Filaggrin Gene Defects Are Independent Risk Factors for Atopic Asthma in a Polish Population: A Study in ECAP Cohort

BACKGROUND: FLG null variants of which 2282del4 and R501X are the most frequent in Caucasians are established risk factors for atopic dermatitis (AD) with an effect probably mediated through impairment of epidermal barrier. Among subjects with AD FLG defects are also consistently associated with asthma and allergic rhinitis (AR) but it is less clear to what extent these associations are also present independently from skin disease. The aim of the present study was to evaluate the role of 2282del4 and R501X in predisposing to these allergic phenotypes in a Polish population. METHODOLOGY: 2282del4 and R501X were typed among 3,802 participants of the Epidemiology of Allergic Diseases in Poland (ECAP) survey, a cross-sectional population-based study using ECRHS II and ISAAC questionnaires, and ambulatory examination. PRINCIPAL FINDINGS: The FLG null variants were associated with AD (OR = 2.01, CI: 1.20-3.36, P = 0.007), allergic rhinitis (in particular persistent form, OR = 1.69, CI:1.12-2.54, P = 0.011), and asthma (in particular atopic asthma, OR = 2.22, CI:1.24-3.96, P = 0.006). Association with atopic asthma (but not persistent allergic rhinitis) was also present in the absence of AD, (OR = 2.02, CI: 1.07-3.81, P = 0.027) as well as in the absence of AD and history of broadly defined inflammatory skin disease (OR = 2.30, CI: 1.07-4.93, P = 0.03). Association to atopic asthma would have not been found if diagnosis was made by questionnaire only (OR = 1.15, CI: 0.58-2.32, P = 0.8). We did not observe an association between FLG variants and allergic sensitizations (P = 0.8) or total IgE. (P = 0.6). CONCLUSIONS/SIGNIFICANCE: In a Polish population FLG 2282del4 and R501X carriage increases risk for development of AD and atopic asthma (also in the absence of AD or history thereof). This suggests that interventions aimed at restoring epidermal barrier may have a general role in asthma prophylaxis/treatment

Rola markerów metabolizmu kostnego w kwalifikacji do leczenia osteoporozy. Wyniki programu POMOST

