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1.
  • Alhamdow, Ayman, et al. (author)
  • Low-level exposure to polycyclic aromatic hydrocarbons is associated with reduced lung function among Swedish young adults
  • 2021
  • In: Environmental Research. - : Elsevier BV. - 0013-9351 .- 1096-0953. ; 197
  • Journal article (peer-reviewed)abstract
    • Background: Exposure to polycyclic aromatic hydrocarbons (PAHs) has been linked to adverse pulmonary effects. However, the impact of low-level environmental PAH exposure on lung function in early adulthood remains uncertain. Objectives: To evaluate the associations between urinary PAH metabolites and lung function parameters in young adults. Methods: Urinary metabolites of pyrene, phenanthrene, and fluorene were analysed in 1000 young adults from Sweden (age 22–25 years) using LC-MS/MS. Lung function and eosinophilic airway inflammation were measured by spirometry and exhaled nitric oxide fraction (FeNO), respectively. Linear regression analysis was used to evaluate associations between PAH metabolites and the outcomes. Results: Median urinary concentrations of 1-OH-pyrene, ∑OH-phenanthrene, and ∑OH-fluorene were 0.066, 0.36, 0.22 μg/L, respectively. We found inverse associations of ∑OH-phenanthrene and ∑OH-fluorene with FEV1 and FVC, as well as between 1-OH-pyrene and FEV1/FVC ratio (adjusted P < 0.05; all participants). An increase of 1% in ∑OH-fluorene was associated with a decrease of 73 mL in FEV1 and 59 mL in FVC. In addition, ∑OH-phenanthrene concentrations were, in a dose-response manner, inversely associated with FEV1 (B from −109 to −48 compared with the lowest quartile of ∑OH-phenanthrene; p trend 0.004) and FVC (B from −159 to −102 compared with lowest quartile; p-trend <0.001). Similar dose-response associations were also observed between ∑OH-fluorene and FEV1 and FVC, as well as between 1-OH-pyrene and FEV1/FVC (p-trend <0.05). There was no association between PAH exposure and FeNO, nor was there an interaction with smoking, sex, or asthma. Conclusion: Low-level PAH exposure was, in a dose-response manner, associated with reduced lung function in young adults. Our findings have public health implications due to i) the widespread occurrence of PAHs in the environment and ii) the clinical relevance of lung function in predicting all-cause and cardiovascular disease mortality.
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2.
  • Bager, Jessica, et al. (author)
  • Prevalence and early-life risk factors for tree nut sensitization and allergy in young adults
  • 2021
  • In: Clinical and Experimental Allergy. - : John Wiley & Sons. - 0954-7894 .- 1365-2222. ; 51:11, s. 1429-1437
  • Journal article (peer-reviewed)abstract
    • Background Tree nut allergy may cause anaphylaxis. There are limited population-based studies on prevalence and early-life risk factors. Methods We evaluated the prevalence of reported symptoms and allergic sensitization to tree nuts at age 24 years in the BAMSE population-based cohort study and assessed early-life factors associated with the development of tree nut allergy. We estimated tree nut allergy prevalence, by analysing questionnaire data on tree nut ingestion and symptoms at age 12, 16 and 24 years, and IgE sensitization at age 24 years to hazelnut, walnut, pecan, cashew, pistachio, Brazil nut, almond extracts and allergen molecules Cor a 1, 9, 14 (hazelnut), Jug r 1 (walnut) and Ana o 3 (cashew). We evaluated eczema, asthma, food allergies, inherited risk of allergy and gender as potential early-life risk factors. Results Data were available for 2215/4089 (54%) BAMSE study participants, for estimation of the prevalence of tree nut sensitization (21.2%), tree nut allergy symptoms (9.8%) and combined sensitization and symptoms (7.9%, 2.1% for storage protein sensitization and symptoms, 4.3% for any sensitization and non-mild symptoms). Sixty-three per cent of sensitized individuals (295/470) were asymptomatic, but only 76/470 (16%) storage protein sensitized individuals. Egg allergy (ORadj 8.50 95% CI 2.15-33.6), eczema (ORadj 2.53 95% CI 1.21-5.32) and asthma (ORadj 5.59 95% CI 2.35-13.3)) at pre-school age were associated with future development of tree nut symptoms and storage protein sensitization. At age 24 years, tree nut allergy was associated with current eczema and with markers of current asthma severity. Sensitization to storage proteins was more strongly associated with symptoms than sensitization to whole extract for all tree nuts evaluated. Conclusions In this Swedish cohort, we found tree nut whole extract sensitization is common but usually asymptomatic. Storage protein sensitization is a more reliable indicator of tree nut symptoms. Tree nut allergy is associated with early onset, persistent and severe atopic disease.
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3.
  • Ballardini, Natalia, et al. (author)
  • Development and comorbidity of eczema, asthma and rhinitis to age 12 : data from the BAMSE birth cohort
  • 2012
  • In: Allergy. - Stockholm : Karolinska Institutet, Dept of Medical Epidemiology and Biostatistics. - 0105-4538 .- 1398-9995.
  • Journal article (peer-reviewed)abstract
    • BACKGROUND: Allergy-related diseases are a public health issue, but knowledge on development and comorbidity among children is scarce. The aim was to study the development of eczema, asthma and rhinitis in relation to sex and parental allergy, in a population-based cohort, during childhood. METHODS: At 1, 2, 4, 8 and 12 years, parental questionnaires were used to obtain data on allergy-related diseases. Complete data for all five follow-up occasions were available from 2916 children. Odds ratios for the risk of any allergy-related disease in relation to heredity and sex were calculated using generalized estimating equations. RESULTS: At 12 years, 58% of the children had had eczema, asthma and/or rhinitis at some time. Disease turnover was high for all three diseases throughout the study. Comorbidity increased with age, and at 12 years, 7.5% of all the children were affected by at least two allergy-related diseases. Parental allergy was associated with increased comorbidity and more persistent disease and increased the risk of having any allergy-related disease (adjusted OR 1.76; 95% CI 1.57-1.97) up to 12 years. Male sex was associated with an increased risk throughout childhood. Boys and girls did not differ in disease persistence, and for comorbidity, the differences were minor. CONCLUSIONS: Allergy-related diseases may affect a majority of children. Eczema, asthma and rhinitis develop dynamically throughout childhood, and allergic comorbidity is common. These findings indicate that allergy-related diseases should be neither seen nor studied as isolated entities.
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4.
  • Berghammer, Malin, et al. (author)
  • The impact of anxiety in relation to COVID-19 on the life-situation of young people in Sweden
  • 2021
  • In: Quality of Life Research. - : SPRINGER. - 0962-9343 .- 1573-2649. ; 30:SUPPL 1, s. S4-S4
  • Journal article (other academic/artistic)abstract
    • Aims: In general, COVID-19 symptoms are milder in children than inadults, but the experience of the pandemic could increase anxiety andsignificantly affect the life situation of children and adolescents. Itcould also lead to a long-term negative effect on their health. To studyhow the corona pandemic affected the life situation of children andadolescents in Sweden. Methods: A self-reported online survey wasperformed July–November 2020. Cross-sectional data were collectedusing non-probability and convenience sampling methods. The sample consisted of children 6–14 years and their guardians, and adolescents 15–19 years. The questionnaire covered items regarding the life situation including demographics, school situation, social isolation, and an open-ended question to provide a subjective expression of the living situation. A standardized measurement of anxiety was collected using the Children’s Anxiety Questionnaire (CAQ) (scores range 4–12) and the Numeric Rating Scale (NRS)(scores range 0–10). Data were analyzed by descriptive statistics andwith qualitative manifest content analysis. Results: In total, 1487 participants, 768 children with guardians and 719 adolescents participated. Most of the participants, 754 children (97.2%) and 634 adolescents (89.2%) attended school where a mixture of physical attendance and distance learning was reported by 79 children (10.2%)and 261 adolescents (36.7%). Two children (0.3%) and 298 adolescents (41.9%) reported only having distance learning. A larger proportion of children (n = 339, 43.9%) and adolescents (n = 420,59.2%) reported abstaining from leisure activities, while a minority ofchildren (n = 103, 13%) and adolescent (n = 135, 19%) reportedexperiencing a feeling of ‘social isolation’. These experiences ofchanges in daily routine were prominent in the qualitative result. Social restrictions and loss of contact with older relatives led to fear and anxiety. However, for young children, their lives continued torevolve around the everyday things in life rather than the coronapandemic, for the adolescents; however, their life situation was negatively affected by isolation from peer groups and the loss ofschool routine. Conclusion: The experiences by children due toCOVID-19 in Sweden highlight the importance that children continue living their lives as unchanged as possible and that particularly adolescents need receiving greater support with the maintenance of an educational routine.
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5.
  • Björkander, Sophia, et al. (author)
  • SARS-CoV-2-specific B- and T-cell immunity in a population-based study of young Swedish adults
  • 2022
  • In: Journal of Allergy and Clinical Immunology. - : Elsevier BV. - 0091-6749 .- 1097-6825. ; 149:1, s. 65-75
  • Journal article (peer-reviewed)abstract
    • Background: Young adults are now considered major spreaders of coronavirus disease 2019 (COVID-19) disease. Although most young individuals experience mild to moderate disease, there are concerns of long-term adverse health effects. The impact of COVID-19 disease and to which extent population-level immunity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) exists in young adults remain unclear.Objective: We conducted a population-based study on humoral and cellular immunity to SARS-CoV-2 and explored COVID-19 disease characteristics in young adults.Methods: We invited participants from the Swedish BAMSE (Barn [Children], Allergy Milieu, Stockholm, Epidemiology) birth cohort (age 24-27 years) to take part in a COVID-19 followup. From 980 participants (October 2020 to June 2021), we here present data on SARS-CoV-2 receptor-binding domain-specific IgM, IgA, and IgG titers measured by ELISA and on symptoms and epidemiologic factors associated with seropositivity. Further, SARS-CoV-2-specific memory B-and T-cell responses were detected for a subpopulation (n 5 108) by ELISpot and FluoroSpot.Results: A total of 28.4% of subjects were seropositive, of whom 18.4% were IgM single positive. One in 7 seropositive subjects was asymptomatic. Seropositivity was associated with use of public transport, but not with sex, asthma, rhinitis, IgE sensitization, smoking, or body mass index. In a subset of representative samples, 20.7% and 35.0% had detectable SARSCoV-2 specific B-and T-cell responses, respectively. B-and T-cell memory responses were clearly associated with seropositivity, but T-cell responses were also detected in 17.2% of seronegative subjects.Conclusions: Assessment of IgM and T-cell responses may improve population-based estimations of SARS-CoV-2 infection. The pronounced surge of both symptomatic and asymptomatic infections among young adults indicates that the large-scale vaccination campaign should be continued. (J Allergy Clin Immunol 2022;149:65-75.)
