Allergic Outcomes Research Articles

Vitamin D and atopy and asthma phenotypes in children: a longitudinal cohort study

Vitamin D has been linked in some studies with atopy- and asthma-associated phenotypes in children with established disease, but its role in disease inception at the community level is less clear. The aim of the present study was to investigate associations between vitamin D status and biological signatures indicative of allergy and asthma development in children aged 6 and 14 years in Perth, WA, Australia (latitude 32° S). Serum vitamin D was assayed in 989 6-yr-olds and 1,380 14-yr-olds from an unselected community birth cohort; 689 subjects were assessed at both ages. Vitamin D levels were assessed as a risk modifier for respiratory and allergic outcomes at both ages, using previously ascertained phenotypic data. The predictive value of vitamin D levels at age 6 yrs for development of clinical phenotypes at age 14 yrs was also examined. Serum vitamin D levels in children of both ages were negatively associated with concurrent allergic phenotypes; sex stratification revealed that this association was restricted mainly to males. Furthermore, vitamin D levels at age 6 yrs were significant predictors of subsequent atopy/asthma-associated phenotypes at age 14 yrs. In an unselected community setting, children (particularly males) with inadequate vitamin D are at increased risk of developing atopy, and subsequently bronchial hyperresponsiveness (BHR) and asthma. In a large unselected cohort, males with inadequate vitamin D at 6 and 14 yrs of age had increased atopy and BHR. Low vitamin D at age 6 yrs was a predictor of atopy and asthma at 14 yrs of age.

Intake of antioxidants during pregnancy and the risk of allergies and asthma in the offspring

The potential immune functions related to the damages induced by oxygen-free radicals suggest that antioxidants may have a role in the development of allergies. The objective was to investigate the association between maternal intake of antioxidants during pregnancy and the risk of asthma, rhinitis and eczema in 5-year-old children. This study was on the basis of the Finnish Type 1 Diabetes Prediction and Prevention Nutrition Study, a population-based birth cohort study with 5-year follow-up. Complete information on maternal food frequency questionnaire data and ISAAC (International Study of Asthma and Allergies in Childhood)-based allergic outcomes were available for 2441 children. Cox proportional regression and logistic regression were used for the analyses. Maternal intake of any of the antioxidants was not significantly associated with the risk of asthma, rhinitis or eczema in the offspring, except for dietary intake of magnesium, which was independently associated with protection against eczema (OR 0.78; 95% CI 0.62-0.97). Maternal intake of dietary magnesium during pregnancy may protect against the risk of eczema in the offspring. We did not confirm previous observations concerning other antioxidants. This may be due to the variable amount of antioxidant intake across studies and also indicative of the hypothesis that there may be a critical time window in pregnancy during which antioxidants might modify the risk of allergies in the offspring.

Association between domestic mould and mould components, and asthma and allergy in children: a systematic review

Critical reviews over the past 10 yrs have found increased respiratory and allergic health outcomes for children living in damp and mouldy environments. However, recent studies have suggested that early childhood exposure to specific mould components may actually protect children from developing allergy. We conducted a systematic review of observational studies published in English from January 1980 to July 2010. This review was conducted according to systematic guidelines for Meta-analyses of Observational Studies in Epidemiology (MOOSE). The literature was searched using a computerised bibliographic database, PubMed. In order to increase the quality of the reviewed studies, meta-analyses of the effects of visible mould exposure on allergic health outcomes were performed and we evaluated the findings according to the Bradford Hill criteria for evidence of causation. The literature search identified 1,398 peer-reviewed scientific publications, and 61 studies that fulfilled the inclusion criteria were included in this review. We observed increased risks of allergic respiratory health outcomes in children exposed to visible mould and mould spores. These findings were confirmed by the results of the meta-analysis and in line with the evaluation criteria according to Bradford Hill. Visible mould was positively associated with asthma (OR 1.49 (95% CI 1.28-1.72)), wheeze (OR 1.68 (95% CI 1.48-1.90)) and allergic rhinitis (OR 1.39 (95% CI 1.28-1.51)). However, there was a tendency of lower risk for allergic health outcomes in children exposed to mould-derived components such as (1,3)-β-d-glucan and extracellular polysaccharides. These findings suggest that home environments with visible mould and mould spore exposure increase the risk of allergic respiratory health outcomes in children. However, further investigations are needed to examine the effects of exposure to mould-derived components as the current literature is inconclusive. In order to disentangle the different effects of overall microbial exposure on children's health, research should focus on specific microbial markers in the home, in combination with new assessment techniques including molecular methods.

