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The impact of early rapid increase in body mass index (BMI) on asthma risk and subsequent lung function remains contentious, with limited prospective studies during a critical window for lung growth. Our aim was to investigate the associations between BMI trajectories in the first 2 years of life and adolescent asthma and lung function. Anthropometric data on 620 infants from the Melbourne Atopy Cohort Study were collected up to 18 times in the first 24 months of the study. BMI trajectories were developed by using group-based trajectory modeling. Associations between these trajectories and spirometry, fractional exhaled nitric oxide level, and current asthma status at 12 and/or 18 years of age were modeled by using multiple linear and logistic regression. A total of 5 BMI trajectories were identified. Compared with those children with the "average" trajectory, the children belonging to the "early-low and catch-up" and "persistently high" BMI trajectories were at higher risk of asthma at the age of 18 years (odds ratios = 2.2 [95% CI = 1.0-4.8] and 2.4 [95% CI = 1.1-5.3], respectively). These trajectories were also associated with a lower ratio of FEV 1 to forced vital capacity and a higher fractional exhaled nitric oxide levels at age 18 years. In addition, children belonging to the persistently low trajectory had lower FEV 1 (β = –183.9 mL [95% CI = –340.9 to –26.9]) and forced vital capacity (β = –207.8 mL [95% CI = –393.6 to –22.0]) values at the age of 18 years. In this cohort, the early-low and catch-up and persistently high trajectories were associated with asthma and obstructive lung function pattern in adolescence. Having a persistently low BMI at an early age was associated with a restrictive pattern. Thus, maintenance of normal growth patterns may lead to improved adolescent respiratory health. [ABSTRACT FROM AUTHOR]

Human milk oligosaccharides (HMO) are a diverse range of sugars secreted in breast milk that have direct and indirect effects on immunity. The profiles of HMOs produced differ between mothers. We sought to determine the relationship between maternal HMO profiles and offspring allergic diseases up to age 18 years. Colostrum and early lactation milk samples were collected from 285 mothers enrolled in a high-allergy-risk birth cohort, the Melbourne Atopy Cohort Study. Nineteen HMOs were measured. Profiles/patterns of maternal HMOs were determined using LCA. Details of allergic disease outcomes including sensitization, wheeze, asthma, and eczema were collected at multiple follow-ups up to age 18 years. Adjusted logistic regression analyses and generalized estimating equations were used to determine the relationship between HMO profiles and allergy. The levels of several HMOs were highly correlated with each other. LCA determined 7 distinct maternal milk profiles with memberships of 10% and 20%. Compared with offspring exposed to the neutral Lewis HMO profile, exposure to acidic Lewis HMOs was associated with a higher risk of allergic disease and asthma over childhood (odds ratio asthma at 18 years, 5.82; 95% CI, 1.59-21.23), whereas exposure to the acidic-predominant profile was associated with a reduced risk of food sensitization (OR at 12 years, 0.08; 95% CI, 0.01-0.67). In this high-allergy-risk birth cohort, some profiles of HMOs were associated with increased and some with decreased allergic disease risks over childhood. Further studies are needed to confirm these findings and realize the potential for intervention. [ABSTRACT FROM AUTHOR]

While exposure to places with higher greenness shows health benefits, evidence is scarce on its lipidemic effects. We assessed the associations between residential greenness and blood lipids and effect mediations by air pollution, physical activity, and adiposity in China. Our study included 15,477 adults from the population-based 33 Communities Chinese Health Study, conducted between April and December 2009, in Northeastern China. We measured total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C). Residential greenness was estimated using two satellite-derived vegetation indices – the Normalized Difference Vegetation Index (NDVI) and the Soil Adjusted Vegetation Index (SAVI). We used both nitrogen dioxide (NO 2) and particles ≤2.5 μm in aerodynamic diameter (PM 2.5) as proxies of outdoor air pollution. Associations were assessed using linear mixed effects regression models and logistic mixed effects regression models, and mediation analyses were also performed. Living in higher greenness areas was consistently associated with lower TC, TG, and LDL-C levels and higher HDL-C levels (e.g., change in TC, TG, LDL-C, and HDL-C per 0.1-unit increase in NDVI 500-m was −1.52%, −3.05%, −1.91%, and 0.52%, respectively). Similar results were obtained for the corresponding dyslipidemias. These associations were generally stronger in women and older adults. While educational levels showed effect modifications, the effect pattern was inconsistent. Both outdoor air pollution and body mass index mediated 9.1–62.3% and 5.6–40.1% of the associations for greenness and blood lipids, respectively, however, physical activity did not. Our results suggest beneficial associations between residing in places with higher greenness and blood lipid levels, especially in women and the elder individuals. The associations were partly mediated by lower air pollution and adiposity. Image 1 • Evidence on the association between greenness and blood lipids is scarce. • We explored this topic in 15,477 Chinese urban adults from the 33CCHS. • Residing in places with higher greenness showed beneficial effects on lipid metabolism. • The beneficial effects were stronger in women and the elder. • Air pollution and adiposity partially mediated the effects of greenness on lipids. Living in places with higher greenness is beneficially associated with blood lipids in Chinese adults, and the associations are partly mediated by air pollution and adiposity. [ABSTRACT FROM AUTHOR]

This review aimed to examine the relationship between surgical weight loss and obstructive sleep apnoea (OSA) severity (i.e., apnoea-hypopnoea index [AHI]), and how this relationship is altered by the various respiratory events scoring (RES) criteria used to derive the AHI. A systematic search of the literature was performed up to December 2017. Before-and-after studies were considered due to a paucity of randomised controlled trials (RCTs) available to be reviewed in isolation. Primary outcomes included pre- and post-surgery AHI and body mass index (BMI). Secondary outcomes included sleep study type and RES criteria. Meta-analysis was undertaken where possible. Overall, surgical weight loss resulted in reduction of BMI and AHI, however, OSA persisted at follow-up in the majority of subjects. There was high between-study heterogeneity which was largely attributable to baseline AHI and duration of follow-up when analysed using meta-regression. There was insufficient data to evaluate the impact of different RES criteria on OSA severity. Therefore, more RCTs are needed to verify these findings given the high degree of heterogeneity and future studies are strongly encouraged to report the RES criteria used to enable fair and uniform comparisons of the impact of any intervention on OSA severity. [ABSTRACT FROM AUTHOR]

Despite substantial disease burden, existing evidence on the risk factors for obstructive sleep apnea (OSA) have been derived primarily from cross-sectional studies without determining temporality. Therefore, we aimed to systematically synthesize the literature on longitudinal risk factors for sleep study-assessed OSA and questionnaire-assessed probable OSA from cohort studies in the general adult population settings. We systematically searched Embase and Medline (on OVID) databases. Eleven studies met the inclusion criteria. Meta-analyses were not conducted due to methodological heterogeneity of exposure and outcome measurements. There was consistent evidence that weight gain was associated with incident (n = 2) and greater severity (n = 2) of OSA. One study each observed an association of higher baseline body-mass index, male sex, asthma, a specific genetic polymorphism in rs12415421 , and insulin resistance/hyperglycemia, with incident OSA. Long-term exposure to ambient air pollution (NO 2 , n = 1) was associated with OSA, and menopausal transitions (n = 1) with higher apnea-hypopnea index. There were no eligible studies on long-term smoking or alcohol use. In conclusion, approximately 10% increase in weight, especially in males, might alert clinicians to consider potential or worsening OSA. Large, well-designed longitudinal studies are needed to consolidate knowledge on other associations with OSA development, especially on potentially modifiable risk factors. [ABSTRACT FROM AUTHOR]

