| 1. |
- Bengtsson, Caroline, et al.
(författare)
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Chronic rhinosinusitis impairs sleep quality : results of the GA(2)LEN study
- 2017
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Ingår i: Sleep. - : Oxford University Press. - 0161-8105 .- 1550-9109. ; 40:1
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Tidskriftsartikel (refereegranskat)abstract
- STUDY OBJECTIVES: To analyse the prevalence of sleep problems in subjects with CRS and to determine whether the disease severity of CRS affects sleep quality.METHODS: Questionnaires were sent to a random sample of 45 000 adults in four Swedish cities. Questions on CRS, asthma, allergic rhinitis, co-morbidities, tobacco use, educational level and physical activity were included. CRS was defined according to the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) epidemiological criteria. The disease severity of CRS was defined by the number of reported CRS symptoms. Sleep quality was assessed using the Basic Nordic Sleep Questionnaire.RESULTS: Of the 26 647 subjects, 2249 (8.4%) had CRS. Reported sleep problems were 50-90% more common among subjects with CRS compared with those without or the total population. The prevalence of reported sleep problems increased in conjunction with the severity of CRS. After adjusting for gender, BMI, age, tobacco use, asthma, somatic diseases, physical activity level and educational level, participants with four symptoms of CRS (compared with subjects without CRS symptoms) displayed a higher risk of snoring (adj. OR (95% CI): 3.13 (2.22-4.41)), difficulties inducing sleep (3.98 (2.94-5.40)), difficulties maintaining sleep (3.44 (2.55-4.64)), early morning awakening (4.71 (3.47-6.38)) and excessive daytime sleepiness (4.56 (3.36-6.18)). The addition of persistent allergic rhinitis to CRS further increased the risk of sleep problems.CONCLUSIONS: Sleep problems are highly prevalent among subjects with CRS. The disease severity of CRS negatively affects sleep quality.
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| 2. |
- Bjerg, Anders, et al.
(författare)
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Increased Prevalence of Symptoms of Rhinitis but Not of Asthma between 1990 and 2008 in Swedish Adults : Comparisons of the ECRHS and GA(2)LEN Surveys
- 2011
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Ingår i: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 6:2, s. e16082-
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Tidskriftsartikel (refereegranskat)abstract
- Background: The increase in asthma prevalence until 1990 has been well described. Thereafter, time trends are poorly known, due to the low number of high quality studies. The preferred method for studying time trends in prevalence is repeated surveys of similar populations. This study aimed to compare the prevalence of asthma symptoms and their major determinants, rhinitis and smoking, in Swedish young adults in 1990 and 2008. Methods: In 1990 the European Community Respiratory Health Survey (ECRHS) studied respiratory symptoms, asthma, rhinitis and smoking in a population-based sample (86% participation) in Sweden. In 2008 the same symptom questions were included in the Global Allergy and Asthma European Network (GA(2)LEN) survey (60% participation). Smoking questions were however differently worded. The regions (Gothenburg, Uppsala, Umea) and age interval (20-44 years) surveyed both in 1990 (n = 8,982) and 2008 (n = 9,156) were analysed. Results: The prevalence of any wheeze last 12 months decreased from 20% to 16% (p<0.001), and the prevalence of "asthma-related symptoms" was unchanged at 7%. However, either having asthma attacks or using asthma medications increased from 6% to 8% (p<0.001), and their major risk factor, rhinitis, increased from 22% to 31%. Past and present smoking decreased. Conclusion: From 1990 to 2008 the prevalence of obstructive airway symptoms common in asthma did not increase in Swedish young adults. This supports the few available international findings suggesting the previous upward trend in asthma has recently reached a plateau. The fact that wheeze did not increase despite the significant increment in rhinitis, may at least in part be due to the decrease in smoking.
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| 3. |
- Golding, Michael A., et al.