Paracetamol use for non-respiratory indications and subsequent asthma: a valuable way to eliminate confounding by respiratory infections

Rusconi et al. report an interesting analysis of the data arising out of SIDRIA-2 (Italian Studies of Respiratory Disorders in Childhood and the Environment phase 2), the Italian arm of phase two of the International Study of Asthma and Allergies in Childhood (ISAAC). Using directed acyclic graph (DAG) and logistic regression analysis, the authors conclude that the association between paracetamol consumption in early life and childhood asthma ‘might fully or in part, be due to confounding’. The use of age of onset of symptoms is innovative and useful, and we appreciate the more comprehensive analysis of ISAAC data relating to this question than has been previously reported. Whereas we agree with the authors’ overall conclusion, we feel that one of the issues raised within this paper needs further discussion to put the results in the context of all the available evidence. The authors state that ‘It is well known that wheeze, especially in the first years of life, is chiefly triggered in susceptible individuals by viral infections for which paracetamol (owing to accompanying fever) and antibiotics (owing to a difficult differential diagnosis with bacterial infections) are often prescribed’. Although paracetamol is commonly used for the management of fever, it is also often used as an analgesic in young children. In the Melbourne Atopy Cohort Study (MACS), a birth cohort of 620 children with a family history of allergic disease, we found that 94% of children had received paracetamol for various forms of physical injury, or for the management of immunization-related pain, by 2 years of age. Examining the impact of paracetamol treatment for non-respiratory causes on subsequent asthma is not confounded by respiratory infections, and allows us to see the direct effect of paracetamol exposure on risk of allergic disease. Such an approach is valuable in disentangling the effect of paracetamol and respiratory tract infections on subsequent risk of asthma. Unfortunately, the indication for use of paracetamol was not collected within the ISAAC study. In the MACS, we found that, although total use of paracetamol was associated with increased risk of childhood asthma (at 6–7 years of age), paracetamol for non-respiratory tract indications was not associated with any allergic disease outcome, including asthma. This provides further evidence that the association between paracetamol intake in early life and childhood asthma is more likely to be due to confounding, rather than a causal relationship. Conflict of interest: Unrelated to the current research, S.C.D. has received a research grant from GlaxoSmithKline, and M.J.A. has acted in advisory roles for GlaxoSmithKline. In addition, M.J.A. has received a research grant from Reckitt Benckiser; these companies might have an interest in this issue. The other author has declared no conflicts of interest. A.J.L. and S.C.D. received personal funding from the National Health and Medical Research Council to support this work.

A longitudinal study of allergy and intestinal helminth infections in semi urban and rural areas of Flores, Indonesia (ImmunoSPIN Study)

BackgroundThe prevalence of asthma and atopic disease has been reported to be low in low income countries, however helminth infections are likely to be high among these communities. The question of whether helminth infections play a role in allergic diseases can best be addressed by intervention studies. None of the studies so far have been based on a large scale placebo-controlled trial.Method/DesignThis study was designed to assess how intestinal helminth infections can influence the immune response and atopic and allergic disorders in children in Indonesia. The relations between allergic outcomes and infection and lifestyle factors will be addressed. This study was set up among school-age children in semi urban and rural areas, located in Ende District of Flores Island, Indonesia. A randomized placebo-controlled anthelmintic treatment trial to elucidate the impact of helminth infections on the prevalence of skin prick test (SPT) reactivity and symptoms of allergic diseases will be performed. The children living in these semi-urban and rural areas will be assessed for SPT to allergens before and after 1 and 2 years of treatment as the primary outcome of the study; the secondary outcome is symptoms (asthma and atopic dermatitis); while the tertiary outcome is immune responses (both antibody levels to allergens and cellular immune responses).DiscussionThe study will provide information on the influence of helminth infections and anthelmintic treatment on immune response, atopy and allergic disorders.Trial registrationCurrent Controlled Trials ISRCTN: ISRCTN83830814