Background Adolescents are at the highest risk of death from anaphylaxis, yet few population-based studies have described the frequencies and risk factors for allergic reactions caused by accidental allergen ingestion in this group. Methods We describe the prevalence, frequency, and associated risk factors for recent adverse food reactions in 10- to 14-year-olds in Melbourne, Australia, recruited from a stratified, random, population-based sample of schools (SchoolNuts, n = 9663; 48% response rate). Self-reported food allergy and adverse reaction details, including anaphylaxis, were identified by using a student questionnaire over the past year. Results Of 547 students with possible IgE-mediated food allergy, 243 (44.4%; 95% CI, 40.3% to 48.7%) reported a reaction to a food. Fifty-three (9.7%; 95% CI, 7.2% to 12.2%) students reported 93 anaphylaxis episodes. Peanut and tree nuts were the most common food triggers. Among students with current IgE-mediated food allergy, those with resolved or current asthma (adjusted odds ratio [aOR], 1.9 [95% CI, 1.1-1.3] and 1.7 [95% CI, 1.1-2.6]) and those with more than 2 food allergies (aOR, 1.9 [95% CI, 1.1-3.1]) were at greatest risk of any adverse food reaction, and those with nut allergy were most at risk of severe reactions (aOR, 2.9 [95% CI, 1.1-4.4]). Resolved or current asthma was not associated with increased risk of severe reactions (aOR, 0.8 [95% CI, 0.3-2.2] and 1.6 [95% CI, 0.7-3.7]). Conclusions Adolescents with food allergy are frequently exposed to food allergens. Those with asthma and more than 2 food allergies were at the greatest risk for adverse food reactions. Those with nut allergies were most at risk of severe reactions. [ABSTRACT FROM AUTHOR]

Background: Rising rates of food-induced anaphylaxis have recently been shown in the adolescent age group, following earlier descriptions of a rise in children younger than 5 years. However, few population-based studies have examined the prevalence of food allergy in adolescence using objective measures such as oral food challenge (OFC). Objective: We sought to determine the prevalence of food allergy among a population-based sample of 10- to 14-year-old adolescents using clinical evaluation including OFC to confirm the diagnosis. Methods: Schools were randomly selected from greater metropolitan Melbourne, Australia. Students aged 10 to 14 years, and their parents, were asked to complete a questionnaire regarding the adolescent's food allergy or food-related reactions. Clinic evaluation, which consisted of skin prick tests and OFC where eligible, was undertaken if students were suspected to have current food allergy from parent response. Among 9816 students assessed, 5016 had complete parent response and clinic evaluation when eligible. An additional 4800 students had student questionnaires only. Results: The prevalence of clinic-defined current food allergy based on history, sensitization data, and OFC results was 4.5% (95% CI, 3.9-5.1), with the most common food triggers being peanut, 2.7% (95% CI, 2.3-3.2), and tree nut, 2.3% (95% CI, 1.9-2.8). Among the additional group of 4800 adolescents who had only self-reported food allergy status available, the prevalence of self-reported current food allergy was 5.5% (95% CI, 4.9-6.2), with peanut, 2.8% (95% CI, 2.3-3.3), and tree nut, 2.3% (95% CI, 1.9-2.8), the most common. Conclusions: Approximately 1 in 20 10- to 14-year-old school students inMelbourne has current food allergy. This high prevalence suggests that the previously reported rise in food-induced anaphylaxis in this age groupmay reflect an increasing prevalence of food allergy rather than simply increased reporting of anaphylaxis. [ABSTRACT FROM AUTHOR]

We aimed to systematically review the Berlin questionnaire as a screening tool for obstructive sleep apnea. We systematically searched PubMed, Embase, and Scopus databases, reviewed articles reporting the Berlin questionnaire's diagnostic utility as measured against type-1 polysomnography, and performed meta-analyses where possible. Thirty five eligible articles showed that the Berlin questionnaire's diagnostic utility varied by study population, definition of hypopnea used, and apnea-hypopnea index threshold used. It had good sensitivity and specificity for detecting clinically relevant obstructive sleep apnea as well as any obstructive sleep apnea in the sleep clinic population. Despite limited evidence, it showed modest to high sensitivity for detecting clinically relevant obstructive sleep apnea or any obstructive sleep apnea in other clinical and general population subgroups. Its specificity was relatively low. Possible reasons for variability in reported diagnostic utility of the Berlin questionnaire are multifaceted. We conclude that the Berlin questionnaire is useful as a clinical screening test and epidemiological tool in the sleep clinic population. Despite limited evidence, it likely has potential clinical and research utility in other populations. Adopting more consistent methodological definitions and focussing more on the general population and specific clinical populations to determine its usefulness as a clinical or epidemiological screening tool are recommended. [ABSTRACT FROM AUTHOR]

Numerous studies have evaluated the effects of long-term exposure to ambient air pollution on hypertension. However, little information exists regarding its effects on prehypertension, a very common, but understudied cardiovascular indicator. We evaluated data from 24,845 adults (ages 18–74 years) living in three Northeastern Chinese cities in 2009. Blood pressure (BP) was measured by trained observers using a standardized mercuric-column sphygmomanometer. Three-year (from 2006 to 2008) average concentrations of particles with an aerodynamic diameter ≤10 μm (PM 10 ), sulfur dioxide (SO 2 ), nitrogen dioxides (NO 2 ), and ozone (O 3 ) were calculated using data from monitoring stations. Effects were analyzed using generalized additive models and two-level regression analyses, controlling for covariates. We found positive associations of all pollutants with prehypertension (e.g. odds ratio (OR) was 1.17 (95% confidence interval (CI), 1.09–1.25) per interquartile range (IQR) of PM 10 ) in a fully adjusted model, as compared to normotensive participants. These associations were stronger than associations with hypertension (e.g. OR was 1.03 (95% CI, 1.00, 1.07) per IQR of PM 10 ). We have also found positive associations of all studied pollutants with systolic and diastolic BP: e.g., associations with PM 10 per IQR were 1.24 mmHg (95% CI, 1.03–1.45) for systolic BP and 0.47 mmHg (95% CI, 0.33–0.61) for diastolic BP. Further, we observed that associations with BP were stronger in women and in older participants (systolic BP only). In conclusion, long-term exposure to ambient air pollution was more strongly associated with prehypertension than with hypertension, especially among females and the elderly. Thus, interventions to reduce air pollution are of great significance for preventing future cardiovascular events, particularly among individuals with prehypertension. [ABSTRACT FROM AUTHOR]