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6.
  • Bousquet, Jean, et al. (author)
  • ARIA digital anamorphosis : Digital transformation of health and care in airway diseases from research to practice
  • 2021
  • In: Allergy. European Journal of Allergy and Clinical Immunology. - : John Wiley & Sons. - 0105-4538 .- 1398-9995. ; 76:1, s. 168-190
  • Research review (peer-reviewed)abstract
    • Digital anamorphosis is used to define a distorted image of health and care that may be viewed correctly using digital tools and strategies. MASK digital anamorphosis represents the process used by MASK to develop the digital transformation of health and care in rhinitis. It strengthens the ARIA change management strategy in the prevention and management of airway disease. The MASK strategy is based on validated digital tools. Using the MASK digital tool and the CARAT online enhanced clinical framework, solutions for practical steps of digital enhancement of care are proposed.
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7.
  • Bousquet, J. Jean, et al. (author)
  • Next-generation ARIA care pathways for rhinitis and asthma : a model for multimorbid chronic diseases
  • 2019
  • In: Clinical and Translational Allergy. - : BMC. - 2045-7022. ; 9
  • Research review (peer-reviewed)abstract
    • Background: In all societies, the burden and cost of allergic and chronic respiratory diseases are increasing rapidly. Most economies are struggling to deliver modern health care effectively. There is a need to support the transformation of the health care system into integrated care with organizational health literacy.Main body: As an example for chronic disease care, MASK (Mobile Airways Sentinel NetworK), a new project of the ARIA (Allergic Rhinitis and its Impact on Asthma) initiative, and POLLAR (Impact of Air POLLution on Asthma and Rhinitis, EIT Health), in collaboration with professional and patient organizations in the field of allergy and airway diseases, are proposing real-life ICPs centred around the patient with rhinitis, and using mHealth to monitor environmental exposure. Three aspects of care pathways are being developed: (i) Patient participation, health literacy and self-care through technology-assisted "patient activation", (ii) Implementation of care pathways by pharmacists and (iii) Next-generation guidelines assessing the recommendations of GRADE guidelines in rhinitis and asthma using real-world evidence (RWE) obtained through mobile technology. The EU and global political agendas are of great importance in supporting the digital transformation of health and care, and MASK has been recognized by DG Sante as a Good Practice in the field of digitally-enabled, integrated, person-centred care.Conclusion: In 20 years, ARIA has considerably evolved from the first multimorbidity guideline in respiratory diseases to the digital transformation of health and care with a strong political involvement.
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8.
  • Brew, Bronwyn K, et al. (author)
  • Breastfeeding, asthma, and allergy : a tale of two cities
  • 2012
  • In: Pediatric Allergy and Immunology. - Stockholm : Karolinska Institutet, Dept of Medical Epidemiology and Biostatistics. - 0905-6157. ; 23:1, s. 75-82
  • Journal article (peer-reviewed)abstract
    • BACKGROUND: The effect of breastfeeding duration on subsequent asthma and allergy remains the subject of much controversy. OBJECTIVE: To investigate whether differences in study design or disease-related exposure modification were the cause of the differences in study findings. METHOD: The data from two cohorts, the Childhood Asthma Prevention Study (CAPS) from Australia and the Barn Allergi Miljo Stockholm cohort from Sweden, which had reported different findings on the association between breastfeeding and asthma, were combined. For this analysis, the definitions for breastfeeding, asthma, and allergy were harmonized. Subjects were included if they had at least one parent with wheeze or asthma and had a gestational age of more than 36 wks (combined n = 882). The risk of disease-related exposure modification was assessed using survival analysis. RESULTS: Breastfeeding reduced the risk of asthma at 4/5 and 8 yrs of age in children with a family history of asthma. The effect was stronger in the Swedish cohort. Breastfeeding had no effect on the prevalence of sensitization to inhaled allergens in this cohort with a family history of asthma but was a risk factor for sensitization to cow's milk, peanuts, and eggs in the CAPS cohort at 4/5 yrs and in the combined cohort at 8 yrs. There was no evidence to support the existence of disease-related exposure modification in either cohort. CONCLUSION: These findings point to the importance of harmonization of features of study design, including subject selection criteria and variable definitions, in resolving epidemiological controversies such as those surrounding the impact of breastfeeding on asthma and allergic sensitization.
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11.
  • Covaciu, Corina, et al. (author)
  • Childhood Allergies Affect Health-Related Quality of Life
  • 2013
  • In: Journal of Asthma. - : Informa UK Limited. - 0277-0903 .- 1532-4303. ; 50:5, s. 522-528
  • Journal article (peer-reviewed)abstract
    • Objective. The majority of studies investigating the effects of allergy on the children's health-related quality of life (HRQoL) address one particular allergic disease, using a disease-specific HRQoL instrument. This work aims to assess the comparative impact on HRQoL of several allergic conditions of childhood (asthma, rhinitis, eczema, and food hypersensitivity) in a large, population-based sample of Swedish 8-year-olds. Methods. Data were obtained from a Swedish birth cohort (BAMSE). At the 8-year follow-up, parents of 3236 children completed the standardized generic HRQoL instrument EQ-5D and reported on the children's symptoms of asthma, rhinitis, eczema, and food hypersensitivity. Information on allergic sensitization and lung function was available for a sub-sample of the children (n = 2370 and 2425, respectively). Results. Children in the study population had a median EQ visual analog scale (VAS) of 98 (Inter Quartile Range, IQR, 90-100). The median EQ VAS was significantly lower in children with allergic diseases. Children with asthma had the lowest median EQ VAS (90, IQR 85-98) and reported the highest prevalence of problems of "pain or discomfort" (18.2%, compared to 5.5% in children without asthma). Frequent wheezing and effort-induced wheezing were associated with high prevalence of problems of "anxiety or depression" (23.3% and 15.4%, respectively). Conclusions. Swedish 8-year-olds enjoy a good HRQoL, which though is significantly impacted by allergic diseases and particularly by asthma. Asthma symptoms are important determinants of HRQoL and symptom control should be a major goal in asthma management.
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12.
  • Dahlén, Elin, et al. (author)
  • Sibship and dispensing patterns of asthma medication in young children : a population based study
  • 2019
  • In: Pharmacoepidemiology & Drug Safety. - Stockholm : Karolinska Institutet, Dept of Medical Epidemiology and Biostatistics. - 1053-8569 .- 1099-1557.
  • Journal article (peer-reviewed)abstract
    • Purpose: Our aim was to study the association between sibship and dispensing patterns of asthma medication in young children, focusing on incidence and persistence, and taking sibship status, asthma diagnoses, and siblings’ medication into account. Methods: A register-based cohort study including all children (n=50,546) born in Stockholm, Sweden 2006–2007, followed up during 2006–2014. Exposure was sibling status; outcome was incidence of dispensed asthma medication and persistence over time. A Cox-model was used to study the association between sibship and asthma medication. Persistence was defined using two different time windows (4- and 18-months) in a refill sequence model including siblings’ and unrelated control children’s medication. Results: After one year of age, the adjusted hazard ratio of dispensed asthma medication was 0.85 (95%CI 0.80–0.90) among children with siblings compared to singletons. The estimated proportion of children with persistent controller medication was 7.2% (4-month model) and 64.5% (18-month model). When including the siblings’ controller medication, the estimated proportion was 8.8% (4-months) and 7.8% for control children (relative risk, RR 0.89, 95%CI 0.81-0.98). The persistence was lower for those with siblings compared to singletons (adj. RR 0.72, 95%CI 0.62-0.85 for 4-months) with similar estimates for older, younger, and full siblings and regardless of asthma diagnoses. Conclusions: Siblings have different dispensing patterns of asthma medications compared to singletons regardless of asthma diagnoses. After including the siblings’ asthma medication and compared with control children, the proportion of children with persistent medication increased which may indicate that siblings share asthma medications.
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13.
  • Ekström, Sandra, et al. (author)
  • Dietary intake and plasma concentrations of PUFAs in childhood and adolescence in relation to asthma and lung function up to adulthood
  • 2022
  • In: American Journal of Clinical Nutrition. - : Oxford University Press (OUP). - 0002-9165 .- 1938-3207. ; 115:3, s. 886-896
  • Journal article (peer-reviewed)abstract
    • Background: PUFAs may influence the risk of asthma; however, long-term prospective studies including objective biomarkers of PUFA intake are lacking.Objectives The objective was to investigate the role of dietary intake and plasma concentrations of n–3 and n–6 (ω-3 and ω-6) PUFAs in childhood and adolescence for the development of asthma and lung function up to young adulthood.Methods: The study included participants from the Swedish prospective birth cohort BAMSE. Dietary intake of PUFAs was calculated from FFQs (n = 1992) and plasma proportions of PUFAs were measured in phospholipids (n = 831). We analyzed the n–3 PUFA α-linolenic acid (ALA; 18:3n–3); the sum of very-long-chain (VLC) n–3 PUFAs: EPA (20:5n–3), DHA (22:6n–3), and docosapentaenoic acid (22:5n–3); and the n–6 PUFAs linoleic acid (LA; 18:2n–6) and arachidonic acid (AA; 20:4n–6). Asthma was assessed by questionnaires at 8, 16, and 24 y and lung function was measured by spirometry at 24 y.Results: A high (≥median) self-reported dietary intake of LA at 8 y and AA at 16 y was associated with increased risk of prevalent asthma at 24 y (OR: 1.41; 95% CI: 1.10, 1.82 and OR: 1.32; 95% CI: 1.02, 1.70, respectively). In contrast, plasma proportions of ALA, ∑VLC n–3 PUFAs, and AA at 8 y, as well as LA at 16 y, were inversely associated with prevalent asthma at 24 y (e.g., OR: 0.55; 95% CI: 0.38, 0.81 for ∑VLC n–3 PUFAs). No consistent associations were observed with lung function.Conclusions: High dietary intake of certain n–6 PUFAs in childhood or adolescence may be associated with increased risk of asthma up to young adulthood, whereas dietary biomarkers of certain n–3 and n–6 PUFAs in plasma may be associated with decreased risk. Thus, the role of diet compared with altered metabolism of PUFAs needs further investigation to improve dietary preventive strategies for asthma.