(författare)
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A scoping review of the caregiver burden of pediatric food allergy
- 2021
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Ingår i: Annals of Allergy, Asthma & Immunology. - : Elsevier. - 1081-1206 .- 1534-4436. ; 127:5, s. 536-
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Tidskriftsartikel (refereegranskat)abstract
- Objective While a number of papers have described the psychosocial impact of raising a child with a food allergy, recent attempts at synthesizing this literature have been narrow in focus and/or methodologically limited. Consequently, the current study aimed to synthesize both the quantitative and qualitative literature in order to achieve a better understanding of the psychosocial and financial burdens faced by families raising children with food allergy.Data Sources Searches were performed on PubMed, Scopus, PsycInfo and CINAHL for articles related to the psychosocial and financial burden experienced by individuals caring for a child with food allergy.Study Selections English language, original research articles were included in the current review.Results A total of 53 articles were deemed eligible for review. Results from the quantitative literature revealed that parents of children with food allergy (i.e., food allergy and food protein-induced enterocolitis, proctocolitis, and enteropathy) consistently reported lower QoL relative to their comparison groups. Within-group analyses suggest that this burden is increased for parents managing multiple food allergies, severe food allergy, and comorbid allergic conditions. Thematic synthesis of the qualitative literature suggests that the psychosocial burden shouldered by parents of children with food allergy stems, in part, from the unpredictable threat of exposure as well as the practical and social burdens of managing a food allergy. In addition to psychosocial burdens, a small but growing body of literature suggests that families with food allergy also incur greater financial costs.Conclusion Findings suggest that pediatric food allergy imposes considerable burdens on parents both quantitatively and qualitatively.
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| 4. |
- Golding, Michael A., et al.
(författare)
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The burden of food allergy on children and teens : A systematic review
- 2022
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Ingår i: Pediatric Allergy and Immunology. - : John Wiley & Sons. - 0905-6157 .- 1399-3038. ; 33:3
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Forskningsöversikt (refereegranskat)abstract
- Background Over the last two decades, researchers have placed increasing attention on understanding how food allergy affects the health-related quality of life (HRQL) and psychosocial well-being of children and teens. In response, a number of reviews have been published that aim at synthesizing the literature. However, many of these papers focus narrowly on HRQL or suffer from methodological limitations.Method The current review aims to fill this gap by providing a comprehensive overview of the burden of pediatric food allergy by synthesizing the quantitative and qualitative literature.Results Findings from the present review provide evidence of reduced HRQL among children and teens with food allergy, particularly older children and those with more severe manifestations of the condition. In comparison to HRQL, the link between food allergy and psychosocial functioning is less clear; however, some evidence can be cited linking food allergy to greater levels of psychological distress. Qualitative evidence suggests that the burden of pediatric food allergy largely stems from worries surrounding exposures outside of the home and the social consequences of the condition. The current review also highlights several gaps in the literature, including a paucity of longitudinal research, research focused on predictors of psychological distress among children and teens with food allergy as well as a dearth of studies comparing rates of bullying in food-allergic and non-food-allergic samples.Conclusion More emphasis should be placed on not only alleviating the social and psychological consequences of food allergy, but also on identifying and assisting those most acutely burdened by the condition.
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| 5. |
- Jansson, Sven-Arne, et al.
(författare)
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Health-related quality of life, assessed with a disease-specific questionnaire, in Swedish adults suffering from well-diagnosed food allergy to staple foods
- 2013
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Ingår i: Clinical and Translational Allergy. - : Wiley. - 2045-7022. ; 3:21
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundOur aim was to investigate the factors that affect health related quality of life (HRQL) in adult Swedish food allergic patients objectively diagnosed with allergy to at least one of the staple foods cow’s milk, hen’s egg or wheat. The number of foods involved, the type and severity of symptoms, as well as concomitant allergic disorders were assessed.MethodsThe disease-specific food allergy quality of life questionnaire (FAQLQ-AF), developed within EuroPrevall, was utilized. The questionnaire had four domains: Allergen Avoidance and Dietary Restrictions (AADR), Emotional Impact (EI), Risk of Accidental Exposure (RAE) and Food Allergy related Health (FAH). Comparisons were made with the outcome of the generic questionnaire EuroQol Health Questionnaire, 5 Dimensions (EQ-5D). The patients were recruited at an outpatient allergy clinic, based on a convincing history of food allergy supplemented by analysis of specific IgE to the foods in question. Seventy-nine patients participated (28 males, 51 females, mean-age 41 years).ResultsThe domain with the most negative impact on HRQL was AADR, assessing the patients’ experience of dietary restrictions. The domain with the least negative impact on HRQL was FAH, relating to health concerns due to the food allergy. One third of the patients had four concomitant allergic disorders, which had a negative impact on HRQL. Furthermore, asthma in combination with food allergy had a strong impact. Anaphylaxis, and particularly prescription of an epinephrine auto-injector, was associated with low HRQL. These effects were not seen using EQ-5D. Analyses of the symptoms revealed that oral allergy syndrome and cardiovascular symptoms had the greatest impact on HRQL. In contrast, no significant effect on HRQL was seen by the number of food allergies.ConclusionsThe FAQLQ-AF is a valid instrument, and more accurate among patients with allergy to staple foods in comparison to the commonly used generic EQ-5D. It adds important information on HRQL in food allergic adults. We found that the restrictions imposed on the patients due to the diet had the largest negative impact on HRQL. Both severity of the food allergy and the presence of concomitant allergic disorders had a profound impact on HRQL.
