Food allergy and asthma morbidity in children

BACKGROUND: Coexisting food allergy and asthma is a significant problem in the pediatric population. Studies have looked at the association between food sensitization and asthma severity. It is unknown whether specific food allergies are associated with increased asthma morbidity. OBJECTIVE: We studied the independent effect that allergy to egg, milk, fish, and peanut has on the number of hospitalizations and courses of systemic steroids in children with asthma. METHODS: We performed a medical record review to evaluate the effect food allergy to egg, fish, peanut, and milk has on asthma morbidity. We reviewed the records of 201 children aged 3 months to 14 years with the diagnosis of asthma (ICD-9 codes 493.90, 493.91, and 493.92), of which 88 had coexistent food allergy. All children in the food allergy group had food-specific IgE concentrations greater than the 95% positive predictive value. We compared the rate of hospitalizations and use of systemic steroids between children with asthma and food allergies and those without coexisting food allergy using direct-entry, multiple regression analysis. Patients were adjusted for the severity of their asthma based on symptoms documented at their first visit to the allergist according to the National Asthma Education and Prevention Program guidelines and presence of environmental allergy, eczema, smoke exposure, and gastroesophageal reflux. RESULTS: Peanut and milk allergies were both associated with increased number of hospitalizations (P=0.009, 0.016), and milk allergy was associated with increased use of systemic steroids (P=0.001). CONCLUSION: Peanut and milk allergies were associated with increased hospitalization and steroid use and may serve as early markers for increased asthma morbidity.     

Food allergy as a cause of rhinitis and/or asthma.

We studied the histories of patients who had visited our Department during the last 5 years, presenting food allergy with exclusively respiratory symptoms (18.5%). We studied the correlation between IgE levels and the histamine release test and the type of food implicated. Seventy-seven percent of patients presented sensitization to one food, and 23% presented polysensitization. We found that foods such as snails and eggs have a strong predilection for the bronchial tree as the shock organ. High total IgE was found in 85.2% of patients. The histamine release test was positive in 66% of cases. We conclude that this is a highly sensitive method for the in vitro diagnosis of food allergy.     

Maternal allergen exposure as a risk factor for childhood asthma

The role of early allergen exposure has been a central focus in the effort to curtail the rising rates of allergic disease. Exposures in pregnancy have been of interest because the first signs of disease are often seen in early infancy. However, so far, strategies to avoid or reduce allergen exposure in pregnancy have had disappointing results in reducing disease. Although there is growing evidence that the fetus is exposed to allergens, this appears to be physiologic and not a risk factor for allergic disease. It is still not clear if this exposure has some role in the context of normal tolerance. Although infants who later develop allergic disease show some differences in neonatal allergen-speci.c responses, these are not consistent. Furthermore, the magnitude and frequency of responses do not correlate well with maternal allergen exposure, and it now seems likely that these responses do not re.ect true immunologic "memory." Despite this, there is accumulating evidence that a number of other exposures in pregnancy have the capacity to signi.cantly in.uence immune development and alter the risk for allergic responses to allergens. This underscores the importance of further de.ning the events in this early period, to determine causal pathways and better strategies for prevention.     

Food allergy in adolescents and adults

There has been an increase in the prevalence of food allergy in the last few decades. Adult food allergy may represent persistence of reactions that commenced in infancy and early childhood or it may be initiated in adulthood through new sensitizations. Persistence of peanut allergy is an example of the former situation. Approximately 20% of children will develop tolerance to peanuts, so there will be an increasing number of individuals reaching adulthood where this problem will need ongoing management. In addition to peanut, tree nuts, fruits, vegetables and seafood are implicated as common causes of food allergy in adulthood. Sensitization may occur directly to a food allergen or indirectly through cross-reactivity with an aeroallergen. Adults may present with a spectrum of clinical manifestations from oral allergy syndrome to fatal anaphylaxis. The management of food allergy consists of appropriate education regarding avoidance of implicated foods, modifying potential risk factors for anaphylaxis, such as asthma and prompt recognition and treatment of acute reactions.     

Blood eosinophil count as risk factor for relapse in acute asthma.

In this retrospective investigation comprising 54 adult patients included in two studies of the treatment of acute asthma, the risk of relapse was studied. The set of variables that best predicted the length of time before a new asthmatic attack comprised blood eosinophil count (P less than 0.001), FEV1 on arrival (P less than 0.001) and increased medication on discharge (P less than 0.01). The set of variables that best predicted the number of new attacks during a period of 1 yr consisted of eosinophil count (P less than 0.001), FEV1 (P less than 0.001), increased medication on discharge, age and breathing rate on arrival (P less than 0.05). Patients with an eosinophil count of more than 500 x 10(6) l-1 and a FEV1 of less tha 1.0 l ran a six-fold greater risk of returning with a new attack within 1 month than patients with lower eosinophil count and higher FEV1. No significant correlation was found between post-treatment PEF variation and relapse in acute asthma.     

