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To date, the treatable traits (TTs) approach has been applied in the context of managing diagnosed diseases. TTs are clinical characteristics and risk factors that can be identified clinically and/or biologically, and that merit treatment if present. There has been an exponential increase in the uptake of this approach by both researchers and clinicians. Realizing the potential of the TTs approach to pre‐clinical disease, this expert review proposes that it is timely to consider acting on TTs present before a clinical diagnosis is made, which might help to prevent development of the full disease. Such an approach is ideal for diseases where there is a long pre‐clinical phase, such as in chronic obstructive pulmonary disease (COPD). The term 'pre‐COPD' has been recently proposed to identify patients with respiratory symptoms and/or structural or functional abnormalities without airflow limitation. They may eventually develop airflow limitation with time but patients with pre‐COPD are likely to have traits that are already treatable. This review first outlines the contribution of recently generated knowledge into lifetime lung function trajectories and the conceptual framework of 'GETomics' to the field of pre‐COPD. GETomics is a dynamic and cumulative model of interactions between genes and the environment throughout the lifetime that integrates information from multi‐omics to understand aetiology and mechanisms of diseases. This review then discusses the current evidence on potential TTs in pre‐COPD patients and makes recommendations for practice and future research. At a broader level, this review proposes that introducing the TTs in pre‐COPD may help reenergize the preventive approaches to health and diseases. [ABSTRACT FROM AUTHOR]

Background: Pediatric asthma hospital readmission is a burden on the individual and costly for Australian hospitals. Grass pollen's role, a known trigger for asthma admissions, is unexamined in readmissions. We examined the association between grass pollen and pediatric asthma readmission. Methods: The Victorian Admitted Episodes Dataset was used to identify all primary admissions with a principal diagnosis of asthma in children aged 2–18 years between 1997 and 2009. Readmissions were defined as subsequent admissions within 28 days of index admission discharge. Generalized additive models were used to assess associations between readmission, grass pollen season, and daily grass pollen counts, lagged and cumulative. Models were further stratified by sex and age group. Results: Mean daily readmission was higher during grass pollen season than other times of the year, incidence rate ratio (IRR) 1.44 (95% CI, 1.03, 2.02) and for children aged 2–5 years, IRR 1.99 (1.26, 3.14). Same day grass pollen was nonlinearly associated with daily readmission for the 13–18 age group between 110 and 256 grains/m3, p <.01. Lag 2 grass pollen was nonlinearly associated with daily readmissions overall (p =.03), boys (p =.01), and younger age groups 2–5 (p =.02) and 6–12 (p <.001). Conclusions: Grass pollen exposure was associated with higher readmission rates for pediatric asthma. Treatment plans prior to discharge could be implemented to reduce the likelihood of readmission by younger children during the pollen season. [ABSTRACT FROM AUTHOR]

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Background: Previous research suggests that children who experience asthma may be less physically active; however, results have been inconclusive. This study aimed to investigate whether the presence of asthma or wheeze is associated with lower physical activity levels in children, and whether sex, body mass index or earlier asthma or wheeze status modifies the association. Methods: This study was conducted in 391 HealthNuts participants in Melbourne, Australia. Asthma and wheeze data were collected via questionnaire at age 4 and 6, and physical activity was measured through accelerometry. Using adjusted linear regression models, the cross‐sectional and longitudinal associations were investigated. Results: There was no evidence of a difference in time spent in moderate‐to‐vigorous physical activity (MVPA) at age 6 years between children with and without asthma at age 4; children with asthma spent 8.3 minutes more time physically active per day (95% CI: −5.6, 22.1, P =.24) than children without asthma. Similar results were seen for children with current wheeze (5.8 minutes per day more, 95% CI: −5.9, 17.5, P =.33) or ever wheeze or asthma (7.7 minutes per day more, 95% CI: −4.8, 20.2, P =.23) at age 4 years. Comparable null results were observed in the cross‐sectional analyses. Interaction with BMI could not be assessed; however, previous asthma or wheeze status and sex were not found to modify these associations. Conclusion: This analysis found no evidence of asthma hindering physical activity in these young children. These results are encouraging, as they indicate that the Australian asthma and physical activity public health campaigns are being effectively communicated and adopted by the public. [ABSTRACT FROM AUTHOR]

Background: While atopic conditions are associated with increased risk of mental health problems, the evidence that a range of allergic conditions are associated with psychological distress in young people is less clear. Methods: We recruited a longitudinal birth cohort study of 620 children with a family history of allergic disease. At the 18-year follow up, atopic sensitization was determined by skin prick testing. Surveys were used to determine psychological distress (Kessler 6), quality of life (SF12), respiratory symptoms and management, presence of current eczema and hay fever. Regression models were used to identify predictors of psychological distress and quality of life, while controlling for potential confounders. Results: Prevalence of serious psychological distress was quite low (n = 22, 5.3%), and there were no associations between psychological distress and current atopic sensitization, symptoms of hay fever, eczema or asthma. Smoking status and lower level of maternal education were associated with lower physical quality of life (SF12 PCS subscale). Psychological distress total score, lower maternal education, smoking, female sex, and current eczema were associated with worse mental quality of life (SF12 MCS subscale). Conclusion: We found relatively low levels of psychological distress in this cohort of young adults, despite a high prevalence of allergic diseases. Positive social factors may serve to buffer psychological distress amongst the cohort accounting for the low prevalence of serious psychological distress observed. [ABSTRACT FROM AUTHOR]

Background: Physical activity may be a potentially modifiable risk factor for asthma and driver of lung function development. This systematic review aimed to summarize the available evidence concerning the longitudinal effect of physical activity on the development of asthma, the persistence of asthma symptoms and lung function outcomes in children and adolescents. Methods: PubMed and Embase electronic databases were searched for all original articles that investigated the longitudinal association between physical activity and asthma outcomes or lung function outcomes in children and adolescents. The search and data extraction were conducted by two independent researchers. The methodological quality of the included studies was assessed using two critical assessment tools. Results: The literature search retrieved 2298 publications from the electronic databases. All articles were screened, and 2289 were subsequently excluded, resulting in nine longitudinal studies eligible for inclusion in this review. Two studies found no association with incident wheeze, and two of four found no association with various asthma outcomes. Three studies investigated the effect on lung function: one observed an association in boys only, one observed an association in girls only, and one found no associations. Conclusion: The evidence was highly inconsistent for the relationship between physical activity and asthma and lung function outcomes. Hence, we conclude that there is insufficient evidence to suggest that physical activity has a long‐term effect on the risk of asthma development in youth. Furthermore, there is insufficient evidence to determine the longitudinal effects of physical activity on lung function in children. [ABSTRACT FROM AUTHOR]

AbstractObjectiveMethodsResultsConclusionsThe ‘two-hit’ hypothesis theorizes that early life allergic sensitization and respiratory infection interact to increase asthma risk.We sought to determine in a high allergy risk birth cohort whether interactions between early life allergic sensitization and respiratory infection were associated with increased risk for asthma at ages 6–7 years and 18 years. Allergic sensitization was assessed at 6, 12, and 24 months by skin prick testing to 3 food and 3 aeroallergens. Respiratory infection was defined as reported “cough, rattle, or wheeze” and assessed 4-weekly for 15 months, at 18 months, and age 2 years. Regression analysis was undertaken with parent-reported asthma at age 6–7 years and doctor diagnosed asthma at 18 years as distinct outcomes. Interactions between allergic sensitization and respiratory infection were explored with adjustment made for potential confounders.Odds of asthma were higher in sensitized compared to nonsensitized children at age 6–7 years (OR = 14.46; 95% CI 3.99–52.4), There was no evidence for interactions between allergic sensitization and early life respiratory infection, with a greater frequency of respiratory infection up to 2 years of age associated with increased odds for asthma at age 6–7 years in both sensitized (OR = 1.13; 95% CI 1.02–1.25, n = 199) and nonsensitized children (OR = 1.31; 1.11–1.53, n = 211) (p interaction = 0.089). At age 18 years, these associations were weaker.Our findings do not support ‘two-hit’ interactions between early life allergic sensitization and respiratory infection on asthma risk. Both early life respiratory infections and allergic sensitization were risk factors and children with either should be monitored closely for development of asthma. [ABSTRACT FROM AUTHOR]