A Seventeen-Year Review of Peri-Operative Anaphylaxis in a Pediatric Hospital

RATIONALE: While serious adverse events are unusual during surgery (0.4% of cases), allergic reactions are among the major factors that contribute to peri-operative morbidity and mortality. The literature on peri-operative anaphylaxis is limited, especially concerning the pediatric population. The study was designed to examine the characteristics of those patients who have adverse allergic peri-operative outcomes and examine the most common agents in pediatrics.

Nutrients and foods for the primary prevention of asthma and allergy: Systematic review and meta-analysis

Epidemiologic studies suggest that deficiencies of the nutrients selenium; zinc; vitamins A, C, D, and E; and low fruit and vegetable intake may be associated with the development of asthma and allergic disorders. To investigate the evidence that nutrient and food intake modifies the risk of children developing allergy. We systematically searched 11 databases. Studies were critically appraised, and meta-analyses were undertaken. We identified 62 eligible reports. There were no randomized controlled trials. Studies used cohort (n = 21), case-control (n = 15), or cross-sectional (n = 26) designs. All studies were judged to be at moderate to substantial risk of bias. Meta-analysis revealed that serum vitamin A was lower in children with asthma compared with controls (odds ratio [OR], 0.25; 95% CI, 0.10-0.40). Meta-analyses also showed that high maternal dietary vitamin D and E intakes during pregnancy were protective for the development of wheezing outcomes (OR, 0.56, 95% CI, 0.42-0.73; and OR, 0.68, 95% CI, 0.52-0.88, respectively). Adherence to a Mediterranean diet was protective for persistent wheeze (OR, 0.22; 95% CI, 0.08-0.58) and atopy (OR, 0.55; 95% CI, 0.31-0.97). Seventeen of 22 fruit and vegetable studies reported beneficial associations with asthma and allergic outcomes. Results were not supportive for other allergic outcomes for these vitamins or nutrients, or for any outcomes in relation to vitamin C and selenium. The available epidemiologic evidence is weak but nonetheless supportive with respect to vitamins A, D, and E; zinc; fruits and vegetables; and a Mediterranean diet for the prevention of asthma. Experimental studies of these exposures are now warranted.

Intestinal lactobacilli and the DC-SIGN gene for their recognition by dendritic cells play a role in the aetiology of allergic manifestations

Diminished exposure to harmless micro-organisms, such as lactobacilli, has been suggested to play a role in the increased prevalence of allergic disorders in Westernized communities. The development of allergies depends on both environmental factors and genetic variations, including polymorphisms in genes encoding pattern recognition receptors. The present study examines the effects of both colonization with specific Lactobacillus species and genetic variations in DC-SIGN, a pattern recognition receptor on dendritic cells that recognizes lactobacilli, on the development of atopic dermatitis (AD) and sensitization in infancy. Within the KOALA Birth Cohort Study, faecal samples of 681 one-month-old infants were collected and quantitatively screened for five Lactobacillus species: L. casei, L. paracasei, L. rhamnosus, L. acidophilus and L. reuteri. Eleven haplotype-tagging polymorphisms in the DC-SIGN gene were genotyped in these children. Allergic outcomes were a clinical diagnosis of AD and sensitization (specific IgE) at age 2 years. L. rhamnosus (31.5 %), L. paracasei (31.3 %) and L. acidophilus (14.4 %) were frequently detected in the faecal samples of one-month-old infants, whereas L. casei (2.5 %) and L. reuteri (<1 %) were rare. Colonization with L. paracasei decreased the risk of AD significantly (odds ratio 0.57, 95 % confidence interval 0.32-0.99), whereas effects of L. acidophilus were of borderline statistical significance (0.46, 0.20-1.04). Two DC-SIGN polymorphisms, rs11465413 and rs8112555, were statistically significantly associated with atopic sensitization. The present study supports the 'old friends' hypothesis suggesting that certain health-beneficial micro-organisms protect us from developing allergies and that these protective effects are species-dependent. Firm conclusions on the potential interaction between lactobacillus colonization and genetic variations in DC-SIGN in association with the development of allergic disorders cannot be drawn, given the limited power of our study. Therefore, incorporation of consecutive faecal sampling in newly started (birth) cohort studies would be a first requisite to further increase our understanding of host-microbial interactions in health and disease.

