Changes in the prevalence of asthma, eczema and hay fever in pre-pubertal children: a 40-year perspective

Surveys of primary schools children in Aberdeen carried out in 1964, 1989, 1994 and 1999 suggested a slowing of the increase in parent-reported wheeze between 1994 and 1999. To assess whether this pattern had continued, questionnaires were distributed to 5712 children aged 7–12 years in the same schools in 2004. A total of 3271 (57.3%) completed questionnaires were returned. As in earlier surveys the results were divided into those for younger children (school years 3–4; age 7–9 years) and older children (school years 5–7; age 9–12 years).
Compared with 1999, the 2004 results showed a decrease in the proportion of children with wheeze in the last 3 years from 30.1% to 23.3% ( P  < 0.001) in the younger group and from 27.6% to 25.1% ( P  = 0.052) in the older group. There was no significant change in the lifetime prevalence of asthma in either the younger or the older group, but the lifetime prevalence of eczema and hay fever increased by around 10% in both the younger and older groups (all P  < 0.001). The differences in the time trends for the different conditions suggest that the causal factors for wheeze and asthma differ from those for other allergic diseases of childhood.     

Effects of early cat or dog ownership on sensitisation and asthma in a high‐risk cohort without disease‐related modification of exposure

Almqvist C, Garden F, Kemp AS, Li Q, Crisafulli D, Tovey ER, Xuan W, Marks GB for the CAPS investigators. Effects of early cat or dog ownership on sensitisation and asthma in a high‐risk cohort without disease‐related modification of exposure. Paediatric and Perinatal Epidemiology 2010; 24: 171–178. Variation in the observed association between pet ownership and allergic disease may be attributable to selection bias and confounding. The aim of this study was to suggest a method to assess disease‐related modification of exposure and second to examine how cat acquisition or dog ownership in early life affects atopy and asthma at 5 years. Information on sociodemographic factors and cat and dog ownership was collected longitudinally in an initially cat‐free Australian birth cohort based on children with a family history of asthma. At age 5 years, 516 children were assessed for wheezing, and 488 for sensitisation. Data showed that by age 5 years, 82 children had acquired a cat. Early manifestations of allergic disease did not foreshadow a reduced rate of subsequent acquisition of a cat. Independent risk factors for acquiring a cat were exposure to tobacco smoke at home odds ratio (OR) 1.92 [95% confidence interval (CI) 1.13, 3.26], maternal education ≤12 years OR 1.95 [1.08, 3.51] and dog ownership OR 2.23 [1.23, 4.05]. Cat or dog exposure in the first 5 years was associated with a decreased risk of any allergen sensitisation, OR 0.50 [0.28, 0.88] but no association with wheeze OR 0.96 [0.57, 1.61]. This risk was not affected by age at which the cat was acquired or whether the pet was kept in‐ or outdoors. In conclusion, cat or dog ownership reduced the risk of subsequent atopy in this high‐risk birth cohort. This cannot be explained by disease‐related modification of exposure. Public health recommendations on the effect of cat and dog ownership should be based on birth cohort studies where possible selection bias has been taken into account.     

Hygiene theory and allergy and asthma prevention

Epidemiological trends of allergic diseases and asthma in children reveal a global rise in their prevalence over the past 50 years. Their rapid rise, especially in metropolitan locales, suggests that recent changes in modern environments and/or life styles underlie these trends. One environmental/life style factor that may be contributing to this trend is called the hygiene hypothesis: that naturally occurring microbial exposures in early life may have prompted early immune maturation and prevented allergic diseases and asthma from developing. Subsequently, children raised in modern metropolitan life styles, relatively devoid of this natural microbial burden, may have under-stimulated immune systems in infancy, thereby allowing for the 'allergic march'– a pattern of pro-allergic immune development and disorders that occurs in early life. Over the past 15 years, hygiene theorising has evolved in shape and substance, in part due to a growing and strengthening burden of evidence from epidemiological, translational and basic research. What was speculation may be key clues to allergy and asthma prevention. The objectives of this article are to summarise the epidemiological trends and allergic march of childhood that may be explained by hygiene theory, to overview current hygiene theory paradigms and to exemplify the strengthening epidemiological evidence in support of the hygiene theory, using bacterial endotoxin exposure as a prototypical example.     