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Summary: Background and Objective: An infant's age at introduction of complementary solids may contribute to food allergy. We aimed to synthesize the literature on the association between age at introduction of complementary solids, excluding milk products, and food allergy and sensitization. Design: We searched the electronic databases PubMed and EMBASE (January 1946‐February 2017) using solid food, allergy and sensitization terms. Methods: Two authors selected papers according to inclusion criteria, identifying 16 cohort studies, 1 case‐control study and 8 randomized controlled trials (RCTs). Pooled effects across studies were estimated using random‐effects meta‐analysis. Results: Cohort studies—Introducing complementary solids at age ≥ 4 months vs <4 months was not associated with food allergy (OR 1.22; 95% CI, 0.76‐1.96) but was associated with food sensitization (OR 1.93; 95% CI 1.57‐2.38). First exposure from age 4 to 6 months vs <4 months was not associated with food allergy (OR 1.01; 95% CI, 0.64‐1.60) but was associated with food sensitization (OR 2.46; 95% CI 1.55‐3.86). Randomized controlled trials—Egg exposure from age 4 months was associated with reduced egg allergy (OR 0.63, 95% CI, 0.44‐0.90) and sensitization (OR 0.76, 95% CI, 0.51‐0.95). Peanut exposure from age 4 months compared to delayed exposure was associated with reduced peanut allergy (OR 0.28, 95% CI 0.14‐0.57). Conclusions: We found no evidence from observational studies that introducing solids before 4 months protected against food allergy, but there was evidence for protection against food sensitization. From RCTs, introducing egg from 4 to 6 months and peanut from 4 to 11 months reduced the risk of egg allergy, peanut allergy and egg sensitization. PROSPERO systematic review registry (CRD42016033473). [ABSTRACT FROM AUTHOR]

The article discusses a case-control study which examines the association of cord-serum per- and poly-fluoroalkyl substances (PFAS) with the risks of eczema and allergic sensitisation in children. Topics include the assessment of individiual sensitisation using skin prick tests, the association of PFAS levels and eczema and atopy outcomes using multinomial logistic regression models and the results on the lack of association of PFAS with sensitisation or eczema.

Summary: Background: Markers of microbial exposure are thought to be associated with risk of allergic sensitization; however, the associations are inconsistent and may be related to gene‐environment interactions. Objective: To examine the relationship between polymorphisms in the CD14 gene and allergic sensitization and whether sibling exposure, as a marker of microbial exposure, modified this relationship. Methods: We used data from the Tasmanian Longitudinal Health Study and the Melbourne Atopy Cohort Study. Two CD14 polymorphisms were genotyped. Allergic sensitization was defined by a positive response to a skin prick test. Sibling exposure was measured as cumulative exposure to siblings before age 6 months, 2 and 4 years. Logistic regression and multi‐level mixed‐effects logistic regression were used to examine the associations. Effect estimates across the cohorts were pooled using random‐effects meta‐analysis. Results: CD14 SNPs were not individually associated with allergic sensitization in either cohort. In TAHS, cumulative sibling exposure before age 6 months, 2 and 4 years was each associated with a reduced risk of allergic sensitization at age 45 years. A similar effect was observed in MACS. Meta‐analysis across the two cohorts showed consistent evidence of an interaction between cumulative sibling exposure before 6 months and the rs5744455‐SNP (P = 0.001) but not with the rs2569190‐SNP (P = 0.60). The pooled meta‐analysis showed that the odds of sensitization with increasing cumulative exposure to sibling before 6 months of age was 20.9% smaller in those with the rs5744455‐C‐allele than the T‐allele (OR = 0.83 vs 1.05, respectively). Conclusion and Clinical Relevance: Cumulative sibling exposure reduced the risk of sensitization from childhood to middle age in genetically susceptible individuals. [ABSTRACT FROM AUTHOR]

Background: Glutathione S-transferase (GST) genes are involved in the management of oxidative stress in the lungs. We aimed to determine whether they modify the associations between early life smoke exposure and adverse lung health outcomes.Methods: The Melbourne Atopy Cohort study (a high-risk birth cohort) enrolled 620 children and followed them prospectively from birth. We recorded perinatal tobacco smoke exposure, asthma, and lung function at 12 (59%) and 18 years (66%) and genotyped for GSTM1, GSTT1, and GSTP1 (69%).Results: GST genotypes were found to interact with tobacco smoke exposure on lung function outcomes (P interaction ≤ .05). Only among children with GSTT1 null genotypes was exposure to mother's, father's, or parental tobacco smoke in early life associated with an increased risk of reductions in prebronchodilator (BD) FEV1 and FVC at both 12 and 18 years. These associations were not seen in children with GSTT1 present. Similarly, only among children with GSTM1 null genotypes was exposure to father's or parental smoking associated with reductions in pre- and post-BD FEV1 and FVC at 18 years. Only among children with Ile/Ile genotypes of GSTP1 was exposure to mother's smoking associated with increased risk of reduced FEV1 at 18 years, but this was not the case among children with Val/Val or Ile/Val genotypes.Conclusions: Our study provides evidence of interaction between early tobacco smoke exposure and GST genotypes on lung function. Carriers of GST null mutations and GSTP1 Ile/Ile alleles may be more susceptible when exposed to tobacco smoke in early life. These findings support stronger recommendations to protect all infants from tobacco smoke exposure.Trial Registry: Australian and New Zealand Clinical Trials Registry; No.: ACTRN12609000734268; URL: http://www.anzctr.org.au/. [ABSTRACT FROM AUTHOR]

There is growing interest in the epidemiology of asthma in developing countries, especially in the Asia‐Pacific Region (APR). A number of reviews have been published in this field, but a comprehensive synthesis of overall data has not been reported. Here, we summarized the burden, risk factors and challenges of asthma management in developing countries with a specific emphasis on the APR by consolidating evidence from both systematic and narrative reviews published up until February 2023. We found that although asthma prevalence in low and low‐middle‐income countries (LMICs) is known to be generally lower compared to high‐income countries, the burden is substantially greater. Studies conducted in APR LMIC have reported a range of risk factors, including pre‐ and post‐natal factors, environmental considerations, lifestyle measures, individual features and genetics. The low and inequitable distribution of quality preventive and curative health care, a lack of advanced diagnostic measures, non‐availability and non‐affordability of novel therapeutics, cultural beliefs and practices, and diverse disease phenotypes make it challenging to achieve optimal asthma control in the region. Hence, we call for the development of a region‐specific blueprint for action to mitigate this challenging situation, to help reduce the burden of asthma in APR LMIC. [ABSTRACT FROM AUTHOR]

GLO:FS9/01mar20:resp13758-fig-0001.jpg PHOTO (COLOR): Hospital deaths due to diseases of the respiratory system (J12-18, J20-22, J40-98) excluding upper respiratory tract infections and influenza in Sri Lanka during 2010-2017 (Source: Annual Health Statistics 2017 by Medical Statistics Unit, Ministry of Health). gl In Sri Lanka, obstructive lung diseases comprise a major proportion of lung diseases in all age groups. The rising problem of poor air quality is claimed to be responsible for the rise of respiratory diseases, namely obstructive lung diseases, interstitial pneumonitis and lung cancers. General practitioners are increasingly aware of newly emerging and uncommon respiratory illnesses including primary and secondary interstitial pneumonias, obstructive sleep apnoea, pneumoconiosis, occupational lung diseases, etc. [Extracted from the article]

Objective: Early life tobacco smoke exposure may influence asthma, lung function and lung function growth into adolescence. We aimed to determine the associations between perinatal smoke exposure and asthma and lung function up to 18 years of age. Methods: We prospectively recorded perinatal parental smoking and measured respiratory outcomes at 12 and 18 years in the Melbourne Atopy Cohort Study (MACS), a longitudinal birth cohort. Multiple logistic regression was used to analyse the associations between perinatal smoke exposure and asthma at 12 (n = 370) and 18 years (n = 411). Multiple linear regression was used to investigate the relationship between perinatal smoking and: lung function (12 and 18 years) and lung function growth (between 12 and 18 years). Results: At 18 years, girls exposed to parental smoking during the perinatal period had increased odds of asthma (OR: 3.45, 95%CI: 1.36, 8.77), reduced pre-bronchodilator Forced expiratory volume in one-second (FEV1) (−272 ml/s; −438, −107); FEV1/ forced vital capacity (FVC) (−0.038; −0.065, −0.010); mid expiratory flow (MEF25-75) (−430 ml/s; −798, −61), and reduced post-bronchodilator FEV1/FVC (−0.028, −0.053, −0.004). No associations were found for boys (pre-bronchodilator FEV1 26ml/s; −202, 255; FEV1/FVC 0.018; −0.013, 0.049). Conclusions: Perinatal smoke may affect risk of asthma, reduce lung function and lung function growth in adolescence. Girls appear to be more susceptible than boys. [ABSTRACT FROM AUTHOR]