The role of food allergy in the atopic march

Cite this as: K. J. Allen and S. C. Dharmage, Clinical &amp; Experimental Allergy, 2010 (40) 1439–1441.

Is there a role for fatty acids in early life programming of the immune system?

There may be a causal relationship between n-6 PUFA intake and allergic disease and there are biologically plausible mechanisms, involving eicosanoid mediators of the n-6 PUFA arachidonic acid, that could explain this. There is some evidence that high linoleic acid intake is linked with increased risk of atopic sensitisation and allergic manifestations. Fish and fish oils are sources of long-chain n-3 PUFA and these fatty acids act to oppose the actions of n-6 PUFA. It is considered that n-3 PUFA will protect against atopic sensitisation and against the clinical manifestations of atopy. All five epidemiological studies investigating the effect of maternal fish intake during pregnancy on atopic or allergic outcomes in infants/children of those pregnancies concluded protective associations. Epidemiological studies investigating the effects of fish intake during infancy and childhood on atopic outcomes in those infants or children are inconsistent, although the majority of the studies (9/14) showed a protective effect of fish. Fish oil provision to pregnant women is associated with immunologic changes in cord blood. Provision of fish oil during pregnancy may reduce sensitisation to common food allergens and reduce the prevalence and severity of atopic dermatitis in the first year of life. This effect may persist until adolescence with a reduction in prevalence and/or severity of eczema, hayfever and asthma. Fish oil supplementation in infancy may decrease the risk of developing some manifestations of allergic disease, but whether this benefit persists as other factors come into play remains to be determined.

Modulation of Allergic Airway Inflammation by the Oral Pathogen Porphyromonas gingivalis

Accumulating evidence suggests that bacteria associated with periodontal disease may exert systemic immunomodulatory effects. Although the improvement in oral hygiene practices in recent decades correlates with the increased incidence of asthma in developed nations, it is not known whether diseases of the respiratory system might be influenced by the presence of oral pathogens. The present study sought to determine whether subcutaneous infection with the anaerobic oral pathogen Porphyromonas gingivalis exerts a regulatory effect on allergic airway inflammation. BALB/c mice sensitized and subsequently challenged with ovalbumin exhibited airway hyperresponsiveness to methacholine aerosol and increased airway inflammatory cell influx and Th2 cytokine (interleukin-4 [IL-4], IL-5, and IL-13) content relative to those in nonallergic controls. Airway inflammatory cell and cytokine contents were significantly reduced by establishment of a subcutaneous infection with P. gingivalis prior to allergen sensitization, whereas serum levels of ovalbumin-specific IgE and airway responsiveness were not altered. Conversely, subcutaneous infection initiated after allergen sensitization did not alter inflammatory end points but did reduce airway responsiveness in spite of increased serum IgE levels. These data provide the first direct evidence of a regulatory effect of an oral pathogen on allergic airway inflammation and responsiveness. Furthermore, a temporal importance of the establishment of infection relative to allergen sensitization is demonstrated for allergic outcomes.

Antioxidants and allergic disease: a case of too little or too much?

