Infant Wheeze Research Articles

478 Post-Bronchiolitis Recurrent Wheezing in Children Under 2 Years of Age - A Clinical Epidemiological Study

ObjectivesThe research involved tracing some causality relationships among acute bronchiolitis, post-bronchiolitis recurrent wheezing and/or the atopic field.Material and methodThe study group was made up of 118 cases of acute bronchiolitis...

Subcutaneous Body Fat in Pregnant New Zealand Women: Association with Wheeze in Their Infants at 18 Months

To investigate the association of subcutaneous body fat levels in pregnant women with wheezing in their 18 month old infants. A prospective study of European and Polynesian volunteers (n = 369) recruited from northern New Zealand were visited in months 4 and 7 of pregnancy when height, weight, and triceps, biceps and costal skinfolds were measured, and questionnaires determining personal details administered; and again visited 18 months after birth when infants were measured and questions on infant feeding and wheeze administered. At 18 months 32 % of infants had wheezed in the past 12 months. Increased wheeze was associated with maternal asthma, eczema or allergy (p = 0.001); receiving family welfare payments (p = 0.010); and being Polynesian (p = 0.021); while exclusive breastfeeding to 2 months (p = 0.045) was associated with decreased wheeze. Individual month 4 and month 7 mean triceps, biceps and costal skinfolds were all greater in mothers of wheezers compared to nonwheezers, biceps and costal skinfolds significantly so (p = 0.002, p = 0.005 at month 7). The sum of these skinfolds at month 4, at month 7, and the difference between these sums, were all significantly associated with increased risk of infant wheeze at 18 months when considered alone (p = 0.037, p = 0.001 and p = 0.015) or in combination. Prevalence of infant wheeze was 22.7 % for mothers with lower quartile month 7 skinfolds, compared to 45.0 % for mothers with upper quartile. After adjusting for significant covariates the difference in skinfolds had the strongest association (p = 0.003) followed by sum at month 4 (p = 0.074 or 0.003 depending on whether Polynesian ethnicity was included in the model). The sum of skinfolds declined between month 4 and month 7 in 34 % of women. Prevalence of wheeze was 19.2 % where the difference in mothers' skinfolds between month 4 and month 7 decreased by 10 mm or more and 41.7 % where the difference increased by 10 mm or more. Mean month 4 weights, BMI and sum of skinfolds were below average in the latter group. As the sum of month 4 or month 7 maternal skinfolds increased the prevalence of infant wheeze increased. In addition as the change in skinfolds between month 4 and month 7 became more positive the prevalence of infant wheeze increased. This study suggests for the first time that changes in subcutaneous fat during pregnancy are associated with prevalence of infant wheeze.

Maternal intestinal flora and wheeze in early childhood

Increasing evidence links altered intestinal flora in infancy to eczema and asthma. No studies have investigated the influence of maternal intestinal flora on wheezing and eczema in early childhood. To investigate the link between maternal intestinal flora during pregnancy and development of wheeze and eczema in infancy. A total of 60 pregnant women from the Boston area gave stool samples during the third trimester of their pregnancy and answered questions during pregnancy about their own health, and about their children's health when the child was 2 and 6months of age. Quantitative culture was performed on stool samples and measured in log(10)colony-forming units (CFU)/gram stool. Primary outcomes included infant wheeze and eczema in the first 6months of life. Atopic wheeze, defined as wheeze and eczema, was analysed as a secondary outcome. In multivariate models adjusted for breastfeeding, day care attendance and maternal atopy, higher counts of maternal total aerobes (TA) and enterococci (E) were associated with increased risk of infant wheeze (TA: OR 2.32 for 1 log increase in CFU/g stool [95% CI 1.22, 4.42]; E: OR 1.57 [95% CI 1.06, 2.31]). No organisms were associated with either eczema or atopic wheeze. In our cohort, higher maternal total aerobes and enterococci were related to increased risk of infant wheeze. Maternal intestinal flora may be an important environmental exposure in early immune system development.

