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| 2. |
- Callesen, Michael Thude, et al.
(author)
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Phthalate metabolites in urine and asthma, allergic rhinoconjunctivitis and atopic dermatitis in preschool children
- 2014
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In: International journal of hygiene and environmental health. - : Elsevier BV. - 1438-4639 .- 1618-131X. ; 217:6, s. 645-652
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Journal article (peer-reviewed)abstract
- Phthalate esters are among the most ubiquitous of indoor pollutants and have been associated with various adverse health effects. In the present study we assessed the cross-sectional association between eight different phthalate metabolites in urine and allergic disease in young children. As part of the Danish Indoor Environment and Children's Health study, urine samples were collected from 440 children aged 3-5 years, of whom 222 were healthy controls, 68 were clinically diagnosed with asthma, 76 with rhinoconjunctivitis and 81 with atopic dermatitis (disease subgroups are not mutually exclusive; some children had more than one disease). There were no statistically significant differences in the urine concentrations of phthalate metabolites between cases and healthy controls with the exception of MnBP and MECPP, which were higher in healthy controls compared with the asthma case group. In the crude analysis MnBP and MiBP were negatively associated with asthma. In the analysis adjusted for multiple factors, only a weak positive association between MEP in urine and atopic dermatitis was found; there were no positive associations between any phthalate metabolites in urine and either asthma or rhinoconjunctivitis. These findings appear to contradict earlier studies. Differences may be due to higher exposures to certain phthalates (e.g., BBzP) via non-dietary pathways in earlier studies, phthalates serving as surrogates for an agent associated with asthma (e.g., PVC flooring) in previous studies but not the present study or altered cleaning habits and the use of "allergy friendly" products by parents of children with allergic disease in the current study in contrast to studies conducted earlier.
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| 3. |
- Clausen, Geo, et al.
(author)
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Children's health and its association with indoor environments in Danish homes and daycare centres - methods
- 2012
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In: Indoor Air. - : Hindawi Limited. - 0905-6947 .- 1600-0668. ; 22:6, s. 467-475
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Journal article (peer-reviewed)abstract
- The principle objective of the Danish research program 'Indoor Environment and Children's Health' (IECH) was to explore associations between various exposures that children experience in their indoor environments (specifically their homes and daycare centers) and their well-being and health. The targeted health endpoints were allergy, asthma, and certain respiratory symptoms. The study was designed with two stages. In the first stage, a questionnaire survey was distributed to more than 17000 families with children between the ages of 1 and 5. The questionnaire focused on the children's health and the environments within the homes they inhabited and daycare facilities they attended. More than 11000 questionnaires were returned. In the second stage, a subsample of 500 children was selected for more detailed studies, including an extensive set of measurements in their homes and daycare centers and a clinical examination; all clinical examinations were carried out by the same physician. In this study, the methods used for data collection within the IECH research program are presented and discussed. Furthermore, initial findings are presented regarding descriptors of the study population and selected characteristics of the children's dwellings and daycare centers. Practical Implications: This study outlines methods that might be followed by future investigators conducting large-scale field studies of potential connections between various indoor environmental factors and selected health endpoints. Of particular note are (i) the two-stage design - a broad questionnaire-based survey followed by a more intensive set of measurements among a subset of participants who have been selected based on their responses to the questionnaire; (ii) the case-base approach utilized in the stage 2 in contrast to the more commonly used case-control approach; (iii) the inclusion of the children's daycare environment when conducting intensive sampling to more fully capture the children's total indoor exposure; and (iv) all clinical examinations conducted by the same physician. We recognize that future investigators are unlikely to fully duplicate the methods outlined in this study, but we hope that it provides a useful starting point in terms of factors that might be considered when designing such a study.