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| 6. |
- Kisiel, Marta, 1984-, et al.
(författare)
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Risk Factors for the Absence of Diagnosis of Asthma Despite Disease Symptoms : Results from the Swedish GA2LEN Study
- 2022
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Ingår i: Journal of Asthma and Allergy. - : Dove Press. - 1178-6965. ; 15, s. 179-186
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Tidskriftsartikel (refereegranskat)abstract
- Background: Asthma is a common chronic disease presenting with airway symptoms such as wheezing, chest tightness and attacks of breathlessness. Underdiagnosis of asthma is common and correlates to negative outcomes such as a lower quality of life and reduced work capacity.Purpose: This study aims to identify factors for not being diagnosed with asthma if presenting with asthma symptoms.Patients and Methods: A questionnaire was sent to 45,000 subjects (age 16-74 years) in Sweden. Subjects who reported both wheeze and breathlessness and wheeze when not having a cold were defined as having asthma-related symptoms. Data on demographics, educational level, smoking, physical activity, comorbidities, symptoms and asthma were collected. Logistic regression was used to identify risk factors for not being diagnosed with asthma.Results: Of the 25,391 who responded to the survey, 6.2% reported asthma-related symptoms. Of these, 946 had been diagnosed with asthma previously, while 632 had not. Independent risk factors for not being diagnosed with asthma were higher age (OR (95% CI) (2.17 (1.39-3.40))), male sex (1.46 (1.17-1.81)), current smoking (2.92 (2.22-3.84)), low level of education (1.43 (1.01-2.01)), low physical activity (1.36 (1.06-1.74)), and hypertension (1.50 (1.06-2.12)).Conclusion: Men, smokers, older subjects, and those with low educational level or low physical activity are less likely to be diagnosed with asthma despite presenting asthma-related symptoms.
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| 7. |
- Middelveld, Roelinde
(författare)
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The role of nitric oxide in porcine models of asthma and acute lung injury
- 2000
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Nitric oxide (NO) is a modulator of many important physiological processes in the body. It is produced endogenously in several cell types by a family of NO synthases (NOS). The lower respiratory tract is a part of the body that has received a lot of attention with regard to the role of NO, as this molecule seems to be involved in the inflammatory processes taking place in for instance asthma and the acute respiratory distress syndrome (ARDS). The purpose of this thesis was to establish models for inflammatory disorders of the respiratory tract in the pig and to characterise the role of NO in these models. The pig was chosen because of its size, and its physiological resemblance to humans. Interest was focused on two areas: the acute allergic reaction (as a model of the early phase of an allergic asthmatic attack) and acute lung injury (ALI, as a model of ARDS). A previously developed model for the acute allergic reaction was used in the first two studies. In this model pigs were sensitised with Ascaris suum allergen. Upon airway challenge with the allergen they react with acute bronchoconstriction and other reactions similar to an acute allergic reaction. In the first study it was found that inhibition of NOS enhanced the antigen -induced, but not the histamine-induced, acute airway reactions. This indicated a protective role of NO. Since histamine levels in bronchoalveolar lavage fluid were increased by pre-treatment with the NOS inhibitor L-NNA, it was proposed that one of the mechanisms through which NO could exert its protective effect is through down-regulation of histamine release from mast cells. In a next study the effects of inhalation of 20 p.p.m. of NO on the allergen -induced acute allergic reaction were studied. A protective effect of NO inhalation was found on arterial oxygenation and pulmonary arterial pressure. However, neither could a significant protective effect of NO inhalation on bronchoconstriction be observed, nor did inhaled NO affect histamine release by mast cells. This would indicate that it is mainly the endogenously produced NO that is responsible for the protective effects, and not high levels of exogenous NO. ALI and septic shock were induced in the pig by infusion of lipopolysaccharide (LPS). Pretreatment with metyrapone (a cortisol-synthesis