Introduction: Increased bone turnover markers (BTM) level is consider as independent risk factor of bone fracture. However, it was not used in 10-year probability of bone fracture method (FRAX) proposed by WHO, which helps in qualification of patients for pharmacological treatment of osteoporosis. The aim of the study was to evaluate the usefulness of BTM in qualification for pharmacological treatment of osteoporosis. Material and methods: The study was performed in 152 subjects (20 men and 132 women) referred to Krajowe Centrum Osteoporozy. One-hundred thirty two of them were qualified for pharmacological treatment and 20 for prophylaxis on the basis of qualitative method. The following BTM were examined in all patients: of bone formation - N-terminal propeptide of procolagen type I (PINP) and N-mid osteocalcin (OC) and of bone resorption - C-terminal cross-linked telopeptide of collagen type I (CTx). Results: The values over that considered as independent fracture risk (in women only, no data for men) were found in 39 women with PINP, 39 with OC and 41 with CTx. Part of women had decreased serum BTM (10 women 3 BTM and 35 with 1 at least). There were not significant differences in serum BTM depending on the presence of clinical fracture risk factors: osteoporotic fracture in past, osteoporotic hip fracture in parents, chronic treatment with glucocorticosteroids and qualification for pharmacological treatment on the basis of qualitative and FRAX method. There was no significant difference in the presence of fracture risk factors depending on increased or decreased serum BTM. Conclusions: Results of the study did not show the practical use of BTM in qualification for pharmacological treatment of osteoporosis.Wstęp: Za niezależny czynnik ryzyka złamania kości uważa się podwyższenie stężenia markerów metabolizmu kostnego (BTM, bone turnover markers). Nie uwzględniono tego jednak w metodzie oceny 10-letniego ryzyka złamania kości (FRAX) zaproponowanej przez Światową Organizację Zdrowia (WHO, World Health Organization), która ma ułatwiać decyzję o farmakologicznym leczeniu osteoporozy. Celem niniejszej pracy była ocena przydatności oznaczania stężenia markerów metabolizmu kostnego w kwalifikacji do leczenia farmakologicznego osteoporozy. Materiał i metody: Badania wykonano u 152 osób (20 mężczyzn i 132 kobiet), skierowanych do Krajowego Centrum Osteoporozy (KCO), spośród których 132 były zakwalifikowane do leczenia, a 20 do profilaktyki osteoporozy na podstawie metody jakościowej stosowanej w KCO. U wszystkich pacjentów oznaczono stężenie w surowicy markerów tworzenia kości: N-końcowy propeptyd prokolagenu typu I (PINP) i N-końcowy fragment osteokalcyny (OC) oraz resorpcji kości: C-końcowy usieciowany telopeptyd kolagenu typu I (CTx). Wyniki: Wartości powyżej progu uznanego za niezależny czynnik ryzyka złamania kości stwierdzono u 39 kobiet w przypadku PINP, 39 - OC i 41 - CTx (brak progowych wartości dla mężczyzn). Część chorych miała obniżone stężenie markerów w surowicy (10 kobiet 3 markery, 35 co najmniej 1). Nie stwierdzono istotnej różnicy stężeń markerów w zależności od obecności poszczególnych czynników ryzyka złamania kości (przebytego złamania osteoporotycznego kości, złamania biodra u rodziców i przewlekłego leczenia glikokortykoidami) oraz od kwalifikacji do leczenia osteoporozy na podstawie metody jakościowej i metody FRAX. Nie było istotnej różnicy w częstości występowania czynników ryzyka złamania kości w zależności od obniżenia czy podwyższenia stężeń (BTM). Wnioski: Nie wykazano praktycznego zastosowania oznaczania stężenia markerów metabolizmu kostnego przy podejmowaniu decyzji o konieczności leczenia farmakologicznego osteoporozy

The relationship between antibiotic therapy in early childhood and the symptoms of allergy in children aged 6–8 years — the questionnaire study results

Introduction: Studies based on the ISAAC questionnaire suggest a correlation between the use of antibiotics and the prevalence of asthma and allergy in children aged 6-7 years. The number of courses of antibiotic therapy is an important factor. Objectives: To investigate the relationship between the use of antibiotics during the fi rst years of life and the prevalence of allergy and asthma among children (aged 6-8 years) in the urban population of Poland. Materials and Methods: A survey-based study with a self-completed questionnaire. The respondents were parents of children aged 6-8 years living in Warszawa, Poland. 1461 completed questionnaires were collected. Results: Asthma was declared in 4.3% of the children. Wheezing and/or sibilant rhonchi within 12 months before the study was observed in 13.5% of the cases. Asthma medication was taken by 21.8% of the children. Allergic rhinitis was declared in 18.7% of the children. Problems with sneezing, rhinorrhea, and nasal congestion not associated with cold or fever were observed in 40.7% of the children. The a nalysis of the odds ratios between the use of antibiotics and the symptoms of allergic diseases revealed a clear correlation. The highest odds ratio was observed between the completion of over three courses of antibiotic therapy prior to the age of 12 months and the declaration of one of the following: asthma (OR = 5.59, 95% CI: 2.6-12.01), wheezing and/or sibilant rhonchi (OR = 4.68, 95% CI: 3.01-7.27) and taking medicines for breathlessness (OR = 5.12, 95% CI: 3.42-7.68). Conclusions: There is a direct relationship between antibiotic use in the fi rst 3 years of life and asthma and allergy symptoms in children aged 6-8 years old

Dissociating polysensitization and multimorbidity in children and adults from a Polish general population cohort