With this systematic review we aimed to determine the prevalence of obstructive sleep apnea (OSA) in adults in the general population and how it varied between population sub-groups. Twenty-four studies out of 3807 found by systematically searching PubMed and Embase databases were included in this review. Substantial methodological heterogeneity in population prevalence studies has caused a wide variation in the reported prevalence, which, in general, is high. At ≥5 events/h apnea-hypopnea index (AHI), the overall population prevalence ranged from 9% to 38% and was higher in men. It increased with increasing age and, in some elderly groups, was as high as 90% in men and 78% in women. At ≥15 events/h AHI, the prevalence in the general adult population ranged from 6% to 17%, being as high as 49% in the advanced ages. OSA prevalence was also greater in obese men and women. This systematic review of the overall body of evidence confirms that advancing age, male sex, and higher body-mass index increase OSA prevalence. The need to a) consider OSA as having a continuum in the general population and b) generate consensus on methodology and diagnostic threshold to define OSA so that the prevalence of OSA can be validly compared across regions and countries, and within age-/sex-specific subgroups, is highlighted. [ABSTRACT FROM AUTHOR]

The impact of ambient air pollution on health causes concerns in China. However, little is known about the association of short-term air pollution exposure with blood pressure (BP) in children. The goal of present study was to assess the association between short-term air pollution and BP in children from a highly polluted area in China. This study enrolled 9354 children in 24 elementary and middle schools (aged 5-17 years) from the Seven Northeast Cities (SNEC) study, respectively, during the period of 2012-2013. Ambient air pollutants, including particulate matter with an aerodynamic diameter of =10 μm (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2) and ozone (O3) on the days (1-5 days) preceding BP examination were collected from local air monitoring stations. Generalized additive models and two-level regression analyses were used to evaluate the relationship between air pollution and BP after adjusting for other covariates. Results showed that with an interquartile range (IQR) increase in PM10 (50.0 μg/m3) and O3 (53.0 μg/m3) level during the 5-day mean exposure, positive associations with elevated BP were observed, with an odds ratio of 2.17 (95% CI, 1.61-2.93) for PM10 and 2.77 (95% CI, 1.94-3.95) for O3. Both systolic BP and diastolic BP levels were positively associated with an IQR increase of four air pollutants at different lag times. Specifically, an IQR increase in the 5-day mean of PM10 and O3 was associated with elevation of 2.07 mmHg (95% CI, 1.71-2.44) and 3.29 mmHg (95% CI, 2.86-3.72) in systolic BP, respectively. When stratified by sex, positive relationships were observed for elevated BP with NO2 exposure only in males. This is the first report on the relationship between ambient short-term air pollution exposure and children BP in China. Findings indicate a need to control air pollutants and protect children from heavy air pollution exposure in China. [ABSTRACT FROM AUTHOR]

The objective of this systematic review is to synthesize the evidence on prevalence, polysomnographic findings and clinical outcomes of co-morbid obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD) - known as the "overlap syndrome". We systematically searched PubMed on 1 December 2015 using appropriate medical subject headings (MeSH) and text words to capture prevalence studies and comparative studies of any observational design examining the clinical outcomes in patients with co-existent COPD and OSA. We reviewed 591 articles and included 27 in the final review. In total, 21 observational studies (n = 29,341 participants) provided prevalence estimates. Overlap syndrome is not common in the general and hospital population (range: 1.0-3.6%), but is highly prevalent in patients diagnosed with either obstructive sleep apnea (range: 7.6-55.7%) or COPD (range: 2.9-65.9%). Overlap syndrome patients have been shown to have greater nocturnal oxygen desaturation (NOD) (i.e., reduced mean peripheral capillary oxygen saturation (SpO2) and increased sleep time spent with SpO2 < 90% (T90)) and worse sleep quality than patients with only OSA. It is associated with more frequent cardiovascular morbidity, poorer quality of life (QoL), more frequent COPD exacerbation and increased medical costs. This systematic review on overlap syndrome highlights the limitations and knowledge gaps of its prevalence, etiology and underlying pathophysiologic mechanisms related to increased morbidity and mortality. [ABSTRACT FROM AUTHOR]

Particulate matter (PM) exposure is associated to the adverse change in blood lipids. Vitamin D is beneficial to lipid metabolism, but whether vitamin D levels modifies the impact of air pollutants on lipids is unclear. The purpose of the study was to investigate if vitamin D modifies the associations of PM and serum lipids in young healthy people. From December 2017 to January 2018, a panel study with five once weekly follow-ups was conducted on 88 healthy adults aged 21.09 (1.08) (mean (SD)) years on average in Guangzhou, China. We measured serum lipids, serum 25-hydroxyvitamin D (25(OH)D) concentrations (440 blood samples in total), mass concentrations of particulate matter with diameters ≤2.5 μm (PM 2.5), ≤1.0 μm (PM 1.0), and ≤0.5 μm (PM 0.5), and number concentrations of particulate matter with diameters ≤0.2 μm (PN 0.2) and ≤0.1 μm (PN 0.1) at each follow-up. Linear mixed-effect models were applied to assess the interaction of vitamin D and size-fractionated PM short-term exposure on four lipid metrics. We found the interactions between 25(OH)D and size-fractionated PM exposure on blood lipids in different lags (lag 3 days and 4 days). An interquartile range increase in PM 2.5 , PM 1.0 , PM 0.5 were significantly associated with increments of 12.30%, 12.99%, and 13.66% in triglycerides (TGs) at lag 4 days at vitamin D levels <15 ng/mL group, respectively. Similar results were found for PN 0.2 , PN 0.1 and low-density lipoprotein cholesterol (LDL-C). All the associations between size-fractionated PM and blood lipids were found null statistically significant in vitamin D levels ≥15 ng/mL group. [Display omitted] • Vitamin D modified the association between particulate matter (PM) and blood lipids. • PM 2.5 , PM 10 , PM 0.5 are associated with increments of TGs at vitamin D < 15 ng/mL group. • PN 0.2 and PN 0.1 are associated with increments of LDL-C at vitamin D < 15 ng/mL group. • No association is observed between PM and blood lipids at vitamin D ≥ 15 ng/mL group. [ABSTRACT FROM AUTHOR]