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14.
  • Forsner, Maria, et al. (author)
  • Mitt i informationsflödet om Covid 19 pandemin, en internationell webbenkätstudie till föräldrar och barn 7-12 år
  • 2020
  • In: State of Art- Covid 2019, Nationell digital konferens, Svenska läkarsällskpet.
  • Conference paper (other academic/artistic)abstract
    • Bakgrund: Tidigt under våren 2020 drabbades Sverige av Covid 19 pandemin. Med pandemin följe en infodemi. Barn skolåldern och deras förälder hamnade mitt i detta informationsflöde. Syfte: Att undersöka hur barn får och tolkar information om Covid 19 pandemin. Metod: Anonymiserad webbenkät. 2 enkäter til barn, respektive föräldrar. Översatt till respektive språk. Deltagare 390 barn, 7-12 är (Sv 50) och 1234 föräldrar ( Sv 235). Insamling april – 1 juni ( Sv 22 maj-1 juni). Initierat av Lucy Bray med team, Edge Hills universitet Storbritannien. Omvårdnad forskare från Sverige, Kanada , Australien, Brasilien och Spanien. Resultat: Majoriteten av barn från andra länderna fick information från föräldrarna. Svaren från de svenska barnen speglade myndighetens rekommendationer. Utomhus skildrades som en positiv plats för de svenska barnen. Teckningar från Sverige visade i stor utsträckning munskydd på både människor och djur. Slutsats: De sveks barnen var medvetna om att coronaviruset kunde vara farligt, vikten av att hålla avstånd och tvätta händerna och skydda de äldre. Svaren från Sverige skiljde sig från de andra länderna med att skolan var främsta och önskade informationskällan. Utomhusaktiviteter uppskattades som önskvärt.
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15.
  • Hammar, Katarina Stenberg, et al. (author)
  • Subnormal levels of vitamin D are associated with acute wheeze in young children
  • 2014
  • In: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 103:8, s. 856-861
  • Journal article (peer-reviewed)abstract
    • Aim: This study evaluated risk factors for acute wheeze in preschool children and investigated whether subnormal levels of vitamin D were associated with increased risk for acute wheeze, atopy or viral/bacterial respiratory infections. Methods: We recruited 130 children with acute wheeze, aged 6 months to 4 years, from paediatric emergency departments in Stockholm, Sweden, and 101 age-matched controls with no history of wheeze or sensitisation to airborne allergens. Parents answered standardised questionnaires, and blood samples were analysed for specific IgE to airborne and food allergens and levels of 25 hydroxyvitamin D (25(OH)D). Nasopharyngeal virus samples were collected during the emergency department visit in the group of children with wheeze, and a subset were also tested for bacteria. Results: Vitamin D insufficiency (25(OH)D < 75 nmol/L (30 ng/mL)) was associated with an odds ratio of 2.7 (95% confidence interval 1.1-6.2) for acute wheeze. However, no association was found between vitamin D insufficiency and atopy, presence of virus or bacteria or recurrent infections. Children older than 24 months were particularly at risk of subnormal vitamin D levels, irrespective of wheezing history. Conclusion: Our findings support the hypothesis that subnormal levels of vitamin D are associated with acute wheeze in young children.
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16.
  • Janzi, Magdalena, et al. (author)
  • Selective IgA deficiency in early life : Association to infections and allergic diseases during childhood
  • 2009
  • In: Clinical Immunology. - : Elsevier BV. - 1521-6616 .- 1521-7035. ; 133:1, s. 78-85
  • Journal article (peer-reviewed)abstract
    • Selective IgA deficiency in early life is quite common in Caucasian populations, but it is unclear whether it increases the risk of infections and allergic diseases during childhood. Serum IgA levels were measured in 2423 children at 4 years of age in a Swedish population based birth cohort (BAMSE). Parental questionnaires were repeatedly sent out during the child's first 8 years of life, collecting information about infections and allergic diseases. 14 children (1:173) were found to be IgA deficient at 4 years of age. These children had an increased risk of pseudocroup at year 1 (p<0.01) and food hypersensitivity at year 4 (p<0.05) as compared to IgA sufficient children. No increased risk was observed in the partial IgA deficiency group. The findings suggest that selective IgA deficiency may increase the risk of parentally reported pseudocroup and food hypersensitivity during early childhood.
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17.
  • Jonsson, Marina, et al. (author)
  • Adherence to national guidelines for children with asthma at primary health centres in Sweden : potential for improvement
  • 2012
  • In: Primary Care Respiratory Journal. - : Elsevier. - 1471-4418 .- 1475-1534. ; 21:3, s. 276-282
  • Journal article (peer-reviewed)abstract
    • BACKGROUND: Although asthma is the most common chronic paediatric disease in Western Europe, the extent of adherence to guidelines for primary care management of paediatric asthma remains unclear. AIMS: To evaluate adherence to national guidelines for primary care management of children with asthma. METHODS: This survey involved 18 primary healthcare centres in Stockholm, Sweden. The medical records of 647 children aged 6 months to 16 years with a diagnosis of asthma, obstructive bronchitis, or cough were selected and scrutinised. 223 children with obstructive bronchitis or cough not fulfilling the evidence-based criteria for asthma were excluded, yielding a total of 424 subjects. Documentation of the most important indicators of quality as stipulated in national guidelines (i.e., tobacco smoke, spirometry, pharmacological treatment, patient education, and demonstration of inhalation technique) was examined. RESULTS: Only 22% (n=49) of the children 6 years of age or older had ever undergone a spirometry test, but the frequency was greater when patients had access to an asthma nurse (p=0.003). Although 58% (n=246) of the total study population were treated with inhaled steroids, documented patient education and demonstration of inhalation technique was present in 14% (n=59). Exposure to tobacco smoke was documented in 14% (n=58). CONCLUSIONS: This study reveals a substantial gap between the actual care provided for paediatric asthma and the recommendations formulated in national guidelines.
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18.
  • Jonsson, Marina, et al. (author)
  • Asthma during adolescence impairs health-related quality of life
  • 2016
  • In: Journal of Allergy and Clinical Immunology. - : Elsevier BV. - 2213-2198 .- 2213-2201. ; 4:1, s. 144-146
  • Journal article (peer-reviewed)abstract
    • Clinical ImplicationsAsthma during adolescence impairs health-related quality of life, especially if the asthma is uncontrolled. To use questions about health-related quality of life (HRQoL) and markers associated with asthma control in the clinic can identify adolescents with an increased risk for impaired HRQoL.
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19.
  • Jonsson, Marina, et al. (author)
  • Experiences of Daily Life Among Adolescents With Asthma - A Struggle With Ambivalence
  • 2017
  • In: Journal of Pediatric Nursing. - : Elsevier BV. - 0882-5963 .- 1532-8449. ; 35, s. 23-29
  • Journal article (peer-reviewed)abstract
    • OBJECTIVE: There is limited knowledge about how adolescents with asthma view their disease in daily life and how these views impact on management. The aim of this study was to describe experiences of daily life, with particular focus on thoughts, feelings and management of adolescents with asthma.METHODS: In this qualitative study, data were obtained from 10 interviews with adolescents (aged 16-18 years) with asthma recruited from the Swedish population-based prospective birth cohort, BAMSE. Data were analysed through Systematic Text Condensation.RESULTS: Experiences of daily life among adolescents with asthma were defined in four categories: Insight and understanding; Asthma not the focus of daily life; Being acknowledged and, Being affected by asthma symptoms. The adolescents had developed an insight into and understanding of their disease, but did not want asthma to be the focus of their daily lives. The adolescents wanted their asthma to be acknowledged, but not to the point that they were defined by their asthma. They reported having many asthma symptoms, especially during physical activity, but also described a desire to feel healthy, "normal" and like their peers.CONCLUSIONS: Having asthma in adolescence involves several struggles with ambivalence between adapting socially, feeling healthy and managing one's asthma.IMPLICATIONS IN CLINICAL PRACTICE: The provision of person-centred care may be one way to handle the ambivalence among adolescents with asthma and thereby help them to manage their asthma.
