergy Medical University of Lodz Lodz Poland
| | - A. Todo‐Bom
- Faculty of Medicine University of Coimbra Coimbra Portugal
| | - K. Toren
- Section of Occupational and Environmental Medicine University of Gothenburg Gothenburg Sweden
| | - C. Janson
- Department of Medical Sciences: Respiratory Medicine and Allergology University of Uppsala Uppsala Sweden
| | - S.‐E. Dahlen
- CfA ‐ The Centre for Allergy Research Karolinska Institute Stockholm Sweden
| | - B. Forsberg
- Occupational and Environmental Medicine Umeå University Umeå Sweden
| | - D. Jarvis
- Respiratory Epidemiology and Public Health Group National Heart and Lung Institute Imperial College London London UK
| | - P. Howarth
- Clinical and Experimental Sciences Faculty of Medicine Southampton General Hospital Southampton UK
| | - G. Brozek
- Department of Epidemiology Medical University of Silesia in Katowice Katowice Poland
| | - J. Minov
- Institute for Occupational Health of Republic of Macedonia Skopje Republic of Macedonia
| | - C. Bachert
- Upper Airway Research Laboratory University of Ghent Ghent Belgium
- Division of Ear, Nose, and Throat Diseases Clintec Karolinska Institute Stockholm Sweden
| | - P. Burney
- Respiratory Epidemiology and Public Health Group National Heart and Lung Institute Imperial College London London UK
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Tomassen P, Jarvis D, Newson R, Van Ree R, Forsberg B, Howarth P, Janson C, Kowalski ML, Krämer U, Matricardi PM, Middelveld RJM, Todo-Bom A, Toskala E, Thilsing T, Brożek G, Van Drunen C, Burney P, Bachert C. Staphylococcus aureus enterotoxin-specific IgE is associated with asthma in the general population: a GA(2)LEN study. Allergy 2013; 68:1289-97. [PMID: 24117882 DOI: 10.1111/all.12230] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Specific IgE to Staphylococcus aureus enterotoxins (SE-IgE) has been associated with asthma. In the general population, we aimed to determine the prevalence of and risk factors for serum SE-IgE and to examine the association with asthma. METHODS A postal questionnaire was sent to a random sample of adults in 19 centers across Europe. A random sample of respondents was invited for clinical examination upon which they answered a questionnaire, underwent skin prick tests (SPTs) for common aeroallergens, and provided blood for measurement of total IgE and SE-IgE. Risks were analyzed within centers using weighted logistic regression, and overall estimates calculated using fixed-effects meta-analysis. RESULTS 2908 subjects were included in this analysis. Prevalence of positive SE-IgE was 29.3%; no significant geographic variation was observed. In contrast to positive skin prick tests, SE-IgE was more common in smokers (<15 pack-year: OR 1.11, P = 0.079, ≥15 pack-year: OR 1.70, P < 0.001), and prevalence did not decrease in older age-groups or in those with many siblings. Total IgE concentrations were higher in those with positive SE-IgE than in those with positive SPT. SE-IgE was associated with asthma (OR 2.10, 95% confidence interval [1.60-2.76], P = 0.001) in a concentration-dependent manner. This effect was independent of SPT result and homogeneous across all centers. CONCLUSIONS We report for the first time that SE-IgE is common in the general population throughout Europe and that its risk factors differ from those of IgE against aeroallergens. This is the first study to show that SE-IgE is significantly and independently associated with asthma in the general population.
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Affiliation(s)
- P. Tomassen
- Upper Airways Research Laboratory; Department of Otorhinolaryngology and Head and Neck Surgery; Ghent University; Ghent; Belgium
| | - D. Jarvis
- Respiratory Epidemiology & Public Health; Imperial College London; London; UK
| | - R. Newson
- Respiratory Epidemiology & Public Health; Imperial College London; London; UK
| | - R. Van Ree
- Department of Experimental Immunology and Department of Otorhinolaryngology; Academic Medical Center; Amsterdam; the Netherlands
| | - B. Forsberg
- Department of Public Health and Clinical Medicine; Occupational and Environmental Medicine; Umeå University; Umeå; Sweden
| | | | - C. Janson
- Department of Medical Sciences: Respiratory Medicine and Allergology; Uppsala University; Uppsala; Sweden
| | - M. L. Kowalski
- Department of Immunology, Rheumatology and Allergy; Medical University of Lodz; Lodz; Poland
| | | | - P. M. Matricardi
- Department of Pediatric Pneumonology and Immunology; Charité University Medical Center; Berlin; Germany
| | - R. J. M. Middelveld
- Centre for Allergy Research and Institute of Environmental Medicine; Karolinska Institutet; Stockholm; Sweden
| | - A. Todo-Bom
- Immunoallergology Department; Coimbra University; Coimbra; Portugal
| | - E. Toskala
- Center for Applied Genomics; The Children's Hospital of Philadelphia; Philadelphia; PA; USA
| | - T. Thilsing
- Department of Occupational and Environmental Medicine; Odense University Hospital; Odense; Denmark
| | - G. Brożek
- Department of Epidemiology; College of Medicine Medical University of Silesia; Katowice; Poland
| | - C. Van Drunen
- Department of Otorhinolaryngology; Academic Medical Center; Amsterdam; the Netherlands
| | - P. Burney
- Respiratory Epidemiology & Public Health; Imperial College London; London; UK
| | - C. Bachert
- Upper Airways Research Laboratory; Department of Otorhinolaryngology and Head and Neck Surgery; Ghent University; Ghent; Belgium
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20
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Bárbara C, Rodrigues F, Dias H, Cardoso J, Almeida J, Matos M, Simão P, Santos M, Ferreira J, Gaspar M, Gnatiuc L, Burney P. Prevalência da doença pulmonar obstrutiva crónica em Lisboa, Portugal: estudo Burden of Obstructive Lung Disease. Revista Portuguesa de Pneumologia 2013; 19:96-105. [DOI: 10.1016/j.rppneu.2012.11.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Revised: 11/02/2012] [Accepted: 11/07/2012] [Indexed: 10/26/2022] Open
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Affiliation(s)
- R. Hooper
- Centre for Primary Care & Public Health, Queen Mary University of London, London, UK
| | - P. Burney
- National Heart Lung Institute, Imperial College, London, UK
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Jarvis D, Newson R, Lotvall J, Hastan D, Tomassen P, Keil T, Gjomarkaj M, Forsberg B, Gunnbjornsdottir M, Minov J, Brozek G, Dahlen SE, Toskala E, Kowalski ML, Olze H, Howarth P, Krämer U, Baelum J, Loureiro C, Kasper L, Bousquet PJ, Bousquet J, Bachert C, Fokkens W, Burney P. Asthma in adults and its association with chronic rhinosinusitis: the GA2LEN survey in Europe. Allergy 2012; 67:91-8. [PMID: 22050239 DOI: 10.1111/j.1398-9995.2011.02709.x] [Citation(s) in RCA: 328] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The prevalence of asthma and its association with chronic rhinosinusitis (CRS) have not been widely studied in population-based epidemiological surveys. METHODS The Global Allergy and Asthma Network of Excellence (GA(2) LEN) conducted a postal questionnaire in representative samples of adults living in Europe to assess the presence of asthma and CRS defined by the European Position Paper on Rhinosinusitis and Nasal Polyps. The prevalence of self-reported current asthma by age group was determined. The association of asthma with CRS in each participating centre was assessed using logistic regression analyses, controlling for age, sex and smoking, and the effect estimates were combined using standard methods of meta-analysis. RESULTS Over 52,000 adults aged 18-75 years and living in 19 centres in 12 countries took part. In most centres, and overall, the reported prevalence of asthma was lower in older adults (adjusted OR for 65-74 years compared with 15-24 years: 0.72; 95% CI: 0.63-0.81). In all centres, there was a strong association of asthma with CRS (adjusted OR: 3.47; 95% CI: 3.20-3.76) at all ages. The association with asthma was stronger in those reporting both CRS and allergic rhinitis (adjusted OR: 11.85; 95% CI: 10.57-13.17). CRS in the absence of nasal allergies was positively associated with late-onset asthma. CONCLUSION Geographical variation in the prevalence of self-reported asthma was observed across Europe, but overall, self-reported asthma was more common in young adults, women and smokers. In all age groups, men and women, and irrespective of smoking behaviour, asthma was also associated with CRS.
