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- Kalm-Stephens, Pia, 1959-
(författare)
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Development of allergic and respiratory symptoms in adolescence and early adulthood : Risk factors and gender differences
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Asthma and allergic diseases have increased in prevalence for several decades and affect a substantial number of individuals in everyday life, as well as their families and public healthcare resources. Subjects with asthma report impaired self-rated health. Fractional exhaled nitric oxide (FeNO) is a marker of type 2 inflammation in the airways and higher levels may precede the development of allergic and respiratory disease.Aims: To investigate the development of allergic and respiratory symptoms in adolescence and early adulthood, and related baseline risk factors. Further, to study self-rated health in young adults with reported asthma.Methods: A total of 959 schoolchildren completed a standardized respiratory questionnaire and underwent lung function and FeNO measurements at baseline (12–15 years; early adolescence). Four (late adolescence) and sixteen (early adulthood) years later, 921 (96%) and 502 (52%) of these individuals completed a similar questionnaire. A total of 491 subjects participated in all three examinations. Nineteen clinically assessed non-asthmatic subjects with elevated FeNO and 28 control subjects with low FeNO and without symptoms of asthma or allergy in early adolescence were identified. Their FeNO, IgE sensitization, airway responsiveness, and inflammatory markers in blood and sputum were measured.Results: The main finding was that higher FeNO in early adolescence was associated with an increased risk of developing allergic symptoms to cat and dog, but not pollen allergens, during adolescence. Gender-stratified data showed that obesity at baseline in girls and an atopic constitution in boys were associated with increased risk of developing wheeze during adolescence. The prevalence of asthma and wheeze had increased in early adulthood, but the increase was significant only in females. Reduced lung function at baseline in females and higher FeNO in males were associated with an increased risk of incident asthma sixteen years later. The increase in allergic symptoms during this period was significant but without sex differences. Asthmatic females rated their health worse than non-asthmatic females, a difference not observed in males. Non-asthmatic adolescents with higher FeNO at baseline were to a higher extent sensitized, had more reactive airways, higher blood eosinophil counts, and lower systemic activation of neutrophils, compared with controls.Conclusions: It is important to detect risk factors for the development of allergic and respiratory diseases at an early stage to optimize health and wellbeing. Gender differences in respiratory development, associated risk factors, and treatment of respiratory symptoms must be taken into account.
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| 2. |
- Kalm-Stephens, Pia, 1959-, et al.
(författare)
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Different baseline characteristics are associated with incident wheeze in female and male adolescents
- 2020
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Ingår i: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 109, s. 2324-2331
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To investigate the independent relationships between baseline characteristics and incident wheeze in adolescents, with particular regard to gender.METHODS: Adolescents (N = 959), aged 12-15 years, answered a standardised respiratory questionnaire and underwent height and weight measurements at baseline. Four years later, 96% of the subjects completed a similar questionnaire. The present study included the adolescents without self-reported wheeze at baseline (n = 795; 394 girls).RESULTS: The proportion of adolescents with obesity was higher among subjects with incident wheeze than among subjects who never reported wheeze: 19.1% vs 8.3%. When stratifying for gender, this difference was only found in girls. In stepwise logistic regression models (odds ratios [95% confidence interval]), obesity (2.84 [1.17-6.86]) and rhinitis (3.04 [1.53-6.03]) at baseline and current smoking (2.60 [1.16-5.82]) at follow-up were associated with incident wheeze in girls. For boys, FEV1 <-1.65 standard deviation (3.20 [1.04-9.79]), family asthma (3.16 [1.46-6.86]) and seasonal allergic symptoms (5.61 [2.56-12.27]) at baseline were independently associated with incident wheeze.CONCLUSION: Data stratified by gender showed that obesity in girls and an atopic constitution in boys were independently associated with increased risk of developing wheeze within four years.
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| 3. |
- Kalm-Stephens, Pia, et al.