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  • Kere, Maura, et al. (author)
  • Exploring proteomic plasma biomarkers in eosinophilic and neutrophilic asthma
  • 2023
  • In: Clinical and Experimental Allergy. - : John Wiley & Sons. - 0954-7894 .- 1365-2222. ; 53:2, s. 186-197
  • Journal article (peer-reviewed)abstract
    • BACKGROUND: Few biomarkers identify eosinophilic and neutrophilic asthma beyond cell concentrations in blood or sputum. Finding novel biomarkers for asthma endotypes could give insight about disease mechanisms and guide tailored treatment. Our aim was to investigate clinical characteristics and inflammation-related plasma proteins in relation to blood eosinophil and neutrophil concentrations in subjects with and without asthma.METHODS: We included 24-26-year-old subjects (n = 2063) from the Swedish population-based cohort BAMSE. Subjects with asthma (n = 239) and without asthma (n = 1824) were subdivided based on blood eosinophil and neutrophil concentrations (cut-offs 0.3 × 109 /L and 5.0 × 109 /L, respectively). We measured the levels of 92 plasma proteins using Olink Proseek Multiplex Inflammation Panel Assay. Group statistics tests were used to analyse the data, as well as adjusted multiple logistic regression models.RESULTS: Among subjects with asthma, 21.8% had eosinophilic asthma and 20.5% neutrophilic asthma. Eosinophilic asthma, but not neutrophilic asthma, was associated with a distinct clinical phenotype with, for example, higher proportions of eczema and sensitization. Most plasma proteins that associated with high eosinophil and/or neutrophil blood concentrations in subjects with asthma showed similar associations in subjects without asthma. However, out of these proteins, MMP10 levels were associated with eosinophilic asthma and were significantly higher as compared to controls with high eosinophilic concentration, while CCL4 levels associated with high neutrophil concentration only in subjects with asthma.CONCLUSIONS: Eosinophilic asthma was associated with a clear clinical phenotype. With our definitions, we identified MMP10 as a possible plasma biomarker for eosinophilic asthma and CCL4 was linked to neutrophilic asthma. These proteins should be evaluated further in clinical settings and using sputum granulocytes to define the asthma endotypes.
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23.
  • Klevebro, Susanna, et al. (author)
  • Inflammation-related plasma protein levels and association with adiposity measurements in young adults
  • 2021
  • In: Scientific Reports. - : Springer Nature. - 2045-2322. ; 11:1
  • Journal article (peer-reviewed)abstract
    • Obesity-related inflammation is associated with cardiovascular, metabolic, and pulmonary diseases. The aim of this study was to demonstrate associations between adiposity measurements and levels of inflammation-related plasma proteins in a population of young adults. Subjects from a population-based birth cohort with a mean age of 22.5 years were included in the study population (n=2074). Protein levels were analyzed using the Olink Proseek Multiplex Inflammation panel. Percentage body fat (%BF) and visceral fat rating (VFR) measurements were collected using Tanita MC 780 body composition monitor. Linear regression of standardized values was used to investigate associations. Potential effect modifications by sex and BMI category were assessed. Of 71 investigated proteins, 54 were significantly associated with all adiposity measurements [%BF, body mass index (BMI), VFR and waist circumference]. Among proteins associated with %BF, seven showed a larger or unique association in overweight/obese subjects and three showed a significant effect modification by sex. Fourteen proteins more strongly associated with VFR in females compared to males. Adipose-associated systemic inflammation was observed in this young adult population. Sex and adiposity localization influenced some of the associations. Our results highlight specific proteins as suitable biomarkers related to adiposity.
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24.
  • Klevebro, Susanna, et al. (author)
  • Risk of SARS-CoV-2 exposure among hospital healthcare workers in relation to patient contact and type of care
  • 2021
  • In: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 49:7, s. 707-712
  • Journal article (peer-reviewed)abstract
    • We aimed to assess prevalence of IgG antibodies to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and factors associated with seropositivity in a large cohort of healthcare workers (HCWs). Methods: From 11 May until 11 June 2020, 3981 HCWs at a large Swedish emergency care hospital provided serum samples and questionnaire data. Presence of IgG antibodies to SARS-CoV-2 was measured as an indicator of SARS-CoV-2 exposure. Results: The total seroprevalence was 18% and increased during the study period. Among the seropositive HCWs, 11% had been entirely asymptomatic. Participants who worked with COVID-19 patients had higher odds for seropositivity: adjusted odds ratio 1.96 (95% confidence intervals 1.59–2.42). HCWs from three of the departments managing COVID-19 patients had significantly higher seroprevalences, whereas the prevalence among HCWs from the intensive care unit (also managing COVID-19 patients) was significantly lower. Conclusions: HCWs in contact with SARS-CoV-2 infected patients had a variable, but on average higher, likelihood for SARS-CoV-2 infections.
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25.
  • Kull, Inger, et al. (author)
  • Astma/KOL-mottagningar i primärvård ger effektivt omhändertagande
  • 2008
  • In: Läkartidningen. - 0023-7205 .- 1652-7518. ; 105:42, s. 2937-2940
  • Journal article (peer-reviewed)abstract
    • Astma och KOL (kroniskt obstruktiv lungsjukdom) har blivit allt vanligare, och möjligheterna till både korrekt diagnos och förbättrad behandling har ökat under det senaste decenniet, vilket ställer nya krav på hälso- och sjukvården. Korrekt diagnos, adekvat patientutbildning och rökslutarstöd är högt prioriterade åtgärder. Ett strukturerat omhändertagande med en välfungerande astma/KOL-mottagning i primärvården underlättar och förbättrar vården av denna stora patientgrupp. I artikeln föreslås nya kriterier för astma/KOL-mottagningar i primärvård.
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26.
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27.
  • Kull, Inger (author)
  • Infant feeding and allergy in children
  • 2005
  • Doctoral thesis (other academic/artistic)abstract
    • Despite intensive research, the knowledge on causes behind the increase in allergic diseases among children is incomplete. Altered environmental exposures and changes in lifestyle have been hypothesised to play a role, including dietary intake. The association between breastfeeding and allergic disease has been extensively studied with diverging results. A focus has also been on vitamins, antioxidants and fatty acids, in particular from fish. However, methodological limitations in many of these studies hamper the possibility to draw conclusions on causal relationships. The overall aim of this thesis was to study different aspect of infant feeding and the association with allergic diseases up to four years of age, in particular to asses the effect of breastfeeding, regular fish consumption and early supplementation of vitamin A and D based in peanut oil or as water-miscible. A prospective birth cohort (BAMSE) of 4,089 infants was followed for 4 years using parental questionnaires at ages 2 months, 1, 2 and 4 years to collect information on exposures and health outcomes. The response rate at 4 years was 91%. Among these children a clinical investigation was performed in 73%, which included peak flow measurement and blood sampling for analysis of specific IgE to common food and airborne allergens. A classification into transient, late onset and persistent disease was used to denote symptoms present up to 2 years of age, at 4 years of age only and in both periods, respectively. To reduce the risk of disease related modification of exposure children with onset of eczema and recurrent wheeze during the first year of life were excluded in the majority of the analyses. Breastfeeding: Exclusive breastfeeding for at least four months reduced the risk of transient (OR 0.53, 95% Cl 0.36-0.78) and persistent asthma, (OR 0.43, 0.27-0.68) but not of late onset asthma OR 0.84, 0541.30). A similar picture was seen for eczema: reduced risk of transient eczema (OR 0.76, 0.58-0.99), and persistent eczema (OR 0.59, 0.45-0.77) but not of onset eczema (OR 1.07, 0.77-1.49). However, the risk of sensitisation against common inhalant or food allergens was not reduced by breastfeeding (OR 0.93, 0.70-1.22). Fish consumption: Both parental allergic disease and onset of eczema or recurrent wheeze during the first year of life delayed introduction of fish in the child's diet. Fish consumption at least twice a months at 1 year of age reduced the risk of persistent eczema, (OR 0.48, 0.32-0.68), late onset and persistent rhinitis (OR 0.67, 0.46-0.97 and OR 0.43, 0.23-0.79, respectively). The risk reduction appeared particularly pronounced for those with multiple allergic disease, i.e. two or three diseases in combination, (OR 0.56, 0.35-0.89). A risk reduction of borderline statistical significance was observed for allergic sensitisation to common food and airborne allergens in relation to regular fish consumption, OR 0.76, 0.57-1.0. IlgE sensitisation to fish was only present among 18 of the 2,614 children. Supplementation of vitamin A and D in peanut oil: Children who regularly received oil-based vitamin A and D during the first year of life had a reduced risk of persistent asthma and allergic rhinitis (OR 0.37, 0.23-0.60, and OR 0.43, 0.25-0.71, respectively), as well as of sensitisation to food and inhalant allergens (OR 0.65, 0.45-0.92 and OR 0.59; 0.41-0.84, respectively). The risk reduction was most pronounced for multiple disease, (OR 0.48, 0.33-0.72). In conclusion, certain aspects of infant feeding, such as breastfeeding for at least four months, regular fish consumption at 1 year of age and supplementation with vitamin A and D in peanut oil during the first year of life appear to offer protection in relation to allergic disease and/or sensitisation in children.
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28.
  • Kull, Inger, et al. (author)
  • Nya kriterier för astma/KOL-mottagningar i primärvården : [Updated criterias for an asthma/COPD clinic in primary care based on Swedish guidelines]
  • 2018
  • In: Läkartidningen. - : Läkartidningen Förlag. - 0023-7205 .- 1652-7518. ; 115
  • Journal article (other academic/artistic)abstract
    • Updated criterias for an asthma/COPD clinic in primary care based on Swedish guidelines We here present updated criterias for an asthma/COPD clinic in primary care based on Swedish guidelines and an estimate of the time required for its tasks. Certified staff should assist in diagnosis and follow-up of asthma/COPD patients, provide patient education, provide and follow up written management plans, facilitate smoking cessation in patients and parents of children with asthma, evaluate symptoms with validated tools (ACT, CAT), and assess and support physical activity. To provide such care, 4.8 hours are required for asthma/COPD nurses and 1.3 hours for physiotherapists per 1,000 listed patients and week. At least 1-2 hours/week are needed for the responsible physician. To ensure high competence, asthma/COPD nurses should have ≥15 credits, advanced level, and physiotherapists ≥7.5 credits in asthma/COPD, advanced level. The responsible physician should have advanced knowledge in the field.
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29.