Advances in infant and preschool lung function testing

Background: Infant lung function tests are currently performed in more than 100 centres worldwide. Increasingly, centres in the AsiaPacific region are purchasing expensive and specialized equipment for this purpose. Equipment for testing preschool equipment is generally less expensive than equipment required for testing infants but assessing preschool children is tricky and requires investment in both time and human resources to get the right people for the job of working with such single-minded individuals. Pulmonary function testing in research: Infant and preschool lung function testing is being used in several research contexts. Recent studies that have used these tests have helped advance our knowledge on the early pathophysiology of diverse respiratory conditions such as cystic fibrosis, infant and preschool wheezing, childhood asthma, broncho-pulmonary dysplasia, as well as providing insights into aspects of lung growth and development. Pulmonary function testing in clinical practice: Infant and preschool lung function tests are also widely used (rightly or wrongly) for clinical evaluation. To be of benefit in clinical practice pulmonary function testing needs to be able to identify diminished lung function that may require a clinical response (this depends on good healthy control or reference data), to monitor disease status over time (depends on data on repeatability in both health and disease) and the response to therapeutic interventions (data on short-term repeatability required). Interpretation is currently limited in all these areas but general consensus is that the tests are on the cusp of being used routinely in clinical practice. Tests used in infants: The most popular tests in infants are those assessing forced expiratory flows and volumes (such as the raised volume and tidal rapid thoraco-abdominal compression techniques), plethysmography to measure functional residual capacity, and tests of ventilation inhomogeneity (such as the multiple breath inert gas washout). Limitations include the need for sedation, labour costs, lack of reference data and lack of longer-term repeatability data. Commercial equipment for each of these tests is, however, available. Tests used in preschool children: Popular tests in preschool children include those performed during tidal breathing such as the forced oscillation technique, resistance interrupter technique and multiple breath washout. Forced expiration using spirometry, with or without incentive, is also possible and widely used in preschool children. The technique of measuring the specific airways resistance is widely used in Europe and is in the process of undergoing standardization. Intervention studies and clinical trial networks: One outcome of lung function testing in infants and preschool children over the past few decades has been the insight gained into this crucial period of lung development where early insults to the developing lung architecture may have life-long effects in both chronic respiratory disorders and health. In the future, it is crucial that interventions are targeted early in life in order to prevent, rather than limit or reverse, the development of lung disease or maldevelopment of the lung. Infant and preschool lung function tests have been proposed as potential outcomes of such early intervention studies and have been used recently in this context. Multi-centre clinical trial networks are being developed for such studies that necessitate ongoing efforts to standardise the tests, develop quality assurance programs and facilitate better interchange of data between centres. Summary: Disappointingly, some of the limitations that have hindered interpretation of the results of infant (in particular), but also preschool, lung function tests over the past three decades are still to be overcome. However, advances in knowledge through research studies that have incorporated these tests, the commercial availability of several tests, the increasing number of centres gaining experience in their use and the recognition of the crucial role of early lung development in life-long lung health have served to highlight the importance of overcoming the limitations so that infant and preschool lung function tests can be used routinely in clinical practice.

Leukocytes from wheezing infants release lower amounts of IL-12 and IFN-γ compared to non-wheezing infants

This study investigated environmental endotoxin exposure during early life, sensitization to aeroallergens, the production of cytokines by LPS-stimulated leukocytes, and the development of a wheezing phenotype in a prospective cohort of infants with high risk of developing allergic diseases. Eighty-four infants were followed from birth until 30 months of age. We assessed endotoxin concentration in house dust of their homes during the first 6 months of life. At age 30 months they were clinically evaluated to determine the development of wheezing and other clinical events, were skin prick tested, and had blood samples collected for the evaluation of cytokine release by LPS-stimulated peripheral blood mononuclear cells (PBMC). The level of endotoxin exposure during early life was not associated with development of a wheezing phenotype. On the other hand a higher incidence of respiratory infections occurred among recurrent wheezing (RW) infants. PBMC from RW children exposed to higher levels of environmental endotoxin (above 50 EU/mg) released less Interleukin (IL)-12p70 and IFN-γ compared to the non-RW group. TNF-α, IL-10, IL-4, IL-5, and IL17 production by LPS-stimulated PBMC from RW and non-RW children was equivalent in both groups of environmental endotoxin exposure. In this prospective cohort of infants with high risk of developing allergic diseases we observed that RW and non-RW children were exposed to similar levels of endotoxin early in life. LPS-stimulated PBMC from RW infants exposed to higher levels of endotoxin released significantly less IL-12 and IFN-γ compared to non-RW infants.