Prospectively collected data on the natural history of food allergy are lacking. We examined the natural history of egg and peanut allergy in children from age 1 to 6 years and assessed whether a skin prick test (SPT) result or other clinical factors at diagnosis are associated with the persistence or resolution of food allergy in early childhood. The HealthNuts cohort consists of 5276 children who were recruited at age 1 year and have been followed prospectively. Children with food allergy at age 1 year (peanut [n = 156] or raw egg [n = 471] allergy) and children who developed new sensitizations or food reactions after age 1 year were assessed for food sensitization and allergy (confirmed by oral food challenge when indicated) at the 6-year follow-up. New-onset food allergy developed by age 6 years was more common for peanut (0.7% [95% CI = 0.5%-1.1%]) than egg (0.09% [95% CI = 0.03%-0.3%]). Egg allergy resolved more commonly (89% [95% CI = 85%-92%]) than peanut allergy (29% [95% CI = 22%-38%]) by age 6 years. The overall weighted prevalence of peanut allergy at age 6 years was 3.1% (95% CI = 2.6-3.7%) and that of egg allergy was 1.2% (95% = CI 0.9%-1.6%). The factors at age 1 year associated with persistence of peanut allergy were peanut SPT result of 8 mm or larger (odds ratio [OR] = 2.35 [95% CI 1.08-5.12]), sensitization to tree nuts (adjusted OR [aOR] = 2.51 [95% CI = 1.00-6.35]), and early-onset severe eczema (aOR = 3.23, [95% CI 1.17-8.88]). Factors at age 1 associated with persistence of egg allergy at age 6 were egg SPT result of 4 mm or larger (OR = 2.98 [95% CI 1.35-6.36]), other (peanut and/or sesame) food sensitizations (aOR = 2.80 [95% CI = 1.11-7.03]), baked egg allergy (aOR = 7.41 [95% CI = 2.16-25.3]), and early-onset severe eczema (aOR = 3.77 [95% CI = 1.35-10.52]). Most egg allergy and nearly one-third of peanut allergy resolves naturally by age 6 years. The prevalence of peanut allergy at age 6 years was similar to that observed at age 1 year, largely owing to new-onset food peanut allergy after age 1 year. Infants with early-onset eczema, larger SPT wheals, or multiple food sensitizations and/or allergies were less likely to acquire tolerance to either peanut or egg. [Display omitted] [ABSTRACT FROM AUTHOR]

Background: It is unknown whether population infant feeding practices have changed since recently revised Australian allergy guidelines removed recommendations to delay allergenic solids. Objectives: We sought to determine whether updated 2008 guidelines were associated with changes in feeding practice and to determine whether sociodemographic factors influenced this response. Methods: In a population-based, cross-sectional study (HealthNuts) of 5276 infants recruited between 2007 and 2011 in Melbourne, Australia, parents reported on infant feeding practices. Multinomial logistic regression was used to investigate the associations between recruitment year and feeding practices and whether these associations were modified by sociodemographic factors. Results: Compared with participants recruited in 2007-2009, those recruited in 2009-2011 were more likely to introduce solids at age 4 months (adjusted multinomial odds ratio [aMOR], 1.21; 95% CI, 1.02-1.45; P = .032) and less likely to introduce solids at age 6 months (aMOR, 0.80; 95% CI, 0.69-0.92; P = .002), egg after 6 months (aMOR, 0.82; 95% CI, 0.71-0.94; P = .004), and peanut after 12 months (aMOR, 0.70; 95% CI, 0.49-0.98; P = .037). Although parents recruited in 2009-2011 were less likely to formula feed (aMOR, 0.84; 95% CI, 0.72-0.98; P = .023), formula-fed infants were more likely to be given a partially hydrolyzed formula (aMOR, 1.37; 95% CI, 1.12-1.70; P = .003). These changes were significantly stronger among families with a higher socioeconomic status and those without a family history of allergies. Conclusion: Updated national allergy guidelines are associated with reduced delay in introduction of solids, egg, and peanut and an increase in partially hydrolyzed formula use among formula-fed infants. Higher socioeconomic status and absence of family history of allergies were associated with better uptake of feeding guidelines. [Copyright &y& Elsevier]

Background: Ninety-five percent positive predictive values (PPVs) provide an invaluable tool for clinicians to avoid unnecessary oral food challenges. However, 95% PPVs specific to infants, the age group most likely to present for diagnosis of food allergy, are limited. Objective: We sought to develop skin prick test (SPT) and allergen-specific IgE (sIgE) thresholds with 95% PPVs for challenge-confirmed food allergy in a large population-based cohort of 1-year-old infants with challenges undertaken irrespective of SPT wheal size or previous history of ingestion. Methods: HealthNuts is a population-based, longitudinal food allergy study with baseline recruitment of 1-year-old infants. Infants were recruited from council-run immunization sessions during which they underwent SPTs to 4 allergens: egg, peanut, sesame, and cow’s milk/shrimp. Any infant with a detectable SPT response was invited to undergo oral food challenge and sIgE testing. Results: Five thousand two hundred seventy-six infants participated in the study. Peanut SPT responses of 8 mm or greater (95% CI, 7-9 mm), egg SPT responses of 4 mm or greater (95% CI, 3-5 mm), and sesame SPT responses of 8 mm or greater (95% CI, 5-9 mm) had 95% PPVs for challenge-proved food allergy. Peanut sIgE levels of 34 kUA/L or greater (95% CI, 14-48 kUA/L) and egg sIgE levels of 1.7 kUA/L or greater (95% CI, 1-3 kUA/L) had 95% PPVs for challenge-proved food allergy. Results were robust when stratified on established risk factors for food allergy. Egg SPT responses and sIgE levels were poor predictors of allergy to egg in baked goods. Conclusion: These 95% PPVs, which were generated from a unique dataset, are valuable for the diagnosis of food allergy in young infants and were robust when stratified across a number of different risk factors. [Copyright &y& Elsevier]

Background: Measurement of whole peanut-specific IgE (sIgE) is often used to confirm sensitization but does not reliably predict allergy. Ara h 2 is the dominant peanut allergen detected in 90% to 100% of patients with peanut allergy and could help improve diagnosis. Objectives: We sought to determine whether Ara h 2 testing might improve the accuracy of diagnosing peanut allergy and therefore circumvent the need for an oral food challenge (OFC). Methods: Infants from the population-based HealthNuts study underwent skin prick tests to determine peanut sensitization and subsequently underwent a peanut OFC to confirm allergy status. In a stratified random sample of 200 infants (100 with peanut allergy and 100 with peanut tolerance), whole peanut sIgE and Ara h 2 sIgE levels were quantified by using fluorescence enzyme immunoassay. Results: By using the previously published 95% positive predictive value of 15 kUA/L for whole peanut sIgE, a corresponding specificity of 98% (95% CI, 93% to 100%) was found in this study cohort. At the equivalent specificity of 98%, the sensitivity of Ara h 2 sIgE is 60% (95% CI, 50% to 70%), correctly identifying 60% of subjects with true peanut allergy compared with only 26% correctly identified by using whole peanut sIgE. We report that when using a combined approach of plasma sIgE testing for whole peanut followed by Ara h 2 for the diagnosis of peanut allergy, the number of OFCs required is reduced by almost two thirds. Conclusion: Ara h 2 plasma sIgE test levels provide higher diagnostic accuracy than whole peanut plasma sIgE levels and could be considered a new diagnostic tool to distinguish peanut allergy from peanut tolerance, which might reduce the need for an OFC. [Copyright &y& Elsevier]

