Environmental and dietary risk factors for infantile atopic eczema among a Slovak birth cohort

Infantile atopic eczema (AE) is a risk marker for future asthma. This study assesses the contribution of modifiable exposures to infantile AE. If modifiable exposures contribute substantially to infantile AE, its prevention might be a sensible approach to asthma prevention. Pregnant women (n = 1978) were systematically recruited from maternity hospitals of the Slovak Republic; their birthed cohort of 1990 children were prospectively followed for 1 yr. Children's exposures to selected environmental and dietary factors were assessed via maternal questionnaires administered at delivery and 1 yr of age. A child was considered to have AE, based on physical examination (SCORAD index >2) or mother's report of a previous physician diagnosis. Multivariate logistic regression was used to calculate adjusted odds ratios and percent total regression scores (TRS) for each variable. At 1 yr of age 1326 (67%) of the children remained in the cohort and 207 (15.6%) developed AE. Various modifiable environmental and dietary exposures increased the likelihood of AE (ownership of cats; consumption of infant formula, eggs, and fish) while others decreased the likelihood of AE (ownership of livestock; exclusive breast feeding for > or =4 months). Overall, modifiable exposures contributed less to the TRS than did non-modifiable exposures (38% vs. 62%, respectively). The modifiable exposure category that contributed most to the TRS was infant feeding practices (27.5% TRS). Modifiable exposures -- especially those related to infant feeding practices -- significantly contribute to infantile AE, although modifiable factors contribute less overall than do non-modifiable exposures.     

Recent advances in epidemiology and prevention of atopic eczema

Atopic dermatitis (AD), named also atopic eczema, is a chronic relapsing inflammatory skin disease with a considerable social and economic burden. The primum movens of AD is in most cases a genetic and/or immune‐supported defect of the skin barrier, facilitating penetration and sensitization to food or airborne allergens, as well as infections by Staphylococcus aureus, herpes simplex virus, or other microbes. New pathogenetic concepts have generated new approaches to prevention and therapy of AD. In particular, the daily use of emollients in newborns at high risk of AD has shown interesting results, with a reduction in the cumulative incidence of AD ranging from 32% to 50% of the treated infants. On the other hand, the AD preventive efficacy of food and/or inhalant allergen avoidance has been questioned, and supplementation strategies (vitamin D, probiotics, or other compounds) need to be further investigated.     

Contact allergy in relation to hand eczema and atopic diseases in north Norwegian schoolchildren

Dotterud LK, Falk ES. Contact allergy in relation to hand eczema and atopic diseases in north Norwegian schoolchildren. Acta Psediatr 1995;84:402–6. Stockholm. ISSN 0803–5253
Patch testing was carried out in 424 schoolchildren (223M, 201F), aged 7–12 years, in northern Norway. In 99 (23.3%) of these children, one or more allergic patch test reactions were demonstrated; 30 children reacted to two and 6 to three or more substances; 53 irritant reactions were recorded in 33 (7.8%) of those tested. From a total of 144 positive tests, the most common allergen was nickel (14.9%), followed by cobalt (5.7%), kathon CG (5.2%), lanolin (1.7%) and neomycin (1.4%). Both allergic and irritant reactions were found twice as frequently in girls as in boys. Positive patch tests were significantly more frequent in atopic (28.8%) than in non–atopic (17.9%) children, being most pronounced in atopic girls (37.4%). Hand eczema was reported to have occurred or to be present in 6.5% of cases. Twenty–nine of 36 children reporting hand eczema participated in the clinical examination. Altogether 15 (3.5%) children had hand eczema at the time of the clinical examination but 12 of these children had no previous history of hand eczema. In 14 of these 15 subjects, the eczema was localized to the back of the hands, with 13 having atopic dermatitis. In 4 of these 15 children, an allergic patch test reaction was found; however, in only 2 of these 4 was the test considered to be clinically relevant for the diagnosis allergic hand eczema. In conclusion, irritant hand eczema may occur in early childhood and is most prevalent in children with atopic dermatitis     