539 Asthma Treatment May Be Useful to Treat Recurrent Wheezing in Infancy.

BackgroundThere are controversies in treating recurrent wheezing (≥3 episodes) in pre-school children. The aim of this study was to verify changes in treatment of recurrent wheezing infants.MethodsCross-sectional study using a standardized and validated questionnaire (EISL: Estudio Internacional sobre Sibilancias en Lactantes) that covers physician diagnosis of asthma, and frequency, severity, and treatment of wheezing episodes. Regarding treatment specific questions are: Has your baby been treated with inhaled short-acting β2-agonists by metered dose inhaler or nebulizer? Has your baby been treated with inhaled corticosteroids? Has your baby been treated with antileukotrienes? Has your baby been treated with oral corticosteroids? Parents of infants, ages 12 to 15 months that attended to Health Centers for routine immunization were interviewed between August/2005 to December/2006 (EISL Phase I) and September/2009 to September/2010 (EISL Phase III). Categorical variables are showed as proportion and differences verified by chi-square test.ResultsThree thousand and 3 parents of infants answered questionnaire in the EISL Phase I and 22.6% had recurrent wheezing episodes. Five years later, in the EISL Phase III, 1003 parents participated in the survey and 19.8% had recurrent wheezing (P = 0.1). Inhaled short-acting β2-agonists continued to be prescribed in the same frequency (89.6% vs 86.5%, P = 0.21), however anti-asthmatic drugs were more used [antileukotrienes (6.9% vs 33%, P < 0.001), inhaled steroids (23.6% vs 37.5%, P = 0.001) and oral steroids (18.6% vs 26.5%, P = 0.01)] and doctor diagnosis of asthma has increased (16.2% vs 23%, P = 0.03). There were reductions on night-time symptoms (73% vs 61.5%, P = 0.001), severity (59.3% vs 42%, P = 0.001) and emergency room visits (69.3% vs 41.5%, P < 0.001) for recurrent wheezing infants, but no difference was seen in hospitalization (17.1% vs 12.5%, P = 0.12).ConclusionsRecurrent wheezing treatment in infancy has increased in past years and may have contributed for reducing emergency room visits, night-time symptoms and severity for wheezing infants.

77 Recurrent Wheezing in Infancy

BackgroundPrevalence of allergic diseases has increased in the last years. Data on recurrent wheezing (≥3 episodes) in infancy is scarce. The aim of this study was to verify changing in prevalence of recurrent wheezing infants in the south of Brazil.MethodsCross-sectional study using a standardized and validated questionnaire (EISL: Estudio Internacional sobre Sibilancias en Lactantes) with questions: Has your baby had wheezing or whistling in the chest area or bronchitis in the first 12 months of life? Has your baby had 3 or more wheezing episodes in the first year of life? Parents of infants, ages 12 to 15 months that attended to Health Centers for routine immunization were interviewed between August 2005 to December 2006 (EISL Phase I) and September 2009 to September 2010 (EISL Phase III). Categorical variables are shown as proportion and differences verified by chi-square test, and continuous variables were expressed as mean ± SD and analyzed by Student t test.ResultsThree thousand three parents of infants answered questionnaire in the EISL Phase I, and 45.4% had had at least one wheezing episode; 50.7% were male, and 22.6% had recurrent wheezing episode starting at 5.5 ± 3.1 months. Five years later, in the EISL Phase III, 1003 parents participated in the survey: 40.6% had at least one wheezing episode (P = 0.46), 51.1% were male, and 19.8% had recurrent wheezing (P = 0.1) starting at 6.1 ± 3 months (P = 0.06).ConclusionsRecurrent wheezing in infancy is highly prevalent and starts early in life. In our population, recurrent wheezing rates did not modify in the time period of study.