Ecological association between childhood asthma and availability of indoor chlorinated swimming pools in Europe

Background

It has been hypothesised that the rise in childhood asthma in the developed world could result at least in part from the increasing exposure of children to toxic chlorination products in the air of indoor swimming pools.

Objectives

Ecological study to evaluate whether this hypothesis can explain the geographical variation in the prevalence of asthma and other atopic diseases in Europe.

Methods

The relationships between the prevalences of wheezing by written or video questionnaire, of ever asthma, hay fever, rhinitis, and atopic eczema as reported by the International Study of Asthma and Allergies in Childhood (ISAAC), and the number of indoor chlorinated swimming pools per inhabitant in the studied centres were examined. Associations with geoclimatic variables, the gross domestic product (GDP) per capita, and several other lifestyle indicators were also evaluated.

Results

Among children aged 13–14 years, the prevalence of wheezing by written questionnaire, of wheezing by video questionnaire, and of ever asthma across Europe increased respectively by 3.39% (95% CI 1.96 to 4.81), 0.96% (95% CI 0.28 to 1.64), and 2.73% (95% CI 1.94 to 3.52), with an increase of one indoor chlorinated pool per 100 000 inhabitants. Similar increases were found when analysing separately centres in Western or Northern Europe and for ever asthma in Southern Europe. In children aged 6–7 years (33 centres), the prevalence of ever asthma also increased with swimming pool availability (1.47%; 95% CI 0.21 to 2.74). These consistent associations were not found with other atopic diseases and were independent of the influence of altitude, climate, and GDP per capita.

Conclusions

The prevalence of childhood asthma and availability of indoor swimming pools in Europe are linked through associations that are consistent with the hypothesis implicating pool chlorine in the rise of childhood asthma in industrialised countries.     

Young infant sepsis: aetiology, antibiotic susceptibility and clinical signs

Globally, young infant mortality comprises 40% of the estimated 10.8 million child deaths annually. Almost all (99%) of these deaths arise in low- and middle-income countries (LMICs). Achievement of the Millennium Development Goal for child survival, however, requires a significant improvement in the management of infections in young infants. We have reviewed current evidence from LMICs on one major cause of young infant mortality, severe infection, and have described the range of pathogens, reported antibiotic susceptibility and value of clinical signs in identifying severe bacterial illness. Evidence from the reviewed studies appears to show that common pathogens in young infant infections change over time and vary within and across settings. However, there are few good, large studies outside major urban settings and many reports describe infections of babies born in hospital when most young infant infections probably occur in the majority born at home. Yet what knowledge there is can aid in instituting prompt and appropriate therapy, and perhaps thus minimize the emergence of multidrug-resistant bacteraemia, a major threat at least in hospital settings. Improved country level data on pattern of microorganisms, resistance and antibiotic use are required to help reduce mortality through development of local, evidence-based clinical guidelines.     

The natural environment,plant diversity,and adult asthma: A retrospective observational study using the CDC's 500 Cities Project Data

A wealth of evidence links microbial exposure to better human immune function. However, few studies have examined whether exposure to plant diversity is protective of immune diseases, despite the fact that plant leaves support ~10²⁶ bacterial cells. Using the Centers for Disease Control and Prevention's 500 cities project data, we found that a 1-SD increase in exposure to taxonomic plant diversity is associated with a 5.3 (95% CI: 4.2–6.4; p < 0.001) percentage-point decline in Census-tract level adult-asthma rate. In contrast, A 1-SD increase in overall greenness exposure (measured using the normalized difference vegetation index) was associated with a 3.8 (95% CI: 2.9–4.8; p < 0.001) percentage-point increase in adult-asthma rate. Interactions between air pollution and both overall greenness and plant diversity were positive, suggesting that air pollution may potentiate the allergic effects of plant pollen. Results show that the relationship between the natural environment and asthma may be more complex than previously thought, and the combination of air pollution and plant pollen may be a particular risk factor for asthma in adults.     