  • Lemonnier, Nathanaël, et al. (author)
  • A novel whole blood gene expression signature for asthma, dermatitis, and rhinitis multimorbidity in children and adolescents
  • 2020
  • In: Allergy. European Journal of Allergy and Clinical Immunology. - : WILEY. - 0105-4538 .- 1398-9995. ; 75:12, s. 3248-3260
  • Journal article (peer-reviewed)abstract
    • Background: Allergic diseases often occur in combination (multimorbidity). Human blood transcriptome studies have not addressed multimorbidity. Large-scale gene expression data were combined to retrieve biomarkers and signaling pathways to disentangle allergic multimorbidity phenotypes.Methods: Integrated transcriptomic analysis was conducted in 1233 participants with a discovery phase using gene expression data (Human Transcriptome Array 2.0) from whole blood of 786 children from three European birth cohorts (MeDALL), and a replication phase using RNA Sequencing data from an independent cohort (EVA-PR, n = 447). Allergic diseases (asthma, atopic dermatitis, rhinitis) were considered as single disease or multimorbidity (at least two diseases), and compared with no disease.Results: Fifty genes were differentially expressed in allergic diseases. Thirty-two were not previously described in allergy. Eight genes were consistently overexpressed in all types of multimorbidity for asthma, dermatitis, and rhinitis (CLC, EMR4P, IL5RA, FRRS1, HRH4, SLC29A1, SIGLEC8, IL1RL1). All genes were replicated the in EVA-PR cohort. RT-qPCR validated the overexpression of selected genes. In MeDALL, 27 genes were differentially expressed in rhinitis alone, but none was significant for asthma or dermatitis alone. The multimorbidity signature was enriched in eosinophil-associated immune response and signal transduction. Protein-protein interaction network analysis identified IL5/JAK/STAT and IL33/ST2/IRAK/TRAF as key signaling pathways in multimorbid diseases. Synergistic effect of multimorbidity on gene expression levels was found.Conclusion: A signature of eight genes identifies multimorbidity for asthma, rhinitis, and dermatitis. Our results have clinical and mechanistic implications, and suggest that multimorbidity should be considered differently than allergic diseases occurring alone.
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30.
  • Lindqvist, Magnus, et al. (author)
  • Natural course of pollen-induced allergic rhinitis from childhood to adulthood : A 20-year follow up.
  • 2023
  • In: Allergy. European Journal of Allergy and Clinical Immunology. - 0105-4538 .- 1398-9995.
  • Journal article (peer-reviewed)abstract
    • BACKGROUND: Allergic rhinitis (AR) is one of the most common chronic diseases worldwide. There are limited prospective long-term data regarding persistency and remission of AR. The objective of this study was to investigate the natural course of pollen-induced AR (pollen-AR) over 20 years, from childhood into early adulthood.METHODS: Data from 1137 subjects in the Barn/Children Allergi/Allergy Milieu Stockholm Epidemiologic birth cohort (BAMSE) with a completed questionnaire regarding symptoms, asthma, treatment with allergen immunotherapy (AIT) and results of allergen-specific IgE for inhalant allergens at 4, 8, 16 and 24 years were analyzed. Pollen-AR was defined as sneezing, runny, itchy or blocked nose; and itchy or watery eyes when exposed to birch and/or grass pollen in combination with allergen-specific IgE ≥0.35kUA /L to birch and/or grass.RESULTS: Approximately 75% of children with pollen-AR at 4 or 8 years had persistent disease up to 24 years, and 30% developed asthma. The probability of persistency was high already at low levels of pollen-specific IgE. The highest rate of remission from pollen-AR was seen between 16 and 24 years (21.5%); however, the majority remained sensitized. This period was also when pollen-specific IgE-levels stopped increasing and the average estimated annual incidence of pollen-AR decreased from 1.5% to 0.8% per year.CONCLUSION: Children with pollen-AR are at high risk of persistent disease for at least 20 years. Childhood up to adolescence seems to be the most dynamic period of AR progression. Our findings underline the close cross-sectional and longitudinal relationship between sensitization, AR and asthma.
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31.
  • Magnusson, Jessica, et al. (author)
  • Polyunsaturated fatty acids in plasma at 8 years and subsequent allergic disease
  • 2018
  • In: Journal of Allergy and Clinical Immunology. - : MOSBY-ELSEVIER. - 0091-6749 .- 1097-6825. ; 142:2, s. 510-516
  • Journal article (peer-reviewed)abstract
    • Background: Polyunsaturated fatty acids (PUFAs) are hypothesized to modulate the risk of allergic disease. However, evidence from previous studies is inconclusive, and limited longitudinal data exist using circulating biomarkers of PUFA intake and metabolism. Objective: We aimed to investigate associations between n-3 and n-6 PUFAs at age 8 years and asthma, rhinitis, and aeroallergen sensitization at age 16 years. Methods: Proportions of n-3 PUFAs (very long-chain n-3 [VLC n-3; sum of eicosapentaenoic acid, docosapentaenoic acid, and docosahexaenoic acid] anda-linolenic acid) and n-6PUFAs (linoleic acid and arachidonic acid [AA]) in blood samples at age 8 years weremeasured for 940 children fromthe prospective Swedish birth cohort BAMSE (Children, Allergy, Milieu, Stockholm, Epidemiology). Allergic disease phenotypes were defined by using questionnaires and IgE measures at the ages of 8 and 16 years. Logistic regression was used to examine potential associations. Results: A higher proportion of total VLC n-3 PUFAs in plasma at age 8 years was associated with a reduced risk of prevalent asthma, rhinitis, and aeroallergen sensitization at age 16 years and with incidence of asthma between 8 and 16 years (adjusted odds ratio, 0.67; 95% CI, 0.47-0.94). AA was associated with a reduced risk of asthma, aeroallergen sensitization, and allergic rhinitis. The findings were most evident for allergic phenotypes of asthma and rhinitis. Additionally, AA was associated with an increased probability of asthma and rhinitis remission between 8 and 16 years of age. Conclusion: Higher proportions of certain VLC n-3 and very long-chain n-6 PUFAs in plasma phospholipids at age 8 years were associated with a reduced risk of allergic disease at age 16 years.
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32.
  • Melén, Erik, et al. (author)
  • Air pollution and IgE sensitization in 4 European birth cohorts : the MeDALL project
  • 2021
  • In: Journal of Allergy and Clinical Immunology. - : Elsevier. - 0091-6749 .- 1097-6825. ; 147:2, s. 713-722
  • Journal article (peer-reviewed)abstract
    • BackgroundWhether long-term exposure air to pollution has effects on allergic sensitization is controversial.ObjectiveOur aim was to investigate associations of air pollution exposure at birth and at the time of later biosampling with IgE sensitization against common food and inhalant allergens, or specific allergen molecules, in children aged up to 16 years.MethodsA total of 6163 children from 4 European birth cohorts participating in the Mechanisms of the Development of ALLergy [MeDALL] consortium were included in this meta-analysis of the following studies: Children, Allergy, Milieu, Stockholm, Epidemiology (BAMSE) (Sweden), Influences of Lifestyle-Related Factors on the Human Immune System and Development of Allergies in Childhood (LISA)/German Infant Study on the Influence of Nutrition Intervention PLUS Environmental and Genetic Influences on Allergy Development (GINIplus) (Germany), and Prevention and Incidence of Asthma and Mite Allergy (PIAMA) (The Netherlands). The following indicators were modeled by land use regression: individual residential outdoor levels of particulate matter with aerodynamic diameters less than 2.5 μm, less than 10 μm, and between 2.5 and 10 μm; PM2.5 absorbance (a measurement of the blackness of PM2.5 filters); and nitrogen oxides levels. Blood samples drawn at ages 4 to 6 (n = 5989), 8 to 10 (n = 6603), and 15 to 16 (n = 5825) years were analyzed for IgE sensitization to allergen extracts by ImmunoCAP. Additionally, IgE against 132 allergen molecules was measured by using the MedALL microarray chip (n = 1021).ResultsAir pollution was not consistently associated with IgE sensitization to any common allergen extract up to age 16 years. However, allergen-specific analyses suggested increased risks of sensitization to birch (odds ratio [OR] = 1.12 [95% CI = 1.01-1.25] per 10-μg/m3 increase in NO2 exposure). In a subpopulation with microarray data, IgE to the major timothy grass allergen Phleum pratense 1 (Phl p 1) and the cat allergen Felis domesticus 1 (Fel d 1) greater than 3.5 Immuno Solid-phase Allergen Chip standardized units for detection of IgE antibodies were related to PM2.5 exposure at birth (OR = 3.33 [95% CI = 1.40-7.94] and OR = 4.98 [95% CI = 1.59-15.60], respectively, per 5-μg/m3 increase in exposure).ConclusionAir pollution exposure does not seem to increase the overall risk of allergic sensitization; however, sensitization to birch as well as grass pollen Phl p 1 and cat Fel d 1 allergen molecules may be related to specific pollutants.
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33.
  • Melen, Erik, et al. (author)
  • Male sex is strongly associated with IgE-sensitization to airborne but not food allergens : results up to age 24 years from the BAMSE birth cohort
  • 2020
  • In: Clinical and Translational Allergy. - : BioMed Central. - 2045-7022. ; 75, s. 161-162
  • Journal article (peer-reviewed)abstract
    • Background Up to half of the population in high-income countries has allergen-specific IgE antibodies. However, data regarding sex differences of IgE-sensitization from childhood to adulthood is limited. Objective To explore IgE-sensitization to common foods and airborne allergens in relation to sex over time in a population-based cohort followed up to young adulthood. Methods The Swedish population-based birth cohort BAMSE includes 4089 subjects who have been followed regularly with questionnaires and clinical investigations. A recent 24-year follow-up included 3069 participants (75%). Sera collected at 4, 8, 16 and 24 years were analyzed for IgE-antibodies to 14 common foods and airborne allergens. Results At 24 years sensitization to foods had decreased compared to previous follow-ups affecting 8.4%, while sensitization to airborne allergens was more common, affecting 42.2%. Male sex was associated with IgE-sensitization to airborne allergens at all ages (overall OR: 1.68, 95% CI 1.46-1.94) while there was no statistically significant association between sex and sensitization to food allergens (overall OR: 1.10, 95% CI 0.93-1.32). Levels of allergen-specific IgE did not differ significantly between males and females for any of the tested foods or airborne allergens at any age, following adjustment for multiple comparisons. Conclusion IgE-sensitization to airborne allergens increases with age up to young adulthood, whereas sensitization to food allergens seems to level off. Male sex is strongly associated with IgE-sensitization to airborne allergens from early childhood up to young adulthood. In contrast, there is little evidence for associations between sex and IgE-sensitization to foods.
