House dust mite sensitization, eczema, and wheeze increase risk of shellfish sensitization

Non peer reviewe

Allergic sensitization trajectories to age 8 years in the Singapore GUSTO cohort

Background: Allergic sensitization is linked to allergy development, with early sensitization often associated with worse outcomes. We aimed to identify if distinct allergic sensitization trajectories existed within a diverse and multi-ethnic Asian cohort.Methods: We administered modified ISAAC questionnaires in the first 8 years and conducted skin prick testing at ages 18 months, 3, 5 and 8 years in the Growing Up in Singapore Towards healthy Outcomes (GUSTO) cohort. We used latent class analysis to derive allergic sensitization trajectories, and adjusted odds ratios (AOR) to evaluate predictive risk factors and associations with allergic comorbidities.Results: Among 997 children, three trajectories were identified: early food and mite sensitization (16.2%), late mite sensitization (24.2%) and no/low sensitization (59.6%). Early food and mite sensitization was associated with early eczema by 6 months [AOR (95%CI) 4.67 (1.78-12.28)], increased risk of wheeze by 3-8 years (ARR 1.72-1.99) and eczema in the first 8 years of life (ARR 1.87-2.41). Late mite sensitization was associated with female sex [AOR 0.58 (0.35-0.96)], cesar-ean section [AOR 0.54 (0.30-0.98)], early eczema by 6 months [AOR 3.40 (1.38-8.42)], and increased risk of eczema by 18 months [ARR 1.47 (1.03-2.08)] and 8 years [ARR 1.35 (1.05-1.73)].Conclusion: Early onset of eczema and early allergic sensitization were strongly associated. Early sensitization, especially to house dust mites, was associated with increased risks of developing wheeze and eczema, pointing to the importance of developing preventive perinatal interventions and effective therapeutics for sensitized toddlers.Peer reviewe

Associations Between Maternal Distress During Early Life Periods and Offspring Respiratory Infections and Allergic Outcomes

DOI does not function. It has been reported to the journal 28.12.2022BackgroundIncreasing evidence suggests that maternal distress is a risk factor for development of respiratory infections and allergic diseases in the offspring. We aim to evaluate the link between maternal distress during critical periods in early life, namely the preconception, pregnancy and postnatal periods, and development of respiratory infections and allergic diseases in the offspring from the Singapore PREconception Study of long Term maternal and child Outcomes (S-PRESTO) cohort. MethodsMaternal perceived distress was evaluated using validated questionnaires including Beck Depression Inventory-II (BDI-II) administered during three time periods: preconception (three months apart at four timepoints), pregnancy (during each trimester) and postnatal (3 and 6 months post-delivery). Child eczema, rhinitis and wheeze outcomes were evaluated using a modified ISAAC questionnaire at ages 3, 6, 12, and 18 months. Child allergic sensitization was determined by skin prick testing at 18 months. ResultsAmong 332 mother-child pairs studied, higher maternal distress during preconception and pregnancy increased the risks of wheeze development in the first 18 months; for example, preconception and pregnancy BDI-II scores >= 20 were associated with increased risks of wheeze by 18 months [adjusted risk ratios 3.2 (95%CI 1.1-9.4) and 2.5 (1.0-5.9), respectively]. Emotional and practical support from family during preconception decreased the risks of offspring wheeze. No associations were observed between maternal distress and offspring eczema, rhinitis and allergic sensitization. ConclusionMaternal distress during critical early life periods was associated with offspring wheeze in the first 18 months of life. Supporting maternal mental health even before pregnancy could reduce the risk of offspring wheeze.Peer reviewe

Associations Between Eczema and Attention Deficit Hyperactivity Disorder Symptoms in Children