Background: Infant feeding guidelines have long recommended delaying introduction of solids and allergenic foods to prevent allergy in high-risk infants, despite a paucity of evidence. Objective: We aimed to determine whether confirmed egg allergy in 12-month-old infants is associated with (1) duration of breast-feeding and (2) ages of introducing egg and solids. Methods: In a population-based cross-sectional study (HealthNuts) parents reported on infant feeding and potential confounding factors before skin prick testing for egg white. Egg-sensitized infants were then offered an egg oral food challenge. Multiple logistic regression was used to investigate associations between diet and egg allergy adjusted for possible confounding factors. Results: A total of 2589 infants (73% response) participated. Compared with introduction at 4 to 6 months, introducing egg into the diet later was associated with higher risks of egg allergy (adjusted odds ratios [ORs], 1.6 [95% CI, 1.0-2.6] and 3.4 [95% CI, 1.8-6.5] for introduction at 10-12 and after 12 months, respectively). These findings persisted even in children without risk factors (OR, 3.3 [95% CI, 1.1-9.9]; 10-12 months). At age 4 to 6 months, first exposure as cooked egg reduced the risk of egg allergy compared with first exposure as egg in baked goods (OR, 0.2 [95% CI, 0.06-0.71]). Duration of breast-feeding and age at introduction of solids were not associated with egg allergy. Conclusions: Introduction of cooked egg at 4 to 6 months of age might protect against egg allergy. Changes in infant feeding guidelines could have a significant effect on childhood egg allergy and possibly food allergy more generally. [ABSTRACT FROM AUTHOR]

Emerging research suggests health effects in offspring after parental chemical exposures before conception. Many future mothers are exposed to potent chemicals at work, but potential offspring health effects are hardly investigated. We sought to investigate childhood asthma in relation to mother's occupational exposure to cleaning products and disinfectants before conception. The multicenter Respiratory Health In Northern Europe/Respiratory Health In Northern Europe, Spain and Australia generation study investigated asthma and wheeze starting at age less than 10 years in 3318 mother-offspring pairs. From an asthma-specific Job-Exposure Matrix and mothers' occupational history, we defined maternal occupational exposure to indoor cleaning agents (cleaning products/detergents and disinfectants) starting before conception, in the 2-year period around conception and pregnancy, or after birth. Never-employed mothers were excluded. Exposed groups include cleaners, health care workers, cooks, and so forth. Associations were analyzed using mixed-effects logistic regression and ordinary logistic regression with clustered robust SEs and adjustment for maternal education. Maternal occupational exposure to indoor cleaning starting preconception and continuing (n = 610) was associated with offspring's childhood asthma: odds ratio 1.56 (95% CI, 1.05-2.31), childhood asthma with nasal allergies: 1.77 (1.13-2.77), and childhood wheeze and/or asthma: 1.71 (95% CI, 1.19-2.44). Exposure starting around conception and pregnancy (n = 77) was associated with increased childhood wheeze and/or asthma: 2.25 (95% CI, 1.03-4.91). Exposure starting after birth was not associated with asthma outcomes (1.13 [95% CI, 0.71-1.80], 1.15 [95% CI, 0.67-1.97], 1.08 [95% CI, 0.69-1.67]). Mother's occupational exposure to indoor cleaning agents starting before conception, or around conception and pregnancy, was associated with more childhood asthma and wheeze in offspring. Considering potential implications for vast numbers of women in childbearing age using cleaning agents, and their children, further research is imperative. [Display omitted] [ABSTRACT FROM AUTHOR]

Background: The association between eczema and asthma is well documented, but the temporal sequence of this association has not been closely examined. Objectives: To examine the association between childhood eczema and asthma incidence from preadolescence to middle age, and between childhood eczema and asthma persisting to middle age. A further aim was to examine any effect modification by nonallergic childhood exposures on the association between childhood eczema and both childhood asthma and later life incident asthma. Methods: Data were gathered from the 1968, 1974, and 2004 surveys of the Tasmanian Longitudinal Health Study. Multivariable logistic regression examined the association between childhood eczema and childhood asthma. Cox regression examined the association between childhood eczema and asthma incidence in preadolescence, adolescence, and adult life. Binomial regression examined the association between childhood eczema and childhood asthma persisting to age 44 years. Results: Childhood eczema was significantly associated with childhood asthma and with incident asthma in preadolescence (hazard ratio [HR], 1.70; 95% CI, 1.05-2.75), adolescence (HR, 2.14; 95% CI, 1.33-3.46), and adult life (HR, 1.63; 95% CI, 1.28-2.09). Although childhood eczema was significantly associated with asthma persisting from childhood to middle age (relative risk, 1.54; 95% CI, 1.17-2.04), this association was no longer evident when adjusted for allergic rhinitis. Conclusion: Childhood eczema increased the likelihood of childhood asthma, of new-onset asthma in later life and of asthma persisting into middle age. [Copyright &y& Elsevier]

Background: A recent cohort study suggested that intake of soy milk or soy formula was associated with peanut allergy. If this finding is confirmed, it suggests an avenue for modification of diet as a peanut allergy prevention strategy. Objective: To investigate the relationship between soy consumption and peanut sensitization in a prospective cohort study of children. Methods: A total of 620 babies with a family history of allergic disease were recruited. Dietary information was obtained from telephone interviews every 4 weeks from birth until 15 months and then again at 18 months and 2 years. Skin prick tests to peanut, milk, and egg were performed at 6, 12, and 24 months. A wheal size ≥3 mm was considered positive for sensitization. Results: Children whose parents elected to introduce soy formula or soy milk into their children''s diet were more likely to be sensitized to peanuts at 2 years (odds ratio, 2.02; 95% CI, 1.04-3.92; P = .039). However, this relationship was explained by feeding of soy to children who had siblings with milk allergy or were themselves sensitized to milk. After adjusting for these factors, there was no evidence of an association between soy consumption and peanut sensitization (odds ratio, 1.34; 95% CI, 0.64-2.79; P = .434). Conclusion: The association between soy consumption and peanut sensitization is not causal but merely a result of preferential use of soy milk in infants with a personal or family history of cow''s milk allergy. Future studies should take the confounding effects related to dietary modifications by parents into account when investigating the association between diet and childhood allergic diseases. [Copyright &y& Elsevier]

Background: The atopic march hypothesis suggests that infants with eczema are at increased risk of asthma. Others argue that eczema is not a risk factor for asthma unless there is also sensitization or early wheezing. Objective: To examine the role of infantile eczema as a predictor of risk of childhood asthma, while allowing for the effects of early wheeze, sensitization, and sex, both as independent effects and possible effect modifiers. Methods: A total of 620 infants with a family history of allergic disease was recruited. Eczema and wheeze was prospectively documented to 2 years of age. Sensitization was determined by skin prick tests at 6, 12, and 24 months to 6 common food and inhalant allergens. Interviews were conducted at 6 and 7 years to ascertain current asthma. Results: Sufficiently complete data were available for 403 children. Eczema within the first 2 years of life was clearly associated with an increased risk of childhood asthma in boys (adjusted odds ratio, 2.45; 95% CI, 1.31-4.46) but not in girls (odds ratio, 0.88; 95% CI, 0.43-1.77; P for interaction = .031) even with adjustment for the effects of early allergic sensitization and wheeze. If these relationships are causal, an intervention to prevent eczema in boys might reduce the incidence of childhood asthma by as much as 28%. Conclusion: Eczema in the first 2 years of life is associated with an increased risk of childhood asthma in boys, but there is no evidence of this in girls. [Copyright &y& Elsevier]