Background: Diabetes is a global public health issue. It is associated with significant disability, morbidity and mortality risks and substantial healthcare costs. Of great concern is the fact that its prevalence is rising, particularly amongst the young, while epidemiological data regarding the incidence, prevalence and complications of early-onset type 2 diabetes is noted to be sparse.Methods: We used data from the baseline wave of Ten to Men, a national cohort study of Australian males, to investigate the social and health-related correlates of Australian males aged 18-49 years reporting being diagnosed with diabetes.Results: The estimated prevalence of a self-reported diabetes diagnosis amongst Australian males aged 18-49 years was 2.95 % (95 % CI: 2.54-3.43 %). Within this age group, approximately 75 % of those diagnosed with diabetes are expected to be living with a known diagnosis of type 2 diabetes; the remainder are expected to be living with type 1 diabetes. Of the 20 social and health-related factors considered, we found evidence to support the association of eighteen factors after adjusting for age and body mass index. The strongest correlates of reporting a diabetes diagnosis, associated with a ≥2-fold increase in the odds of reporting diabetes were being aged 35-49 years, being unemployed, being obese, seeing a doctor for a check-up more frequently, reporting comorbid high blood pressure or physical or mental health comorbidities and worse self-rated and physical health status.Conclusion: Australian males aged 18-49 years who are living with a known diagnosis of diabetes are more likely to be socio-economically disadvantaged and suffer substantially worse health status than Australian males aged 18-49 years living without a diabetes diagnosis. Based on the associations detected in this study, older, single males living in regional areas who are socioeconomically disadvantaged, obese and/or who have other comorbidities may be an important subgroup to target for diabetes screening, disease management and prevention efforts. [ABSTRACT FROM AUTHOR]

Objective: Indoor environment factors have been associated with risk of asthma exacerbations in children but little is known about their role on asthma hospital readmissions. As children in Western societies continually spend more time indoors, understanding the influence of these factors on asthma exacerbation is important. We examined the role of indoor environmental and lifestyle characteristics on child asthma readmissions.Methods: A hospital-based case–control study recruited 22 children readmitted for asthma and 22 controls not readmitted for asthma. Logistic regression models were used to examine the association between aeroallergens and fungi in the bedroom and indoor lifestyle characteristics factors for asthma readmissions. To determine the best possible set of predictors among a large set of risk factors, we used random forests (RF) techniques.Results: Higher levels of airborneCladosporiumand yeast in the child’s bedroom increased risk of readmission (OR = 1.68, 95% CI 1.04–2.72 and OR = 1.52, 95% CI 0.99–2.34, respectively). Carpeted floors in the bedroom and synthetic doonas were also associated with increase in asthma readmissions (OR = 4.07, 95% CI 1.03–16.06 and OR = 14.6, 95% CI 1.26–169.4, respectively). In the home, frequent vacuuming using bagged cleaners increased risk of asthma readmission OR = 15.7 (95% CI 2.82–87.2).Conclusions: Factors in the child’s bedroom play an important role in increasing the risk of asthma hospital readmissions. These findings have major clinical implications as the identified potential risk factors may be modifiable. Further epidemiological studies with larger samples are necessary to evaluate these associations further. [ABSTRACT FROM AUTHOR]

Asthma is a significant global public health issue. Severe asthma exacerbations can be triggered by environmental factors and require medical care from health services. Although it is known that fungal exposure may lead to allergic sensitization, little is understood about its impact on asthma exacerbations. This review aims to examine whether outdoor fungi play a significant role in child asthma exacerbations. Systematic search of seven electronic databases and hand searching for peer-reviewed studies published in English, up to 31 August 2013. Inclusion criteria were study population aged <18 yr, diagnosis of asthma, attended a health service; outdoor fungi exposure was reported. Quality and risk of bias assessments were conducted. Due to significant heterogeneity, meta-analysis was not conducted. Of the 1896 articles found, 15 were eligible. Findings were not consistent, possibly due to methodological variations in exposure classifications, statistical methods and inclusion of confounders. Cross-sectional studies found no or weak associations. All but one time series studies indicated an association that varied between fungal species. Increasing evidence indicates that asthmatic children are susceptible to asthma exacerbations when exposed to outdoor fungal spores. There is limited understanding of the contributions of different fungal species. Research is needed to investigate interactions of outdoor fungi with pollen, air pollutants and respiratory viruses. [ABSTRACT FROM AUTHOR]

Background/Objectives: Eczema is a common chronic debilitating skin condition in childhood. Data on the epidemiology and natural history of eczema across the life course are lacking. This analysis aimed to describe these epidemiological features in Australian children and adults. Methods: Data collected on eczema from four Australian cohort studies were analysed: namely HealthNuts, Melbourne Atopic Cohort Study (MACS), Tasmanian Longitudinal Health Study (TAHS) and the Australian arm of the European Community Respiratory Health Survey (ECRHS). Results: Among children aged under 6 years, 28.8%–35.6% have ever‐had eczema, and 16.7%–26.6% had 'current eczema'. Among those aged 6–12 years, 14.6%–24.7% had 'current eczema' with 12.0%–18.5% of those at ages of 6 and 10 years classified as having moderate‐to‐severe eczema according to the Scoring of Atopic Dermatitis (SCORAD) index. In adults, the prevalence of 'eczema ever' ranged between 13.8% and 48.4%. The 12‐month period prevalence of eczema was 15.1% at age 18, while current eczema was 8.5% at an average age of 51, and 8.8% at an average age 53 years. Eczema was more common among young boys, but this difference became non‐significant for older children and early adolescents. In contrast, eczema was more common for adult women than men. Conclusions: Eczema is common both in children and adults. The proportion of severe eczema in children was substantial. [ABSTRACT FROM AUTHOR]

Background: We examined whether physical activity risk differed between migrant sub-groups and the Australianborn population. Methods: Data were drawn from the Australian National Health Survey (2001) and each resident's country of birth was classified into one of 13 regions. Data were gathered on each resident's physical activity level in the fortnight preceding the survey. Multivariable logistic regression, adjusted for potential confounders examined the risk of physical inactivity of participants from each of the 13 regions compared to the Australian-born population. Results: There was a greater prevalence of physical inactivity for female immigrants from most regions compared to male immigrants from a like region. Immigrants from South East Asia (OR 2.04% 95% CI 1.63, 2.56), Other Asia (OR 1.53 95% CI 1.10, 2.13), Other Oceania (1.81 95% CI 1.11, 2.95), the Middle East (OR 1.42 95% CI 0.97, 2.06 [note: border line significance]) and Southern & Eastern Europe are at a significantly higher risk of being physically inactive compared to those born in Australian. In contrast, immigrants from New Zealand (OR 0.77 95% CI 0.62, 0.94), the UK & Ireland (OR 0.82 95% CI 0.73, 0.92), and other Africa (OR 0.69 95% CI 0.51, 0.94) are at a significantly lower risk of being physically inactive compared to the Australian born population. Conclusion: Future research identifying potential barriers and facilitators to participation in physical activity will inform culturally sensitive physical activity programs that aim to encourage members of specific regional ethnic sub-groups to undertake physical activity. [ABSTRACT FROM AUTHOR]

Prevalence of dietary complementary and alternative medicine (CAM) and consultation with a CAM practitioner was examined in a cross-sectional study of 75 AS patients. Seventy one of 75 (94.7%) study participants reported previous or current CAM use. Among these AS patients, 44 (72.1%) reported dietary CAM use and 27 (36.0%) were seeing a CAM practitioner at the time of study. Of 89 dietary CAM, 50 (56.4%) were perceived to be of slight or no benefit, and only 10 (11.2%) were initiated by a CAM practitioner. Compared with non-users, current dietary CAM users were more likely to be female (OR 6.5; 95% CI, 1.8–23.9). Patients attending a CAM practitioner were more likely to have university education (OR 5.7; 95% CI, 1.5–21.9) and higher BASDAI (OR 1.3; 95%CI, 1.0–1.7). Despite low rates of perceived benefit, dietary CAM use and CAM practitioner attendance is common among AS patients. [ABSTRACT FROM AUTHOR]