Perinatal and Neonatal Manipulation of the Intestinal Microbiome: A Note of Caution

As we learn more about interactions between microbes and the developing gastrointestinal (GI) tract, it is becoming clear that the establishment of the intestinal "microbiome" shortly after birth plays a critical role in the early origins of health and disease. Nutrition, mode of delivery, the use of maternal or postnatal antibiotics, and pre- and probiotics are factors that may alter the microbial ecology and affect lifelong gene expression. Because the neonatal period is a critical period of development when microbes become established in the GI tract, the long-term effects of manipulations of the GI microbial ecology during this time are more amplified than the effects of later manipulations. In this paper, recent research findings are reviewed with the intent of providing information about the benefits of early manipulation of the GI microbiome, but also to give a warning about its indiscriminant manipulation during the perinatal and neonatal time periods.     

新生儿院内感染的原因分析与应对策略研究

目的了解新生儿院内感染发生的现状,分析其原因,并提出政策建议。方法采用文献分析法,掌握新生儿发生院内感染的特殊原因,分别从新生儿自身的特殊性、新生儿科室的特殊性、新生儿治疗的特殊性3方面探讨,归纳得出新生儿科易发生院内感染的原因。结果新生儿免疫力低,新生儿病房布局合理性差、护理人员数量不足、防感意识差,新生儿治疗时侵入性操作多、医护人员与患儿接触频繁、滥用抗生素等。结论应对新生儿院内感染应从预防、发生、结束3个方面来采取相应措施。     

儿童哮喘的全球流行及影响因素

哮喘是儿童期最常见的慢性疾病。20多年来,其患病率在全球范围内呈现惊人的上升趋势,给个人和各国卫生资源带来沉重的负担。识别高危人群及认识危险因素是哮喘病最有效的预防策略。该文就哮喘的全球流行状况及影响因素进行综述。     

早期呼吸道感染性疾病与儿童哮喘的关系研究

【目的】 初步探讨儿童哮喘与生命早期羅患呼吸道疾病之间的关系。 【方法】 共301例哮喘儿童纳入研究,301例非喘息性疾病患儿作为对照。采用向家长书面问卷调查方法询问各组婴儿围生期因素、家族史及既往感染性疾病等资料进行综合调查。 【结果】 本地区儿童早期呼吸道感染和中耳炎患病次数、既往毛细支气管炎、肺炎和支气管炎、新生儿期接受NICU治疗、男性、哮喘家族史、过敏体质以及被动吸烟等均与儿童后期哮喘发病密切相关,而呼吸道感染和中耳炎的发病年龄则与哮喘的关系不明显。 【结论】 本地区儿童早期呼吸道感染和中耳炎患病次数与儿童哮喘的发生发展以及发作程度密切相关,具有上述高危因素的儿童是本地区制定哮喘预防措施重点关注人群。     

基于风险识别与聚类分析的医疗机构保洁人员手卫生监测指标研究

目的 拟借助风险识别与聚类分析方法探索适用于医疗机构保洁人员手卫生监测的指征与时机,为保洁人员手卫生依从性的监测提供工具及标准.方法 通过随机抽样方法匿名观察50名保洁人员工作流程及行为,遴选10名专家判别工作流程,借助风险识别工具划分风险带,通过聚类分析确定手卫生指征.结果 保洁人员17类工作行为风险得分均达到纳入聚...     

早期呼吸道感染疾病与儿童哮喘发病关系的病例对照研究

【目的】 初步探讨儿童后期哮喘患病与早期羅患呼吸道感染性疾病之间的关系。 【方法】 共317例哮喘儿童纳入研究,317例非喘息性疾病患儿作为对照。采用向家长书面问卷调查方法询问各组婴儿围产期因素、家族史及既往呼吸道感染性疾病等资料进行综合调查。采用后退法进行哮喘患病危险因素的多因素配比条件Logistic回归分析。 【结果】 在校正了其他与儿童哮喘发生发展密切相关的因素后,既往上/下呼吸道感染次数以及下呼吸道初发年龄与儿童期哮喘的发病存在密切相关;上呼吸道感染和下呼吸道感染的发作次数以及下呼吸道感染的初次发作年龄均与哮喘中度、重度发作关系密切。上呼吸道感染初次发作年龄与儿童哮喘发作以及病情程度均无显著关系。 【结论】 本地区儿童早期呼吸道感染与儿童四岁左右哮喘的发生发展以及发作程度密切相关。     