54 Antibiotics but not Paracetamol Reduce the Risk for Recurrent Wheezing in Infants

BackgroundParacetamol (PCM) and antibiotic (ATB) use have been associated with risk for wheezing and asthma in children. The aim of this study was to verify the association of recurrent wheezing (≥3 episodes) in infancy and use of ATB or PCM in the first year of life.MethodsCross-sectional study using a standardized and validated questionnaire (EISL: Estudio Internacional sobre Sibilancias en Lactantes) with questions: Has your baby had wheezing or whistling in the chest area or bronchitis in the first 12 months of life? Has your baby had 3 or more wheezing episodes in the first year of life? How often has your baby used antibiotics in the first year of life? How often has your baby used paracetamol in the first year of life? Parents of infants, ages 12 to 15 months that attended to Health Centers for routine immunization were interviewed between September 2009 to September 2010 (EISL Phase III). Risk was demonstrated using Odds ratio and 95% CI.ResultsOne thousand and 3 parents participated in the survey and 19.8% of infants had recurrent wheezing starting at 6.1 ± 3 months. The use of PCM was not related to the presence of recurrent wheezing [No PCM (OR = 0.91; 95% CI, 0.38-2.19; P = 0.83), PCM 1–3 times (OR = 1.21; 95% CI, 0.77-1.91; P = 0.4), PCM 4–6 times (OR = 1.21; 95% CI, 0.77-1.9; P = 0.41) and PCM ≥7 times (OR = 0.76; 95% CI, 0.51-1.13; P = 0.17)], while more frequent use of ATB reduced the risk of recurrent wheezing in the first year of life [No ATB (OR = 2.18; 95% CI, 1.35-3.51; P = 0.001), ATB 1–3 times (OR = 1.39; 95% CI, 0.93-2.07; P = 0.1), ATB 4–6 times (OR = 0.37; 95% CI, 0.22-0.62; P = 0.001) and PCM≥7 times (OR = 0.22; 95% CI, 0.07-0.66; P = 0.001)].ConclusionsThe frequent use of ATB reduced the risk of recurrent wheezing in the first year of life unlike PCM that was not associated with recurrent wheezing in this study population.

Current Resources for Evidence‐Based Practice January/February 2012

The Institute of Medicine Report on Clinical Preventive Services for Women: From Evidence to Policy As a central component of the Affordable Care Act (ACA), new health insurance plans will be required to cover preventive health services without cost sharing to plan members beginning on or after August 1, 2012. In response to this directive within the ACA, the United States Department of Health and Human Services (HHS) charged the Institute of Medicine (IOM) with conducting a comprehensive review of women’s preventive health services and recommending those services deemed necessary for the health of women in the United States (Gee et al, 2011).

Pre-natal exposure to dichlorodiphenyldichloroethylene and infant lower respiratory tract infections and wheeze

The aim of our study was to examine whether pre-natal exposure to dichlorodiphenyldichloroethylene (DDE) increases the risk of lower respiratory tract infections (LRTIs) and wheeze in infants. The study is based on a birth cohort of 1,455 mother-child pairs. Maternal serum concentrations of DDE, polychlorinated biphenyls (PCBs) and hexachlorobenzene (HCB) were measured during pregnancy. Parental reports on LRTI and wheeze were obtained when children were 12-14 months old. 35.4% of children developed at least one LRTI episode and 33.6% at least one wheezing episode during their first 12-14 months of life. Median DDE, PCBs and HCB concentrations were 116.3, 113.7 and 46.4 ng · g(-1) lipid, respectively. DDE concentrations were associated with LRTI risk (relative risk (RR) per 10% increase 1.11, 95% CI 1.00-1.22), also after adjustment for PCBs and HCB. In all quartiles of DDE exposure, the risk of LRTI was increased compared with the lowest quartile, but the increase was statistically significant only in the third quartile (RR 1.33, 95% CI 1.08-1.62). No association was observed for PCBs and HCB. Results were similar for wheeze. This study suggests that pre-natal DDE exposure is associated with a higher risk of LRTI and wheeze in infants independently of exposure to other organochlorine compounds.