Speculation persists as to the possible role, if any, of dietary antioxidants in allergic disease. While it has been hypothesized that the recent increase in allergic disease is a consequence of declining dietary antioxidant intake, an alternative hypothesis proposes that the increase in allergic disease is due to increasing antioxidant intake. Dietary trends are conflicting; the intake of some antioxidants has declined, for others intakes are likely to have increased. Animal model studies demonstrate that antioxidant supplementation at the time of primary and subsequent allergen exposure attenuates allergic inflammatory responses. The data from human studies are less clear. Observational epidemiological studies of humans are beset by several methodological limitations associated with the assessment of diet and predominantly focus on asthma. Most observational studies report potentially beneficial associations between dietary antioxidants and allergic outcomes, but a small minority report potentially adverse associations. Human intervention studies suggest that single antioxidant supplements confer minimal, if any clinical benefit in adults with asthma, however, there is still scope for studies in children, atopic dermatitis, allergic rhinitis (AR) and of antioxidant combinations. More recently, it has been suggested that dietary antioxidants in the developmental context of fetal and infant development influence the development childhood asthma and atopic sensitization possibly by affecting the first interactions between the neonatal immune system and allergens. While a small number of birth cohort studies have reported potentially beneficial associations between maternal intake of some antioxidants during pregnancy and childhood asthma, there is very limited data suggesting associations between maternal antioxidant intake and childhood atopic dermatitis and AR. The available epidemiological, animal, molecular and immunological data suggest that there are associations between antioxidants and asthma and to a much lesser extent, atopic dermatitis and AR. However, the exact nature of the relationships and the potential for therapeutic intervention remain unclear.

Reduced IFN‐γ‐ and enhanced IL‐4‐producing CD4+ cord blood T cells are associated with a higher risk for atopic dermatitis during the first 2 yr of life

The aim of this study was to analyse whether altered cytokine production by cord blood (CB) T cells is of relevance regarding the development of allergic diseases during the first 2 yr of life independent from known or suspected risk factors for allergy. Within an ongoing birth cohort study (Life style - Immune System - Allergy; LISA) the cytokine production of PMA/ionomycin-stimulated CB cells was measured by intracellular cytokine staining. Data of 98 children from Leipzig and Munich with complete information on cytokine production at birth and allergic outcomes during the first 2 yr were analysed. Statistical analysis was performed using a regression model adjusted for gender, month of birth, parental history of atopy, parental education, exposure to environmental tobacco smoke, maternal smoking during pregnancy, renovation activities during pregnancy, pet ownership and study centre. During the first 2 yr of life, 17.3% of the children developed a physician-diagnosed atopic dermatitis. Children with reduced frequencies of interferon-gamma (IFN-gamma)-producing CD4(+) T cells in the CB (1st quartile) had a higher risk to develop atopic dermatitis (adjusted OR 5.16, 95% CI: 1.04-25.6). Furthermore, a high percentage of interleukin (IL)-4-producing T cells in CB in children from the Leipzig cohort were associated with an increased risk for atopic dermatitis (adjusted OR 8.92, 95% CI: 1.40-56.93 for the 90th percentile). CD8(+) cytokine-producing CB T cells had no relation to increased risk for atopic dermatitis. Low amounts of IFN-gamma and high amounts of IL-4-producing T cells at birth may enhance the risk of subsequent development of atopic dermatitis.

Atopy Risk in Infants and Children in Relation to Early Exposure to Fish, Oily Fish, or Long-Chain Omega-3 Fatty Acids: A Systematic Review

There are two main families of polyunsaturated fatty acids (PUFAs), the n-6 and the n-3 families. It has been suggested that there is a causal relationship between n-6 PUFA intake and allergic disease, and there are biologically plausible mechanisms, involving eicosanoid mediators of the n-6 PUFA arachidonic acid, that could explain this. Fish and fish oils are sources of long-chain n-3 PUFAs and these fatty acids act to oppose the actions of n-6 PUFAs. Thus, it is considered that n-3 PUFAs will protect against atopic sensitization and against the clinical manifestations of atopy. Evidence to examine this has been acquired from epidemiologic studies investigating associations between fish intake in pregnancy, lactation, infancy, and childhood, and atopic outcomes in infants and children and from intervention studies with fish oil supplements in pregnancy, lactation, infancy, and childhood, and atopic outcomes in infants and children. All five epidemiological studies investigating the effect of maternal fish intake during pregnancy on atopic or allergic outcomes in infants/children of those pregnancies concluded protective associations. One study investigating the effects of maternal fish intake during lactation did not observe any significant associations. The evidence from epidemiological studies investigating the effects of fish intake during infancy and childhood on atopic outcomes in those infants or children is inconsistent, although the majority of the studies (nine of 14) showed a protective effect of fish intake during infancy or childhood on atopic outcomes in those infants/children. Fish oil supplementation during pregnancy and lactation or during infancy or childhood results in a higher n-3 PUFA status in the infants or children. Fish oil provision to pregnant women is associated with immunologic changes in cord blood and such changes may persist. Studies performed to date indicate that provision of fish oil during pregnancy may reduce sensitization to common food allergens and reduce prevalence and severity of atopic dermatitis in the first year of life, with a possible persistence until adolescence with a reduction in eczema, hay fever, and asthma. Fish oil provision to infants or children may be associated with immunologic changes in the blood but it is not clear if these are of clinical significance and whether they persist. Fish oil supplementation in infancy may decrease the risk of developing some manifestations of allergic disease, but this benefit may not persist as other factors come into play. It is not clear whether fish oil can be used to treat children with asthma as the two studies conducted to date give divergent results. Further studies of increased long-chain n-3 PUFA provision in during pregnancy, lactation, and infancy are needed to more clearly identify the immunologic and clinical effects in infants and children and to identify protective and therapeutic effects and their persistence.