Glutamine-enriched enteral nutrition in very low birthweight infants and allergic and infectious diseases at 6 years of age

In a previous randomised controlled trial, we found that glutamine-enriched enteral nutrition in 102 very low birthweight (VLBW) infants decreased both the incidence of serious infections in the neonatal period and the risk of atopic dermatitis during the first year of life. We hypothesised that glutamine-enriched enteral nutrition in VLBW infants in the neonatal period influences the risk of allergic and infectious disease at 6 years of age. Eighty-eight of the 102 infants were eligible for the follow-up study (13 died, 1 chromosomal abnormality). Doctor-diagnosed allergic and infectious diseases were assessed by means of validated questionnaires. The association between glutamine-enriched enteral nutrition in the neonatal period and allergic and infectious diseases at 6 years of age was based on univariable and multivariable logistic regression analyses. Seventy-six of the 89 (85%) infants participated, 38 in the original glutamine-supplemented group and 38 in the control group. After adjustment, we found a decreased risk of atopic dermatitis in the glutamine-supplemented group: adjusted odds ratio (aOR) 0.23 [95% CI 0.06, 0.95]. No association between glutamine supplementation and hay fever, recurrent wheeze and asthma was found. A decreased risk of gastrointestinal tract infections was found in the glutamine-supplemented group (aOR) 0.10 [95% CI 0.01, 0.93], but there was no association with upper respiratory, lower respiratory or urinary tract infections. We concluded that glutamine-enriched enteral nutrition in the neonatal period in VLBW infants decreased the risk of atopic dermatitis and gastrointestinal tract infections at 6 years of age.     

Effect of maternal asthma on birthweight and neonatal outcome in a British inner-city population

During pregnancy, asthma-related alterations in placental function and the maternal immune system, and reduced growth affecting female but not male fetuses have been reported in a study of selected Australian women. The objective of this study was to evaluate the effect of asthma management, declared during pregnancy, on birthweight and neonatal outcome at an inner-city hospital in England. Between June 2001 and December 2003, women at antenatal clinics were questioned about asthma (n = 10 983). Women with asthma and singleton uncomplicated pregnancies ending at term were selected (n = 718), with non-asthmatic controls (n = 718). Among asthmatic women using inhaled steroids and bronchodilators (n = 170), 43% of the newborn boys had birthweights <10th centile, compared with 27% of controls (P = 0.011; OR 2.51 [95% CI: 1.52, 4.14]). For girls, the proportions were 28% and 27%. In women using bronchodilators only (n = 178) or those declaring no treatment (n = 370), birthweights were not significantly reduced. Taking account of smoking, ethnicity, gestational age and parity, there was a mean birthweight reduction with inhaled steroids and bronchodilators of 118 g [95% CI 36.0, 199.0 g] compared with the control group. There was no interaction between the effect of asthma treatment and infant gender. Infants of asthmatic women in the three subgroups who required intensive care were more likely to exhibit transient tachypnoea of the newborn than infants of control women (P < 0.005). In our population-based sample, the risk of low birthweight among asthmatic women did not depend on infant gender, while neonatal respiratory morbidity remains a significant health issue in boys and girls.     

儿童哮喘危险因素的Meta分析及归因危险度百分比的探讨

目的:分析儿童哮喘发病相关危险因素,为临床早期干预提供依据.方法；收集国内1995年1月～ 2012年11月公开发表的关于儿童哮喘发病危险因素的研究文献进行Meta分析及人群归因危险度百分比,查找儿童哮喘发病危险因素.结果:个人过敏史、特应性体质、家族哮喘史、一二级家族过敏史、感冒、呼吸道感染、环境因素包括异味、吸烟、吸人物等是发生儿童哮喘的危险因素,母乳喂养是保护因素.危险因素权重估计分别为个人过敏史11.15％,特应性体质14.29％,家族哮喘史19.17％,一二级家族过敏史21.44％,诱因1感冒、呼吸道感染26.22％,诱因2环境异味、吸烟、吸入物等7.73％.结论:对于特应性体质儿童提倡母乳喂养,尽量避免呼吸道感染,避开常见吸人性过敏原或可预防儿童哮喘发生.     