Background: There is ongoing conjecture over whether childhood immunisation leads to an increased risk of developing atopic diseases. Objective: To examine associations between childhood immunisation and the risk of atopic disease. Method: Immunisation histories of 8443 Tasmanian children born in 1961 obtained from school medical records were linked to the Tasmanian Asthma Study. Associations between immunisation status and atopic diseases were examined while adjusting for possible confounders using multiple logistic regression. Results: Diphtheria immunisation was weakly associated with an increased risk of asthma by age 7 years (odds ratio (OR) 1 .3, 95% confidence interval (CI) 1 .1 to 1 .7), but there was no evidence of any association for four other vaccinations studied. An increased risk of eczema by age 7 years was associated with immunisation against diphtheria (OR 1 .5, 95% CI 1 .1 to 2.1), tetanus (OR 1 .5, 95% CI, 1 .1 to 2.0), pertussis (OR 1.5, 95% CI 1.1 to 1.9) and polio (OR 1.4, 95% CI 1.0 to 1.9) but not small pox. Similar but slightly weaker patterns of association were observed between the risk of food allergies and immunisation against diphtheria (OR 1 .5, 95% Cl 1 .0 to 2.1), pertussis (OR 1 .4, 95% CI 1 .1 to 1 .9), polio (OR 1 .4, 95% CI 1 .00 to 2.1) and tetanus (OR 1.30 95% Cl 0.99 to 1.70), but not with small pox. There was no evidence of associations between immunisation history and hay fever, or incidence of later-onset atopic outcomes. Conclusions: The few effects seen in this study are small and age-dependent, and nearly all our findings support numerous previous studies of no effect of vaccines on asthma. Based on these findings, the fear of their child developing atopic disease should not deter parents from immunising their children, especially when weighed against the benefits. [ABSTRACT FROM AUTHOR]

They have shown that there are multiple early-life longitudinal wheeze phenotypes, with some affecting lung growth,[4] and that lung function deficits in COPD are partly established in early life. There is increasing evidence that early-life risk factors interact with adult asthma, smoking and occupational exposures to increase the risk of COPD in a multiplicative fashion. Childhood predictors of lung function trajectories and future COPD risk: a prospective cohort study from the first to the sixth decade of life. [Extracted from the article]

Background Objectives Methods Results Conclusion There are no studies of longitudinal immunoglobulin measurements in a population‐based cohort alongside challenge‐confirmed peanut allergy outcomes. Little is known about biomarkers for identifying naturally resolving peanut allergy during childhood.To measure longitudinal trends in whole peanut and component Ara h 2 sIgE and sIgG4 in the first 10 years of life, in a population cohort of children with challenge‐confirmed peanut allergy, and to determine whether peanut‐specific immunoglobulin levels or trends are associated with peanut allergy persistence or resolution by 10 years of age.One‐year‐old infants with challenge‐confirmed peanut allergy (n = 156) from the HealthNuts study (n = 5276) were prospectively followed at ages 4, 6, and 10 years with questionnaires, skin prick tests, oral food challenges, and plasma total‐IgE, sIgE and sIgG4 to peanut and Ara h 2.Peanut allergy resolved in 33.9% (95% CI = 25.3%, 43.3%) of children by 10 years old with most resolving (97.4%, 95% CI = 86.5%, 99.9%) by 6 years old. Decreasing Ara h 2 sIgE (p = .01) and increasing peanut sIgG4 (p < .001), Ara h 2 sIgG4 (p = .01), peanut sIgG4/sIgE (p < .001) and Ara h 2 sIgG4/sIgE (p < .001) from 1 to 10 years of age were associated with peanut allergy resolution. Peanut sIgE measured at 1 year old had the greatest prognostic value (AUC = 0.75 [95% CI = 0.66, 0.82]); however, no single threshold produced both high sensitivity and specificity.One third of infant peanut allergy resolved by 10 years of age. Decreasing sIgE and sIgG4 to peanut and Ara h 2 over time were associated with natural resolution of peanut allergy. However, biomarker levels at diagnosis were not strongly associated with the natural history of peanut allergy. [ABSTRACT FROM AUTHOR]

Background: While exposure to environmental greenness in childhood has shown mixed associations with the development of allergic disease, the relationship with food allergy has not been explored. We investigated the association between exposure to environmental greenness and challenge‐confirmed food allergy in a large population‐based cohort. Methods: The HealthNuts study recruited 5276 12‐month‐old infants in Melbourne, Australia, who underwent skin prick testing to peanut, egg, and sesame; infants with a detectable wheal underwent food challenges to determine food allergy status. Environmental greenness was estimated using the normalized difference vegetation index (NDVI) for five buffer zones around the infant's home address: at the home, 100 m, 500 m, 800 m, and 1600 m radial distances. Environmental greenness was categorized into 3 tertiles and mixed effects logistic regression models quantified the association between greenness and the risk of food allergy, adjusting for confounding and accounting for clustering at the neighborhood level. Results: NDVI data were available for n = 5097. For most buffer zones, medium and high greenness, compared to low greenness, was associated with an increased risk of peanut allergy (eg, 100 m tertile 2 aOR 1.89 95% CI 1.22–2.95, tertile 3 aOR 1.78 95% CI 1.13–2.82). For egg allergy, the effect sizes were smaller (100 m tertile 2 aOR 1.52 95% CI 1.16–1.97, tertile 3 aOR 1.38 95% CI 1.05–1.82). Socioeconomic status (SES) modified the association between greenness and peanut allergy, but not egg allergy; associations were apparent in the low SES group but not in the high SES group (p for interaction 0.08 at 100 m). Air pollution (PM2.5) also modified the associations between environmental greenness and food allergy, with associations present in high air pollution areas but not low (p for interaction at 100 m 0.05 for peanut and 0.06 for egg allergy.) Conclusion: Increased exposure to environmental greenness in the first year of life was associated with an increased risk of food allergy. Increased greenness may correlate with higher pollen levels which may trigger innate immune responses skewing the immune system to the Th2‐dependent allergic phenotype; additionally, some pollen and food allergens are cross‐reactive. Given the mixed data on greenness and other allergies, the relationship appears complex and may also be influenced by confounding variables outside those that were measured in this study. [ABSTRACT FROM AUTHOR]

Thunderstorm asthma is defined as epidemics of asthma occurring shortly after a thunderstorm. While grass pollen has been implicated in thunderstorm asthma events, little is known about the role of fungi and studies have not been synthesised. This systematic review aims to evaluate whether grass pollen is necessary in thunderstorm asthma events and whether fungi also play a part in these associations. We conducted a systematic search using six electronic databases (i.e. CINAHL, Medline (Ovid), Web of Science, ProQuest Central, EMBASE and Google Scholar) and checked reference lists. The search terms used were pollen AND thunderstorm* AND asthma. The inclusion criteria were studies published in English with original human data relating to outdoor pollen and thunderstorm asthma. Twenty of 2198 studies were eligible. Reported findings differed due to variation in methodological approaches and a meta-analysis was not possible. Nonetheless, of the 20 studies included, 15 demonstrated some relationship with nine demonstrating lagged effects up to four days for increasing grass pollen counts associated with increased risk of thunderstorm asthma. Of the 10 studies that examined fungi, nine demonstrated a positive relationship with thunderstorm asthma. The fungal taxa involved varied, depending on whether measurements were recorded before, during or after the thunderstorm. Nevertheless, none of the studies considered fungi as a potential effect modifier for the pollen-thunderstorm asthma association. We found evidence to suggest that grass pollen was a necessary factor for thunderstorm asthma but there are other as yet unrecognised environmental factors that may also be important. Further research is required to examine the role of fungi and other environmental factors such as air quality as potential effect modifiers of the association. • Grass pollen is most commonly associated with thunderstorm asthma. • There is a lagged effect of up to four days. • Grass pollen on its own is not enough to cause thunderstorm asthma. • Fungi is also important, but more studies are required. [ABSTRACT FROM AUTHOR]

The complex nature of chronic bronchitis (CB) and changing definitions have contributed to challenges in understanding its aetiology and burden. In children, CB is characterised by persistent airway inflammation often linked to bacterial infections and is therefore termed "protracted bacterial bronchitis" (PBB). Longitudinal studies suggest that CB in childhood persists into adulthood in a subgroup. It can also be associated with future chronic respiratory diseases including asthma, bronchiectasis, and chronic obstructive pulmonary disease (COPD). Adult CB is traditionally associated with smoking, occupational exposures, and lower socioeconomic status. The interplay between risk factors, childhood CB, adult CB, and other chronic respiratory diseases is intricate, requiring comprehensive longitudinal studies for a clearer understanding of the natural history of CB across the lifespan. Such longitudinal studies have been scarce to date given the logistic challenges of maintaining them over time. In this review, we summarise current evidence on the evolution of the definitions, pathophysiology, risk factors, and consequences of childhood and adulthood chronic bronchitis. [ABSTRACT FROM AUTHOR]