Practical prebiotics, probiotics and synbiotics for allergists: how useful are they?

With the advent of the hygiene hypothesis, probiotics have provided an avenue of hope in curbing the allergic epidemic. The initial enthusiasm has been tempered by recognition of the inherent complexities of this approach. This review examines the current clinical evidence and practical issues in using probiotics and related products, for the prevention and treatment of allergic disease. So far, probiotics have shown more promise, albeit limited, in the primary prevention of allergic disease rather than in the treatment of established disease. These effects have largely been limited to the prevention of early childhood conditions such as eczema, with no consistent effects on other allergic outcomes. There is emerging evidence that clinical effects may be strain specific, but again these findings have been inconsistent. While there have been several meta-analyses to examine probiotics in both the prevention and the treatment of allergic disease, these have been hampered by significant heterogeneity between studies, including wide variations in the strains used, the methods and timing of administration and the age and assessment of allergic outcomes. In any case, these have also become outdated by a series of new studies published in the last year. Although it is not yet clear exactly how the growing number of new studies will modify the results of meta-analyses, it is likely that these will add yet further heterogeneity that will continue to make interpretation of pooled data difficult. At this stage, the effects of prebiotics, synbiotics and postbiotics are even less clear. Thus, while there is little doubt that microbiota modulate immune development and can prevent the allergic phenotype, the optimal way of achieving this is far from clear. Given the current level of evidence, it is not appropriate to recommend prebiotics/probiotics/synbiotics or postbiotics as a part of standard therapy or for the prevention of any allergic conditions. Further studies are needed to address the growing speculation that supplementation with a single probiotic strain may be oversimplistic and that approaches that have a more global effect on colonization may be warranted.

Atopic Diseases, Allergic Sensitization, and Exposure to Traffic-Related Air Pollution in Children

Morgenstern V, Zutavern A, Cyrys J, et al. Am J Respir Crit Care Med. 2008;177(12):1331–1337PURPOSE OF THE STUDY. To assess the relationship between exposure to traffic-related air pollutants and allergic disease outcomes in a prospective birth cohort during the first 6 years of life.METHODS. A birth cohort of 3061 children in the Munich, Germany, metropolitan area were followed with serial questionnaires of their parents inquiring about asthma, hay fever, and eczema. Specific immunoglobulin E against common allergens was determined at the age of 6 years. Air pollution measurements were made for particulate matter ≤2.5 μm in diameter and nitrogen dioxide. Distances between the children's street address and the nearest main road were noted. Outcomes of atopic disease and allergic sensitization were compared with the children's exposure to the pollutants.RESULTS. Positive associations were found between the distance to the nearest main road and asthma, hay fever, eczema, and sensitization, with the highest odds ratios (ORs) for children living <50 m from busy streets. For particulate matter ≤2.5 μm in diameter, statistically significant effects were found for asthma (OR: 1.56 [95% confidence interval [CI]: 1.03–2.37]), hay fever (OR: 1.59 [95% CI: 1.11–2.27]), and allergic sensitization to pollen (OR: 1.40 [95% CI: 1.20–1.64]). Nitrogen dioxide exposure was associated with eczema, whereas no association was found for allergic sensitization.CONCLUSIONS. The results provide strong evidence for the adverse effects of traffic-related air pollutants on atopic diseases and allergic sensitization.REVIEWER COMMENTS. Several previous studies suggested an association between exposure to air pollution and the development of atopic sensitization and disease. This study supports that connection, even adding a “dose-response” element in which the closer you live to a busy street, the more likely you are to develop allergic disease.