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Affiliation(s)
- D Jarvis
- Imperial College, Respiratory Epidemiology and Public Health Group and MRC-HPA Centre for Environment and Health, London, UK.
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Gnatiuc L, Coton S, Buist S, Kato B, Mejza P, Burney P. P209 Risk factors for respiratory exacerbations in the BOLD study. Thorax 2011. [DOI: 10.1136/thoraxjnl-2011-201054c.209] [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: 11/04/2022]
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25
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Enright P, Vollmer W, Lamprecht B, Jensen R, Jithoo A, Tan W, Studnicka M, Burney P, Gillespie S, Buist A. Quality of Spirometry tests performed by 9893 adults in 14 countries: The BOLD Study. Respir Med 2011; 105:1507-15. [DOI: 10.1016/j.rmed.2011.04.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2011] [Revised: 04/11/2011] [Accepted: 04/12/2011] [Indexed: 10/18/2022]
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Hastan D, Fokkens WJ, Bachert C, Newson RB, Bislimovska J, Bockelbrink A, Bousquet PJ, Brozek G, Bruno A, Dahlén SE, Forsberg B, Gunnbjörnsdóttir M, Kasper L, Krämer U, Kowalski ML, Lange B, Lundbäck B, Salagean E, Todo-Bom A, Tomassen P, Toskala E, van Drunen CM, Bousquet J, Zuberbier T, Jarvis D, Burney P. Chronic rhinosinusitis in Europe--an underestimated disease. A GA²LEN study. Allergy 2011; 66:1216-23. [PMID: 21605125 DOI: 10.1111/j.1398-9995.2011.02646.x] [Citation(s) in RCA: 648] [Impact Index Per Article: 49.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) is a common health problem, with significant medical costs and impact on general health. Even so, prevalence figures for Europe are unavailable. In this study, conducted by the GA²LEN network of excellence, the European Position Paper on Rhinosinusitis and nasal Polyps (EP³OS) diagnostic criteria are applied to estimate variation in the prevalence of Chronic rhinosinusitis (CRS) for Europe. METHOD A postal questionnaire was sent to a random sample of adults aged 15-75 years in 19 centres in Europe. Participants reported symptoms of CRS, and doctor diagnosed CRS, allergic rhinitis, age, gender and smoking history. Definition of CRS was based on the EP³OS diagnostic criteria: the presence of more than two of the symptoms: (i) nasal blockage, (ii) nasal discharge, (iii) facial pain/pressure or (iv) reduction in sense of smell, for >12 weeks in the past year--with at least one symptom being nasal blockage or discharge. RESULTS Information was obtained from 57,128 responders living in 19 centres in 12 countries. The overall prevalence of CRS by EP³OS criteria was 10.9% (range 6.9-27.1). CRS was more common in smokers than in nonsmokers (OR 1.7: 95% CI 1.6-1.9). The prevalence of self-reported physician-diagnosed CRS within centres was highly correlated with the prevalence of EP³OS-diagnosed CRS. CONCLUSION This is the first European international multicentre prevalence study of CRS. In this multicentre survey of adults in Europe, about one in ten participants had CRS with marked geographical variation. Smoking was associated with having CRS in all parts of Europe.
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Affiliation(s)
- D Hastan
- Department of Otorhinolaryngology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
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27
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Bakolis I, Hooper R, Burney P, Shaheen S. P1-8 Principal components analysis of diet is not good at identifying foods that are causally linked to disease: a simulation study. Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976c.3] [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: 11/03/2022]
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28
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Tomassen P, Newson RB, Hoffmans R, Lötvall J, Cardell LO, Gunnbjörnsdóttir M, Thilsing T, Matricardi P, Krämer U, Makowska JS, Brozek G, Gjomarkaj M, Howarth P, Loureiro C, Toskala E, Fokkens W, Bachert C, Burney P, Jarvis D. Reliability of EP3OS symptom criteria and nasal endoscopy in the assessment of chronic rhinosinusitis--a GA² LEN study. Allergy 2011; 66:556-61. [PMID: 21083566 DOI: 10.1111/j.1398-9995.2010.02503.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The European Position Paper on Rhinosinusitis and Nasal Polyps (EP3OS) incorporates symptomatic, endoscopic, and radiologic criteria in the clinical diagnosis of chronic rhinosinusitis (CRS), while in epidemiological studies, the definition is based on symptoms only. We aimed to assess the reliability and validity of a symptom-based definition of CRS using data from the GA(2) LEN European survey. METHODS On two separate occasions, 1700 subjects from 11 centers provided information on symptoms of CRS, allergic rhinitis, and asthma. CRS was defined by the epidemiological EP3OS symptom criteria. The difference in prevalence of CRS between two study points, the standardized absolute repeatability, and the chance-corrected repeatability (kappa) were determined. In two centers, 342 participants underwent nasal endoscopy. The association of symptom-based CRS with endoscopy and self-reported doctor-diagnosed CRS was assessed. RESULTS There was a decrease in prevalence of CRS between the two study phases, and this was consistent across all centers (-3.0%, 95% CI: -5.0 to -1.0%, I(2) = 0). There was fair to moderate agreement between the two occasions (kappa = 39.6). Symptom-based CRS was significantly associated with positive endoscopy in nonallergic subjects, and with self-reported doctor-diagnosed CRS in all subjects, irrespective of the presence of allergic rhinitis. CONCLUSION Our findings suggest that a symptom-based definition of CRS, according to the epidemiological part of the EP3OS criteria, has a moderate reliability over time, is stable between study centers, is not influenced by the presence of allergic rhinitis, and is suitable for the assessment of geographic variation in prevalence of CRS.
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Affiliation(s)
- P Tomassen
- Upper Airways Research Laboratory, Department of Otorhinolaryngology and Logopaedic-Audiologic Science, Ghent University, Gent, Belgium.