Lung development starts in utero and continues during childhood through to adolescence, reaching its peak in early adulthood. This growth is followed by gradual decline due to physiological lung ageing. Lung-function development can be altered by several host and environmental factors during the life course. As a result, a range of lung-function trajectories exist in the population. Below average trajectories are associated with respiratory, cardiovascular, metabolic, and mental health comorbidities, as well as with premature death. This Review presents progressive research into lung-function trajectories and assists the implementation of this knowledge in clinical practice as an innovative approach to detect poor lung health early, monitor respiratory disease progression, and promote lung health. Specifically, we propose that, similar to paediatric height and weight charts used globally to monitor children's growth, lung-function charts could be used for both children and adults to monitor lung health status across the life course. To achieve this proposal, we introduce our free online Lung Function Tracker tool. Finally, we discuss challenges and opportunities for effective implementation of the trajectory concept at population level and outline an agenda for crucial research needed to support such implementation. [ABSTRACT FROM AUTHOR]

Background and Objective: Chronic, low‐intensity air pollution exposure has been consistently associated with reduced lung function throughout childhood. However, there is limited research regarding the implications of acute, high‐intensity air pollution exposure. We aimed to determine whether there were any associations between early life exposure to such an episode and lung growth trajectories. Methods: We conducted a prospective cohort study of children who lived in the vicinity of the Hazelwood coalmine fire. Lung function was measured using respiratory oscillometry. Z‐scores were calculated for resistance (R5) and reactance at 5 Hz (X5) and area under the reactance curve (AX). Two sets of analyses were conducted: (i) linear regression to assess the cross‐sectional relationship between post‐natal exposure to mine fire‐related particulate matter with an aerodynamic diameter of less than 2.5 micrometres (PM2.5) and lung function at the 7‐year follow‐up and (ii) linear mixed‐effects models to determine whether there was any association between exposure and changes in lung function between the 3‐ and 7‐year follow‐ups. Results: There were no associations between mine fire‐related PM2.5 and any of the lung function measures, 7‐years later. There were moderate improvements in X5 (β: −0.37 [−0.64, −0.10] p = 0.009) and AX (β: −0.40 [−0.72, −0.08] p = 0.014), between the 3‐ and 7‐year follow‐ups that were associated with mean PM2.5, in the unadjusted and covariance‐adjusted models. Similar trends were observed with maximum PM2.5. Conclusion: There was a moderate improvement in lung stiffness of children exposed to PM2.5 from a local coalmine fire in infancy, consistent with an early deficit in lung function at 3‐years after the fire that had resolved by 7‐years. [ABSTRACT FROM AUTHOR]

Background and Objective: Despite the high burden of respiratory disease amongst Indigenous populations, prevalence data on spirometric deficits and its determinants are limited. We estimated the prevalence of abnormal spirometry in young Indigenous adults and determined its relationship with perinatal and early life factors. Methods: We used prospectively collected data from the Australian Aboriginal Birth Cohort, a birth cohort of 686 Indigenous Australian singletons. We calculated the proportion with abnormal spirometry (z‐score <−1.64) and FEV1 below the population mean (FEV1% predicted 0 to −2SD) measured in young adulthood. We evaluated the association between perinatal and early life exposures with spirometry indices using linear regression. Results: Fifty‐nine people (39.9%, 95%CI 31.9, 48.2) had abnormal spirometry; 72 (49.3%, 95%CI 40.9, 57.7) had a FEV1 below the population mean. Pre‐school hospitalisations for respiratory infections, younger maternal age, being overweight in early childhood and being born remotely were associated with reduced FEV1 and FVC (absolute, %predicted and z‐score). The association between maternal age and FEV1 and FVC were stronger in women, as was hospitalization for respiratory infections before age 5. Being born remotely had a stronger association with reduced FEV1 and FVC in men. Participants born in a remote community were over 6 times more likely to have a FEV1 below the population mean (odds ratio [OR] 6.30, 95%CI 1.93, 20.59). Conclusion: Young Indigenous adults have a high prevalence of impaired lung function associated with several perinatal and early life factors, some of which are modifiable with feasible interventions. [ABSTRACT FROM AUTHOR]

Background and Objective: Early‐life risk factors for obstructive sleep apnoea (OSA) are poorly described, yet this knowledge may be critical to inform preventive strategies. We conducted the first study to investigate the association between early‐life risk factors and OSA in middle‐aged adults. Methods: Data were from population‐based Tasmanian Longitudinal Health Study cohort (n = 3550) followed from 1st to 6th decades of life. Potentially relevant childhood exposures were available from a parent‐completed survey at age 7‐years, along with previously characterized risk factor profiles. Information on the primary outcome, probable OSA (based on a STOP‐Bang questionnaire cut‐off ≥5), were collected when participants were 53 years old. Associations were examined using logistic regression adjusting for potential confounders. Analyses were repeated using the Berlin questionnaire. Results: Maternal asthma (OR = 1.5; 95% CI 1.1–2.0), maternal smoking (OR = 1.2; 1.05, 1.5), childhood pleurisy/pneumonia (OR = 1.3; 1.04, 1.7) and frequent bronchitis (OR = 1.2; 1.01, 1.5) were associated with probable OSA. The risk‐factor profiles of 'parental smoking' and 'frequent asthma and bronchitis' were also associated with probable OSA (OR = 1.3; 1.01, 1.6 and OR = 1.3; 1.01–1.9, respectively). Similar associations were found for Berlin questionnaire‐defined OSA. Conclusions: We found novel temporal associations of maternal asthma, parental smoking and frequent lower respiratory tract infections before the age of 7 years with adult OSA. While determination of their pathophysiological and any causal pathways require further research, these may be useful to flag the risk of OSA within clinical practice and create awareness and vigilance among at‐risk groups. This study provides the first known evidence for individual and profiled early‐life and childhood risk factors for OSA in adults. It shows that early exposures to smoking and lower respiratory tract infections could be risks for adult OSA, which may stimulate future research and help flag future risk of OSA. See relatededitorial [ABSTRACT FROM AUTHOR]

Background: Outdoor Alternaria and Cladosporium spores are ubiquitous. Few studies have assessed their impact on asthma hospitalizations providing conflicting results, mainly focused on vulnerable paediatric populations. We aimed to study the impact of outdoor Alternaria and Cladosporium concentrations on acute hospitalizations in the Capital Region of Denmark. Methods: This is a bi‐directional case‐crossover study with 26 years of national registry data at individual level on acute asthma hospitalizations and daily average data on Alternaria and Cladosporium, pollen (Artemisia, Poaceae), maximal temperature, and air pollution. Conditional logistic regression models were applied to assess the associations. Concentration quartiles at lag 0 were used for categorizing the exposure. Results: For lags 0–2, the odds of hospitalization were significantly higher for both Alternaria and Cladosporium at concentration quartile 2–4 compared with quartile 1. When stratified for age and sex, odds of hospitalization at Alternaria quartiles 2–4 were significantly higher in males below 40 years at lag 0–2, and at lag 0 in females (18–30 years), while quartiles 2–4 of Cladosporium concentrations were associated with significantly higher odds in boys (0–17 years) at lag 1–3, males (18–39 years) at lag 0–1, females (18–39 years) at lag 1–2, males (40–64 years) at lag 0–2, females (40–64 years) at lag 0 and 2, in seniors (65+ years) male at lag 1–2 and female at lag 0–1. The effect of Alternaria varied significantly depending on the level of Cladosporium (p <.0001). Conclusion: Ambient Alternaria and Cladosporium spores can induce asthma hospitalizations. Males are more susceptible to both genera. Males and females under age 40 years are more susceptible to Alternaria. [ABSTRACT FROM AUTHOR]

BACKGROUND: Episodic spikes in air pollution due to landscape fires are increasing, and their potential for longer term health impacts is uncertain. OBJECTIVE: Our objective is to evaluate associations between exposure in utero and in infancy to severe pollution from a mine fire, background ambient air pollution, and subsequent hospital care. METHODS: We linked health records of births, emergency department (ED) visits, and hospitalizations of children born in the Latrobe Valley, Australia, 2012–2015, which included a severe pollution episode from a mine fire (9 February 2014 to 25 March 2014). We assigned modeled exposure estimates for fire-related and ambient particulate matter with an aerodynamic diameter of 2.5 μm (PM2.5) to residential address. We used logistic regression to estimate associations with hospital visits for any cause and groupings of infectious, allergic, and respiratory conditions. Outcomes were assessed for the first year of life in the in utero cohort and the year following the fire in the infant cohort. We estimated exposure-response for both fire-related and ambient PM2.5 and also employed inverse probability weighting using the propensity score to compare exposed and not/minimally exposed children. RESULTS: Prenatal exposure to fire-related PM2.5 was associated with ED presentations for allergies/skin rash [odds ratio (OR)=1.34, 95% confidence interval (CI): 1.01, 1.76 per 240 μg/m³ increase]. Exposure in utero to ambient PM2.5 was associated with overall presentations (OR=1.18, 95% CI: 1.05, 1.33 per 1.4 μg/m³) and visits for infections (ED: OR=1:13, 95% CI: 0.98, 1.29; hospitalizations: OR=1:23, 95% CI: 1.00, 1.52). Exposure in infancy to fire-related PM2.5 compared to no/minimal exposure, was associated with ED presentations for respiratory (OR =1.37, 95% CI: 1.05, 1.80) and infectious conditions (any: OR=1.21, 95% CI: 0.98, 1.49; respiratory-related: OR=1.39, 95% CI: 1.05, 1.83). Early life exposure to ambient PM2.5 was associated with overall ED visits (OR=1.17, 95% CI: 1.05, 1.30 per 1.4 μg/m³ increase). DISCUSSION: Higher episodic and lower ambient concentrations of PM2.5 in early life were associated with visits for allergic, respiratory, and infectious conditions. Our findings also indicated differences in associations at the two developmental stages. [ABSTRACT FROM AUTHOR]