inhibitor) severely enhanced LPS-induced ALI and septic shock and was therefore included in the subsequent sepsis studies. Inhalation of a low (0.2 p.p.m.) and a high (20 p.p.m.) dose of NO was shown to have protective effects on arterial oxygenation, whereas the high dose also improved pulmonary arterial pressure. The underlying inflammatory responses were not affected by NO. The reactivity of the bronchial circulation to increasing doses of NO was demonstrated to be severely reduced after 4 h of septic shock, whereas the reactivity of the pulmonary circulation was not affected. Infusion of the Gram-positive bacterial cell wall components peptidoglycan (PepG) and lipoteichoic acid (LTA) demonstrated that these two components act in synergy to induce ALI and septic shock in the pig. Despite haemodynamic similarities to Gram-negative (LPS) ALI and septic shock, marked differences were observed in the inflammatory mechanisms. In conclusion, inhalation of NO in two different models of inflammation of the lower respiratory tract resulted in protective effects on arterial oxygenation and pulmonary arterial pressure, but not on the inflammatory responses. Inhibition of endogenously produced NO resulted in an increased allergic reaction, including inflammatory responses. Therefore, it seems likely that it is the endogenously produced NO that plays a protective role in allergic inflammation, and not artificially administered inhaled NO. Induction of ALI and septic shock via infusion of LPS led to distinctly different observations in bronchial and pulmonary vascular reactivity to inhalation of NO. Bronchial vascular reactivity to NO inhalation was reduced, whereas pulmonary vascular reactivity remained. This may be an important observation, as the bronchial circulation is of importance in healing mechanisms during inflammation in the lower respiratory tract.
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| 8. |
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| 9. |
- Protudjer, Jennifer L. P., et al.
(författare)
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Household Costs Associated with Objectively Diagnosed Allergy to Staple Foods in Children and Adolescents
- 2015
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Ingår i: Journal of Allergy and Clinical Immunology-In Practice. - : Elsevier BV. - 2213-2198 .- 2213-2201. ; 3:1, s. 68-75
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: We previously reported that indirect and intangible costs burden households with a food allergic adult. We now extend our investigation to households with food allergic children and adolescents. OBJECTIVE: The objective of this study was to estimate direct, indirect, and intangible costs of food allergy in households with a child and/or adolescent with objectively diagnosed allergy to staple foods (cow's milk, hen's egg, and/or wheat), and to compare these costs with age-and sex-matched controls. METHODS: Direct and indirect cost parent-reported data collected via the Food Allergy Socio-Economic Questionnaire of 84 children (0-12 years) and 60 adolescents (13-17 years) with objectively diagnosed allergy to staple foods ("cases") and age- and sex-matched controls (n = 94 children; n = 56 adolescents) were compared. Annual household costs were calculated. Total household costs included direct plus indirect costs. Intangible costs included parent-reported health of their child and/or adolescent, standard of living, and perceptions of well-being. RESULTS: Amongst cases, total household costs were higher by (sic)3961 for children and (sic)4792 for adolescents versus controls (P < .05), and were driven by direct (eg, medications) and indirect (eg, time with health care professionals) costs. For children only, a history of anaphylaxis was associated with higher direct costs than no anaphylaxis ((sic)13,016 vs (sic)10,044, P < .05). Intangible costs (eg, parent-reported health of a child and/or adolescent) were significantly impacted amongst cases versus controls (P < .01). CONCLUSION: Households with a child and/or adolescent with objectively diagnosed allergy to staple foods have higher total household costs than controls. Direct and indirect costs were significantly higher for cases versus controls amongst children only. Amongst both age groups, such allergy adversely impacted intangible costs. (C) 2015 The Authors. Published by Elsevier Inc. on behalf of the American Academy of Allergy, Asthma & Immunology.
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| 10. |
- Protudjer, Jennifer Lisa Penner, et al.