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Abstract
AIM Reduced basal cortisol is reported in allergic disease. We investigated if basal salivary cortisol levels were reduced in children with asthma or allergic rhinitis, controlling for inhaled corticosteroids (ICS) use. METHODS Morning and evening saliva of asthmatic children aged 7-12 years (n = 50) and that of controls (n = 52) were sampled. A total of 19 asthmatics and four controls had allergic rhinitis. Healthy children were controls without rhinitis. Of all, 14 asthmatic children used low, and 12 used moderate or high doses of ICS. Cortisol was analysed by radioimmunoassay. RESULTS Morning salivary cortisol median (95% CI) was lower in asthmatics (8.7 (7.1, 9.7)) compared with that in controls (10.4 (9.6, 11.8); p = 0.006), which was similar for evening cortisol levels. Regression analyses demonstrated that asthmatics using moderate or high doses of ICS had reduced morning salivary cortisol adjusted (for age and gender) odds ratio (aOR) (95% CI) (0.54 (0.37, 0.80); p = 0.002) and reduced evening cortisol aOR (0.09 (0.01, 0.6); p = 0.02) compared with that in healthy children. Asthmatics with rhinitis on no or low doses of ICS had reduced morning cortisol aOR (0.73 (0.56, 0.96); p = 0.02) compared with that in healthy children. CONCLUSION Asthmatic children on moderate or high doses of inhaled corticosteroids had reduced salivary cortisol, but co-morbidity of asthma and rhinitis was also associated with reduced cortisol levels.
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Affiliation(s)
- E Bakkeheim
- Department of Paediatrics, Oslo University Hospital, Ullevål, Oslo, Norway.
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30
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Edginton ME, Miller DL, Burney P, El Sony AI, Lwilla FI, O'Brien R, Roldan MB, Roldan A, Srinath S. Surveillance for MDR-TB: is there an obligation to ensure treatment for individuals identified with MDR-TB? Int J Tuberc Lung Dis 2010; 14:1094-1096. [PMID: 20819252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
This article raises ethical issues that result if individuals, during the course of research to measure the prevalence of drug-resistant tuberculosis, are identified with the disease but are not provided with or referred for appropriate treatment. It draws attention to and applauds recently published World Health Organization guidelines on the subject. Questions posed are: 1) Should treatment be provided for individuals identified through surveillance projects for MDR-TB, whatever their purpose (specific research or 'routine' national prevalence studies)? 2) If treatment availability is a problem, who is responsible for assuring this?
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Affiliation(s)
- M E Edginton
- Ethics Advisory Group, International Union Against Tuberculosis and Lung Disease, Paris, France.
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31
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Burney P, Summers C, Chinn S, Hooper R, van Ree R, Lidholm J. Prevalence and distribution of sensitization to foods in the European Community Respiratory Health Survey: a EuroPrevall analysis. Allergy 2010; 65:1182-8. [PMID: 20180791 DOI: 10.1111/j.1398-9995.2010.02346.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Reports of adverse reactions to foods are increasing, but there is limited information on the comparative prevalence of sensitization to food allergens using standardized methods. METHODS Sera from the 'random sample' of young adults seen during the second phase of the European Community Respiratory Health Survey were analysed for IgE against 24 foods using ImmunoCAP. Sera were tested on five food mixes, and subsequently on individual foods in each positive mix. RESULTS Sera from 4522 individuals living in 13 countries were tested for at least one food allergen mix. Prevalence of sensitization to any of the 24 food allergens ranged from 24.6% in Portland (USA) to 7.7% in Reykjavik (Iceland). With few exceptions, the relative prevalence of sensitization to different foods was similar in all countries. Sensitization rates to egg, fish and milk were each less than 1%, and the most common sensitizations are not represented in current commercial mixes. The prevalence of sensitization to foods was not related to that of sensitization to aeroallergens but was related to the geometric mean total IgE for the country. CONCLUSIONS Sensitization to foods is common but highly variable. The relative prevalence of sensitization to different foods is more consistent than would be expected by chance, suggesting that quantity of consumption of specific foods does not determine prevalence. The aetiology of food sensitization is only partly similar to that for aeroallergens but is related to local levels of total IgE. This may provide an important clue to the origins of food sensitization.
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Affiliation(s)
- P Burney
- Respiratory Epidemiology and Public Health, Imperial College, London, UK.
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Antó JM, Sunyer J, Basagaña X, Garcia-Esteban R, Cerveri I, de Marco R, Heinrich J, Janson C, Jarvis D, Kogevinas M, Kuenzli N, Leynaert B, Svanes C, Wjst M, Gislason T, Burney P. Risk factors of new-onset asthma in adults: a population-based international cohort study. Allergy 2010; 65:1021-30. [PMID: 20132157 DOI: 10.1111/j.1398-9995.2009.02301.x] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The occurrence of new-onset asthma during adulthood is common, but there is insufficient understanding of its determinants including the role of atopy. OBJECTIVE To assess the risk factors for the development of new-onset asthma in middle-aged adults and to compare them according to atopy. METHODS A longitudinal analysis of 9175 young adults who participated in two surveys of the European Community Respiratory Health Survey (ECRHS) conducted 9 years apart. FINDINGS We observed 179 cases of new-onset asthma among 4588 participants who were free of asthma and reported at the beginning of the follow-up that they had never had asthma (4.5 per 1000 person-years). In a logistic regression, the following risk factors were found to increase the risk of new-onset asthma: female gender (OR: 1.97; 95% confidence interval (CI): 1.38, 2.81), bronchial hyperresponsiveness (3.25; 2.19, 4.83), atopy (1.55; 1.08, 2.21), FEV(1) < 100 % predicted (1.87; 1.34, 2.62), nasal allergy (1.98;1.39,2.84) and maternal asthma (1.91; 1.13; 3.21). Obesity, respiratory infections in early life and high-risk occupations increased the risk of new-onset asthma although we had limited power to confirm their role. Among the atopics, total IgE and sensitization to cat were independently related to the risk of new-onset asthma. The proportion of new-onset asthma attributable to atopy varied from 12% to 21%. CONCLUSION Adults reporting that they had never had asthma were at a substantial risk of new-onset asthma as a result of multiple independent risk factors including lung function. Atopy explains a small proportion of new-onset adult asthma.
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Affiliation(s)
- J M Antó
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona.
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Wong GWK, Mahesh PA, Ogorodova L, Leung TF, Fedorova O, Holla AD, Fernandez-Rivas M, Clare Mills EN, Kummeling I, van Ree R, Yazdanbakhsh M, Burney P. The EuroPrevall-INCO surveys on the prevalence of food allergies in children from China, India and Russia: the study methodology. Allergy 2010; 65:385-90. [PMID: 19889114 DOI: 10.1111/j.1398-9995.2009.02214.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Very little is known regarding the global variations in the prevalence of food allergies. The EuroPrevall-INCO project has been developed to evaluate the prevalence of food allergies in China, India and Russia using the standardized methodology of the EuroPrevall protocol used for studies in the European Union. The epidemiological surveys of the project were designed to estimate variations in the prevalence of food allergy and exposure to known or suspected risk factors for food allergy and to compare the data with different European countries. METHODS Random samples of primary schoolchildren were recruited from urban and rural regions of China, Russia and India for screening to ascertain possible adverse reactions to foods. Cases and controls were then selected to answer a detailed questionnaire designed to evaluate the possible risk factors of food allergies. Objective evidence of sensitisation including skin-prick test and serum specific IgE measurement was also collected. RESULTS More than 37 000 children from the three participating countries have been screened. The response rates for the screening phase ranged from 83% to 95%. More than 3000 cases and controls were studied in the second phase of the study. Further confirmation of food allergies by double blind food challenge was conducted. CONCLUSIONS This will be the first comparative study of the epidemiology of food allergies in China, India, and Russia using the same standardized methodology. The findings of these surveys will complement the data obtained from Europe and provide insights into the development of food allergy.