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34.
  • Merid, Simon Kebede, et al. (author)
  • Epigenome-wide meta-analysis of blood DNA methylation in newborns and children identifies numerous loci related to gestational age
  • 2020
  • In: Genome Medicine. - Stockholm : Karolinska Institutet, Dept of Clinical Science and Education, Södersjukhuset. - 1756-994X.
  • Journal article (peer-reviewed)abstract
    • Background: Preterm birth and shorter duration of pregnancy are associated with increased morbidity in neonatal and later life. As the epigenome is known to have an important role during fetal development, we investigated associations between gestational age and blood DNA methylation in children. Methods: We performed meta-analysis of Illumina's HumanMethylation450-array associations between gestational age and cord blood DNA methylation in 3648 newborns from 17 cohorts without common pregnancy complications, induced delivery or caesarean section. We also explored associations of gestational age with DNA methylation measured at 4-18 years in additional pediatric cohorts. Follow-up analyses of DNA methylation and gene expression correlations were performed in cord blood. DNA methylation profiles were also explored in tissues relevant for gestational age health effects: fetal brain and lung. Results: We identified 8899 CpGs in cord blood that were associated with gestational age (range 27-42 weeks), at Bonferroni significance, P < 1.06 × 10- 7, of which 3343 were novel. These were annotated to 4966 genes. After restricting findings to at least three significant adjacent CpGs, we identified 1276 CpGs annotated to 325 genes. Results were generally consistent when analyses were restricted to term births. Cord blood findings tended not to persist into childhood and adolescence. Pathway analyses identified enrichment for biological processes critical to embryonic development. Follow-up of identified genes showed correlations between gestational age and DNA methylation levels in fetal brain and lung tissue, as well as correlation with expression levels. Conclusions: We identified numerous CpGs differentially methylated in relation to gestational age at birth that appear to reflect fetal developmental processes across tissues. These findings may contribute to understanding mechanisms linking gestational age to health effects.
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35.
  • Merid, Simon Kebede, et al. (author)
  • Integration of gene expression and DNA methylation identifies epigenetically controlled modules related to PM2.5 exposure
  • 2020
  • In: Environment International. - Stockholm : Karolinska Institutet, Dept of Clinical Science and Education, Södersjukhuset. - 0160-4120 .- 1873-6750.
  • Journal article (peer-reviewed)abstract
    • Air pollution has been associated with adverse health effects across the life-course. Although underlying mechanisms are unclear, several studies suggested pollutant-induced changes in transcriptomic profiles. In this meta-analysis of transcriptome-wide association studies of 656 children and adolescents from three European cohorts participating in the MeDALL Consortium, we found two differentially expressed transcript clusters (FDR p < 0.05) associated with exposure to particulate matter < 2.5 µm in diameter (PM2.5) at birth, one of them mapping to the MIR1296 gene. Further, by integrating gene expression with DNA methylation using Functional Epigenetic Modules algorithms, we identified 9 and 6 modules in relation to PM2.5 exposure at birth and at current address, respectively (including NR1I2, MAPK6, TAF8 and SCARA3). In conclusion, PM2.5 exposure at birth was linked to differential gene expression in children and adolescents. Importantly, we identified several significant interactome hotspots of gene modules of relevance for complex diseases in relation to PM2.5 exposure.
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36.
  • Mitselou, Niki, 1982-, et al. (author)
  • Preterm birth reduces the risk of IgE sensitization up to early adulthood : A population-based birth cohort study
  • 2022
  • In: Allergy. European Journal of Allergy and Clinical Immunology. - : Munksgaard Forlag. - 0105-4538 .- 1398-9995. ; 77:5, s. 1570-1582
  • Journal article (peer-reviewed)abstract
    • Background: Immunoglobulin E (IgE) sensitization is associated with asthma and allergic diseases. Gestational age influences early immune system development, thereby potentially affecting the process of tolerance induction to allergens.Objective: To study IgE sensitization to common allergens by gestational age from childhood up to early adulthood.Methods: Population-based birth cohort, data from the Swedish BAMSE study were used. Allergen-specific IgE antibodies to a mix of common food (fx5) and inhalant (Phadiatop) allergens were analysed at 4, 8, 16 and 24 years. Sensitization was defined as allergen-specific IgE >= 0.35 kU(A)/L to fx5 and/or Phadiatop at each time point. Using logistic regression and generalized estimated equations, adjusted odds ratios (aORs) for sensitization in relation to gestational age were calculated. Replication was sought within the Swedish twin study STOPPA.Results: In BAMSE, 3522 participants were screened for IgE antibodies during follow-up; of these, 197 (5.6%) were born preterm (<37 gestational weeks) and 330 (9.4%) post-term (>= 42 weeks). Preterm birth reduced the risk of sensitization to common food and/or inhalant allergens up to early adulthood by 29% (overall aOR = 0.71; 95% CI: 0.52-0.98), and to food allergens specifically by 40% (overall aOR = 0.60; 95% CI: 0.38-0.93). No relation was found between post-term birth and IgE sensitization at any time point. Replication analyses in STOPPA (N = 675) showed similar risk estimates for sensitization to food and/or inhalant allergens (aOR = 0.72; 95% CI: 0.42-1.21), which resulted in a combined meta-analysis aOR = 0.71 (95% CI: 0.54-0.94).Conclusions: Our study suggests an inverse association between preterm birth and long-term IgE sensitization.
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37.
  • Mogensen, Ida, et al. (author)
  • Lung function before and after COVID-19 in young adults : A population-based study.
  • 2022
  • In: The journal of allergy and clinical immunology. Global. - : University of Wisconsin Press. - 2772-8293. ; 1:2, s. 37-42
  • Journal article (peer-reviewed)abstract
    • BACKGROUND: There is limited evidence on the long-term impact of mild-to-moderate coronavirus disease 2019 (COVID-19) on lung function among young adults.OBJECTIVES: We aimed to assess whether COVID-19 has a negative impact on lung function in young adults and whether asthma, allergic sensitization, or use of inhaled corticosteroids (ICSs) modifies a potential association.METHODS: Participants from the population-based BAMSE (Barn, Allergi, Miljö, Stockholm, Epidemiologi) cohort with spirometry assessed before (2016-2019) and after onset of the COVID-19 pandemic (2020-2021) were included. Serum levels of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) receptor-binding domain-specific IgG, IgM, and/or IgA (determined with ELISA) defined seropositivity. Mean change in lung function (ie, change in FEV1, forced vital capacity [FVC], and FEV1/FVC ratio expressed as percent of predicted [pp]) from before to after onset of the pandemic were compared between the seronegative and seropositive participants. In seropositive participants, change in lung function was assessed in relation to allergic sensitization and self-reported ICS use.RESULTS: Of the 853 included participants, 29% (n = 243) were seropositive. There were no differences in change in lung function between the seronegative and seropositive participants (for mean change in FEV1 pp [SD], seropositivity = 0.87% [4.79%] and seronegativity = 1.03% (4.76%) [P = .66] for difference using a t test; FVC pp (SD), seropositivity = 1.34% (4.44%) and seronegativity = 1.29% (4.27%) [P = .87]; and for FEV1/FVC pp (SD), seropositivity = -0.25% (3.13%) and seronegativity = -0.13% (3.15%) [P = .61]). Similar results were observed among participants with asthma (n = 147 [17%]). Among seropositive participants, allergic sensitization or ICS use did not influence lung function.CONCLUSION: We found no evidence of mild-to-moderate COVID-19 affecting lung function long term in a population-based cohort of young adults. Moreover, neither asthma nor allergic sensitization nor ICS use affected the results.
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38.
  • Neuman, Åsa, et al. (author)
  • Infant wheeze, comorbidities and school age asthma
  • 2014
  • In: Pediatric Allergy and Immunology. - : Wiley. - 0905-6157 .- 1399-3038. ; 25:4, s. 380-386
  • Journal article (peer-reviewed)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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39.
  • Protudjer, Jennifer L. P., et al. (author)
  • Milk-Related Symptoms and Immunoglobulin E Reactivity in Swedish Children from Early Life to Adolescence
  • 2018
  • In: Nutrients. - : MDPI. - 2072-6643. ; 10:5
  • Journal article (peer-reviewed)abstract
    • Cow's milk often causes symptoms in infants. Whereas, some continue to experience symptoms through childhood, others become tolerant. Yet, the ages at which persistence and tolerance occur are less clear. Thus, we examined the age of onset and persistence of milk-related symptoms from early life to adolescence, and Immunoglobulin E (IgE) milk reactivity, focusing on gender differences in a large, population-based birth cohort. Overall, 20.0% (537/2985) of children, with a comparable gender distribution, had early life milk-related symptoms. At 16y, approximately 2% (62/2985) children had persistent symptoms and high milk IgE levels (e.g., median at 4 years: 1.5 kU(A)/L) that were beginning in early life. In contrast, 94% had transient symptoms and low median IgE levels (early life: 0.63 kU(A)/L, 8y: 0.72 kU(A)/L; 16 years: 1.1 kU(A)/L). Also, at 16 years, approximately 6% of females and 3% of males without any previously reported symptoms reported adolescent-onset of symptoms (p < 0.001). Such symptoms were almost exclusively gastrointestinal symptoms and were not associated with detectable IgE. In conclusion, early life milk-related symptoms are common, although most cases are transient by 16 years. Twice as many females vs. males report adolescent-onset symptoms, and particularly gastrointestinal symptoms. Children with persistent symptoms have both a higher prevalence and higher milk IgE levels, as compared to other phenotypes.
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40.
  • Protudjer, Jennifer, et al. (author)
  • Puberty and asthma in a cohort of Swedish children
  • 2014
  • In: Annals of Allergy, Asthma & Immunology. - Stockholm : Karolinska Institutet, Dept of Medical Epidemiology and Biostatistics. - 1534-4436 .- 1081-1206.
  • Journal article (other academic/artistic)
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41.