IL10 Family Member Genes IL19 and IL20 Are Associated With Recurrent Wheeze After Respiratory Syncytial Virus Bronchiolitis

Mechanisms underlying the increased risk of recurrent wheeze after respiratory syncytial virus lower respiratory tract infection (RSV LRTI) are unclear. Specifically, information about genetic determinants of recurrent wheeze after RSV LRTI is limited. We performed a candidate gene association study to identify genetic determinants of recurrent wheeze after RSV LRTI. We investigated 346 single nucleotide polymorphisms (SNPs) in 220 candidate genes in 166 Dutch infants hospitalized for RSV LRTI. Logistic regression analysis was used to study associations between genotypes and haplotypes and recurrent wheeze after RSV LRTI. We found associations with recurrent wheeze for SNPs in IL19, IL20, MUC5AC, TNFRSF1B, C3, CTLA4, CXCL9, IL4R, and IL7 genes. Haplotype analysis of the combined IL19/IL20 genotyped polymorphisms demonstrated an inverse association between the TGG haplotype and recurrent wheeze after RSV LRTI. IL19 and IL20 genes were notably associated with recurrent wheeze in infants without asthmatic parents. The association of IL20 SNP rs2981573 with recurrent wheeze was confirmed in a healthy birth cohort. We concluded that genetic variation in adaptive immunity genes and particularly in IL19/IL20 genes associates with the development of recurrent wheeze after RSV LRTI, suggesting a role for these IL10 family members in the etiology of airway disease during infancy.

Dairy Food, Calcium and Vitamin D Intake in Pregnancy, and Wheeze and Eczema in Infants

Y Miyake, S Sasaki, K Tanaka, Y Hirota. Eur Respir J. 2010;35(6):1228–1234 Previous studies have provided mixed results regarding a relationship of intake of dairy products with allergic disorders. This study examined the association between maternal consumption of dairy products, calcium, and vitamin D during pregnancy and risk of wheeze and eczema in Japanese children at 16 to 24 months of age. A total of 763 mother-child pairs in the Osaka Maternal and Child Health Study (OMCHS) were included. The OMCHS is a prospective cohort study. Participants mailed each of 3 questionnaires to the data center. …

THE EFFECT OF PRENATAL AND POST NATAL EXPOSURE TO SECOND HAND SMOKE ON THE DEVELOPMENT OF WHEEZING BEFORE THE AGE OF 2: A EUROPEAN STUDY

Background-Aim. It has been estimated that at least 700 million children worldwide breathe air polluted by second hand smoke (SHS) at home. We assessed the independent and combined role of prenatal and postnatal exposure to SHS on the development of wheeze in infants before age 2. Methods. We examined pooled data for 49415 mother-child pairs from 19 birth cohorts in 9 countries participating in the EU funded ENRIECO project (ALSPAC, AMICS-Barcelona, AMICS-Menorca, BAMSE, CONER, DARC, EDEN, Generation R, GINI, INMA Guipuzkoa, INMA Sabadell, INMA Valencia, KOALA, Leicester, LISA, MAS, NINFEA, PIAMA-NHS, and RHEA). Information on prenatal exposure to maternal active smoking, prenatal exposure to SHS (paternal or others smoking in the mother’s environment) and postnatal SHS exposure (parents or others smoking in the child’s environment) was collected. We used multilevel mixed-effects logistic regression. Complete information on wheeze, active and passive smoking and covariates used in adjusted models was available for 25727 children. Results. Among non-smoking mothers an increased risk towards the development of wheeze during the first 2 years of life was associated with any exposure to SHS as a fetus and/or during infancy in both the pooled (OR=1.18, 95%CI 1.10-1.27) and in the meta-analysis (OR = 1.16, 1.06-1.26). Increased risks were observed for fetal exposure to SHS only during pregnancy (OR= 1.14, 1.05-1.24) and to children exposed to SHS during both pregnancy and infancy (OR=1.29, 1.18-1.42). Combined active maternal smoking during pregnancy and SHS exposure during infancy led to the highest risks observed (OR=1.76, 1.60-1.93). Approximately 8% of wheeze during the first 2 years in children of non-smoking mothers could be attributed to SHS. Conclusions. SHS exposure during pregnancy and infancy was associated both mutually and independently with the development of wheeze before the age of 2 indicating the importance of adopting smoke free homes and environments.