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Affiliation(s)
- G W K Wong
- Department of Paediatrics and School of Public Health, Chinese University of Hong Kong, Shatin, NT, Hong Kong, China
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Bousquet PJ, Brozek J, Bachert C, Bieber T, Bonini S, Burney P, Calderon M, Canonica GW, Compalati E, Daures JP, Delgado L, Demoly P, Dahl R, Durham SR, Kowalski ML, Malling HJ, Merk H, Papadopoulos N, Passalacqua G, Simon HU, Worms M, Wahn U, Zuberbier T, Schünemann HJ, Bousquet J. The CONSORT statement checklist in allergen-specific immunotherapy: a GA2LEN paper. Allergy 2009; 64:1737-45. [PMID: 19860788 DOI: 10.1111/j.1398-9995.2009.02232.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The methodology of randomized clinical trials is essential for the critical assessment and registration of therapeutic interventions. The CONSORT (Consolidated Standards of Reporting Trials) statement was developed to alleviate the problems arising from the inadequate reporting of randomized controlled trials. The present article reflects on the items that we believe should be included in the CONSORT checklist in the context of conducting and reporting trials in allergen-specific immunotherapy. Only randomized, blinded (in particular blinding of patients, health care providers, and outcome assessors), placebo-controlled Phase III studies in this article. Our analysis focuses on the definition of patients' inclusion and exclusion criteria, allergen standardization, primary, secondary and exploratory outcomes, reporting of adverse events and analysis.
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Affiliation(s)
- P J Bousquet
- Département de Biostatistique, Epidémiologie Clinique Santé Publique et Information Médicale, Groupe Hospitalo-Universtaire Carémeau, Nîmes Cedex, France
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Gjomarkaj M, Pace E, Canonica GW, Bonini S, Ricci G, Burney P, Zuberbier T, Van Cauwenberge P, Bousquet J. [GA(2)LEN (Global Allergy and Asthma European Network): European network of excellence for asthma and allergic diseases]. Minerva Med 2009; 100:525-534. [PMID: 20010485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Allergic diseases represent some of the main health problems in Europe. These are increasing in prevalence, seriousness and social cost. The Global Allergy and Asthma European Network (GA(2)LEN), a network of excellence of the 6 degrees management program, was created in the 2005 with the aim to gather the European leader institutions of the research and clinical assistance fields, in order to guarantee the excellence and avoid the fragmentation of the energy spent in fighting allergy diseases in general. The GA(2)LEN has drawn a great advantage from the personal efforts of every single researcher who have proved their strong motivation in carrying on this "pan-European" model of collaboration. The network has been organized in order to increase the team work in scientific research projects in allergic and asthma disease field, making the GA(2)LEN the worldwide leader in this area. On these basis research projects have been carried on about which first data have been already published. The activities of the GA(2)LEN include in general the establishment of a lasting organization of the planning phase, the activity linked to every single project and to the improving on the existing projects, as well as the draft of new guidelines. This review reports the main achieved goals.
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Affiliation(s)
- M Gjomarkaj
- Consiglio Nazionale delle Ricerche-Istituto di Biomedicina ed Immunologia Molecolare Palermo, Italia.
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Heinzerling LM, Burbach GJ, Edenharter G, Bachert C, Bindslev‐Jensen C, Bonini S, Bousquet J, Bousquet‐Rouanet L, Bousquet PJ, Bresciani M, Bruno A, Burney P, Canonica GW, Darsow U, Demoly P, Durham S, Fokkens WJ, Giavi S, Gjomarkaj M, Gramiccioni C, Haahtela T, Kowalski ML, Magyar P, Muraközi G, Orosz M, Papadopoulos NG, Röhnelt C, Stingl G, Todo‐Bom A, Von Mutius E, Wiesner A, Wöhrl S, Zuberbier T. GA(2)LEN skin test study I: GA(2)LEN harmonization of skin prick testing: novel sensitization patterns for inhalant allergens in Europe. Allergy 2009; 64:1498-1506. [PMID: 19772515 DOI: 10.1111/j.1398-9995.2009.02093.x] [Citation(s) in RCA: 220] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Skin prick testing is the standard for diagnosing IgE-mediated allergies. However, different allergen extracts and different testing procedures have been applied by European allergy centres. Thus, it has been difficult to compare results from different centres or studies across Europe. It was, therefore, crucial to standardize and harmonize procedures in allergy diagnosis and treatment within Europe. AIMS The Global Asthma and Allergy European Network (GA(2)LEN), with partners and collaborating centres across Europe, was in a unique position to take on this task. The current study is the first approach to implement a standardized procedure for skin prick testing in allergies against inhalant allergens with a standardized pan-European allergen panel. METHODS The study population consisted of patients who were referred to one of the 17 participating centres in 14 European countries (n = 3034, median age = 33 years). Skin prick testing and evaluation was performed with the same 18 allergens in a standardized procedure across all centres. RESULTS The study clearly shows that many allergens previously regarded as untypical for some regions in Europe have been underestimated. This could partly be related to changes in mobility of patients, vegetation or climate in Europe. CONCLUSION The results of this large pan-European study demonstrate for the first time sensitization patterns for different inhalant allergens in patients across Europe. The standardized skin prick test with the standardized allergen battery should be recommended for clinical use and research. Further EU-wide monitoring of sensitization patterns is urgently needed.
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Affiliation(s)
- L. M. Heinzerling
- Department of Dermatology and Allergy, Charité Universitätsmedizin‐Berlin, Berlin, Germany
| | - G. J. Burbach
- Department of Dermatology and Allergy, Charité Universitätsmedizin‐Berlin, Berlin, Germany
| | - G. Edenharter
- Department of Dermatology and Allergy, Charité Universitätsmedizin‐Berlin, Berlin, Germany
| | - C. Bachert
- Department of Otorhinolaryngology, University Hospital, Ghent, Belgium
| | | | - S. Bonini
- Consiglio Nazionale delle Ricerche, Rome, Italy
| | | | | | | | | | - A. Bruno
- Consiglio Nazionale delle Ricerche, Palermo, Italy
| | - P. Burney
- Imperial College for Science, Technology and Medicine, London, UK
| | | | - U. Darsow
- Department of Dermatology and Allergy Biederstein and Division of Environmental Dermatology and Allergy Helmholtz Center, Technical University, Technische Universität, Munich, Germany
| | - P. Demoly
- University Hospital, Montpellier, France
| | - S. Durham
- Department of Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - W. J. Fokkens
- Academic Medical Centre, Department of Otorhinolaryngology, Amsterdam, the Netherlands
| | - S. Giavi
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University, Athens, Greece
| | - M. Gjomarkaj
- Consiglio Nazionale delle Ricerche, Palermo, Italy
| | | | - T. Haahtela
- Skin and Allergy Hospital, University Central Hospital, Helsinki, Finland
| | - M. L. Kowalski
- Department of Clinical Immunology and Allergy, Medical University of Lodz, Lodz, Poland
| | - P. Magyar
- Semmelweis Medical University, Budapest, Hungary
| | - G. Muraközi
- Semmelweis Medical University, Budapest, Hungary
| | - M. Orosz
- Semmelweis Medical University, Budapest, Hungary
| | - N. G. Papadopoulos
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University, Athens, Greece
| | - C. Röhnelt
- Department of Dermatology and Allergy, Charité Universitätsmedizin‐Berlin, Berlin, Germany
| | - G. Stingl
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | | | | | - A. Wiesner
- Children’s University Hospital, Zurich, Switzerland
| | - S. Wöhrl
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - T. Zuberbier
- Department of Dermatology and Allergy, Charité Universitätsmedizin‐Berlin, Berlin, Germany
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37
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Kummeling I, Mills ENC, Clausen M, Dubakiene R, Pérez CF, Fernández‐Rivas M, Knulst AC, Kowalski ML, Lidholm J, Le T, Metzler C, Mustakov T, Popov T, Potts J, Van Ree R, Sakellariou A, Töndury B, Tzannis K, Burney P. The EuroPrevall surveys on the prevalence of food allergies in children and adults: background and study methodology. Allergy 2009; 64:1493-1497. [PMID: 19385958 DOI: 10.1111/j.1398-9995.2009.02046.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The epidemiological surveys in children and adults of the EU-funded multidisciplinary Integrated Project EuroPrevall, launched in June 2005, were designed to estimate the currently unknown prevalence of food allergy and exposure to known or suspected risk factors for food allergy across Europe. We describe the protocol for the epidemiological surveys in children and adults. This protocol provides specific instructions on the sampling strategy, the use of questionnaires, and collection of blood samples for immunological analyses. METHODS The surveys were performed as multi-centre, cross-sectional studies in general populations. Case-control studies were nested within these surveys. The studies in children aged 7-10 years and adults aged 20-54 years were undertaken in eight centres representing different social and climatic regions in Europe. RESULTS After a community-based survey collecting basic information on adverse reactions to foods, all those stating they had experienced such reactions, as well as of a random sample of those stating 'no reactions' to foods, completed a detailed questionnaire on potential risks and exposures. Also a blood sample was taken to allow serological analysis to establish patterns of food and aeroallergen sensitization. We also included a questionnaire to schools on their preparedness for dealing with food allergy amongst pupils. Subjects reporting adverse reactions to foods and sensitized to the same food(s) were called in for a full clinical evaluation that included a double blind placebo controlled food challenge (DBPCFC), following a protocol which is described in detail elsewhere. CONCLUSIONS The outcome of these studies will help to improve our understanding of several important aspects of food allergies in the European Community, providing for more well-informed policies and effective measures of disease prevention, diagnosis and management.