孕期及婴幼儿期补充益生菌预防儿童特应性皮炎效果的Meta分析

目的 系统评价孕期及婴幼儿期补充益生菌预防儿童特应性皮炎的效果。方法 运用RevMan5.3软件,对2008年1月至2018年5月国内外发表的有关孕期及婴幼儿期使用益生菌预防儿童特应性皮炎的随机对照试验研究进行Meta分析,并按干预菌株、随访时间、补充益生菌时间、研究地区进行亚组分析。结果 最终纳入22篇文献,干预组和对照组病例分别为3280例和3 281例。合并效应量结果显示,孕期和/或婴幼儿期使用益生菌可减少儿童特应性皮炎的发生（RR=0.81,95% CI：0.70~0.93,P < 0.05）。亚组分析结果显示,使用乳酸杆菌和双歧杆菌混合菌株干预效果显著（RR=0.68,95% CI：0.52~0.90,P < 0.05）;孕期及婴幼儿期均补充益生菌效果显著（RR=0.77,95% CI：0.66~0.90,P < 0.05）;孕期和/或婴幼儿期补充益生菌预防特应性皮炎对≤ 2岁儿童效果较显著（RR=0.74,95% CI：0.61~0.90）,而对2岁以上儿童效果不显著;研究地区为澳洲或欧洲/美国的效果显著（P < 0.05）,合并RR及95% CI分别为0.83（95% CI：0.73~0.96）、0.74（95% CI：0.61~0.91）。异质性主要源于不同随访时间（I²=62.7%）和补充益生菌时间（I²=53.5%）。结论 孕期及婴幼儿期补充益生菌有利于预防儿童特应性皮炎的发生,其中使用乳酸杆菌和双歧杆菌混合菌株干预效果显著。     

Association of food allergy with asthma severity and atopic diseases in Jewish and Arab adolescents

Aim: To investigate the prevalence of reported food allergy and its association with atopic diseases and asthma severity among Jewish and Arab adolescents. Subjects and methods: The self‐report questionnaire of the International Study of Asthma and Allergies in Childhood (ISAAC) was administered to adolescents aged 13–14 years from randomly selected junior high schools in Israel. Questions regarding food allergy were added. Results: A total of 11 171 questionnaires were available for analysis. Food allergy was reported by 3.6% of participants: 1.9% milk, 0.6% egg, 0.6% peanut and 0.4% sesame. On multivariate analysis, food allergy was strongly associated with current asthma (OR, 2.5; 95% CI, 1.8–3.3), atopic eczema (OR, 3.2; 95% CI, 2.4–4.3) and allergic rhinitis (OR, 2.4; 95% CI, 1.8–3.1). Arabs were significantly more allergic to peanut (OR, 2.5; 95% CI, 1.5–4.1), egg (OR, 3.5; 95% CI, 2.1–5.9) and sesame (OR, 2.3; 95% CI, 1.2–4.5) than Jews, and less allergic to milk (OR, 0.6; 95% CI, 0.4–0.9). Asthmatic subjects with food allergy had significantly more parameters of severe asthma than those without food allergy (p < 0.001). Conclusions: The prevalence of allergy to specific foods differs between Jews and Arabs. Asthmatic adolescents with food allergy report more severe asthma than those without food allergy.     

Systematic review of randomised controlled trials of interventions that aim to reduce the risk,either directly or indirectly,of overweight and obesity in infancy and early childhood

The risk factors for childhood overweight and obesity are known and can be identified antenatally or during infancy, however, the majority of effective interventions are designed for older children. This review identified interventions designed to reduce the risk of overweight/obesity that were delivered antenatally or during the first 2 years of life, with outcomes reported from birth to 7 years of age. Six electronic databases were searched for papers reporting randomised controlled trials of interventions published from January 1990 to September 2013. A total of 35 eligible studies were identified, describing 27 unique trials of which 24 were behavioural and three were non‐behavioural. The 24 behavioural trials were categorised by type of intervention: (1) nutritional and/or responsive feeding interventions targeted at parents of infants, which improved feeding practices and had some impact on child weight (n = 12); (2) breastfeeding promotion and lactation support for mothers, which had a positive effect on breastfeeding but not child weight (n = 5); (3) parenting and family lifestyle (n = 4); and (4) maternal health (n = 3) interventions that had some impact on feeding practices but not child weight. The non‐behavioural trials comprised interventions manipulating formula milk composition (n = 3). Of these, lower/hydrolysed protein formula milk had a positive effect on weight outcomes. Interventions that aim to improve diet and parental responsiveness to infant cues showed most promise in terms of self‐reported behavioural change. Despite the known risk factors, there were very few intervention studies for pregnant women that continue during infancy which should be a priority for future research.     

Development of atopic sensitization and allergic diseases in early childhood

Atopic diseases and atopic sensitization were studied from birth up to 2 y in a population-based prospective study. Physical examinations were done at 6, 12 and 24 mo, including skin-prick tests and blood samples, for the determination of serum IgE level and circulating IgE antibodies to food and inhalant allergens. In addition, questionnaire surveys were done about clinical symptoms of allergy, infections and the home environment. At 2 y the prevalences of definite and probable atopic diseases were 17% and 13%, respectively. The cumulative incidence of allergy was 25%. Atopic dermatitis was the main manifestation of atopy, with a peak prevalence of 15% at 2 y. The prevalence of positive skin-prick tests was constant at all ages, i.e. 7% at 6, 12 and 24 mo. Positive skin-prick tests against inhaled allergens were more than twice as common at 24 than at 12 mo, while sensitivity to food decreased. In contrast, circulating IgE antibodies to egg became more common with age, reaching 20% at 2 y. Conclusions: The present study indicates that manifestations of allergic diseases and incidence of sensitization to foods and inhalants are equally common in Estonian and Scandinavian children during the first 2 y of life, despite a much lower prevalence among older children and adults in Estonia.     