围产因素与儿童哮喘关系研究进展

儿童哮喘发病率在世界范围内有不断升高的趋势,但相关病因仍然不清楚。近年来大量的流行病学研究证据说明遗传因素、围产儿子宫内外环境暴露与儿童哮喘发生密切相关。该文从遗传因素、母亲孕期吸烟、胎儿宫内生长环境、胚胎发育水平、胎儿的免疫状况等几个角度,对近年来有关围产因素与儿童哮喘关系的流行病学研究结果进行简要综述。     

Professional cleaning and risk of asthma – a Danish nationwide register-based study

ObjectiveThis study aimed to investigate the risk of asthma among professional cleaners in a nationwide population-based study.MethodsProfessional cleaners, aged 16–50 years, were identified according to the yearly assigned administrative job and industrial codes in a register-based, matched cohort study with other manual workers as references (1995–2016). Asthma was defined from national registers based on hospitalization and medication. Associations between recent and cumulative cleaning years and risk of asthma were estimated using Poisson regression, first in a full cohort and then in an inception cohort, among workers aged 16–20 years at the start of follow-up.ResultsThe risk of asthma was not increased for recent cleaning compared to references [adjusted incidence rate ratio (IRR_adj) 1.02 [95% confidence interval (CI) 0.99–1.04]. Similar results were seen for the inception cohort, where cumulative years of cleaning were associated with increased risk of asthma, more prominent for the group with the maximum of six years of cleaning IRR_adj 2.53 (95% CI 1.38–4.64). Cumulative years of cleaning were associated with decreased risk of asthma, more pronounced for the maximum of ten compared to one year of cleaning [IRR_adj 0.74 (95% CI 0.63–0.88)].ConclusionsAsthma risk was increased in the inception cohort for cumulative years of cleaning but decreased in the full cohort. We could not confirm that recent work within cleaning was associated with increased risk of asthma. This may be due to healthy worker bias. Thus, we cannot rule out that long-term professional cleaning may be associated with increased risk of asthma.     

儿童反复喘息与4位点哮喘基因预测模型的关系及危险因素分析

目的 探讨儿童反复喘息与4位点哮喘基因预测模型的关系,分析反复喘息的危险因素。方法 选取2019年1月—2021年3月在玉环市人民医院住院或门诊就诊的喘息儿童91例,根据哮喘预测指数(API)是否阳性,分为API阳性组55例,API阴性组36例,同时选择健康体检儿童30例为对照组。比较3组儿童4位点哮喘基因预测模型的高危率;将反复喘息儿童进行单因素及多因素Logistic回归分析。结果 API阳性组4位点哮喘基因预测模型的高危率较API阴性组及对照组显著升高(χ²=12.487,P＜0.05);API阳性组4位点哮喘基因预测模型的高危风险是API阴性组的2.54倍,是对照组的5.32倍。单因素分析儿童反复喘息与4位点哮喘基因预测模型的高危型、过敏史、过敏疾病家族史、吸入过敏原阳性、食入过敏原阳性、被动吸烟、嗜酸性粒细胞计数升高及呼吸道合胞病毒感染等因素有关(χ²=13.831,22.817,25.475,20.573,6.373,11.487,10.790,10.789,P＜0.05),而与居住环境无关(P＞0.05)。多因素Logistic回归分析显示4位点哮喘基因预测模型的高危型(OR=5.535,95%CI:1.928~15.893)、过敏史(OR=4.921,95%CI:1.661~14.577)、过敏疾病家族史(OR=4.460,95%CI:1.560~12.749)、吸入过敏原阳性(OR=13.105,95%CI:2.436~70.503)、被动吸烟(OR=3.704,95%CI:1.304~10.521)为喘息的独立危险因素。结论 反复喘息儿童,尤其是API阳性儿童,4位点哮喘基因预测模型的高危率显著升高;反复喘息与多种因素有关,其中4位点哮喘基因预测模型高危型是一个重要原因。