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Affiliation(s)
- I. Kummeling
- Department of Respiratory Epidemiology and Public Health, National Heart and Lung Institute, Imperial College London, London, UK
| | - E. N. C. Mills
- Institute of Food Research, Materials Science, Norwich, UK
| | - M. Clausen
- Children’s Hospital Iceland, Landspitali, University Hospital, Reykjavík, Iceland
| | - R. Dubakiene
- Clinics of Chest, Allergology and Radiology, Medical faculty, Vilnius University, Vilnius, Lithuania
| | - C. Farnãndez Pérez
- Clinical Epidemiology Unit, Preventive Medicine Department. Hospital Clínico San Carlos, Madrid, Spain
| | | | - A. C. Knulst
- University Medical Center Utrecht, Department of Dermatology/Allergology, Utrecht, the Netherlands
| | - M. L. Kowalski
- Department of Immunology, Rheumatology and Allergy, Faculty of Medicine, Medical University of Lodz, Poland
| | | | - T.‐M. Le
- University Medical Center Utrecht, Department of Dermatology/Allergology, Utrecht, the Netherlands
| | - C. Metzler
- Allergy Unit, Department of Dermatology, University Hospital of Zürich, Switzerland
| | - T. Mustakov
- Medical University, Clinical Centre of Allergology of the Alexandrovska Hospital, Sofia, Bulgaria
| | - T. Popov
- Medical University, Clinical Centre of Allergology of the Alexandrovska Hospital, Sofia, Bulgaria
| | - J. Potts
- Department of Respiratory Epidemiology and Public Health, National Heart and Lung Institute, Imperial College London, London, UK
| | - R. Van Ree
- Department of Experimental Immunology and Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, the Netherlands
| | - A. Sakellariou
- Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece
| | - B. Töndury
- Allergy Unit, Department of Dermatology, University Hospital of Zürich, Switzerland
| | - K. Tzannis
- Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece
| | - P. Burney
- Department of Respiratory Epidemiology and Public Health, National Heart and Lung Institute, Imperial College London, London, UK
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38
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Cochrane S, Beyer K, Clausen M, Wjst M, Hiller R, Nicoletti C, Szepfalusi Z, Savelkoul H, Breiteneder H, Manios Y, Crittenden R, Burney P. Factors influencing the incidence and prevalence of food allergy. Allergy 2009; 64:1246-55. [PMID: 19663867 DOI: 10.1111/j.1398-9995.2009.02128.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Food allergy is an increasing problem in Europe and elsewhere and severe reactions to food are also becoming more common. As food allergy is usually associated with other forms of allergic sensitisation it is likely that many risk factors are common to all forms of allergy. However the potential severity of the disease and the specific public heath measures required for food allergy make it important to identify the specific risk factors for this condition. Food allergy is unusual in that it often manifests itself very early in life and commonly remits with the development of tolerance. Hypotheses that explain the distribution of food allergy include specific genetic polymorphisms, the nature of the allergens involved and the unique exposure to large quantities of allergen through the gut. Progress has been made in developing more specific and testable hypotheses but the evidence for any of these is still only preliminary. Further collaborative research is required to develop an appropriate public health response to this growing problem.
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Affiliation(s)
- S Cochrane
- Safety and Environmental Centre, Unilever Colworth, Colworth Park, Sharnbrook, Bedford, UK
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39
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Vollmer WM, Gíslason T, Burney P, Enright PL, Gulsvik A, Kocabas A, Buist AS. Comparison of spirometry criteria for the diagnosis of COPD: results from the BOLD study. Eur Respir J 2009; 34:588-97. [PMID: 19460786 DOI: 10.1183/09031936.00164608] [Citation(s) in RCA: 161] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Published guidelines recommend spirometry to accurately diagnose chronic obstructive pulmonary disease (COPD). However, even spirometry-based COPD prevalence estimates can vary widely. We compared properties of several spirometry-based COPD definitions using data from the international Burden of Obstructive Lung Disease (BOLD)study. 14 sites recruited population-based samples of adults aged > or =40 yrs. Procedures included standardised questionnaires and post-bronchodilator spirometry. 10,001 individuals provided usable data. Use of the lower limit of normal (LLN) forced expiratory volume in 1 s (FEV(1)) to forced vital capacity (FVC) ratio reduced the age-related increases in COPD prevalence that are seen among healthy never-smokers when using the fixed ratio criterion (FEV(1)/FVC <0.7) recommended by the Global Initiative for Chronic Obstructive Lung Disease. The added requirement of an FEV(1) either <80% predicted or below the LLN further reduced age-related increases and also led to the least site-to-site variability in prevalence estimates after adjusting for potential confounders. Use of the FEV(1)/FEV(6) ratio in place of the FEV(1)/FVC yielded similar prevalence estimates. Use of the FEV(1)/FVC<LLN criterion instead of the FEV(1)/FVC <0.7 should minimise known age biases and better reflect clinically significant irreversible airflow limitation. Our study also supports the use of the FEV(1)/FEV(6) as a practical substitute for the FEV(1)/FVC.
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Affiliation(s)
- W M Vollmer
- Kaiser Permanente, Center for Health Research, Portland, OR 97227-1110, USA.