Perception of asthma as a factor in career choice among young adults with asthma

BACKGROUND/AIM:

Asthma is a common chronic condition that can be aggravated by workplace exposures. Young adults with asthma should know how their future occupation might affect their asthma, and potentially, their quality of life. The aim of the present study was to assess the awareness of young adults to occupational risks for asthma and high-risk occupations, as well as their perception of the role of asthma in career choice.

METHODS:

Young adults 16 to 22 years of age with reported physician-diagnosed asthma were recruited to complete a questionnaire eliciting information regarding asthma control, career choice and awareness of occupational exposure risks.

RESULTS:

A small majority of the study cohort (56.4%) could identify occupations that cause or exacerbate asthma, and 34.7% indicated that asthma was an important factor in their career plans. Family physicians were most responsible for asthma management (80.2%), but young adults were more likely to discuss asthma and career plans with their parents (43.6%) or friends (29.7%) than with their family physician (13.9%; P<0.001).

CONCLUSION:

Young adults with asthma have suboptimal awareness of potential work-related asthma risks. Family physicians most commonly provide asthma care to these young adults. However, few young adults are talking to their family physicians about career choices and asthma. This observation represents an area of asthma care that needs to be explored in young adults with asthma.     

Is month of birth a risk factor for subsequent development of pollen allergy in adults?

A comparison of the date of birth of 1501 adult patients with severe seasonal respiratory allergy (allergic rhinitis or bronchial asthma) due to parietaria, olive, and grass pollens with the expected births within 2,020,420 births in South Greece during the same period, was performed. The relative risk for developing respiratory allergy was characteristically increased in those born in a specific period of time different for each pollen. The relative risk for parietaria was increased (1.47) in those born in March; for olive it was 1.6 for May; 1.2 for April; and 1.4 for March, while the relative risk for grasses was 1.2 in those born in June and July. These findings are indicative of the importance of the month of birth; that is, the early exposure to pollens, for the development of respiratory allergy to certain pollens during adulthood. Because our findings do not directly correlate completely with the aerobiology studies on pollen calculation in Athens' atmosphere, we supposed that other environmental factors, e.g., the local intensity of the first pollination or the influence of weather conditions, may contribute to the final development of respiratory allergy as well. The most impressive finding was the significant influence of the month of birth in the development of respiratory allergy due to parietaria and olive pollens during adulthood.     

Preclinical disability as a risk factor for falls in community-dwelling older adults

BACKGROUND: Falls are common and serious problems in older adults. The goal of this study was to examine whether preclinical disability predicts incident falls in a European population of community-dwelling older adults. METHODS: Secondary data analysis was performed on a population-based longitudinal study of 1644 community-dwelling older adults living in London, U.K.; Hamburg, Germany; Solothurn, Switzerland. Data were collected at baseline and 1-year follow-up using a self-administered multidimensional health risk appraisal questionnaire, including validated questions on falls, mobility disability status (high function, preclinical disability, task difficulty), and demographic and health-related characteristics. Associations were evaluated using bivariate and multivariate logistic regression analyses. RESULTS: Overall incidence of falls was 24%, and increased by worsening mobility disability status: high function (17%), preclinical disability (32%), task difficulty (40%), test-of-trend p <.003. In multivariate analysis adjusting for other fall risk factors, preclinical disability (odds ratio [OR] = 1.7, 95% confidence interval [CI], 1.1-2.5), task difficulty (OR = 1.7, 95% CI, 1.1-2.6) and history of falls (OR = 4.7, 95% CI, 3.5-6.3) were the strongest significant predictors of falls. In stratified multivariate analyses, preclinical disability equally predicted falls in participants with (OR = 1.7, 95% CI, 1.0-3.0) and without history of falls (OR = 1.8, 95% CI, 1.1-3.0). CONCLUSIONS: This study provides longitudinal evidence that self-reported preclinical disability predicts incident falls at 1-year follow-up independent of other self-reported fall risk factors. Multidimensional geriatric assessment that includes preclinical disability may provide a unique early warning system as well as potential targets for intervention.     