  • Protudjer, Jennifer, et al. (author)
  • The influence of childhood asthma on puberty and height in Swedish adolescents
  • 2015
  • In: Pediatric Allergy and Immunology. - Stockholm : Karolinska Institutet, Dept of Medical Epidemiology and Biostatistics. - 0905-6157. ; 26:5, s. 474-481
  • Journal article (peer-reviewed)abstract
    • BACKGROUND: Evidence relating to the effect of asthma on puberty or height is inconclusive. We aimed to examine whether the exposure of childhood asthma, including timing and phenotypes, and inhaled corticosteroid (ICS) use is either cross-sectionally or longitudinally associated with the outcomes of pubertal staging or height. METHODS: This study employed data from a longitudinal, population-based cohort of Swedish children (born 1994-1996). At ages 1, 2, 4, 8, and 12 years, parent-reported data on asthma and ICS use in the previous 12 months were collected. At 8 and 12 years, height was ascertained at a clinical visit, and child-reported, respectively. At 12 years, children answered puberty-related questions. RESULTS: Retention through 12 years was 82% (3366/4089). Participants without puberty data (n = 620) were excluded, yielding a study population of 2746 (67%). Asthma at 8 years, including timing of onset and phenotypes, was not statistically significantly associated with pubertal staging in adjusted models. Children with asthma averaged 0.93 cm (95% CI 0.35-1.50) shorter than children without asthma. Children with asthma using ICS were 1.28 (95% CI 0.62-1.95) shorter than those with asthma without using ICS. CONCLUSIONS: We found no consistent association between asthma and pubertal staging. Children with asthma were shorter than those without asthma. Moreover, children with asthma using ICS were shorter than those not using ICS.
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42.
  • Rydstrom, Lise-Lott, et al. (author)
  • How children in Sweden accessed and perceived information during the first phase of the Covid-19 pandemic
  • 2022
  • In: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 50:1, s. 144-151
  • Journal article (peer-reviewed)abstract
    • Aim: To describe how children in Sweden accessed and perceived information about SARS-CoV2 and Covid-19 during the first phase of the outbreak. Methods: This study is a substudy of an international cross-sectional online mixed methods survey examining elements of children's health literacy in relation to Covid-19. The survey included multiple-choice questions, open-ended questions and drawings and collected information from 50 Swedish children (7-12 years). Data were analysed concurrently on a descriptive level using statistics and content analysis. Quantitative and qualitative data, including the drawings, were considered equally important and resulted in six categories, illuminating how children accessed and perceived information about the pandemic. Results: The survey showed that children accessed information mainly from school but also from TV. They preferred information from reliable sources. Children reported the information they accessed as easy to understand and it prompted them to ask new questions. They reported they knew a lot about the pandemic, for example, the potential danger to themselves and others and how to act to protect themselves and others. They perceived the pandemic as an intrusion on their lives. Conclusions: This study indicates that Swedish children between 7 and 12 years old were well informed about SARS-CoV2 and Covid-19 during the first phase of the pandemic. School was shown to be an important source of information. The children could explain how to act to protect themselves and others from becoming infected by the virus.
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43.
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44.
  • Sdona, Emmanouela, et al. (author)
  • Dietary antioxidant intake in school age and lung function development up to adolescence
  • 2020
  • In: European Respiratory Journal. - : EUROPEAN RESPIRATORY SOC JOURNALS LTD. - 0903-1936 .- 1399-3003. ; 55:2
  • Journal article (peer-reviewed)abstract
    • Dietary antioxidant intake has been hypothesised to influence lung function. The association between total antioxidant capacity (TAC) of the diet at age 8 years and lung function development up to 16 years in 2307 participants from the Swedish population-based birth cohort BAMSE (Children, Allergy, Milieu, Stockholm, Epidemiology) was investigated. Information on TAC was obtained from a food frequency questionnaire at 8 years. Lung function was measured by spirometry at 8 and 16 years, impulse oscillometry (IOS) and exhaled nitric oxide fraction (F-eNO) at 16 years. Low lung function was defined as forced expiratory volume in 1 s (FEV1) z-score below the 25th percentile. Longitudinal associations between TAC and lung function were analysed by mixed effect models adjusted for potential confounders. Stratification by asthma at 8 years was performed to examine effect modification. The median TAC intake was 10 067 mu mol Trolox equivalents (TE).g(-1), with males having a lower mean compared to females (9963 versus 10819 mu mol TE.g(-1)). In analyses of lung function change between 8 and 16 years, there were no statistically significant associations between TAC in tertiles and spirometry results for the total study population. Among children with asthma at 8 years (prevalence 7%), higher TAC was associated with higher mean FEV1 (0.46 SD, 95% CI 0.11-0.80) and decreased odds of low lung function at 16 years (OR 0.28, 95% CI 0.12-0.65). There were no associations between TAC and forced vital capacity or IOS/F-eNO results. High dietary antioxidant intake in school age may be associated with improved lung function development from school age to adolescence among children with asthma.
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45.
  • Sdona, Emmanouela, et al. (author)
  • Dietary fibre in relation to asthma, allergic rhinitis and sensitization from childhood up to adulthood
  • 2022
  • In: Clinical and Translational Allergy. - : John Wiley & Sons. - 2045-7022. ; 12:8
  • Journal article (peer-reviewed)abstract
    • Background: Dietary fibre may reduce the risk of allergy. Our aim was to investigate the association between fibre intake in childhood, asthma, allergic rhinitis and IgE sensitization up to adulthood.Methods: The individual fibre intake of 2285 participants from the Swedish population-based birth cohort BAMSE was estimated between 98- and 107-item food frequency questionnaires at ages 8 and 16 years, respectively. At 8, 16 and 24 years, asthma and allergic rhinitis symptoms were assessed by questionnaires, and sensitization to common allergens by serum IgE. Longitudinal associations were analysed by generalized estimating equations, adjusting for potential confounders.Results: An inverse overall association was indicated between fibre intake at 8 years and allergic rhinitis symptoms up to 24 years (OR per 5 g/d 0.86; 95% CI 0.77-0.96), particularly in combination with airborne (0.74; 0.62-0.89) and food (0.69; 0.54-0.88) allergen sensitization. Higher fibre intake was also associated with specific allergen sensitization, for example, birch (0.77; 0.67-0.88) and soy (0.68; 0.53-0.87). No association was observed with asthma. Regarding sources, fruit (0.79; 0.67-0.94) and other (potatoes, chips/popcorn, legumes, and nuts, 0.71; 0.50-0.99), but not cereal or vegetable fibre were associated with allergic rhinitis. In additional analyses, including long-term fibre intake at 8 and 16 years, excluding participants with food-related allergic symptoms to examine reverse causation, as well as adjusting for antioxidant intake, associations were attenuated and became non-significant.Conclusion: Higher fibre intake in mid-childhood may be inversely associated with allergic rhinitis and sensitization to specific allergens up to adulthood. However, avoidance of food triggers of allergic symptoms in allergic rhinitis patients may contribute to the protective associations.
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46.
  • Sdona, Emmanouela, et al. (author)
  • Fruit, vegetable and dietary antioxidant intake in school age, respiratory health up to young adulthood.
  • 2022
  • In: Clinical and Experimental Allergy. - : John Wiley & Sons. - 0954-7894 .- 1365-2222. ; 52:1, s. 104-114
  • Journal article (peer-reviewed)abstract
    • BACKGROUND: Dietary antioxidants may protect the lung against oxidative damage and prevent chronic respiratory disease. We aimed to investigate fruit, vegetable and antioxidant intake (measured as total antioxidant capacity, TAC) at age 8 years in relation to asthma and lung function up to 24 years.METHODS: In this study of 2506 participants from a Swedish birth cohort, diet was assessed using food frequency questionnaires. Information on asthma was collected by questionnaires, and lung function was measured by spirometry at ages 8, 16 and 24 years. Generalized estimating equations and mixed effect models were used to assess overall, age- and sex-specific associations.RESULTS: After adjustment for confounders, a higher fruit intake at age 8 years was associated with a tendency to reduced odds of prevalent asthma (T3 vs. T1, OR 0.78; 95% CI 0.60-1.01, p-trend .083), with reduced odds of incident asthma and increased odds of remittent asthma (≥median, OR 0.76; 95% CI 0.58-0.99 and OR 1.60; 95% CI 1.05-2.42, respectively) up to 24 years. Comparable, but non-significant, odds ratios were observed in analyses of long-term fruit intake (mean intake at ages 8 and 16 years). In contrast, no association was observed with vegetable intake. A higher dietary TAC (T3 vs. T1) at 8 years was associated with reduced odds of prevalent asthma (OR 0.73; 95% CI 0.58-0.93, p-trend .010) and improved lung function development (FEV1 -z +0.11; 95% CI 0.01-0.21, p-trend .036 and FVC-z +0.09; 95% CI -0.01-0.20, p-trend .072) up to 24 years. Associations were more pronounced among males, and regarding asthma, participants sensitized to aeroallergens.CONCLUSIONS: Antioxidant intake in school age may improve asthma and lung function up to young adulthood. Although our results should be interpreted with caution, they emphasize the importance of following current dietary guidelines regarding consumption of antioxidant-rich foods as part of a balanced diet.
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47.