Bioaerosol in Composting Facilities: Occupational Health Risk Assessment

This research found evidence of an association between occupational exposure to bioaerosols in composting plants and health outcome occurrence in exposed workers. An occupational exposure assessment in six composting plants was performed to better characterize personal exposure levels and evaluate associated health risk in workers. Sampling results showed large ranges of concentrations of dust, bacteria, molds, and endotoxin in ambient air and in personal samples, both when driving a front-end loader and when cleaning, monitoring, and performing maintenance tasks. Mean personal exposure levels were high at 100 to more than 10,000 times higher than outdoor background levels and fully consistent with occurrence of inflammatory and allergic respiratory outcomes among workers. Engineering control, personal protection, and education and training programs for employees, health, and safety officials, and occupational physicians are being developed and implemented.

Further confirmation of the relevance of cockroach and dust mite sensitization to inner‐city asthma morbidity

Further confirmation of the relevance of cockroach and dust mite sensitization to inner‐city asthma morbidity

Self-reported truck traffic on the street of residence and symptoms of asthma and allergic disease: a global relationship in ISAAC phase 3.

BackgroundAssociations between traffic pollution on the street of residence and a range of respiratory and allergic outcomes in children have been reported in developed countries, but little is known about such associations in developing countries.MethodsThe third phase of the International Study of Asthma and Allergies in Childhood (ISAAC) was carried out in 13- to 14-year-old and 6- to 7-year-old children across the world. A question about frequency of truck traffic on the street of residence was included in an additional questionnaire. We investigated the association between self-reported truck traffic on the street of residence and symptoms of asthma, rhinoconjunctivitis, and eczema with logistic regression. Adjustments were made for sex, region of the world, language, gross national income, and 10 other subject-specific covariates.ResultsFrequency of truck traffic on the street of residence was positively associated with the prevalence of symptoms of asthma, rhinoconjunctivitis, and eczema with an exposure–response relationship. Odds ratios (95% confidence intervals) for “current wheeze” and “almost the whole day” versus “never” truck traffic were 1.35 (1.23–1.49) for 13- to 14-year-olds and 1.35 (1.22–1.48) for 6- to 7-year-olds.ConclusionsHigher exposure to self-reported truck traffic on the street of residence is associated with increased reports of symptoms of asthma, rhinitis, and eczema in many locations in the world. These findings require further investigation in view of increasing exposure of the world’s children to traffic.

Réduction du risque allergique après injection d’aprotinine et traitement des tendinopathies

Aprotinin is a collagenase inhibitor previously shown to be effective for treating tendinopathies but associated with systemic allergic reactions. This historical cohort study aimed to determine whether or not the injection regime used affected the risk of allergic reaction and outcome. It compared 223 tendinopathy cases (group R) generally treated with a rapid series of aprotinin injections spaced one to two weekly and 158 cases (group D) generally given a single injection or a delay in their repeat injection(s) of over 6 weeks. Side effects and outcome measures were documented by questionnaire with a response rate of 75%. Systemic allergic reactions occurred in 7% of group R cases compared with 2% in group D (NS). Injections given 2–4 weeks after a previous injection were significantly more likely to lead to allergic reactions (6%) than initial injections (0.3%) and injections given >6 weeks after a previous injection (0.9%) ( p < 0.05). Overall patient rated satisfaction and outcome measures were similar between groups. In summary the current published regime of multiple aprotinin injections over a period of a few weeks has a fairly high rate of systemic allergic reactions. This can be reduced by minimising repeat injections and recommending a delay of at least 6 weeks between injections. Practitioners using aprotinin must have available facilities to treat anaphylaxis.