Food allergy to wheat flour in adults

Wheat flour is a basic foodstuff. Food allergy has been especially described in children, in the form of atopic dermatitis. Food allergy in adults is rare and especially described in the form of anaphylactic shock sometimes induced by effort. Four observations of adult food allergy are presented. The IgE dependent mechanism is documented. The positive oral provocation tests needed doses of 17 to 30 grams. One crossed sensitivity between rye and barley was seen. The major allergen was probably gluten, particularly gliadines. Sensitization was probably due to prolonged inhalation of wheat flour. The authors stress the possibility of food allergy to wheat flour by other mechanisms, the difficulty of diagnosis, needed for a diet without cereal and gluten that is now non reimbursable.     

Chronic obstructive pulmonary disease as a risk factor for cardiovascular morbidity and mortality

Chronic obstructive pulmonary disease and other disorders, associated with reduced lung function, are strong risk factors for cardiovascular events, independent of smoking. Overall, when the lowest quintile of lung function, as measured by FEV1 is compared with the highest quintile, the risk of cardiovascular mortality increases by approximately 75% in both men and women. Having symptoms of chronic bronchitis alone increases the risk of coronary deaths by 50%. Reduced ratio of FEV1 to FVC by itself is a modest independent risk factor for coronary events, increasing the risk by 30%. However, if patients have ventricular arrhythmias, the risk of coronary events is increased twofold, suggesting that the cardiotoxic effects of obstructive airways disease are amplified in those who have underlying cardiac rhythm disturbances. In general, for every 10% decrease in FEV1, all-cause mortality increases by 14%, cardiovascular mortality increases by 28%, and nonfatal coronary event increases by almost 20%. These data indicate that chronic obstructive pulmonary disease is a powerful, independent risk factor for cardiovascular morbidity and mortality.     

Hand eczema as a risk factor for food allergy among occupational kitchen workers

Background

An increasing number of studies in children is highlighting the importance of transdermal routes of exposure to food allergens through damaged skin in the pathogenesis of food allergies. However, data on this in adults are limited. A few case-series studies has documented development of food allergy among kitchen workers with hand eczema after direct contact exposure to foods.

Atopy as a risk factor for the development of asthma in young recruits

Objective: Asthma is one of the most common chronic diseases globally. Atopy, and especially allergic rhinitis (AR), was found as an important risk factor for asthma. The purpose of this study was to examine the association between different atopic parameters and military professions to the incidence of asthma. Methods: In a retrospective study, we included 128?591 Israel Defense Forces soldiers drafted between the mid-nineties to the early-2000s. We examined the incidence rates of asthma in relation to atopic background and to military profession. Results: The relative risk (RR) for the development of asthma in persons with a history of AR and the RR for asthma in atopics vs. nonatopics was 1.86 (95% CI: 1.57–2.21) and 1.73 (95% CI: 1.47–2.04), respectively. The RR for the development of asthma in persons with a history of AR was higher in Combat Units (CU) and Administrative and Driving units (ADU) (RR?=?2.80; 95% CI: 2.09–3.76 and RR?=?1.58; 95% CI: 1.19–2.12, respectively) than in Maintenance Units (MU) (RR?=?1.27; 95% CI: 0.93–1.74). When comparing the risk for asthma amongst persons with AR, we found it lower in MU compared to ADU (RR?=?0.65; 95% CI: 0.43–0.97). In atopics vs. non-atopics, the risk for asthma was higher in ADU as compared to other occupations. Conclusions: Atopy, particularly AR, is a risk factor for the development of new-onset asthma in young adults. Atopy has the highest significant effect in CU where the physical demands are higher.     

Country of birth as a risk factor for asthma among Mexican Americans

In the United States, among Hispanics, Mexican Americans have the lowest rate of asthma. However, this population includes Mexican Americans born in the United States and in Mexico, and risk factors that might impact the prevalence of asthma differ between these groups. To determine the prevalence of and risk factors for asthma among U.S.- and Mexican-born Mexican Americans, we analyzed data from two U.S. surveys that included 4,574 persons who self-reported their ethnicity as Mexican American from the Third National Health and Nutrition Examination Survey (NHANES III) 1998-1994 and 12,980 persons who self-reported their ethnicity as Mexican American from National Health Interview Survey (NHIS) 1997-2001. U.S.-born Mexican Americans were more likely than Mexican-born Mexican Americans to report ever having asthma in both the NHANES III (7% [SE 0.5] vs. 3% [SE 0.3], p < 0.001) and NHIS surveys (8.1% [0.4] vs. 2.5% [0.2], p < 0.001). In a multivariate regression model controlling for multiple demographic variables and health care, the risk for asthma was higher among U.S.-born Mexicans in NHANES III (odds ratio 2.1, 95% confidence interval 1.4-3.3) and NHIS (odds ratio 2.7, 95% confidence interval 1.6-5.5). In conclusion, the prevalence of asthma was higher in U.S.-born than in Mexican-born Mexican Americans. This finding highlights the importance of environmental exposures in developing asthma in a migratory population.     