Background: Previous systematic reviews have focused on associations between single time point measures of Body Mass Index (BMI) and asthma and allergic diseases. As BMI changes dynamically during childhood, examination of associations between longitudinal trajectories in BMI and allergic diseases is needed to fully understand the nature of these relationships. Objective: To systematically synthesise the association between BMI trajectories in childhood (0–18 years) and allergic diseases (asthma, eczema, allergic rhinitis, or food allergies outcomes). Design: We conducted a systematic review following the PRISMA guidelines, and two independent reviewers assessed the study quality using the ROBINS‐E and GRADE tools. A narrative synthesis was performed as the statistical heterogeneity did not allow a meta‐analysis. Data Sources: A search was performed on PubMed and EMBASE databases on 4th January 2023. Eligibility Criteria: Longitudinal cohort studies assessing the associations between childhood BMI trajectories and allergic diseases were included. Results: Eleven studies met the inclusion criteria with a total of 37,690 participants between 0 and 53 years of age. Ten studies examined asthma outcomes, three assessed association with allergic rhinitis, two assessed eczema, and one assessed food allergy. High heterogeneity and high risk of bias were observed. Overall, the quality of evidence was very low. Nevertheless, two consistent findings were identified: (1) a persistently high BMI between 6 and 10 years of age may be associated with an increased risk of asthma at 18 years and (2) a rapid increase in BMI in the first 2 years of life may be associated with subsequent asthma. Conclusions: Maintaining a normal BMI trajectory during childhood may reduce the risk of asthma. Future research that adequately addresses confounding and includes longer‐term follow‐up is needed. Moreover, additional studies examining potential associations with eczema, food allergies, and allergic rhinitis outcomes are needed. [ABSTRACT FROM AUTHOR]

Background: Experimental studies suggest that exposures may impact respiratory health across generations via epigenetic changes transmitted specifically through male germ cells. Studies in humans are, however, limited. We aim to identify epigenetic marks in offspring associated with father's preconception smoking. Methods: We conducted epigenome-wide association studies (EWAS) in the RHINESSA cohort (7–50 years) on father's any preconception smoking (n = 875 offspring) and father's pubertal onset smoking < 15 years (n = 304), using Infinium MethylationEPIC Beadchip arrays, adjusting for offspring age, own smoking and maternal smoking. EWAS of maternal and offspring personal smoking were performed for comparison. Father's smoking-associated dmCpGs were checked in subpopulations of offspring who reported no personal smoking and no maternal smoking exposure. Results: Father's smoking commencing preconception was associated with methylation of blood DNA in offspring at two cytosine-phosphate-guanine sites (CpGs) (false discovery rate (FDR) < 0.05) in PRR5 and CENPP. Father's pubertal onset smoking was associated with 19 CpGs (FDR < 0.05) mapped to 14 genes (TLR9, DNTT, FAM53B, NCAPG2, PSTPIP2, MBIP, C2orf39, NTRK2, DNAJC14, CDO1, PRAP1, TPCN1, IRS1 and CSF1R). These differentially methylated sites were hypermethylated and associated with promoter regions capable of gene silencing. Some of these sites were associated with offspring outcomes in this cohort including ever-asthma (NTRK2), ever-wheezing (DNAJC14, TPCN1), weight (FAM53B, NTRK2) and BMI (FAM53B, NTRK2) (p < 0.05). Pathway analysis showed enrichment for gene ontology pathways including regulation of gene expression, inflammation and innate immune responses. Father's smoking-associated sites did not overlap with dmCpGs identified in EWAS of personal and maternal smoking (FDR < 0.05), and all sites remained significant (p < 0.05) in analyses of offspring with no personal smoking and no maternal smoking exposure. Conclusion: Father's preconception smoking, particularly in puberty, is associated with offspring DNA methylation, providing evidence that epigenetic mechanisms may underlie epidemiological observations that pubertal paternal smoking increases risk of offspring asthma, low lung function and obesity. [ABSTRACT FROM AUTHOR]

Asthma phenotypes based on age-of-onset may be differently influenced by the interaction between variation in toll-like receptor (TLR)/CD14 genes and environmental microbes. We examined the associations between single-nucleotide polymorphisms (SNP) in the TLR/CD14 genes and asthma, and their interaction with proxies of microbial exposure (childhood farm exposure and childhood rural environment). Ten SNPs in four genes (TLR2, TLR4, TLR6, CD14) were genotyped for 1,116 participants from the Tasmanian Longitudinal Health Study (TAHS). Using prospectively collected information, asthma was classified as never, early- (before 13 years) or late-onset (after 13 years). Information on childhood farm exposure/childhood rural environment was collected at baseline. Those with early-onset asthma were more likely to be males, had a family history of allergy and a personal history of childhood atopy. We found significant interaction between TLR6 SNPs and childhood farm exposure. For those with childhood farm exposure, carriers of the TLR6-rs1039559 T-allele (p-interaction = 0.009) and TLR6-rs5743810 C-allele (p-interaction = 0.02) were associated with lower risk of early-onset asthma. We suggest the findings to be interpreted as hypothesis-generating as the interaction effect did not withstand correction for multiple testing. In this large, population-based longitudinal study, we found that the risk of early- and late-onset asthma is differently influenced by the interaction between childhood farming exposure and genetic variations. [ABSTRACT FROM AUTHOR]

Even with more complete data sets, simply reporting a single asthma prevalence for each country assumes a homogenous population with one risk profile for asthma and overlooks potential variation between host population and indigenous or migrant/ethnic minority groups. Keywords: asthma; ethnicity; phenotype EN asthma ethnicity phenotype 529 531 3 05/19/21 20210601 NES 210601 Asthma is a global health problem but certain ethnic groups exhibit substantially poorer outcomes than other populations.1-3 Research in such ethnic minorities is limited, so traditional treatment approaches are predominantly based on data derived from Caucasian individuals - applying, in short, a one-size-fits-all model.4-8 However, there is growing evidence that asthma phenotypes and treatment responses may vary considerably between ethnicities.9-11 Understanding these interactions has the potential to refine and even re-define personalized asthma care. Is ethnicity a "treatable trait" in asthma?. [Extracted from the article]

Abstract Background Perfluoroalkyl substances (PFASs) are synthetic chemicals widely used in industry and for commercial products. Their immunomodulatory effects are a growing health concern in children. Hand, Foot and Mouth Disease (HFMD) is a common childhood viral infection, and increased incidence of which has parallel the rise in PFAS exposure in the Asia-Pacific region. Objective We conducted the first study to assess whether prenatal exposure to PFAS was associated with a reduction in HFMD virus antibodies in infants. Methods We enrolled 201 mother-infant pairs from the Guangzhou Birth Cohort Study from July to October 2013. High performance liquid chromatography-mass spectrometry was employed to determine concentrations of specific PFAS isomers in cord blood. Neutralizing antibodies titers were measured against two HFMD viruses, enterovirus 71 (EV71) and coxsackievirus A 16 (CA16), in cord blood serum and blood serum at three months of age. Results Higher umbilical cord blood PFAS concentrations were associated with lower EV71 and CA16 antibody concentrations. A doubling in the composite sum of cord blood PFASs in three month old infants was associated with significant increase in the risk of HFMD antibody concentration below clinical protection level (≥1:8 titers) for CA16 (odds ratio, OR: 2.74 [95% confidence interval (CI): 1.33, 5.61] and for EV71 (OR = 4.55, 95% CI: 1.45, 4.28). This association was higher in boys at three months of age for CA16. Conclusions Our findings suggest that cord blood PFAS exposure is associated with lower HFMD antibody in infancy. Given the widespread nature of PFAS exposures and the high global incidence of HFMD globally, these findings have substantial public health implications and therefore, these associations need to be replicated in a larger study to more definitively address the risk. Graphical abstract Unlabelled Image Highlights • Higher PFAS concentration in cord blood was related to lower hand, foot and mouth disease antibody levels in infants. • We identified obvious immunosuppressive effects from exposure to branched PFOS isomers. • This association was apparent in boys at three months of age for CA16. [ABSTRACT FROM AUTHOR]