Background: The literature regarding the association between breast-feeding and atopic diseases has been contradictory. Objective: We have assessed the relationship between breast-feeding and atopic disorders in a cohort followed into middle age. Methods: The Tasmanian Asthma Study is a population-based prospective cohort study that has followed participants from the age of 7 to 44 years. Exclusive breast-feeding in the first 3 months of life was examined as a risk factor for atopic diseases by using multiple logistic regression and generalized estimating equation analyses. Results: At age 7 years, exclusively breast-fed children with a maternal history of atopy had a marginally lesser risk of current asthma than those not exclusively breast-fed (odds ratio [OR], 0.8; 95% CI, 0.6-1.0). However, after age 7 years, the risk reversed, and exclusively breast-fed children had an increased risk of current asthma at 14 (OR, 1.46; 95% CI, 1.02-2.07), 32 (OR, 1.84; 95% CI, 1.06-3.3), and 44 (OR, 1.57; 95% CI, 1.15-2.14) years. Exclusively breast-fed children also had a reduced risk of food allergy at age 7 years but an increased risk of food allergy (OR, 1.26; 95% CI, 1.1-1.5) and allergic rhinitis (OR, 1.2; 95% CI, 1.0-1.3) at 44 years. Conclusion: Exclusively breast-fed babies with a maternal history of atopy were less likely to develop asthma before the age of 7 years, but more likely to develop asthma after the age of 7 years. Clinical implications: The current recommendation to breast-feed high-risk infants for protection against early wheezing illness can be confirmed. However, the recommendation should be reconsidered for protection against allergic asthma and atopy in the longer term. [Copyright &y& Elsevier]

Background: The association between allergic rhinitis and asthma is well documented, but the temporal sequence of this association has not been closely examined. Objective: We sought to assess the associations between childhood allergic rhinitis and (1) asthma incidence from preadolescence to middle age and (2) asthma persistence to middle age. Methods: Data were gathered from the 1968, 1974, and 2004 surveys of the Tasmanian Asthma Study. Cox regression was used to examine the association between childhood allergic rhinitis and asthma incidence in preadolescence, adolescence, and adult life. Binomial regression was used to examine the association between childhood allergic rhinitis and asthma beginning before the age of 7 years and persisting at age 44 years. Results: Childhood allergic rhinitis was associated with a significant 2- to 7-fold increased risk of incident asthma in preadolescence, adolescence, or adult life. Childhood allergic rhinitis was associated with a 3-fold increased risk of childhood asthma persisting compared with remitting by middle age. Conclusions: Childhood allergic rhinitis increased the likelihood of new-onset asthma after childhood and the likelihood of having persisting asthma from childhood into middle age. Clinical implications: Asthma burden in later life might be reduced by more aggressive treatment of allergic rhinitis in early life. [Copyright &y& Elsevier]

Summary: Background: Respiratory symptoms in adulthood have been found to be associated with childhood respiratory infection, but few studies have analyzed adult bronchial responsiveness (BHR) with adequate adjustment for known risk factors. Objective: To estimate the relation of BHR with serious childhood respiratory infections in a large population study. Methods: The European Community Respiratory Health Survey (ECRHS) was a cross-sectional population-based survey in 34 centers. Data on serious respiratory infections before the age of 5 years and possible confounders were obtained from a questionnaire administered in the clinic. Blood samples were taken for measurement of total immunoglobulin E (IgE) and specific IgE to four common allergens, and spirometry and bronchial challenge with methacholine were performed. A continuous measure of BHR was analyzed by multiple regression, in 11,282 participants, in relation to serious respiratory infection and other potential risk factors, adjusted for center and major determinants of adult BHR. Results: Those reporting a serious childhood respiratory infection had greater BHR, by an amount corresponding to approximately 0.23 doubling doses (95% confidence interval 0.02–0.44) of the amount of methacholine causing a 20% fall (PD20) in forced expiratory volume in 1s (FEV1). All childhood factors explained less than 0.3% of variation in BHR in addition to over 20% by factors measured in adulthood. The relation of BHR to BMI was confined to smokers. Conclusions: We found an effect of serious childhood respiratory infection on adult BHR, but this was small in comparison to relations of BHR to IgE-sensitization and airway caliber. [Copyright &y& Elsevier]

Background: Asthma and allergy might influence the choice of keeping pets, leading to apparent protective effects of pets on allergic disease. Objective: We investigated the effects of asthma and allergy on subsequent pet keeping in childhood and adulthood. Methods: Information about asthma and pet keeping at ages 0 to 4, 5 to 15, 20 to 44, and 26 to 56 years was provided by 9812 subjects participating in the 9-year follow-up of the European Community Respiratory Health Survey. Results: In childhood asthma debut at younger than 5 years was associated with less cat keeping at 5 to 15 years (odds ratio [OR], 0.60; 95% CI, 0.44-0.82), an effect only observed when the parents did not have asthma or allergy (P interaction = .045). Childhood asthma did not influence adult pet ownership, unless there were adult symptoms. Adults less often acquired cats at follow-up if they had 3 or more asthma symptoms (OR, 0.78; 95% CI, 0.64-0.95), were taking asthma medication (OR, 0.48; 95% CI, 0.31-0.74), had hay fever (OR, 0.75; 95% CI, 0.62-0.91), had atopy (OR, 0.75; 95% CI, 0.61-0.91), or had specific IgE to cat (OR, 0.57; 95% CI, 0.39-0.82) at baseline. Adults who already had pets usually continued keeping the same type of pet, except that the presence of 3 or more asthma symptoms was associated with less subsequent dog keeping (OR, 0.69; 95% CI, 0.53-0.89). Pet removal between surveys to reduce allergen was reported by 4.7%. Conclusion: Selective avoidance subsequent to asthma or allergy was observed for childhood cat keeping and adult cat acquisition. Avoidance would produce an apparent protective effect of cats on childhood asthma (large OR, 0.83). Avoidance was generally not observed for dogs or birds. Clinical implications: A part of the protective effects of childhood cats on asthma and allergy can be attributed to selective avoidance. [Copyright &y& Elsevier]