(författare)
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Elevated exhaled nitric oxide in adolescents is associated with incident allergic symptoms : a prospective cohort study
- 2019
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Ingår i: Journal of investigational allergology & clinical immunology. - : ESMON Publicidad. - 1018-9068 .- 1698-0808. ; 29:3, s. 231-238
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Tidskriftsartikel (refereegranskat)abstract
- Background: The fraction of exhaled nitric oxide (FeNO) is a marker of type-2 inflammation in the airways and elevated FeNO may precede development of allergic disease. The aim of the present study was to investigate the association between elevated FeNO and the development of allergic symptoms.Methods: A total of 959 adolescents from a general population answered, together with their parents, a standardized questionnaire, performed lung function and FeNO measurements at a baseline visit. Four years later, 921 of these subjects (96%) completed a to a great extent same version of the baseline questionnaire.Results: Adolescents with self-reported incident allergic symptoms to cat (n = 50) or dog (n = 33) had higher baseline FeNO (p < 0.001) than subjects without allergic symptoms to cat and dog at either time point (n = 776 and n = 838, respectively). Adolescents with incident allergic symptoms to pollen did not have elevated baseline FeNO. The adjusted odds ratio [aOR (95% confidence interval)] for incident allergic symptoms to cat was 4.2 (2.2, 8.0) times higher if FeNO was > 75th percentile (vs. < 75th percentile) at baseline. This was consistent after exclusion of subjects with reported asthma, wheeze or rhinitis at baseline [aOR (95% CI) 8.6 (3.0, 24.1)].Conclusion: Elevated FeNO in adolescents related to an increased risk of developing allergic symptoms to cat and dog, but not pollen allergens, within four years.
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| 4. |
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| 5. |
- Neuman, Åsa
(författare)
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Asthma and IgE-reactivity in childhood : risk factors and consequences
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Many children have asthma-like wheezing symptoms during their first years of life, yet only a minority develop asthma. Attempts to identify wheezing children at increased risk of asthma have been conducted, but the value for the clinician has been limited. The risk of developing asthma is influenced already in utero if the foetus is exposed to maternal tobacco smoke, but prior studies have not been able to differentiate pre- and postnatal smoke exposure effects. Conversely, the role of foetal or early postnatal smoke exposure for the risk of allergic sensitization in childhood is still under debate. It has been suggested that allergies may play a role in the pathogenesis of recurrent abdominal pain due to a mutual immunologic origin. Previous studies investigating potential associations between allergy-like symptoms, IgE-reactivity and abdominal pain have shown contradictory results. The aim of the epidemiological studies in this thesis were to contribute to the knowledge on the role of pre- and early postnatal tobacco smoke exposure for the development of asthma and aeroallergen sensitization in children. We also explored which clinical risk factors and comorbidities to wheezing in infancy that were associated with having asthma at school age. Moreover, associations between allergy-related symptoms and IgE-reactivity during childhood and recurrent abdominal pain at age 12 years were investigated. The results regarding risks of tobacco smoke exposure were based on data from eight European birth cohorts consisting of a total of 32,774 children. The studies on wheeze and school age asthma as well as allergy-related symptoms and abdominal pain were based on data from the population-based Swedish birth cohort BAMSE consisting of 4,089 children. In study I we showed that among the children that wheezed at least once during their first two years of life, the risk of school age asthma was almost fourfold. Allergic heredity, increased severity of wheeze, infant eczema and recurrent abdominal pain were independent risk factors for having asthma at age eight years. In study II, maternal tobacco smoking during pregnancy was associated with an increased risk of wheeze or asthma in preschool children even among the children that had not been exposed late in pregnancy or after birth. We observed no convincing associations between early second hand tobacco smoke exposure and sensitization to pets, house dust mite, pollen or all aeroallergens combined in preschool or school age in study III. In study IV all allergy-related diseases at the age of 12 years were associated with recurrent abdominal pain at the same age. Moreover, food sensitization and food allergy at age four or eight years were also associated with recurrent abdominal pain at age 12 years. The results of this thesis consolidate previous knowledge regarding early factors associated with childhood asthma development. The significant association between allergy-related diseases and recurrent abdominal pain supports the hypothesis of a mutual immunologic pathway. The knowledge that maternal smoking during pregnancy is associated with wheeze and asthma in preschool children, even if they were not exposed late in pregnancy or after birth, should be used to motivate women not to start smoking or to quit before conceiving to prevent asthma in their children.