International audienceBackground: Links between multimorbidity of allergic diseases and allergen sensitization are still under debate, especially in adults. This study aimed to establish a relationship between polysensitization and allergic multimorbidity in children and adults and the allergens involved in multimorbidity.Material and method: A cross-sectional multicentre study enrolled children aged 6-7 and 13-14 years and adults aged 20-44 years from a Polish national cohort. The diagnosis of allergic diseases was made by a physician. Skin prick tests to 13 allergens and serum IgE levels to 4 allergens were tested.Results: Among the 3856 participants, single disease (asthma, allergic rhinitis or atopic dermatitis) was diagnosed in 27.7% subjects and allergic multimorbidity in 9.3%. Allergic multimorbidity occurred more commonly in children than in adults (p < 0.01). Asthma or atopic dermatitis alone were not associated with polysensitization. Rhinitis and multimorbidity were associated with polysensitization. Allergic multimorbidity occurred in 2.2% of participants with negative skin prick tests, 9.8% of those with one positive prick test (SPT ≥ 3 mm) and 20.6% of polysensitized ones (p < 0.001). There was an increasing risk of multimorbidity depending on the number of positive prick tests for both SPT ≥ 3 mm (OR 9.6-16.5) and SPT ≥ 6 mm (OR 5.9-13.7). A statistically significant relationship was found between allergic multimorbidity and sensitization to cat and mite allergens.Conclusions: Multimorbidity is associated with polysensitization especially in children compared with adults in Polish population cohort. New insights into single disease patterns were found: bronchial asthma is the strongest risk factor for the development of multimorbidity in comparison with allergic rhinitis and atopic dermatitis

Prevalence of rhinitis in Polish population according to the ECAP (Epidemiology of Allergic Disorders in Poland) study

SummaryThe prevalence of allergic disorders, especially allergic rhinitis (AR), has dramatically increased in the past few decades and multicentre, standardized, randomized epidemiological studies are required to quantify this phenomenon in Poland.AimThe aim of the study was to estimate the prevalence of rhinitis and allergic rhinitis in Poland.Material and MethodThe ECAP study was conducted using the ECRHS II and ISAAC questionnaires translated into the Polish language and validated, in selected nine regions of Poland, including eight cities and one rural area. The respondents within the regions were selected by means of multistage proportional stratified random sampling based on the identity number (PESEL) as the operat. The survey was conducted in 20 454 subjects (response rate of 41.9%) and 18 617 questionnaires were valid. Approximately 25% of the subjects (n = 4783) were subsequently evaluated by clinicians (response rate of 43.4%).ResultsRhinitis was self-reported by 36.08% of the respondents (37.8% of 6–7 year olds, 34.5% of 13–14 year olds, and 36.0% of adults). The lowest prevalence rate was in the rural region (22.9%). Allergic rhinitis (AR) was self-reported by 22.54% of the respondents (23.6% of 6–7 year olds, 24.6% of 13–14 year olds, and 21.0% of adults). Again, the lowest prevalence rate was in the rural region (16.0%). AR was more frequent in males (24.0%) than in females (21.2%) (OR = 1.079; 95%CI: 1.044–1.116). AR was actually diagnosed by a clinician in 28.9%, including intermittent AR in 47.7% and persistent AR in 52.3%. Seasonal AR was diagnosed in 15.55%, and perennial rhinitis in 15.2%ConclusionAllergic rhinitis is common in Poland as it affects nearly 25% of the population and it is a major social problem. Standards of early detection and prevention of allergic rhinitis should be introduced

Distribution of the <i>FLG</i> variants in subjects with persistent allergic rhinitis (pAR) stratified by diagnosis of atopic dermatitis.

<p>All comparisons vs. healthy controls (<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0016933#pone-0016933-t001" target="_blank">Table 1</a>), NA: not available.</p

Distribution of the <i>FLG</i> variants in subjects with atopic asthma (AA) stratified by diagnosis of atopic dermatitis.

<p>All comparisons vs. healthy controls (<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0016933#pone-0016933-t001" target="_blank">Table 1</a>), NA: not available.</p

Prevalence of <i>FLG</i> variants according to clinical diagnosis.

1<p>In 24 subjects allergic rhinitis could not be classified as intermittent or persistent; NA not applicable; All comparisons vs. healthy controls.</p