Background: A number of studies have observed an association between breast-feeding and increased risk of development of asthma and eczema. It has been proposed that these results might be due to early signs of atopic disease in the infant causing mothers to prolong breast-feeding. Objective: We sought to determine whether early symptoms of atopic disease (eczema, food reaction, or asthma) or positive skin prick test responses reduce the likelihood of ceasing breast-feeding. Methods: A prospective birth cohort of 620 infants from Melbourne, Australia, was used. Telephone interviews every 4 weeks were conducted until 64 weeks and then again at 78 and 104 weeks to determine duration of breast-feeding (both exclusive and total) and evidence of atopic disease. Because of the varying time of onset of atopic symptoms, they were modeled as time-varying covariates in Cox models. Results: Only 52 (8.4%) infants did not establish breast-feeding, whereas an additional 103 (25.0%) did not establish exclusive breast-feeding. Early signs of atopic disease or sensitization were independently associated with an approximately 28% reduction in risk of ceasing exclusive breast-feeding (adjusted hazard ratio, 0.72; 95% CI, 0.53-0.97); P = .029), but there was no evidence for a relationship with risk of ceasing breast-feeding completely (adjusted hazard ratio, 1.12; 95% CI, 0.92-1.37; P = .262). Conclusion: Early signs of atopic disease might prolong the duration of exclusive breast-feeding. This could mask a protective effect of breast-feeding or even result in breast-feeding appearing to be a risk factor for the development of atopic diseases. Future investigation of the relationship between breast-feeding and atopic diseases should consider this possibility. [Copyright &y& Elsevier]

Recent evidence suggests that air pollution exposure may be a contributing risk factor for obstructive sleep apnea (OSA), however, current evidence is conflicting. This systematic review aims to determine the association between air pollution and OSA in the general population, and examine for potential effect modification by seasonality, temperature and humidity. Five full-text articles were included in the review out of 905 articles found by systematically searching PubMed, Embase and Scopus databases. The included studies were limited to OSA in adults that were conducted in middle to high-income countries. The results highlight heterogeneity in the diagnostic criteria for OSA and method used to assess air pollution exposure. There is some evidence to support a relationship between air pollution exposure and OSA. However, the duration of exposure to different air pollutants including particulate matter (PM2.5 and PM10) and nitric oxides (NO2) in relation to OSA varied across different seasons, temperatures, and countries. This variability of the pollutants across studies warrants a more robust study design using time-series analysis with multiple follow-ups to strengthen the evidence for this relationship before considering its implications. [ABSTRACT FROM AUTHOR]

Although the impact of early life acetaminophen on asthma risk is still not clear, potential interactions with glutathione S-transferase (GST) genes due to reduced antioxidant function in particular polymorphisms, and possible impact on lung function, have never been investigated in adolescents. We aimed to investigate associations between early life acetaminophen use and adolescent asthma and lung function and to assess potential interactions by GST polymorphisms. Acetaminophen use was recorded 18 times up to age 2 years (n = 575 [92.7%]). Participants were genotyped for GST polymorphisms (GSTM1/T1/P1) (n = 429 [69.2%]). Asthma and lung function were measured at 12 (n = 365 [58.9%]) and 18 years (n = 413 [66.6%]). Regression models assessed associations and interactions. Doubling of days of acetaminophen use was associated with reduced prebronchodilator FEV 1 /forced vital capacity (β coefficient, −0.10; 95% CI, −0.19 to −0.01) and midexpiratory flow (−0.09; 95% CI, −0.18 to 0) at 18 years, but this association was not found when restricted for nonrespiratory reasons, suggesting confounding by indication. However, in children with GSTM1 null and GSTT1 present, increasing acetaminophen use for nonrespiratory reasons was associated with reduced FEV 1 and midexpiratory flow at 18 years (interaction between GSTM1/T1 and acetaminophen P <.05). Increased acetaminophen use was associated with asthma at 18 years for children with GSTP1 Ile/Ile (odds ratio, 1.66; 95% CI, 1.07 to 2.57), but not other GSTP1 genotypes. These novel findings need to be investigated for consistency in other studies but suggest that children carrying risk genotypes may be susceptible to respiratory consequences from acetaminophen use. [ABSTRACT FROM AUTHOR]

Overweight status and asthma have increased during the last decades. Being overweight is a known risk factor for asthma, but it is not known whether it might also increase asthma risk in the next generation. We aimed to examine whether parents being overweight in childhood, adolescence, or adulthood is associated with asthma in their offspring. We included 6347 adult offspring (age, 18-52 years) investigated in the Respiratory Health in Northern Europe, Spain and Australia (RHINESSA) multigeneration study of 2044 fathers and 2549 mothers (age, 37-66 years) investigated in the European Community Respiratory Health Survey (ECRHS) study. Associations of parental overweight status at age 8 years, puberty, and age 30 years with offspring's childhood overweight status (potential mediator) and offspring's asthma with or without nasal allergies (outcomes) was analyzed by using 2-level logistic regression and 2-level multinomial logistic regression, respectively. Counterfactual-based mediation analysis was performed to establish whether observed associations were direct or indirect effects mediated through the offspring's own overweight status. We found statistically significant associations between both fathers' and mothers' childhood overweight status and offspring's childhood overweight status (odds ratio, 2.23 [95% CI, 1.45-3.42] and 2.45 [95% CI, 1.86-3.22], respectively). We also found a statistically significant effect of fathers' onset of being overweight in puberty on offspring's asthma without nasal allergies (relative risk ratio, 2.31 [95% CI, 1.23-4.33]). This effect was direct and not mediated through the offspring's own overweight status. No effect on offspring's asthma with nasal allergies was found. Our findings suggest that metabolic factors long before conception can increase asthma risk and that male puberty is a time window of particular importance for offspring's health. [ABSTRACT FROM AUTHOR]

Evidence of health effects following early life exposure to short-to-medium duration of high pollution levels is extremely limited. We aimed to evaluate the associations between: 1. intrauterine exposure to fine particulate matter (PM 2.5) from coal mine fire emissions and the frequencies of general practitioner attendances and dispensations of prescribed asthma inhalers, steroid skin creams, and antibiotics during the first year of life; 2. infant exposure and those outcomes during the year following the fire. All participants were recruited from the Latrobe Valley of Victoria, Australia. Participants' 24-h average and hourly peak mine fire-specific PM 2.5 exposures from 09/02/2014 to 31/03/2014 were estimated using chemical transport modelling. Outcome data were obtained from the Australian Medicare Benefits Schedule and Pharmaceutical Benefits Scheme from each child's birth to 31/12/2016. We used negative binomial and logistic regression models to independently assess risks of the outcomes associated with every 10 and 100 μg m−3 increase in average or peak PM 2.5 exposure, respectively, while adjusting for potential confounders. We included 286 of 311 children whose parents consented to be linked, comprising 77 with no exposure, 88 with intrauterine exposure and 121 with exposure in infancy. 10- and 100- μg m−3 increases in average and peak PM 2.5 exposure during infancy were associated with greater incidence of antibiotics being dispensed during the year following the fire: the adjusted incidence rate ratios were 1.24 (95% CI 1.02, 1.50, p = 0.036) and 1.14 (1.00, 1.31, p = 0.048) respectively. No other significant associations were observed. Exposure to coal mine fire emissions during infancy was associated with increased dispensing of antibiotics. This could reflect increased childhood infections or increased prescriptions of antibiotics in the year following the fire. Image 1 • Evidence on long-term health effects following early life air pollution is scarce. • We assessed the health impact of perinatal fire smoke exposure on 286 children. • Infant exposure was associated with increased antibiotic dispensation. Main findings: Infant exposure to air pollution from coal mine fire emissions might be associated with increased childhood infections. [ABSTRACT FROM AUTHOR]