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| 6. |
- Neuman, Åsa, et al.
(författare)
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Dyspnea in relation to symptoms of anxiety and depression : A prospective population study
- 2006
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Ingår i: Respiratory Medicine. - : Elsevier BV. - 0954-6111 .- 1532-3064. ; 100:10, s. 1843-1849
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Tidskriftsartikel (refereegranskat)abstract
- Background: Respiratory symptoms are related to anxiety and depression in several cross-sectional studies but the association has not been explored in longitudinal studies. Study objectives: To prospectively study the change in dyspnea in relation to symptoms of anxiety and depression over a 9-year time period. Methods: The study comprised of 515 adults from a population sample who had participated in the European Commission Respiratory Health Survey (ECRHS) I in 1991-1992 and in the ECRHS II in 1999-2000. The questionnaire included a modified British Medical Research Council Scale for dyspnea grading and the Hospital Anxiety and Depression scale questionnaire. Results: The prevalence of dyspnea was 10.7% in the first and 12.6% in the second survey. Symptoms of depression was an independent determinants for dyspnea in both surveys (OR (95% CI) 3.72 (1.51-9.17) and 3.40 (1.49-7.80), respectively). In subjects that did not have dyspnea at the first survey onset of symptoms of anxiety (OR 3.53 (1.03-12.1)) and depression (OR 12.2 (3.97-37.5)) were significantly related to having dyspnea at the second survey, whereas onset of dyspnea was not significantly associated with developing symptoms of anxiety or depression when each disorder was entered separately. Conclusion: Our data indicates that there is a causal relationship between development of symptoms of anxiety and depression and dyspnea. Psychological status is therefore an important factor to consider both when evaluating the results of epidemiological respiratory studies and in clinical settings when treating patients that have dyspnea.
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| 7. |
- Neuman, Åsa, et al.
(författare)
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Infant wheeze, comorbidities and school age asthma
- 2014
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Ingår i: Pediatric Allergy and Immunology. - : Wiley. - 0905-6157 .- 1399-3038. ; 25:4, s. 380-386
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Tidskriftsartikel (refereegranskat)abstract
- Background: Factors associated with early onset of wheeze have been described, but there is limited knowledge on which of these infant wheezers who will have developed asthma in school age. The aim was to identify clinical risk factors for asthma in the 8-yr-old children that wheezed during infancy in a population-based setting. Methods: Three thousand two hundred and fifty-one children from a population-based birth cohort followed prospectively from infancy until age 8 yr were included in the study. Data were analyzed using multivariate logistic regression analysis. Results: Parents reported any wheeze episode before age 2 yr in 823 subjects (25%). Infant wheezers had an almost fourfold risk of asthma at age 8 [adjusted odds ratio (aOR) 3.68, 95% CI 2.74-4.96], equivalent to an asthma prevalence of 14% compared with 4% among non-wheezers (p < 0.001). After adjustments for sex, exposure to tobacco smoke and indoor dampness/mould, allergic heredity (aOR 1.53, 95% CI 1.02-2.30), increased frequency of wheeze (aOR 3.41, 95% CI 2.09-5.56 for children with >= 3 episodes compared with <= 2 episodes during the first 2 yr of life), infant eczema (aOR 2.31, 95% CI 1.52-3.49), and recurrent abdominal pain (aOR 2.33, 95% CI 1.30-4.16) remained risk factors for school age asthma in the infant wheezing group. Conclusions: Among infant wheezers, allergic heredity, increased severity of wheeze, infant eczema, and recurrent abdominal pain were independent risk factors for asthma at age 8 yr. Among children with three or four of these risk factors, 38% had asthma at school age.