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| 4. |
- Devenney, Irene, 1959-
(author)
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Assessing eczema and food allergy in young children
- 2006
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Doctoral thesis (other academic/artistic)abstract
- Background: Atopic disease is an increasing problem. Eczema affects 10-20% of young children, and 33-37% of children with eczema are food allergic. Among other factors, nitric oxide (NO) is thought to play a role in eczema and food allergy. Following the atopic march, pproximately 80% of children with atopic eczema will become sensitized to aeroallergens and develop asthma and/or allergic rhinitis. Skin prick test is used for investigating sensitization and is considered a safe method. However, systemic allergic reactions may appear when the test is performed. In diagnosing food allergy and for evaluating achievement of tolerance, the oral food challenge is the method of choice, and the double-blind placebocontrolled fashion is 'the gold standard'.Skin prick test: We examined six cases of generalized allergic reactions in connection with skin prick testing in order to identify risk factors, and thereby increase safety, and we investigated the necessity of performing skin prick tests in duplicate. We found that all six children with generalized reactions were <6 months of age. When analyzing skin prick tests in duplicate, we found only 1.3% that showed diverging results, and in infants <6 months even fewer, 0.9%.Food challenge: We developed recipes and a protocol for low-dose oral food challenge to milk and egg to be used in young children outgrowing their food allergy so as to facilitate early re-/introduction of small amounts of milk and egg. We performed 52 challenges, both open and double-blind placebo controlled. The recipes were validated for blinding. The lowdose challenge was tolerated well by the children and was easy to perform. Four children had a positive challenge outcome, all reacting to very small amounts of milk. All but two of the non-reacting children were able to introduce milk and egg into their diet.Nitric oxide and eczema: We investigated the effect of eczema treatment on the NO levels in urine. The sum of nitrite and nitrate was measured in urinary samples from 94 infants at two visits, with an interval of 6 weeks, and the results were compared with clinical data. The levels of NO products increased significantly when the eczema improved.The atopic march: The aim was to evaluate the atopic march in children with eczema, from referral at <2 years until 4½ years of age. We followed 123 children with eczema, 78 sensitized and 45 not sensitized to milk and/or egg, with respect to eczema severity, other allergic manifestations, development of airway sensitization, and achievement of food tolerance. The difference in severity of eczema at referral was significant when comparing food-sensitized with non-sensitized children. At follow-up, 62% were still affected by eczema, although 56% only mildly so. Tolerance was achieved in 81% of the children allergic to milk and 68% of those allergic to egg. Fifty-eight percent of the food-sensitized children and 26% of the non-sensitized children had become sensitized to aeroallergens, a significant difference. The difference in airway symptoms was not significant. Very few children were exposed to tobacco smoke in their homes.Conclusions: Increased precautions should be considered when performing skin prick tests in infants <6 months of age. The use of a single prick, to avoid the risk of summation of reactions, is justified when performing skin prick tests. We report recipes and a protocol for standardized open and double-blind placebo-controlled low-dose food challenge in young children, enabling the introduction of small amounts of egg and milk into the diet during tolerance development. NO products in urine increases when eczema improves. This might be due to a Th2/Th1 shift induced by the eczema treatment and skin healing, and the variation in NO response may be due to individual variations in NO-induced feedback downregulation of Th1 and Th2 proliferation. The prognosis for achieving clinical tolerance is very good in children early sensitized and allergic to milk and egg, but they will become significantly more often sensitized to aeroallergens.
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| 5. |
- Ferdousi, Hosne Ara, et al.
(author)
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Clinical characteristics of school children with birch and/or grass pollen hay-fever (The PAT-Study)
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Other publication (other academic/artistic)abstract
- Background: To describe the clinical characteristics of school children with hay-fever based on baseline data from the PAT-Study.Material: Two hundred and five children, 6-15 years, mean 10.7 years, with birch and or grass pollen hay-fever, without known asthma were recruited by six pediatric allergy centers in Northern and Central Europe.Methods: Bronchial hyperresponsiveness (BHR) to methacholine tested by methacholine bronchial provocation test (MBPT) expressed in PC20 was registered during the birch and grass pollen seasons. During the winter symptoms of conjunctivitis, rhinitis and asthma were graded by visual analogue scale (VAS), conjunctival provocation test with birch and or timothy pollen extracts, skin tests with a panel of allergen extracts and MBPT were done and a questionnaire was filled in. Differences of p <0.01 level or less were considered significant.Results: Despite the children were included because of seasonal hay-fever without known asthma, 42/205 children (21 %) got doctor diagnosed asthma (DDA) after the first season. During the three seasons, between 60 and 73 % of the children had a PC20 to methacholine ≤ 8 mg/ml, about 30 % to ≤ 2 mg/ml and 7-10% even to ≤ 0.5 mg/ml. Most children had both rhinitis and conjunctivitis. Furthermore, 119/201 children (59%) were regularly exposed to furred animals.There was an association between DDA and the sum of VAS for asthma during the pollen seasons.The BHR was significantly more pronounced in those with than those without DDA during all three seasons: Using the three cut offs, the difference was most pronounced during the winter season but reached also significance using the cut off limit 0.5 mg/ml during the birch pollen season.Doctor diagnosed asthma correlated to PC20 during the seasons for most of the cut off limits for PC20 and in general there was an association in PC20 between the seasons independent of cut off limits.Furthermore, DDA, but not BHR, correlated to exposure to traffic and there was an association between exposure to traffic and industrial pollution, but not to ETS or duration of breastfeeding.Conclusion: The most striking feature of school children with uncomplicated hay-fever was the high frequency of DDA and BHR, most pronounced during the winter, the high frequency of exposure to living animals and sensitization to indoor allergens. Hay-fever is a generalized disease. Even without obvious asthma, BHR is common and most children have symptoms from both the eyes and the airways. Diagnosis of asthma in children with hay-fever and early anti-inflammatory treatment may improve the prognosis.
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| 6. |
- Möller, Christian, et al.