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40
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Bachert C, Van Bruaene N, Toskala E, Zhang N, Olze H, Scadding G, Van Drunen CM, Mullol J, Cardell L, Gevaert P, Van Zele T, Claeys S, Halldén C, Kostamo K, Foerster U, Kowalski M, Bieniek K, Olszewska-Ziaber A, Nizankowska-Mogilnicka E, Szczeklik A, Swierczynska M, Arcimowicz M, Lund V, Fokkens W, Zuberbier T, Akdis C, Canonica G, Van Cauwenberge P, Burney P, Bousquet J. Important research questions in allergy and related diseases: 3-chronic rhinosinusitis and nasal polyposis - a GALEN study. Allergy 2009; 64:520-33. [PMID: 19317839 DOI: 10.1111/j.1398-9995.2009.01964.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Chronic rhinosinusitis is one of the most common health care challenges, with significant direct medical costs and severe impact on lower airway disease and general health outcomes. The diagnosis of chronic rhinosinusitis (CRS) currently is based on clinical signs, nasal endoscopy and CT scanning, and therapeutic recommendations are focussing on 2 classes of drugs, corticosteroids and antibiotics. A better understanding of the pathogenesis and the factors amplifying mucosal inflammation therefore seems to be crucial for the development of new diagnostic and therapeutic tools. In an effort to extend knowledge in this area, the WP 2.7.2 of the GA(2)LEN network of excellence currently collects data and samples of 1000 CRS patients and 250 control subjects. The main objective of this project is to characterize patients with upper airway disease on the basis of clinical parameters, infectious agents, inflammatory mechanisms and remodeling processes. This collaborative research will result in better knowledge on patient phenotypes, pathomechanisms, and subtypes in chronic rhinosinusitis. This review summarizes the state of the art on chronic rhinosinusitis and nasal polyposis in different aspects of the disease. It defines potential gaps in the current research, and points to future research perspectives and targets.
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41
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Castro-Giner F, Kogevinas M, Imboden M, de Cid R, Jarvis D, Mächler M, Berger W, Burney P, Franklin KA, Gonzalez JR, Heinrich J, Janson C, Omenaas E, Pin I, Rochat T, Sunyer J, Wjst M, Antó JM, Estivill X, Probst-Hensch NM. Joint effect of obesity and TNFA variability on asthma: two international cohort studies. Eur Respir J 2009; 33:1003-9. [PMID: 19196817 DOI: 10.1183/09031936.00140608] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Obesity is a risk factor for asthma. Adipose tissue expresses pro-inflammatory molecules including tumour necrosis factor (TNF), and levels of TNF are also related to polymorphisms in the TNF-alpha (TNFA) gene. The current authors examined the joint effect of obesity and TNFA variability on asthma in adults by combining two population-based studies. The European Community Respiratory Health Survey and the Swiss Cohort Study on Air Pollution and Lung and Heart Disease in Adults used comparable protocols, questionnaires and measures of lung function and atopy. DNA samples from 9,167 participants were genotyped for TNFA -308 and lymphotoxin-alpha (LTA) +252 gene variants. Obesity and TNFA were associated with asthma when mutually adjusting for their independent effects (odds ratio (OR) for obesity 2.4, 95% confidence interval (CI) 1.7-3.2; OR for TNFA -308 polymorphism 1.3, 95% CI 1.1-1.6). The association of obesity with asthma was stronger for subjects carrying the G/A and A/A TNFA -308 genotypes compared with the more common G/G genotype, particularly among nonatopics (OR for G/A and A/A genotypes 6.1, 95% CI 2.5-14.4; OR for G/G genotype 1.7, 95% CI 0.8-3.3). The present findings provide, for the first time, evidence for a complex pattern of interaction between obesity, a pro-inflammatory genetic factor and asthma.
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Affiliation(s)
- F Castro-Giner
- Centre for Research in Environmental Epidemiology, Municipal Institute of Medical Research (IMIM-Hospitaldel Mar), Barcelona, Spain
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42
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Bousquet PJ, Leynaert B, Neukirch F, Sunyer J, Janson CM, Anto J, Jarvis D, Burney P. Geographical distribution of atopic rhinitis in the European Community Respiratory Health Survey I. Allergy 2008; 63:1301-9. [PMID: 18782108 DOI: 10.1111/j.1398-9995.2008.01824.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND No large studies in adults has examined geographical variation in the prevalence of nasal allergy/allergic rhinitis in adults or considered the proportion of reported nasal symptoms on exposure to allergen attributable to atopy. The aim of this report was to describe the geographic distribution of subjects with nasal symptoms who are sensitized as determined by skin prick tests, using data from the European Community Respiratory Health Survey I. METHODS Information on the presence of nasal allergy, nasal symptoms on exposure to allergen and atopy using skin prick tests was collected from 15,394 adults aged 20-44 years living in 35 centres in 15 countries. Age sex standardized prevalence of symptoms and the attributable fraction of IgE sensitization for nasal symptoms on exposure to allergen were determined. RESULTS The age-sex standardized prevalence of nasal allergy ranged from 11.8% in Oviedo (Spain) to 46.0% in Melbourne (Australia). The prevalence of atopic nasal allergy ranged from 4.6% in Oviedo to 31.8% in Melbourne (analysis limited on 12,566 subjects). The median attributable fraction for atopy on nasal symptoms on exposure ranged between 12.8% and 65.9% (median 27.2%). CONCLUSION In the general population there is a wide variation in the prevalence of nasal allergy in young adults. Many subjects complaining from nasal symptoms on exposure to allergen are not atopic.
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Affiliation(s)
- P-J Bousquet
- Imperial College, Emmanuel Kaye Building, London, UK
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43
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Burney P, Potts J, Makowska J, Kowalski M, Phillips J, Gnatiuc L, Shaheen S, Joos G, Van Cauwenberge P, van Zele T, Verbruggen K, van Durme Y, Derudder I, Wohrl S, Godnic-Cvar J, Salameh B, Skadhauge L, Thomsen G, Zuberbier T, Bergmann KC, Heinzerling L, Renz H, Al-Fakhri N, Kosche B, Hildenberg A, Papadopoulos NG, Xepapadaki P, Zannikos K, Gjomarkaj M, Bruno A, Pace E, Bonini S, Bresciani M, Gramiccioni C, Fokkens W, Weersink EJM, Carlsen KH, Bakkeheim E, Loureiro C, Villanueva CM, Sanjuas C, Zock JP, Lundback B, Janson C. A case-control study of the relation between plasma selenium and asthma in European populations: a GAL2EN project. Allergy 2008; 63:865-71. [PMID: 18588552 DOI: 10.1111/j.1398-9995.2008.01716.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is evidence that selenium levels are relatively low in Europe and may be falling. Low levels of selenium or low activity of some of the enzymes dependent on selenium have been associated with asthma. METHODS The GA(2)LEN network has organized a multicentre case-control study in Europe to assess the relation of plasma selenium to asthma. The network compared 569 cases in 14 European centres with a diagnosis of asthma and reporting asthma symptoms in the last 12 months with 576 controls from the same centres with no diagnosis of asthma and no asthmatic symptoms in the last 12 months. RESULTS All cases and controls were selected from the same population defined by age and place of residence. Mean plasma selenium concentrations among the controls ranged from 116.3 microg/l in Palermo to 67.7 microg/l in Vienna and 56.1 microg/l among the children in Oslo. Random effects meta-analysis of the results from the centres showed no overall association between asthma and plasma selenium [odds ratio (OR)/10 microg/l increase in plasma selenium: 1.04; 95% confidence interval (CI): 0.89-1.21] though there was a significantly protective effect in Lodz (OR: 0.48; 95% CI: 0.29-0.78) and a marginally significant adverse effect in Amsterdam (OR: 1.68; 95% CI: 0.98-2.90) and Ghent (OR: 1.35; 95% CI: 1.03-1.77). CONCLUSION This study does not support a role for selenium in protection against asthma, but effect modification and confounding cannot be ruled out.