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| 8. |
- Neuman, Åsa, et al.
(författare)
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Maternal Smoking in Pregnancy and Asthma in Preschool Children A Pooled Analysis of Eight Birth Cohorts
- 2012
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Ingår i: American Journal of Respiratory and Critical Care Medicine. - 1073-449X .- 1535-4970. ; 186:10, s. 1037-1043
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Tidskriftsartikel (refereegranskat)abstract
- Rationale: Although epidemiological studies suggest that exposure to maternal smoking during fetal and early life increases the risk of childhood wheezing and asthma, previous studies were not able to differentiate the effects of prenatal from postnatal exposure. Objectives: To assess the effect of exposure to maternal smoking only during pregnancy on wheeze and asthma among preschool-age children. Methods: A pooled analysis was performed based on individual participant data from eight European birth cohorts. Cohort-specific effects of maternal smoking during pregnancy, but not during the first year, on wheeze and asthma at 4 to 6 years of age were estimated using logistic regression and then combined using a random effects model. Adjustments were made for sex, parental education, parental asthma, birth weight, and siblings. Measurements and Main Results: Among the 21,600 children included in the analysis, 735 children (3.4%) were exposed to maternal smoking exclusively during pregnancy but not in the first year after birth. In the pooled analysis, maternal smoking only during pregnancy was associated with wheeze and asthma at 4 to 6 years of age, with adjusted odds ratios of 1.39 (95% confidence interval, 1.08-1.77) and 1.65 (95% confidence interval, 1.18-2.31), respectively. The likelihood to develop wheeze and asthma increased statistically significantly in a linear dose-dependent manner in relation to maternal daily cigarette consumption during the first trimester of pregnancy. Conclusions: Maternal smoking during pregnancy appears to increase the risk of wheeze and asthma among children who are not exposed to maternal smoking after birth.
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| 9. |
- Olen, O., et al.
(författare)
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Allergy-related diseases and recurrent abdominal pain during childhood - a birth cohort study
- 2014
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Ingår i: Alimentary Pharmacology & Therapeutics. - : Wiley. - 0269-2813 .- 1365-2036. ; 40:11, s. 1349-1358
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundAllergy and immune dysregulation may have a role in the pathophysiology of recurrent abdominal pain of functional origin, but previous studies of allergy-related diseases and abdominal pain have contradictory results. AimTo examine the association between allergy-related diseases or sensitisation during childhood and abdominal pain at age 12years. MethodsIn this birth cohort study of 4089 children, parents answered questionnaires regarding asthma, allergic rhinitis, eczema and food hypersensitivity (allergy-related diseases') at ages 0,1,2,4,8 and 12years. Blood for analyses of allergen-specific IgE was sampled at 4 and 8years. At 12years, the children answered questions regarding abdominal pain. Children with coeliac disease or inflammatory bowel disease were excluded. Associations were examined using multivariable logistic regression. ResultsAmong 2610 children with complete follow-up, 9% (n=237) reported abdominal pain at 12years. All allergy-related diseases were associated with concurrent abdominal pain at 12years and the risk increased with increasing number of allergy-related diseases (P for trend <0.001). Asthma at 1 and 2years and food hypersensitivity at 8years were significantly associated with abdominal pain at 12years. There was an increased risk of abdominal pain at 12years in children sensitised to food allergens at 4 or 8years, but in stratified analyses, this was confined to children whose parents had not reported food hypersensitivity at time of sensitisation. ConclusionAllergy-related diseases as well as sensitisation to food allergens were associated with an elevated risk of abdominal pain, and the risk increased with the number of allergy-related diseases.
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