Summary: Background: Pollen is an important aeroallergen that triggers asthma exacerbations in children, but we know little about the impact of different pollen types in cities with varying climatic conditions and pollen seasons. Objectives: We aimed to assess the role of ambient level of different types of pollen on a large time series of child and adolescent asthma hospitalizations in Sydney, Australia. Methods: Childhood asthma hospitalization and the daily ambient pollen concentrations of different species were collected in South‐West Sydney. With a bidirectional case‐crossover design, we fitted conditional logistic regression models to measure the associations between instantaneous and up to 3 days lagged effects of pollen concentrations on asthma hospitalizations after controlling for potential confounders and testing for interactions. Results: A total of 2098 children, more boys (59.7%) and 2‐5 years old (62.6%), were hospitalized due to asthma. The geometric mean concentration of Cupressus, 7.88 [5.02] grains/m3, was the highest during the study period. The increase from 75th to 90th percentile of grass (OR = 1.037, 95% CI 1.005‐1.070), weed other than Plantago species (OR = 1.053, 95% CI 1.009‐1.098) and unclassified pollen (OR = 1.034, 95% CI 1.010‐1.058) were significantly associated with the odds of asthma hospitalizations. Boys were at greater risk of asthma exacerbations associated with grass (OR = 1.046, 95% CI 1.003‐1.090) and unclassified pollen (OR = 1.041, 95% CI 1.010‐1.073). There was evidence of effect modification by age groups for Cupressus, conifer, total tree and total pollen. Conclusions: Although boys are more vulnerable to grass pollen, weed, and other pollen are also important triggers of asthma exacerbations in all children and adolescents. These findings are important for urban green space planning and the development of pollen monitoring systems for families with children at risk of asthma exacerbations during peak pollen seasons. [ABSTRACT FROM AUTHOR]

Background: Oral immunotherapy (OIT) is a promising treatment for food allergies; however, safety is a concern. We synthesized evidence from the best randomized controlled trials (RCTs) on efficacy/safety of OIT for desensitization (DS) and remission (sustained unresponsiveness (SU)) in IgE mediated allergy to peanut, hen's eggs, and cow's milk. Body: We searched Pubmed, EMBASE, and Cochrane databases (Until Oct 22) identifying 16 eligible RCTs published in English measuring food allergy by food challenge at the beginning and at the end of the study. The Cochrane Risk of Bias tool was used to assess study quality. We found 18 eligible studies. There was evidence of efficacy for DS for all allergens: peanut (RR 11.32; 95% CI 5.93, 21.60, I2 49%, 8 studies); hen's egg (RR 4.67; 2.66, 8.21, I2 0%, 5 studies); cow's milk (RR 13.98; 3.51, 55.65, I2 0%, 4 studies) and evidence for SU for peanut (RR 7.74; 2.90, 20.69, I2 0%, 3 studies) and hen's egg (RR 6.91; 1.67, 28.57, I2 0%, 2 studies). Allergic events were increased with intervention, and risk of adrenaline use increased for peanut RR 2.96; 1.63, 5.35, I2 0%, 8 studies; egg RR 1.71; 0.42, 6.92, I2 0%, 6 studies; and milk RR 8.45; 2.02, 35.27, I2 0%, 4 studies. Conclusion: We found strong evidence that peanut, hen's egg, and cow's milk OIT can induce DS and some evidence for remission. There was a high risk of allergic reactions. Generalizability to the entire food allergic population is not known. [ABSTRACT FROM AUTHOR]

Genetic ancestry is associated with asthma, and this could be modified by environmental factors. Keywords: asthma; country; environment; ethnicity; genetic ancestry EN asthma country environment ethnicity genetic ancestry 668 671 4 06/09/23 20230601 NES 230601 Key messages While Native American genetic ancestry appears protective against asthma, African ancestry increases risk. (B) Asthma risk per 10% increase in African ancestry, among different populations. gl Two of three manuscripts examining European ancestry in Americans reported no association with asthma (a self-identified Hispanic American cohort: OR 1.06, I p i > .05; a self-identified African American cohort: no OR or p value reported). Complex gene-environment interactions contribute to asthma in ethnic populations, highlighting the need for nuanced risk stratification. [Extracted from the article]

Childhood is a critical period of immune development. During this time, naïve CD4 (nCD4) T cells undergo programmed cell differentiation, mediated by epigenetic changes, in response to external stimuli leading to a baseline homeostatic state that may determine lifelong disease risk. However, the ontogeny of epigenetic signatures associated with CD4 T cell activation during key developmental periods are yet to be described. We investigated genome‐wide DNA methylation (DNAm) changes associated with nCD4 T activation following 72 h culture in media+anti‐CD3/CD28 beads in healthy infants (aged 12 months, n = 18) and adolescents (aged 10–15 years, n = 15). We integrated these data with transcriptomic and cytokine profiling from the same samples. nCD4 T cells from both age groups show similar extensive epigenetic reprogramming following activation, with the majority of genes involved in the T cell receptor signaling pathway associated with differential methylation. Additionally, we identified differentially methylated probes showing age‐specific responses, that is, responses in only infants or adolescents, including within a cluster of T cell receptor (TCR) genes. These encoded several TCR alpha joining (TRAJ), and TCR alpha variable (TRAV) genes. Cytokine data analysis following stimulation revealed enhanced release of IFN‐γ, IL‐2 and IL‐10, in nCD4 T cells from adolescents compared with infants. Overlapping differential methylation and cytokine responses identified four probes potentially underpinning these age‐specific responses. We show that DNAm in nCD4T cells in response to activation is dynamic in infancy and adolescence, with additional evidence for age‐specific effects potentially driving variation in cytokine responses between these ages. [ABSTRACT FROM AUTHOR]

Objective: To summarise the associations between antenatal or early‐life blood vitamin D and the development of eczema/food allergy in childhood. Design: A systematic review and meta‐analyses were conducted to synthesize the published literature. Two reviewers independently performed the study selection and data extraction on Covidence. We assessed the risk of bias for observational studies by using the Newcastle‐Ottawa Scale and the Cochrane Risk of Bias tool for clinical trials. The certainty of the evidence was assessed using Grading of Recommendations, Assessment, Development and Evaluations (GRADE). Data sources We systematically searched PubMed and Embase from inception and April 2022. Eligibility criteria: Human studies that investigated prospective associations between antenatal or early‐life blood vitamin D levels, dietary intake or supplementation and childhood eczema/food allergy. Results: Forty‐three articles including six randomised controlled trials (RCTs) were included. Four RCTs of vitamin D supplementation during pregnancy showed no evidence of an effect on the incidence of eczema (pooled odds ratio [OR] = 0.85; 0.67–1.08, I2 = 6.7%, n = 2074). Three RCTs reported null associations between supplementation in pregnancy/infancy and food allergy. From six cohort studies, increasing cord blood vitamin D levels were associated with reduced prevalence of eczema at/close to age one (OR per 10 nmol/L increase = 0.89; 0.84–0.94, I2 = 0%, 2025 participants). We found no evidence of an association between maternal antenatal or infant vitamin D level or dietary intake and the development of food allergy or eczema in offspring. Conclusions: We found an association between higher vitamin D levels in cord blood and reduced risk of eczema in cohort studies. Further trials with maternal and infant supplementation are needed to confirm if vitamin D supplementation can effectively prevent eczema or food allergy in childhood. Systematic review registration: PROSPERO, No. CRD42013005559. [ABSTRACT FROM AUTHOR]

Objective: It is recognized that human rhinovirus (HRV) infection is an important factor in asthma exacerbations requiring hospitalization in children. However, previous studies have disagreed on the differential impact of various HRV species. We sought to assess the impact of HRV species on the severity of asthma exacerbations in children and adolescents. We also examined whether the effect of HRV species on severity was modified by age and gender. Methods: Virus strain was determined for 113 children with HRV detectable at the time of admission for asthma exacerbation. Patient characteristics were collected on admission and exacerbation severity was scored using several validated scales. Results: HRV species by itself was not associated with moderate/severe vs. mild exacerbations. Boys with HRV-C infections were more likely (OR: 3.7, 95% CI: 1.2-13.4) to have a moderate/severe exacerbation than girls with HRV-C (p = 0.04 for interaction term). Higher odds were observed in younger boys (3 years old: OR: 9.1, 95% CI: 1.8-47.1 vs 5 years old: OR: 3.3, 95% CI: 0.9-11.8 vs 7 years old: OR: 1.2, 95% CI: 0.2-6.6). In contrast, children with HRV-C infection and sensitized to pollen during the pollen season were less likely to have moderate/severe exacerbations (p = 0.01 for the interaction term). Conclusion: Acute asthma exacerbations are more likely to be moderate/severe in boys under 5 years of age who had HRV-C infection on admission. The opposite was found in children with sensitization to pollen during pollen season. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to an article related to whole-cell pertussis-containing vaccines and acellular pertussis-containing vaccines by M.A. Witt et al. in the 2013 issue.