(author)
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Pollen immunotherapy reduces the development of asthma in children with seasonal rhinoconjunctivitis (the PAT-study)
- 2002
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In: Journal of Allergy and Clinical Immunology. - : Elsevier BV. - 0091-6749 .- 1097-6825. ; 109:2, s. 251-256
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Journal article (peer-reviewed)abstract
- Background: Children with allergic rhinitis are likely to develop asthma.Objective: The purpose of this investigation was to determine whether specific immunotherapy can prevent the development of asthma and reduce bronchial hyperresponsiveness in children with seasonal allergic rhinoconjunctivitis.Methods: From 6 pediatric allergy centers, 205 children aged 6 to 14 years (mean age, 10.7 years) with grass and/or birch pollen allergy but without any other clinically important allergy were randomized either to receive specific immunotherapy for 3 years or to an open control group. All subjects had moderate to severe hay fever symptoms, but at inclusion none reported asthma with need of daily treatment. Symptomatic treatment was limited to loratadine, levocabastine, sodium cromoglycate, and nasal budesonide. Asthma was evaluated clinically and by peak flow. Methacholine bronchial provocation tests were carried out during the season(s) and during the winter.Results: Before the start of immunotherapy, 20% of the children had mild asthma symptoms during the pollen season(s). Among those without asthma, the actively treated children had significantly fewer asthma symptoms after 3 years as evaluated by clinical diagnosis (odds ratio, 2.52; P < .05). Methacholine bronchial provocation test results improved significant in the active group (P < .05).Conclusion: Immunotherapy can reduce the development of asthma in children with seasonal rhinoconjunctivitis.
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| 7. |
- Oldaéus, Göran
(author)
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Cows' milk hydrolysates : Prevention and treatment of cows' milk allergy
- 1998
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Doctoral thesis (other academic/artistic)abstract
- Cows' milk allergy (CMA) develops early in infancy and the incidence is 2-5% in developed countries. The onset of symptoms is in most cases related to the introduction of a cows' ntilk based formula. The treatment of choice is total avoidance of cows' milk proteins and, at least in infancy, replacement with a whole protein soy or a hydrolysed cows' milk based formula (HP). The hypoallergenicity of HPs has been questioned, and studies evaluating remaining antigenicity and allergenicity as well as the allergy preventive effect of early feeding with HFs have been prompted.In vivo allergenicity of HPs was studied by skin prick tests and double-blind placebo controlled oral challenges in cows' milk allergic children, and in vitro allergenicity was analysed by RAST, RAST inhibition, immunoblotting and dot immunobinding. The protein content of the HPs was analysed by chromatography, electrophoresis, and determination of i)-lactoglobulin by ELISA (I,Il). The allergy preventive effect of feeding a partially (pHF) and an extensively HP (eHF) compared with a regular cows' milk formula from the start of weaning up to 9 months of age, was evaluated in a randomised, blinded study including infants from families with a history of allergy. The children were followed from birth up to 18 months of age (Ill). The antibody response to cows' milk antigens was analysed at 9 months of age with a chemiluminometric assay (IgE) and a sensitive ELISA (IgG) in a subgroup of these infants, who were fed a randomised formula for at least 3 months (IV). The presence of cord blood IgE, IgG, IgG1 and IgG4 antibodies to cows' milk antigens in relation to subsequent cows' milk sensitisation or allergic disease was evaluated (V).All tested HPs retained some allergenicity, but it was higher for pHPs than for eHPs, both in vivo and in vitro. The content of i)lactoglobulin was more than 2000 times higher in a pHF than in the eHFs. An allergy preventive effect was seen for the eHP but not the pHP on the develop-ment of cumulative atopic symptoms and atopic dermatitis. The lgG response to i)-lactoglobulin was more pronounced in the pHP than in the eHP fed group, but markedly reduced in both groups compared with the regular formula group. Cows' milk specific IgE antibodies were detected in 14% of cord blood sera, but the predictive capacity of these antibodies to detect subsequent cows' milk sensitisation and atopic disease up to 18 months of age was poor.In conclusion, all HPs may retain antigens capable of eliciting allergic reactions, but eHPs are far less allergenic than pHFs. Only eHPs should be recommended for treatment and prevention of cows' milk allergy.
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| 8. |
- Phrochaska, JO, et al.
(author)
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Engage in the Process of Change : Facts and Methods
- 2012
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Book (other academic/artistic)abstract
- This textbook advocates patients’ empowerment for improving health outcomes and health system performance. It emphasizes the important implications of improving communication between patient and health professionals and the adherence to treatment regimens. Based on research including theories of Stages of Change and Decision Balance, and by incorporating examples from daily clinical practice, this document sets out the guiding principles to support health professionals in better understanding and empowering patients to change lifestyle and behaviour. These principles describe a general approach to patients’ empowerment, consisting of three main tools: the LINE, the BOX and the CIRCLE. It specifically addresses the major risk factors such as smoking, diet, alcohol consumption and physical activity by putting the focus of action upstream to the causes of these types of lifestyle and behaviour. It is built on accumulating evidence, which shows that tailoring interventions to the characteristics of the target audience is key for success.
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