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Affiliation(s)
- P Burney
- National Heart Lung Institute, Imperial College, London, UK
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Bousquet J, Fokkens W, Burney P, Durham SR, Bachert C, Akdis CA, Canonica GW, Dahlen SE, Zuberbier T, Bieber T, Bonini S, Bousquet PJ, Brozek JL, Cardell LO, Crameri R, Custovic A, Demoly P, van Wijk RG, Gjomarkaj M, Holland C, Howarth P, Humbert M, Johnston SL, Kauffmann F, Kowalski ML, Lambrecht B, Lehmann S, Leynaert B, Lodrup-Carlsen K, Mullol J, Niggemann B, Nizankowska-Mogilnicka E, Papadopoulos N, Passalacqua G, Schünemann HJ, Simon HU, Todo-Bom A, Toskala E, Valenta R, Wickman M, Zock JP. Important research questions in allergy and related diseases: nonallergic rhinitis: a GA2LEN paper. Allergy 2008; 63:842-53. [PMID: 18588549 DOI: 10.1111/j.1398-9995.2008.01715.x] [Citation(s) in RCA: 134] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Nonallergic rhinitis (NAR) can be defined as a chronic nasal inflammation which is not caused by systemic IgE-dependent mechanisms. It is common and probably affects far more than 200 million people worldwide. Both children and adults are affected. However, its exact prevalence is unknown and its phenotypes need to be evaluated using appropriate methods to better understand its pathophysiology, diagnosis and management. It is important to differentiate between infectious rhinitis, allergic/NAR and chronic rhinosinusitis, as management differs for each of these cases. Characterization of the phenotype, mechanisms and management of NAR represents one of the major unmet needs in allergic and nonallergic diseases. Studies on children and adults are required in order to appreciate the prevalence, phenotype, severity and co-morbidities of NAR. These studies should compare allergic and NAR and consider different age group populations including elderly subjects. Mechanistic studies should be carried out to better understand the disease(s) and risk factors and to guide towards an improved diagnosis and therapy. These studies need to take the heterogeneity of NAR into account. It is likely that neuronal mechanisms, T cells, innate immunity and possibly auto-immune responses all play a role in NAR and may also contribute to the symptoms of allergic rhinitis.
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Affiliation(s)
- J Bousquet
- University Hospital and INSERM, Montpellier, France
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Shaheen S, Potts J, Gnatiuc L, Makowska J, Kowalski ML, Joos G, van Zele T, van Durme Y, De Rudder I, Wöhrl S, Godnic-Cvar J, Skadhauge L, Thomsen G, Zuberbier T, Bergmann KC, Heinzerling L, Gjomarkaj M, Bruno A, Pace E, Bonini S, Fokkens W, Weersink EJM, Loureiro C, Todo-Bom A, Villanueva CM, Sanjuas C, Zock JP, Janson C, Burney P. The relation between paracetamol use and asthma: a GA2LEN European case-control study. Eur Respir J 2008; 32:1231-6. [PMID: 18579547 DOI: 10.1183/09031936.00039208] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Studies from the UK and USA suggest that frequent use of paracetamol (acetaminophen) may increase the risk of asthma, but data across Europe are lacking. As part of a multicentric case-control study organised by the Global Allergy and Asthma European Network (GA(2)LEN), it was examined whether or not frequent paracetamol use is associated with adult asthma across Europe. The network compared 521 cases with a diagnosis of asthma and reporting of asthma symptoms within the last 12 months with 507 controls with no diagnosis of asthma and no asthmatic symptoms within the last 12 months across 12 European centres. All cases and controls were selected from the same population, defined by age (20-45 yrs) and place of residence. In a random effects meta-analysis, weekly use of paracetamol, compared with less frequent use, was strongly positively associated with asthma after controlling for confounders. There was no evidence for heterogeneity across centres. No association was seen between use of other analgesics and asthma. These data add to the increasing and consistent epidemiological evidence implicating frequent paracetamol use in asthma in diverse populations.
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Affiliation(s)
- S Shaheen
- National Heart and Lung Institute, Imperial College London, Emmanuel Kaye Building, Manresa Road, London SW3 6LR, UK.
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46
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Shaheen S, Potts J, Gnatiuc L, Makowska J, Kowalski ML, Joos G, van Zele T, van Durme Y, De Rudder I, Wöhrl S, Godnic-Cvar J, Skadhauge L, Thomsen G, Zuberbier T, Bergmann KC, Heinzerling L, Gjomarkaj M, Bruno A, Pace E, Bonini S, Fokkens W, Weersink EJM, Loureiro C, Todo-Bom A, Villanueva CM, Sanjuas C, Zock JP, Janson C, Burney P. The relation between paracetamol use and asthma: a GA2LEN European case-control study. Eur Respir J 2008. [PMID: 18579547 DOI: 10.1183/09031936.00039208.] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Studies from the UK and USA suggest that frequent use of paracetamol (acetaminophen) may increase the risk of asthma, but data across Europe are lacking. As part of a multicentric case-control study organised by the Global Allergy and Asthma European Network (GA(2)LEN), it was examined whether or not frequent paracetamol use is associated with adult asthma across Europe. The network compared 521 cases with a diagnosis of asthma and reporting of asthma symptoms within the last 12 months with 507 controls with no diagnosis of asthma and no asthmatic symptoms within the last 12 months across 12 European centres. All cases and controls were selected from the same population, defined by age (20-45 yrs) and place of residence. In a random effects meta-analysis, weekly use of paracetamol, compared with less frequent use, was strongly positively associated with asthma after controlling for confounders. There was no evidence for heterogeneity across centres. No association was seen between use of other analgesics and asthma. These data add to the increasing and consistent epidemiological evidence implicating frequent paracetamol use in asthma in diverse populations.
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Affiliation(s)
- S Shaheen
- National Heart and Lung Institute, Imperial College London, Emmanuel Kaye Building, Manresa Road, London SW3 6LR, UK.