Effects of a 17q21 chromosome gene variant, tobacco smoke and furred pets on infant wheeze

The first common genetic factor identified for pediatric asthma by genome-wide association is the chromosome 17q21 locus, harbouring the ORMDL3 gene. ORMDL3 is involved in facilitation of endoplasmic reticulum-mediated inflammatory responses, believed to underlie its asthma association. We investigated associations between the rs7216389 polymorphism in the 17q21 locus affecting ORMDL3 expression and the risk for recurrent wheeze and interactions with exposure to tobacco smoke and furred pets during pregnancy and infancy using a birth cohort of 101,042 infants. Rs7216389 was significantly associated with recurrent wheeze risk among 18-month-old infants. There was a 1.35-fold higher risk of recurrent wheeze among homozygous variant allele carriers compared with homozygous wild-type allele carriers. There was significant interaction between rs7216389 and domestic furred pets, with a positive association between pets and wheeze among homozygous wild-type carriers and a negative association among homozygous variant allele carriers. There was no interaction between rs7216389 and tobacco smoke exposure.

Predicting the Long-Term Course of Asthma in Wheezing Infants Is Still a Challenge

Background. In recurrent wheezing infants, it is important to identify those likely to remain asthmatic in order to propose appropriate long-term management. Objective. To establish predictive factors for persistent asthma at adolescence in a population of recurrent wheezing infants. Methods. Retrospective study of 227 infants. Inclusion criteria were age under 36 months, a history of at least three wheezing episodes assessed via a doctor-led ISAAC questionnaire and a standardized allergy testing programme. At 13 years, active asthma was assessed by questionnaire. Results. Risk factors for asthma persisting into adolescence were allergic sensitization to multiple airborne allergens (OR 4.6, CI-95% (1.9–11.2) P = 0.001), initial atopic dermatitis (OR 3.4, CI-95% (1.9–6.3) P < 0.001), severe recurrent wheezing (OR 2.3, CI-95% (1.3–4.2) P = 0.007), and hypereosinophilia ≥470/mm3 (OR 2.2, CI-95% (1.07–4.7) P = 0.033). Conclusion. While it is still difficult to predict the long-term course of asthma, atopy remains the major risk factor for persistent asthma.

Endotoxin Exposure and Childhood Wheeze and Asthma: A Meta-Analysis of Observational Studies

Background. Exposure to endotoxin has been widely investigated as a potential factor for asthma and associated symptoms in children with different results. To clarify a potential relationship, we performed the present meta-analysis to integrate the results of studies examining the association of endotoxin exposure with wheeze and asthma in children. Methods. A search for relevant studies and reviews was conducted in MEDLINE, Highwire, CINAHL, and The Cochrane Library databases. Adjusted odds ratio (OR) with corresponding 95% confidence interval (CI) for endotoxin exposure and wheeze or asthma were retrieved and pooled to generate summary effect estimates in STATA 11.1. Results. Nineteen studies were included in the meta-analysis. The summary estimates suggested that endotoxin was positively associated with wheeze in infants and toddlers (meta-OR: 1.48, 95% CI: 1.10–1.98), but negatively related to asthma in school-aged children (meta-OR: 0.82, 95% CI: 0.69–0.97 for endotoxin concentration and 0.68, 95% CI: 0.50–0.93 for endotoxin load). Conclusions. Based on the studies evaluated, endotoxin is a risk factor for wheeze in younger children, but a protective factor for asthma in older children. Thus, this study supports the “hygiene hypothesis.”

Serum Levels of Lipoxin A4 do not Predict the Development of Subsequent Asthma among Young Children with Acute Bronchiolitis

Background. Acute bronchiolitis frequently causes wheezing in infants and young children, although its relationship to asthma remains unclear. We hypothesized that serum lipoxin A4 levels may be used as an early predictive biomarker of subsequent asthma in young children with acute bronchiolitis. Methods. We recruited 69 children who were divided into 3 groups: 47 children younger than 24 months with acute bronchiolitis as an experimental group (Group 1); 11 children aged 2–24 months with viral acute gastroenteritis as a non-allergic control group (Group 2); and 11 children older than 24 months with physician-diagnosed asthma exacerbations as an asthma control group (Group 3). We determined white blood cell counts, eosinophil counts, and serum levels of C-reactive protein, interleukin-4, interleukin-5, prostaglandin E2, tumor necrosis factor-alpha, and lipoxin A4. Results. The mean serum levels of lipoxin A4 in the groups with acute bronchiolitis (1), acute gastroenteritis (2), and asthma (3) were 0.0430.028, 0.0540.015, and 0.0510.031 ng/ml, respectively. When compared by t-tests, there were no significant differences between Groups 1 and 2, or Groups 1 and 3 (p0.05), despite a significant difference between Groups 2 and 3 (p=0.0392). In a final regression model, serum lipoxin A4 levels were positively correlated with age, female gender, white blood cell counts, and interleukin-5 levels in all patients, while asthma patients had lower serum lipoxin A4 levels compared to the other two groups. Conclusion. Serum levels of lipoxin A4 cannot be used as an early predictive diagnostic marker for asthma in young children with acute bronchiolitis.