Randomised controlled trial of advice on an egg exclusion diet in young children with atopic eczema and sensitivity to eggs

Background: The role of exclusion diets in the management of atopic eczema in young children is uncertain. This randomised controlled trial evaluates the effect of excluding egg from the diet in young children with atopic eczema and sensitivity to eggs. Fifty-five such children were randomised either to a 4-week regimen, in which mothers were given general advice on care of eczema and additional specific advice from a dietician about an egg exclusion diet (diet group), or to a control group in which general advice only was given. Both groups continued conventional topical treatment. Disease activity was assessed by estimates of the surface area affected by eczema and by an arbitrary severity score. Possible egg sensitivity was identified by RAST before randomisation and after the trial by double-blind placebo-controlled egg challenge. Results: The mean reduction in surface area affected by eczema was significantly greater (p = 0.02) in the group receiving dietary advice (from 19.6% to 10.9% area affected) than in the control group (from 21.9% to 18.9%). A significant improvement also occurred in severity score (p=0.04): from 33.9 to 24.0 units for the diet group compared with a decrease from 36.7 to 33.5 in the control group. The study suggests that advice on the dietary exclusion of eggs is useful as part of the overall management of young children with atopic eczema and sensitivity to eggs.     

Failure of cortisone acetate therapy in 21-hydroxylase deficiency in early infancy

BACKGROUND: Pediatric endocrinologists initially treat congenital adrenal hyperplasia with either cortisone acetate (CA) or hydrocortisone (HC). Despite high doses of CA, we noted that 17-hydroxyprogesterone (17-OHP) and corticotropin were not fully suppressed in serum from neonates with 21-hydroxylase deficiency (21-OHD) until they were 40- to 80-days-old. In contrast, serum concentrations of 17-OHP were suppressed immediately by oral treatment with HC. METHODS: We sought to understand the reason for this discrepancy. Serum cortisol (F), cortisone (E), and 17-OHP were measured by radioimmunoassay or high-performance liquid chromatography in seven neonates with 21-OHD and in 118 normal subjects. From the time of diagnosis, CA was administered to four of the neonates with 21-OHD, while HC was given to the other three. RESULTS: In normal subjects serum E concentrations were greater than F during the first 2 months after birth, whereas F concentrations exceeded E after 2 months of age. Although infants receiving CA initially were given a high dose, serum F concentrations were extremely low, while 17-OHP concentrations were high until about 2 months of age. Then serum F exceeded E, and 17-OHP became fully suppressed even though infants received only a moderate dose of CA. In contrast, HC administration successfully normalized serum 17-OHP in the neonatal period. With temporary switching of neonates from HC to CA, serum F concentrations immediately decreased and 17-OHP concentrations increased. CONCLUSION: Conversion of E to F may be limited during early infancy, adversely affecting treatment with CA. Cortisone acetate may be inappropriate as a glucocorticoid replacement during early infancy in patients with 21-OHD.     

分型不明的婴幼儿糖尿病病因学探讨

目的探讨分型不明的婴幼儿糖尿病的病因。方法回顾分析2013年-2016年收治,3岁内起病的自身抗体阴性胰岛素依赖1型糖尿病(T1DM)患儿的临床资料。结果共收集19例患儿,男12例、女7例,起病年龄8个月～3岁;主要症状为乏力、消瘦、多饮、多尿;糖化血红蛋白8.6%～12%,合并酮症酸中毒14例;19例患儿的胰岛细胞抗体(ICA)、谷氨酸脱羧酶抗体(GAD65-Ab)、胰岛素抗体(IAA)均为阴性,胰岛素水平正常偏低。采用二代测序及甲基化MLPA方法检测28个糖尿病相关基因,2例患儿阳性;其中1例携带HNF1A c.1699GA,为已报道的杂合突变,来自其血糖正常的母亲;另1例携带CEL基因的c.2214delT,为尚未见报道的杂合突变,来自其空腹血糖正常的父亲。结论自身抗体阴性T1DM与单基因糖尿病之间存在交叉与重叠,二代测序对早期明确诊断有重要意义。     

The changing prevalence of asthma, allergic rhinitis and atopic eczema in African adolescents from 1995 to 2002