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47
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Cerveri I, Corsico AG, Accordini S, Niniano R, Ansaldo E, Antó JM, Künzli N, Janson C, Sunyer J, Jarvis D, Svanes C, Gislason T, Heinrich J, Schouten JP, Wjst M, Burney P, de Marco R. Underestimation of airflow obstruction among young adults using FEV1/FVC <70% as a fixed cut-off: a longitudinal evaluation of clinical and functional outcomes. Thorax 2008; 63:1040-5. [PMID: 18492741 DOI: 10.1136/thx.2008.095554] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Early detection of airflow obstruction is particularly important among young adults because they are more likely to benefit from intervention. Using the forced expiratory volume in 1 s (FEV(1)) to forced vital capacity (FVC) (FEV(1)/FVC) <70% fixed ratio, airflow obstruction may be underdiagnosed. The lower limit of normal (LLN), which is statistically defined by the lower fifth percentile of a reference population, is physiologically appropriate but it still needs a clinical validation. METHODS To evaluate the characteristics and longitudinal outcomes of subjects misidentified as normal by the fixed ratio with respect to the LLN, 6249 participants (aged 20-44 years) in the European Community Respiratory Health Survey were examined and divided into three groups (absence of airflow obstruction by the LLN and the fixed ratio; presence of airflow obstruction only by the LLN; presence of airflow obstruction by the two criteria) for 1991-1993. LLN equations were obtained from normal non-smoking participants. A set of clinical and functional outcomes was evaluated in 1999-2002. RESULTS The misidentified subjects were 318 (5.1%); only 45.6% of the subjects with airflow obstruction by the LLN were also identified by the fixed cut-off. At baseline, FEV(1) (107%, 97%, 85%) progressively decreased and bronchial hyperresponsiveness (slope 7.84, 6.32, 5.57) progressively increased across the three groups. During follow-up, misidentified subjects had a significantly higher risk of developing chronic obstructive pulmonary disease and a significantly higher use of health resources (medicines, emergency department visits/hospital admissions) because of breathing problems than subjects without airflow obstruction (p<0.001). CONCLUSIONS Our findings show the importance of using statistically derived spirometric criteria to identify airflow obstruction.
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Affiliation(s)
- I Cerveri
- Division of Respiratory Diseases, IRCCS San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
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48
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Castro-Giner F, Kogevinas M, Mächler M, de Cid R, Van Steen K, Imboden M, Schindler C, Berger W, Gonzalez JR, Franklin KA, Janson C, Jarvis D, Omenaas E, Burney P, Rochat T, Estivill X, Antó JM, Wjst M, Probst-Hensch NM. TNFA -308G>A in two international population-based cohorts and risk of asthma. Eur Respir J 2008; 32:350-61. [PMID: 18385169 DOI: 10.1183/09031936.00155607] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Genetic association studies have related the tumour necrosis factor-alpha gene (TNFA) guanine to adenine substitution of nucleotide -308 (-308G>A) polymorphism to increased risk of asthma, but results are inconsistent. The aim of the present study was to test whether two single-nucleotide polymorphisms, of TNFA and of the lymphotoxin-alpha gene (LTA), are associated with asthma, bronchial hyperresponsiveness and atopy in adults, by combining the results of two large population-based multicentric studies and conducting a meta-analysis of previously published studies. The European Community Respiratory Health Survey (ECRHS) and Swiss Cohort Study on Air Pollution and Lung and Heart Diseases in Adults (SAPALDIA) used comparable protocols, including questionnaires for respiratory symptoms and measures of lung function and atopy. DNA samples from 11,136 participants were genotyped at TNFA -308 and LTA 252. Logistic regression employing fixed and random effects models and nonparametric techniques were used. The prevalence of asthma was 6%. The TNFA -308G>A polymorphism was associated with increased asthma prevalence and with bronchial hyperresponsiveness. No consistent association was found for atopy. The LTA 252A>G polymorphism was not associated with any of the outcomes. A meta-analysis of 17 studies showed an increased asthma risk for the TNFA -308 adenine allele. The tumour necrosis factor-alpha gene nucleotide -308 polymorphism is associated with a moderately increased risk of asthma and bronchial hyperresponsiveness, but not with atopy. These results are supported by a meta-analysis of previously published studies.
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Affiliation(s)
- F Castro-Giner
- Centre de Recerca en Epidemiologia Ambiental (CREAL), Barcelona, Spain
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49
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Abstract
BACKGROUND There are large differences in the prevalence of atopic disease between urban and rural areas of developing countries, without good explanation. Diet has been associated with atopic disease, but studies of specific nutrients are contradictory, cross-sectional studies often being unsupported by trials. We investigated diet as an explanation for the difference in the prevalence of atopy between urban and rural areas in South Africa. METHODS A cross-sectional analysis of food frequency questionnaires and allergen skin tests from 698 children aged 8-13 years, recruited from 24 schools in Cape Province, South Africa, who were taking part in a case-control study of exercise-induced bronchospasm. Food frequency data were analysed with a principal components analysis (PCA). RESULTS The first two principal components of diet explained 25% of the variance, and discriminated almost perfectly between urban and rural subjects. The 'urban' component of diet was strongly associated with positive skin tests even after adjusting for urban residence. There were no significant associations between individual foods or nutrients and positive skin tests, allowing for multiple testing. CONCLUSIONS Diet explains part of the difference in prevalence between urban and rural areas. The ability to demonstrate this using PCA, but not by exhaustive analysis of all foods, reflects the value of reducing the number of dietary dimensions. The number of foods and nutrients which can be assessed, and the possibility of confounding and effect modification, make it difficult to identify the features of diet most directly implicated in disease. This may explain inconsistencies in dietary studies.
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Affiliation(s)
- R Hooper
- National Heart & Lung Institute, Imperial College London, London, UK
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50
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Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A, Zuberbier T, Baena-Cagnani CE, Canonica GW, van Weel C, Agache I, Aït-Khaled N, Bachert C, Blaiss MS, Bonini S, Boulet LP, Bousquet PJ, Camargos P, Carlsen KH, Chen Y, Custovic A, Dahl R, Demoly P, Douagui H, Durham SR, van Wijk RG, Kalayci O, Kaliner MA, Kim YY, Kowalski ML, Kuna P, Le LTT, Lemiere C, Li J, Lockey RF, Mavale-Manuel S, Meltzer EO, Mohammad Y, Mullol J, Naclerio R, O'Hehir RE, Ohta K, Ouedraogo S, Palkonen S, Papadopoulos N, Passalacqua G, Pawankar R, Popov TA, Rabe KF, Rosado-Pinto J, Scadding GK, Simons FER, Toskala E, Valovirta E, van Cauwenberge P, Wang DY, Wickman M, Yawn BP, Yorgancioglu A, Yusuf OM, Zar H, Annesi-Maesano I, Bateman ED, Ben Kheder A, Boakye DA, Bouchard J, Burney P, Busse WW, Chan-Yeung M, Chavannes NH, Chuchalin A, Dolen WK, Emuzyte R, Grouse L, Humbert M, Jackson C, Johnston SL, Keith PK, Kemp JP, Klossek JM, Larenas-Linnemann D, Lipworth B, Malo JL, Marshall GD, Naspitz C, Nekam K, Niggemann B, Nizankowska-Mogilnicka E, Okamoto Y, Orru MP, Potter P, Price D, Stoloff SW, Vandenplas O, Viegi G, Williams D. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy 2008; 63 Suppl 86:8-160. [PMID: 18331513 DOI: 10.1111/j.1398-9995.2007.01620.x] [Citation(s) in RCA: 2986] [Impact Index Per Article: 186.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
MESH Headings
- Adolescent
- Asthma/epidemiology
- Asthma/etiology
- Asthma/therapy
- Child
- Global Health
- Humans
- Prevalence
- Rhinitis, Allergic, Perennial/complications
- Rhinitis, Allergic, Perennial/diagnosis
- Rhinitis, Allergic, Perennial/epidemiology
- Rhinitis, Allergic, Perennial/therapy
- Rhinitis, Allergic, Seasonal/complications
- Rhinitis, Allergic, Seasonal/diagnosis
- Rhinitis, Allergic, Seasonal/epidemiology
- Rhinitis, Allergic, Seasonal/therapy
- Risk Factors
- World Health Organization
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Affiliation(s)
- J Bousquet
- University Hospital and INSERM, Hôpital Arnaud de Villeneuve, Montpellier, France
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