Prenatal exposure to polychlorinated biphenyls and dioxins is associated with increased risk of wheeze and infections in infants

The birth cohort BraMat (n=205; a sub-cohort of the Norwegian Mother and Child Cohort Study (MoBa) conducted by the Norwegian Institute of Public Health) was established to study whether prenatal exposure to toxicants from the maternal diet affects immunological health outcomes in children. We here report on the environmental pollutants polychlorinated biphenyls (PCBs) and dioxins, as well as acrylamide generated in food during heat treatment. The frequency of common infections, eczema or itchiness, and periods of more than 10days of dry cough, chest tightness or wheeze (called wheeze) in the children during the first year of life was assessed by questionnaire data (n=195). Prenatal dietary exposure to the toxicants was estimated using a validated food frequency questionnaire from MoBa. Prenatal exposure to PCBs and dioxins was found to be associated with increased risk of wheeze and exanthema subitum, and also with increased frequency of upper respiratory tract infections. We found no associations between prenatal exposure to acrylamide and the health outcomes investigated. Our results suggest that prenatal dietary exposure to dioxins and PCBs may increase the risk of wheeze and infectious diseases during the first year of life.

Maternal dietary patterns during pregnancy and risk of wheeze and eczema in Japanese infants aged 16–24 months: The Osaka Maternal and Child Health Study

Maternal diet during pregnancy might influence the development of childhood allergic disorders. This prospective study examined the relationship between maternal dietary patterns during pregnancy and the risk of wheeze and eczema in the offspring aged 16-24 months. Subjects were 763 mother-child pairs. Data on maternal intake during pregnancy were assessed with a diet history questionnaire. Dietary patterns were derived from factor analysis of 33 predefined food groups. Symptoms of wheeze and eczema were based on criteria of the International Study of Asthma and Allergies in Childhood. Adjustment was made for maternal age, gestation, residential municipality, family income, maternal and paternal education, maternal and paternal history of allergic disorders, changes in maternal diet in pregnancy, season at baseline, maternal smoking during pregnancy, baby's older siblings, sex, birth weight, age at the third survey, household smoking, and breastfeeding duration. Three dietary patterns were identified: 'healthy', characterized by high intake of green and yellow vegetables, seaweed, mushrooms, white vegetables, pulses, potatoes, fish, sea products, fruit, and shellfish; 'Western', characterized by high intake of vegetable oil, salt-containing seasonings, beef and pork, processed meat, eggs, chicken, and white vegetables; and 'Japanese', characterized by high intake of rice, miso soup, sea products, and fish. There was a tendency for an inverse exposure-response relationship between the maternal Western pattern during pregnancy and the risk of childhood wheeze by crude analysis. After adjustment for the confounding factors under study, the inverse relationship was strengthened: the adjusted OR between extreme quartiles was 0.59 (95% CI: 0.35-0.98, p for trend = 0.02). No such inverse association was observed for childhood eczema. Neither the maternal healthy pattern nor the Japanese pattern during pregnancy was related to childhood wheeze or eczema. The maternal Western pattern during pregnancy may be preventive against wheeze in the offspring.

Entwickelt sich hier ein Asthma oder wächst sich das wieder aus?

Viele Kinder zeigen vor allem in den ersten zwei Lebensjahren giemende Atemgerausche. Doch von einem Asthma kann man bei Kindern im Vorschulalter nur mit groster Zuruckhaltung sprechen, weil eine exakte Fruhdiagnose nicht moglich ist. Ob es Pradiktoren fur ein spateres Asthma gibt, wurde beim Kongress der Deutschen Gesellschaft fur Pneumologie diskutiert.