Parental intermittent claudication as risk factor for claudication in adults

Little is known about the familial aggregation of intermittent claudication (IC). Our objective was to examine whether parental IC increased the risk of IC in adult offspring, independent of the established cardiovascular risk factors. We evaluated the Offspring Cohort Participants of the Framingham Heart Study who were ≥30 years old, cardiovascular disease free, and had both parents enrolled in the Framingham Heart Study (n = 2,970 unique participants, 53% women). Pooled proportional hazards regression analysis was used to examine whether the 12-year risk of incident IC in offspring participants was associated with parental IC, adjusting for age, gender, diabetes, smoking, systolic blood pressure, total cholesterol, high-density lipoprotein cholesterol, and antihypertensive and lipid treatment. Of the 909 person-examinations in the parental IC history group and 5,397 person-examinations in the no-parental IC history group, there were 101 incident IC events (29 with parental IC history and 72 without a parental IC history) during follow-up. The age- and gender-adjusted 12-year cumulative incidence rate per 1,000 person-years was 5.08 (95% confidence interval [CI] 2.74 to 7.33) and 2.34 (95% CI 1.46 to 3.19) in participants with and without a parental IC history. A parental history of IC significantly increased the risk of incident IC in the offspring (multivariable adjusted hazard ratio 1.81, 95% CI 1.14 to 2.88). The hazard ratio was unchanged, with an adjustment for the occurrence of cardiovascular disease (hazard ratio 1.83, 95% CI 1.15 to 2.91). In conclusion, IC in parents increases the risk of IC in adult offspring, independent of the established risk factors. These data suggest a genetic component of peripheral artery disease and support future research into genetic causes.     

Environmental exposure to Toxocara as a possible risk factor for asthma: a clinic-based case-control study.

The zoonotic ascarid Toxocara has been suggested as a possible etiologic agent of asthma. We conducted a clinic-based case-control study to examine whether the zoonotic infection acquired by ingesting Toxocara eggs is associated with asthma in children. Blood samples were collected from children aged 2-15 years, 95 of whom had asthma and 229 of whom did not have asthma. Risk factors for asthma and Toxocara infection were assessed by a questionnaire given to each child's parent or legal guardian. Blood samples were tested for the presence of Toxocara antibodies, using an enzyme-linked immunosorbent assay. No significant association was found between Toxocara infection and asthma. Significant associations were found between asthma and risk factors and between Toxocara infection and risk factors. High prevalence of Toxocara infection was noted among Hispanic children of Puerto Rican descent.     

Diabetes mellitus as a risk factor for hip fracture in mexican american older adults

BACKGROUND: Hip fracture in older adults is a significant medical, social, and economic concern to society. Little is known regarding diabetes as a risk factor for hip fracture in the Mexican American population. The objective of this study was to examine diabetes and other potential risk factors for hip fracture in a sample of community-dwelling, older, Mexican American adults. METHODS: The study was a prospective cohort design involving the Hispanic Established Population for the Epidemiologic Study of the Elderly, a longitudinal study involving a weighted probability sample of Mexican American adults (>65 years) living in the southwestern United States. Included in the study were 3050 older Mexican American subjects who were originally interviewed and tested at baseline and then followed with reassessment at 2, 5, and 7 years. Incidence of hip fracture was examined for subjects over 7-year follow-up. RESULTS: At baseline, 690 subjects were identified with diabetes. One hundred and thirty-four subjects experienced a first-time hip fracture during follow-up. Cox proportional hazard regression revealed an increased hazard ratio for hip fracture in subjects with diabetes compared to those without diabetes (hazard ratio = 1.57, 95% confidence interval [CI(95)] = 1.03, 2.39, p <.04) when adjusted for age, body mass index, smoking, and previous stroke. The hazard ratio for Mexican Americans taking insulin was 2.84 (CI(95) = 1.49, 5.43, p <.002) when adjusted for covariates. CONCLUSIONS: We found diabetes was associated with increased risk for a hip fracture in older Mexican Americans, particularly subjects taking insulin. Diabetes has not previously been considered a risk factor for hip fracture in older adults. The high incidence of type 2 diabetes in the Mexican American population highlights the need for increased research on risk factors in this ethnic group.