The prevalence of asthma and allergic disease in children has been increasing in developed countries, but there is little information on these trends in Africa. The aim of this study was to assess time trends in the symptoms of asthma, allergic rhinitis, and atopic eczema among South African adolescents. The study was carried out by comparing cross-sectional data from two International Study of Asthma and Allergies in Childhood (ISAAC phase I and phase III) questionnaire based surveys conducted 7 yr apart of self-reported symptoms in 13- to 14-yr-old adolescents. In both surveys, schools in the same geographical area in Cape Town, South Africa, were randomly selected. A school-based sample of 5178 (in 1995) and 5037 (in 2002) pupils participated. The 12-month prevalence of wheezing (16% vs. 20.3%), exercise-induced wheeze (21.5% vs. 32.5%), nocturnal cough (23.6% vs. 36.6%), sleep disturbance due to wheeze (9.6% vs. 16%), or severe wheeze (5.1% vs. 7.8%) increased significantly, as measured by the written questionnaire. A rise in asthma symptoms was confirmed by the video questionnaire responses, in which the 12-month prevalence of wheezing (6.5% vs.11.2%), exercise-induced wheeze (11.5% vs. 13.9%), nocturnal wheeze (3.9% vs. 5.3%), nocturnal cough (11.6% vs. 19.2%), or severe wheeze (5% vs. 7%) also increased significantly. There was a small increase in the percentage of children diagnosed with asthma from 1995 to 2002 (13.1% vs. 14.4%), this was not significant. The 12-month prevalence of symptoms of allergic rhinitis (30.4% vs. 38.5%), rhinoconjunctivitis (17.6% vs. 24.3%) and eczema (11.8% vs. 19.4%) also increased significantly. An increase in the prevalence of allergic symptoms occurred in girls and boys. Limitation of daily activity from nasal symptoms (22.3% vs. 37.8%) and sleep disturbance because of eczema (8.4% vs. 15.7%) increasingly affected quality of life on the quality of life. Symptoms of asthma, allergic rhinitis and atopic eczema in adolescents have increased over the past 7 yr in this geographical area. Allergic diseases are common in this group of adolescents and increasingly impair their quality of life.     

Influence of SNPs in cytokine-related genes on the severity of food allergy and atopic eczema in children

Although many single nucleotide polymorphism (SNP) studies have reported an association of atopy, allergic diseases and total serum immunoglobulin E (IgE) levels, almost all of these studies sought risk factors for the onset of these allergic diseases. Furthermore, many studies have analyzed a single gene and hardly any have analyzed environmental factors. In these analyses, the results could be masked and the effects of other genes and environmental factors may be decreased. Here, we described the correlation between four genes [interleukin (IL)-4 (C-590T), IL-4 receptor (A1652G), FCER1B (G6842A) and STAT6 (G2964A)] in connection with IgE production; the role of IL-10 (C-627A) as a regulatory cytokine of allergy; and the severity of food allergy (FA) and atopic eczema (AE) in 220 Japanese allergic children. In addition to these SNPs, environmental factors, i.e., patient's attitude, indoor environment, and so on, were also investigated in this study. Our study was retrospective, and the correlation was analyzed by our defined clinical scores divided into three terms: worst symptoms, recent symptoms and general amelioration at the most recent examination during the disease course. Our results indicated that IL-10 AA, the genotype with lower IL-10 production, is associated with higher IgE levels in the serum (p < 0.0001, estimate; 0.912). Marginal liver abnormalities were observed in the subject group with both FA and AE (p < 0.1191, estimate; 0.1490). Our defined clinical scores enabled evaluation of various aspects of disease severity. Based on the scores, while no single SNP selected in this study determined severity, the combination of the SNP with laboratory data and environmental factors appeared to determine severity.     

Atopy in Children with and without a Family History of Atopy

ABSTRACT. The influence of a family history of atopy on atopic morbidity, and relationships between diet in infancy and allergic manifestations at the ages of one and five years were prospectively studied in 91 children. A control group consisted of 72 children with no family history of atopy. At the age of one year, atopic manifestations were found in 19 % of 163 children, in 23 % of those with a family history of atopy and in 14 % of those with no such history. Skin problems were more common in children with a family history of atopy (43 %) than in the control children (19 %). Of the children with a family history of atopy, 23 % had prolonged rhinorrhoea during infancy. The corresponding figure in children with no family history of atopy was 10 %. Prolonged rhinorrhoea during infancy correlated with parental smoking only in children with a family history of atopy (47 % vs. 18 %). At the age of five years, atopic disease was found in 17 % of 128 children, 24 % of those with a family history of atopy and 9 % of those with no such history. Atopic eczema was more common in children with a family history of atopy, irrespective of the diet consumed during infancy. Atopic signs were found in about half of all the children with a family history of atopy. If atopy had been present in the family, the child usually exhibited the same manifestation. Onset of atopic manifestations was not prevented or delayed.