Background: The extent to which biomarkers of asthma activity persist in spontaneous asthma remission and whether such markers are associated with future respiratory outcomes remained unclear. We investigated the association between sub‐clinical inflammation in adults with spontaneous asthma remission and future asthma relapse and lung function decline. Methods: The Tasmanian Longitudinal Health Study is a population‐based cohort (n = 8583). Biomarkers of systemic inflammation were measured on participants at age 45, and latent profile analysis was used to identify cytokine profiles. Bronchial hyperresponsiveness (BHR) and nitric oxide products in exhaled breath condensate (EBC NOx) were measured at age 50. Participants with spontaneous asthma remission at ages 45 (n = 466) and 50 (n = 318) were re‐evaluated at age 53, and associations between baseline inflammatory biomarkers and subsequent asthma relapse and lung function decline were assessed. Results: We identified three cytokine profiles in adults with spontaneous asthma remission: average (34%), Th2‐high (42%) and Th2‐low (24%). Compared to the average profile, a Th2‐high profile was associated with accelerated decline in post‐BD FEV1/FVC (MD −0.18% predicted per‐year; 95% CI −0.33, −0.02), while a Th2‐low profile was associated with accelerated decline in both post‐BD FEV1 (−0.41%; −0.75, −0.06) and post‐BD FVC (−0.31%; −0.62, 0.01). BHR and high TNF‐α during spontaneous remission were associated with an increased risk of asthma relapse. In contrast, we found no evidence of association between EBC NOx and either asthma relapse or lung function decline. Conclusion: BHR and serum inflammatory cytokines have prognostic value in adults with spontaneous asthma remission. At‐risk individuals with BHR, Th2‐high or Th2‐low cytokine profiles may benefit from closer monitoring and on‐going follow‐up. [ABSTRACT FROM AUTHOR]

• Helminthiasis in children is positively associated with asthma. • The extent of helminth infestation is not associated with asthma. • Trichiuris trichura but no other helminths are associated with asthma. The association between helminthiasis and asthma remains inconclusive but can only be investigated in counties where helminthiasis is transitioning from a high to low burden. We investigated this association using data from a childhood respiratory cohort in Sri Lanka. A case-control study was nested within a population-based cohort of children aged 6-14 years in Sri Lanka. The stool samples of 190 children with asthma and 190 children without asthma were analyzed to assess the burden of helminth infestation. Logistic regression models were fitted to investigate the association of gastrointestinal helminth species with asthma. Helminthiasis in children with and without asthma was 23.3% (n = 44) and 15.3% (n = 23), respectively. Those with asthma were more likely to have helminthiasis (odds ratio 3.7; 95% confidence interval 1.7, 7.7; P = 0.001), particularly with Trichiuris trichura (odds ratio 4.5; 95% confidence interval 1.6, 12.3; P = 0.004). Helminth eggs per gram of feces were not associated with asthma (P >0.05). Our findings demonstrate a positive association between T. trichura infestation and asthma and point to the need to fully characterize this association to understand the likely immunological mechanism that drives it. This association highlights an important public health intervention in countries where these infestations are still prevalent, affecting 24% of the population worldwide. [ABSTRACT FROM AUTHOR]

Most households in low- and middle-income countries (LMICs) rely on biomass fuel for daily cooking. Studies investigating the association between early life exposure to household air pollution and health outcomes in children in LMICs are limited. To investigate the effects of biomass fuel for cooking and different types of stoves on wheeze and allergies in children of rural Sri Lankan communities. A cross-sectional study was conducted on 452 children aged 5 years and younger in Kandy, Sri Lanka. Mothers completed a questionnaire on the use of biomass fuel and respiratory and allergic outcomes in children. The associations between biomass fuel and outcomes were analyzed using logistic regression models, adjusting for potential confounders. Use of biomass fuel for cooking was associated with increased risk of childhood wheeze (aOR 2.29; 95% CI 1.04–5.08) and eczema (aOR 4.57; 95% CI 1.24–16.89) compared with households that used clean fuel (liquid petroleum gas (LPG), electricity and/or biogas). Among households that used biomass fuel, use of traditional biomass stoves was associated with a higher risk of childhood wheeze (aOR 2.95; 95% CI 1.19–7.33), allergic rhinitis (aOR 3.01; 95% CI 1.42–6.39), and eczema (aOR 7.39; 95% CI 1.70–32.06) compared with households that used clean stoves. Children living in households that use biomass fuel, especially traditional biomass cookstoves, have a higher risk of wheeze and allergic diseases. Access to affordable clean energy sources that reduce air pollution may help improve the health of children in rural LMICs. Supplemental data for this article is available online at at www.tandfonline.com/ijas. [ABSTRACT FROM AUTHOR]

BACKGROUND: Multiple systematic reviews examine the introduction of foods in relation to individual health outcomes, but the balance of harms and benefits has not been overviewed systematically. OBJECTIVES: We aimed to perform an overview of systematic reviews on age of introduction of complementary and allergenic foods to the infant diet and long and short-term health outcomes. DATA SOURCES: We searched Medline, Embase, Cochrane, and PubMed (July 25, 2022). STUDY SELECTION: Included systematic reviews examining the introduction of complementary or allergenic foods before age 1. Outcomes included allergic, autoimmune, and inflammatory diseases, neurodevelopment, nutrition, and weight. DATA EXTRACTION: Extraction and quality assessment were performed in duplicate (A Measurement Tool to Assess Systematic Reviews) and strength of evidence was assessed. RESULTS: We screened 4015 articles and included 32 systematic reviews. There was moderate evidence that peanut and egg should be introduced from 4 to 11 months to prevent food allergy (6 of 10 reviews). Complementary food introduction was not associated with food allergy. Moderate certainty evidence suggested age of complementary food introduction was not associated with eczema. Age at introduction of gluten was not associated with celiac disease (high certainty evidence; 3 of 4 reviews). Low certainty evidence indicated that introducing solids before 4 months may increase the risk of childhood obesity, but not growth. There was insufficient evidence regarding an association between any food introduction and bone health, gastrointestinal diseases, autoimmune disorders, asthma, or allergic rhinitis. LIMITATIONS: Gray literature was not included. CONCLUSIONS: Current evidence supports introducing complementary foods around 6 months and allergenic foods before 11 months. [ABSTRACT FROM AUTHOR]

Background and Objective: The association between birth weight, particularly relative to gestational age, and adult lung function is uncertain. We investigated the associations between birth weight relative to gestational age and measures of lung function in middle age, and mediation of these associations by adult height. Methods: Participants in the Tasmanian Longitudinal Health Study who had both known birth weight and lung function assessment at age 45 years were included (n = 849). Linear regression models were fitted to investigate the association between small for gestational age and birth weight with post‐bronchodilator lung function measures (forced expiratory volume in 1 second [FEV1], forced vital capacity [FVC], FEV1/FVC, diffusing capacity for carbon monoxide [DLco], residual volume [RV] and total lung capacity [TLC]), adjusting for potential confounders. The contribution of adult height as a mediator of these associations was investigated. Results: Compared with infants born with normal weight for gestational age, those born small for gestational age had reduced FEV1 (coefficient: −191 ml [95%CI: −296, −87]), FVC (−205 ml [−330, −81]), TLC (−292 ml [−492, −92]), RV (−126 ml [−253, 0]) and DLco (−0.42 mmol/min/kPa [−0.79, −0.041]) at age 45 years. However, they had comparable FEV1/FVC. For every 1 kg increase in birth weight, lung function indices increased by an average of 117 ml (95%CI: 40, 196) for FEV1, 124 ml (30, 218) for FVC, 215 ml (66, 365) for TLC and 0.36 mmol/min/kPa (0.11, 0.62) for DLco, independent of gestational age, but again not for FEV1/FVC. These associations were significantly mediated by adult height (56%–90%). Conclusion: Small for gestational age was associated with reduced lung function that is likely due to smaller lungs with little evidence of any specific parenchymal impairment. [ABSTRACT FROM AUTHOR]