(författare)
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Impaired health-related quality of life in adolescents with allergy to staple foods
- 2016
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Ingår i: Clinical and Translational Allergy. - : Wiley. - 2045-7022. ; 6
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Tidskriftsartikel (refereegranskat)abstract
- Background: Cow's milk, hen's egg and wheat are staple foods in a typical western diet. Despite the ubiquity of these foods, the impact of staple food allergy on health-related quality of life (HRQL) amongst adolescents is incompletely understood. The aims of this study were to make use of the Swedish version of EuroPrevall's disease-specific food allergy quality of life questionnaire-teenager form (FAQLQ-TF) and to investigate the association between objectively-diagnosed staple food allergy and HRQL amongst adolescents. Methods: In this cross-sectional study, 58 adolescents aged 13-17 years [n = 40 (69 %) boys] with objectively-diagnosed allergy to the staple foods cow's milk, hen's egg and/or wheat and living in Stockholm, Sweden were included. Adolescents completed the FAQLQ-TF, which has a corresponding scale of 1 = best HRQL, and 7 = worst HRQL. Overall HRQL and domain-specific HRQL were established. Adolescents also reported symptoms, adrenaline auto injector (AAI) prescription and presence of other food allergies. A history of anaphylaxis was defined among those reporting difficulty breathing, inability to stand/collapse, and/or loss of consciousness. Clinically different HRQL was set at a mean difference of >= 0.5. Results: Overall mean HRQL was poorer than average [mean: 4.70/7.00 (95 % CI 4.30-5.01)]. The domain risk of accidental exposure was significantly associated with clinically better HRQL than the domain allergen avoidance and dietary restrictions (mean difference = 0.76; p < 0.001). Girls had clinically worse, but not statistically significantly different mean HRQL than boys (mean difference = 0.71; p < 0.07). HRQL tended to be worse amongst those with allergies to more than three foods or an AAI prescription. The number and types of symptoms, including a history of anaphylaxis were not associated with worse HRQL. Conclusions: As ascertained via a food allergy-specific questionnaire, adolescents with staple food allergy report poorer than average HRQL, specifically in relation to emerging independence and the need for support. Girls have clinically worse HRQL than boys. The number and type of previous symptoms and history of anaphylaxis were not associated with worse HRQL.
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| 11. |
- Thörnqvist, Victoria, et al.
(författare)
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Health-related quality of life worsens by school age amongst children with food allergy
- 2019
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Ingår i: Clinical and Translational Allergy. - : BMC. - 2045-7022. ; 9
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Background: Food allergy is negatively associated with health-related quality of life (HRQL). Although differences exist between parents and children, less is known about age-specific differences amongst children. As such, we aimed to identify if age, as well as other factors, are associated with food allergy-specific HRQL in an objectively defined population of children. Methods: Overall, 63 children (boys: n = 36; 57.1%) with specialist-diagnosed food allergy to 1 + foods were included. Parents/guardians completed the Swedish version of a disease-specific questionnaire designed to assess overall-and domain-specific HRQL. Descriptive statistics and linear regression were used. Results: The most common food allergy was hens egg (n = 40/63; 63.5%). Most children had more than one food allergy (n = 48; 76.2%). Nearly all had experienced mild symptoms (e.g. skin; n = 56/63; 94.9%), and more than half had severe symptoms (e.g. respiratory; 39/63; 66.1%). Compared to young children (0-5 years), older children (6-12 years) had worse HRQL (e.g. overall HRQL: B = 0.60; 95% CI 0.05-1.16; p amp;lt; 0.04.). Similarly, multiple food allergies, and severe symptoms were significantly associated with worse HRQL (all p amp;lt; 0.05) even in models adjusted for concomitant allergic disease. No associations were found for gender or socioeconomic status. Conclusion: Older children and those with severe food allergy have worse HRQL.
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| 12. |
- Wai, Hay Mar, et al.
(författare)
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Pediatric food allergy-related household costs are influenced by age, but not disease severity
- 2019
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Ingår i: World Allergy Organization Journal. - : ELSEVIER. - 1939-4551. ; 12:9
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The economic burden of food allergy on households is poorly understood. We evaluated the household costs associated with specialist-diagnosed pediatric food allergy, with focus on age and disease severity. Study design: A cross-sectional study of 70 Swedish case-control pairs (59% boys) was conducted using Food Allergy Economic questionnaire. Household costs were analyzed between age- and gender-matched cases (children aged 0-17 years, with specialist-diagnosed food allergy) and controls (non-food allergic households). Results: Parents were predominantly university-educated and employed full-time. Most cases had parent-reported previous anaphylaxis. Mean total annual household costs were comparable between cases and controls. However, compared to controls, cases had significantly higher direct medical-, and non-medical related costs; higher indirect medical-related costs, and higher intangible costs (all p amp;lt; 0.05). In a sensitivity analyses of only cases aged 0-12 years, direct household costs, including lost earnings due to childs hospitalization, were significantly higher than controls. Results from only children with severe disease paralleled those of all cases vs. controls. Conclusions: Although pediatric food allergy is not associated with higher total annual household costs, these households have significantly higher direct medical-related, indirect and intangible costs vs. non-food allergic households. Higher household costs were identified amongst younger children, but not disease severity.
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