Evidence suggests that residential greenness may be protective of high blood pressure, but there is scarcity of evidence on the associations between greenness around schools and blood pressure among children. We aimed to investigate this association in China. Our study included 9354 children from 62 schools in the Seven Northeastern Cities Study. Greenness around each child's school was measured by NDVI (Normalized Difference Vegetation Index) and SAVI (Soil-Adjusted Vegetation Index). Particulate matter ≤ 1 μm (PM 1) concentrations were estimated by spatiotemporal models and nitrogen dioxide (NO 2) concentrations were collected from air monitoring stations. Associations between greenness and blood pressure were determined by generalized linear and logistic mixed-effect models. Mediation by air pollution was assessed using mediation analysis. Higher greenness was consistently associated with lower blood pressure. An increase of 0.1 in NDVI corresponded to a reduction in SBP of 1.39 mmHg (95% CI: 1.86, −0.93) and lower odds of hypertension (OR = 0.76, 95% CI: 0.69, 0.82). Stronger associations were observed in children with higher BMI. Ambient PM 1 and NO 2 mediated 33.0% and 10.9% of the association between greenness and SBP, respectively. In summary, greater greenness near schools had a beneficial effect on blood pressure, particularly in overweight or obese children in China. The associations might be partially mediated by air pollution. These results might have implications for policy makers to incorporate more green space for both aesthetic and health benefits. Image 1 • Evidence on the association between greenness and blood pressure among children is scarce. • We are the first to explore this topic based on school surrounding greenness exposure. • Attending schools with higher greenness showed beneficial effects on blood pressure. • The beneficial effects were stronger in children with higher BMI levels. • Air pollution might partially mediate the effects of greenness on blood pressure. Greater greenness near schools was associated with lower blood pressure among children, which might have implications for policy makers to incorporate more green space. [ABSTRACT FROM AUTHOR]

Little information exists on interaction effects between air pollution and influenza vaccination on allergic respiratory diseases. We conducted a large population-based study to evaluate the interaction effects between influenza vaccination and long-term exposure to ambient air pollution on allergic respiratory diseases in children and adolescents. A cross-sectional study was investigated during 2012–2013 in 94 schools from Seven Northeastern Cities (SNEC) in China. Questionnaires surveys were obtained from 56 137 children and adolescents aged 2–17 years. Influenza vaccination was defined as receipt of the influenza vaccine. We estimated air pollutants exposure [nitrogen dioxide (NO 2) and particulate matter with aerodynamic diameters ≤1 μm (PM 1), ≤2.5 μm (PM 2.5) and ≤10 μm (PM 10)] using machine learning methods. We employed two-level generalized linear mix effects model to examine interactive effects between influenza vaccination and air pollution exposure on allergic respiratory diseases (asthma, asthma-related symptoms and allergic rhinitis), after controlling for important covariates. We found statistically significant interactions between influenza vaccination and air pollutants on allergic respiratory diseases and related symptoms (doctor-diagnosed asthma, current wheeze, wheeze, persistent phlegm and allergic rhinitis). The adjusted ORs for doctor-diagnosed asthma, current wheeze and allergic rhinitis among the unvaccinated group per interquartile range (IQR) increase in PM 1 and PM 2.5 were significantly higher than the corresponding ORs among the vaccinated group [For PM 1 , doctor-diagnosed asthma: OR: 1.89 (95%CI: 1.57–2.27) vs 1.65 (95%CI: 1.36–2.00); current wheeze: OR: 1.50 (95%CI: 1.22–1.85) vs 1.10 (95%CI: 0.89–1.37); allergic rhinitis: OR: 1.38 (95%CI: 1.15–1.66) vs 1.21 (95%CI: 1.00–1.46). For PM 2.5 , doctor-diagnosed asthma: OR: 1.81 (95%CI: 1.52–2.14) vs 1.57 (95%CI: 1.32–1.88); current wheeze: OR: 1.46 (95%CI: 1.21–1.76) vs 1.11 (95%CI: 0.91–1.35); allergic rhinitis: OR: 1.35 (95%CI: 1.14–1.60) vs 1.19 (95%CI: 1.00–1.42)]. The similar patterns were observed for wheeze and persistent phlegm. The corresponding p values for interactions were less than 0.05, respectively. We assessed the risks of PM 1 -related and PM 2.5 -related current wheeze were decreased by 26.67% (95%CI: 1.04%–45.66%) and 23.97% (95%CI: 0.21%–42.08%) respectively, which was attributable to influenza vaccination (both p for efficiency <0.05). Influenza vaccination may play an important role in mitigating the detrimental effects of long-term exposure to ambient air pollution on childhood allergic respiratory diseases. Policy targeted at increasing influenza vaccination may yield co-benefits in terms of reduced allergic respiratory diseases. Image 1 • Few studies on interaction between air pollution and influenza vaccine on asthma. • A large population-based study to assess these interaction effects in China. • Influenza vaccine may mitigate the detrimental effects of air pollution on asthma. • Boys seem to be more sensitive to these interaction effects than girls. [ABSTRACT FROM AUTHOR]

Randomized controlled trials demonstrate that timely introduction of peanut to infants reduces the risk of peanut allergy. However, much debate remains regarding how to best achieve earlier peanut introduction at the population level. Our previous study in 2007-2011 (HealthNuts, n = 5300) indicated that few infants were consuming peanut in the first year. Australian infant feeding guidelines were updated in 2016 to recommend introducing peanut before 12 months for all infants. There were no data available on the subsequent effect on peanut introduction or peanut reactions. We sought to assess the consequences of a nonscreening approach to allergenic food introduction in a population-based sample of infants in their first year of life. EarlyNuts is a population-based, cross-sectional study of 12-month-old infants in Melbourne, Australia, recruited by using an identical sampling frame and methods to HealthNuts (72% response rate vs 73% response rate in HealthNuts). We report here on the first 860 participants recruited between November 2016 and October 2018. Most infants (88.6%; 95% CI, 86.1% to 90.7%) had introduced peanut by 12 months (median age, 6 months), an increase from 28.4% (95% CI, 27.2% to 29.7%) in the HealthNuts study. By 12 months, the majority of these (76.4%) had consumed peanut more than 4 times, and 28% were eating peanut more than once per week. Preliminary results on parent-reported reactions show that 4.0% of those consuming peanut by 12 months had possible IgE-mediated reactions. There has been a striking shift toward earlier peanut introduction, with a 3-fold increase in peanut introduction by age 1 year in 2018 compared with 2007-2011. [ABSTRACT FROM AUTHOR]