  • Sjölund, Jessica, 1988, et al. (author)
  • Quality of Life and Bidirectional Gut-Brain Interactions in Irritable Bowel Syndrome From Adolescence to Adulthood
  • 2024
  • In: Clinical Gastroenterology and Hepatology. - 1542-3565 .- 1542-7714. ; 22:4
  • Journal article (peer-reviewed)abstract
    • Backgrounds and Aims: Reports on cross-sectional and longitudinal associations between health-related quality of life (HRQoL), psychological distress, and irritable bowel syndrome (IBS) in the adolescent and young adult general population are few. We aimed to describe cross-sectional associations between HRQoL and IBS in adolescence and young adulthood, and examine bidirectional gut-brain interactions in the transition from childhood to adulthood. Methods: We included 3391 subjects from a prospective birth cohort study, with data on IBS at 16 years of age and 24 years of age. IBS was assessed using the pediatric Rome III (16 years of age) and the adult Rome IV (24 years of age) diagnostic questionnaires. HRQoL and psychological distress were assessed through EQ-5D. Sex-adjusted logistic regression models were used to examine associations between overall HRQoL/psychological distress at 16 years of age and new-onset IBS at 24 years of age (brain-gut) and between IBS at 16 years of age and new-onset psychological distress at 24 years of age (gut-brain). Results: In subjects with vs without IBS at 16 and 24 years of age, overall HRQoL (EQ visual analog scale, EQ-5D index value) was lower, and it was more common reporting problems in 4 of 5 EQ-5D dimensions (all P <.05). EQ-5D index value at 16 years of age was inversely associated (odds ratio [OR], 0.1, 95% confidence interval [CI], 0.01–0.6), and psychological distress at 16 years of age was positively associated (OR, 1.6; 95% CI, 1.2–2.3), with new-onset IBS at 24 years of age. Having any abdominal pain–related disorder of gut-brain interaction at 16 years of age was associated with new-onset psychological distress at 24 years of age (OR, 1.7; 95% CI, 1.2–2.5). Conclusions: Adolescents and young adults with IBS in the general population have impaired HRQoL. Bidirectional gut-brain interactions are relevant for symptom generation in abdominal pain–related disorders of gut-brain interaction, and for HRQoL impairment and psychological distress in the transition from childhood to adulthood.
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48.
  • Sousa-Pinto, Bernardo, et al. (author)
  • Validity, reliability, and responsiveness of daily monitoring visual analog scales in MASK-air®
  • 2021
  • In: Clinical and Translational Allergy. - : John Wiley & Sons. - 2045-7022. ; 11:7
  • Research review (peer-reviewed)abstract
    • Background: MASK-air® is an app that supports allergic rhinitis patients in disease control. Users register daily allergy symptoms and their impact on activities using visual analog scales (VASs). We aimed to assess the concurrent validity, reliability, and responsiveness of these daily VASs.Methods: Daily monitoring VAS data were assessed in MASK-air® users with allergic rhinitis. Concurrent validity was assessed by correlating daily VAS values with those of the EuroQol-5 Dimensions (EQ-5D) VAS, the Control of Allergic Rhinitis and Asthma Test (CARAT) score, and the Work Productivity and Activity Impairment Allergic Specific (WPAI-AS) Questionnaire (work and activity impairment scores). Intra-rater reliability was assessed in users providing multiple daily VASs within the same day. Test–retest reliability was tested in clinically stable users, as defined by the EQ-5D VAS, CARAT, or “VAS Work” (i.e., VAS assessing the impact of allergy on work). Responsiveness was determined in users with two consecutive measurements of EQ-5D-VAS or “VAS Work” indicating clinical change.Results: A total of 17,780 MASK-air® users, with 317,176 VAS days, were assessed. Concurrent validity was moderate–high (Spearman correlation coefficient range: 0.437–0.716). Intra-rater reliability intraclass correlation coefficients (ICCs) ranged between 0.870 (VAS assessing global allergy symptoms) and 0.937 (VAS assessing allergy symptoms on sleep). Test–retest reliability ICCs ranged between 0.604 and 0.878—“VAS Work” and “VAS asthma” presented the highest ICCs. Moderate/large responsiveness effect sizes were observed—the sleep VAS was associated with lower responsiveness, while the global allergy symptoms VAS demonstrated higher responsiveness.Conclusion: In MASK-air®, daily monitoring VASs have high intra-rater reliability and moderate–high validity, reliability, and responsiveness, pointing to a reliable measure of symptom loads.
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49.
  • Stemann Larsen, Pernille, et al. (author)
  • Pregnancy and Birth Cohort Resources in Europe: a Large Opportunity for Aetiological Child Health Research
  • 2013
  • In: Paediatric and Perinatal Epidemiology. - : Wiley-Blackwell. - 0269-5022 .- 1365-3016. ; 27:4, s. 393-414
  • Research review (peer-reviewed)abstract
    • Background During the past 25 years, many pregnancy and birth cohorts have been established. Each cohort provides unique opportunities for examining associations of early-life exposures with child development and health. However, to fully exploit the large amount of available resources and to facilitate cross-cohort collaboration, it is necessary to have accessible information on each cohort and its individual characteristics. The aim of this work was to provide an overview of European pregnancy and birth cohorts registered in a freely accessible database located at http://www.birthcohorts.net. Methods European pregnancy and birth cohorts initiated in 1980 or later with at least 300 mother-child pairs enrolled during pregnancy or at birth, and with postnatal data, were eligible for inclusion. Eligible cohorts were invited to provide information on the data and biological samples collected, as well as the timing of data collection. Results In total, 70 cohorts were identified. Of these, 56 fulfilled the inclusion criteria encompassing a total of more than 500000 live-born European children. The cohorts represented 19 countries with the majority of cohorts located in Northern and Western Europe. Some cohorts were general with multiple aims, whilst others focused on specific health or exposure-related research questions. Conclusion This work demonstrates a great potential for cross-cohort collaboration addressing important aspects of child health. The web site, http://www.birthcohorts.net, proved to be a useful tool for accessing information on European pregnancy and birth cohorts and their characteristics.
  •  
50.
  • Strinnholm, Åsa, 1962- (author)
  • Food hypersensitivity among schoolchildren : prevalence, Health Related Quality of Life and experiences of double-blind placebo-controlled food challenges
  • 2017
  • Doctoral thesis (other academic/artistic)abstract
    • Background: The prevalence of reported food hypersensitivity among children has increased in Western countries. However, the prevalence varies largely due to differences in methods used in different studies. Double-blind placebo-controlled food challenge (DBPCFC) is the most reliable method to verify or exclude food hypersensitivity. The use of double-blind food challenges is increasing in clinical praxis, but since the method is time- and resource consuming it is rarely used in population-based cohort studies. There is a lack of knowledge on how adolescents and mothers experience participation in double-blind placebocontrolled food challenges and to what extent the food is reintroduced after a negative challenge. While several studies have described the impact of IgEmediated food allergy on Health-Related Quality of Life (HRQL), few studies have described HRQL among children with other food hypersensitivity phenotypes.Aim: The aim of this thesis was to estimate the prevalence of reported food hypersensitivity, associated risk factors, and symptom expressions among schoolchildren. We also examined HRQL among children with total elimination of cow's milk, hen’s egg, fish or wheat due to food hypersensitivity as a group compared with children with unrestricted diet, and after we categorised the children with eliminated foods into different phenotypes of FHS. Finally, adolescents' and mothers' experience of DBPCFC was examined as well if the food had been reintroduced.Methods: Three studies were based on the Obstructive Lung Disease in Northern Sweden (OLIN) paediatric cohort II. The cohort was recruited in 2006 when all children in first and second grade (7-8 years) in three municipalities in Norrbotten were invited to a parental questionnaire study and 2,585 (96% of invited) participated. The questionnaire included questions about food hypersensitivity, asthma, rhinitis, eczema and possible risk factors. The children in two municipalities were also invited to skin prick testing with 10 airborne allergens, and 1,700 (90%) participated. Paper I is based on this initial survey of the cohort. Four years later, at age 11-12 years, the cohort was followed up using the same methods and with the same high participation rate. At the follow-up, 125 children (5% of the cohort) reported total elimination of cow's milk, hen's egg, fish or wheat due to food hypersensitivity. These children were invited to a clinical examination and to complete a generic (KIDSCREEN-52) and a diseasespecific HRQL questionnaire (FAQLQ-TF) (n=75). Based on the clinical examination the children were categorised into different phenotypes of food hypersensitivity: current food allergy, outgrown food allergy and lactose intolerance. In addition, a random sample of children with unrestricted diet from the same cohort, answered the generic questionnaire (n=209). Paper II is based on this HRQL study. Children categorised as having current food allergy were invited to a further evaluation including DBPCFC. Eighteen months after the challenges, these children were interviewed about their experiences during and after the challenge (n=17). Paper III is based on these interviews. Paper IV was based on interviews with mothers to children referred to a paediatric allergy specialist for evaluation of food allergy using DBPCFC (n=8). In the two interview studies results were analysed using qualitative content analysis.Results: At age 7-8 years, the prevalence of reported food hypersensitivity was 21%. Food hypersensitivity to milk, egg, fish, wheat or soy was reported by 10.9% and hypersensitivity to fruits or nuts by 14.6%. The most common essential food to trigger symptoms was milk, reported by 9%. The most frequently reported food induced symptoms, were oral symptoms mainly caused by fruits, followed by gastrointestinal symptoms mainly caused by milk. The risk factor pattern was different for food hypersensitivity to milk compared to hypersensitivity to other foods. No significant difference in distribution in generic or disease-specific HRQL was found among children with reported total elimination of milk, egg, fish and/or wheat due to FHS compared to children with unrestricted diet. However, a trend indicated that the disease-specific HRQL was most impaired among children with current food allergy compared to children with outgrown food allergy and lactose intolerance. The proportion of poor HRQL defined as ≥75 percentile was significantly higher among children with current food allergy than the other phenotypes. A DBPCFC was an opportunity for the adolescents and the mothers to overcome the fear of reactions to food that had been eliminated for a long time. After the challenge, when the food was partially or fully reintroduced, socializing became easier and both adolescents and mothers experienced more freedom regarding food intake. A negative challenge was not consistently associated with reintroduction of the food. Reasons for reintroduction failure were fear of allergic reactions, that the adolescent did not like the taste of the food, or that living with an elimination diet was considered as normal. Conclusion In this population-based study, one in five of children at age 7-8 years reported food hypersensitivity to any food. The generic HRQL was similar among children with and without food hypersensitivity. However, poor disease-specific HRQL was more common among children with current food allergy compared to children with other FHS phenotypes. If the tested food was reintroduced after a DBPCFC, both adolescents and mothers described a changed life with less fear, and that life had become easier regarding meal preparations and social events. As reintroduction failure was present despite a negative food challenge, follow-ups and evaluations of food reintroduction should be performed independent of the outcome of a food challenge.
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