Background: Epidemiological studies suggest a link between eczema and attention deficit hyperactivity disorder (ADHD), but underlying mechanisms have not been examined.Objective: We aim to investigate the association between eczema and subsequent ADHD symptoms in the Growing Up in Singapore Towards healthy Outcomes cohort and explore the role of pro-inflammatory cytokines and gut microbiome.Methods: The modified International Study of Asthma and Allergies in Childhood questionnaire and Computerized Diagnostic Interview Schedule for Children Version IV were administered to assess reported eczema within the first 18 months and presence of ADHD symptoms at 54 months, respectively. Skin prick testing at 18 months, cytokines in maternal blood during pregnancy and cord blood and the mediating role of the gut microbiome at 24 months were assessed.Results: After adjusting for confounders, eczema with or without a positive skin prick test was associated with doubling the risk of ADHD symptoms. No differences in maternal and cord blood cytokines were observed in children with and without eczema, or children with and without ADHD. Gut microbiome dysbiosis was observed in children with eczema and children with ADHD. Children with eczema also had lower gut bacterial Shannon diversity. However, the relationship between eczema and ADHD was not mediated by gut microbiome.Conclusion: Early life eczema diagnosis is associated with a higher risk of subsequent ADHD symptoms in children. We found no evidence for underlying inflammatory mechanism or mediation by gut microbiome dysbiosis. Further research should evaluate other mechanisms underlying the link between eczema and ADHD.Peer reviewe

Assessment of smoking/tobacco smoke exposure and provision of smoking cessation advice/assistance by healthcare professionals at a women´s and children´s hospital - practices and barriers

Background Children and pregnant women are vulnerable to the harms of tobacco smoke. All healthcare professionals (HCPs) have a responsibility to protect them from tobacco smoke. This study aims to identify the gaps between this knowledge and real world practice in a clinical setting. Methods Self administered questionnaires were distributed to 2436 HCPs at a women´s and children´s hospital. The HCPs were asked about their practice of smoking/tobacco smoke exposure (TSE) assessment and provision of smoking cessation advice/assistance in their clinical work, and the barriers they face in carrying out these activities. Results The response rate was 74.6% (1817 respondents), from 276 (15.2%) doctors, 1498 (82.4%) nurses and 43 pharmacists (2.4%). Only 20% of HCPs would always ask about smoking/TSE, while 19.5% do not at all. Only 15.1% of HCPs would always provide smoking cessation advice/assistance to patient smokers or smoker parents/caregivers, while 28.4% do not at all. Only 7.9% of Paediatrics HCPs would always ask about smoking/TSE, while 38.7% of O&G HCPs would always do so ( p = 0.000 ). The reasons/barriers for not always assessing smoking/TSE or providing smoking cessation advice/assistance are listed in Table 1. Not always assessing for smoking/TSE Not always providing smoking cessation advice/assistance Smoking/TSE is not a common/significant issue (35.6%) Smoking/TSE is not a common/significant issue (23.4%) Not my direct responsibility (21.7%) Not my direct responsibility (20.9%), Smoking/TSE is not related to the patient´s disease (19.4%) Smoking/TSE is not related to the patient´s disease (17.0%) Fear of negative reaction from smoker (14.5%) Lack of counseling skills (16.5%) Lack of time (7.5%) Fear of negative reaction from smoker (15.7%) Inadequate resource personnel to assist (3.2%) Lack of time (14.6%) [Table 1 - Reasons and Barriers] The most common interventions for patient smokers and smoker parents/caregivers are provision of general advice for the smoker to quit smoking (36.5%), assessment of smoker willingness to quit (15.7%), and provision of reading materials (9.9%). The suggestions from HCPs on how to overcome the barriers identified are relevant training courses for all HCPs (62.2%), setting up of smoking cessation clinics (42.4%), and training more smoking cessation counselors (30.6%). Conclusions There is room for improvement in the real world practice of HCPs in protecting children and women from tobacco smoke. Awareness and mindset issues are barriers to be addressed. Fear of negative reaction and lack of counseling skills limit HCPs´ confidence but the majority are receptive to receiving training

Pregnancy trimester-specific exposure to ambient air pollution and child respiratory health outcomes in the first 2 years of life: Effect modification by maternal pre-pregnancy BMI

10.3390/ijerph15050996International Journal of Environmental Research and Public Health155996GUSTO (Growing up towards Healthy Outcomes

Burden of varicella in the Asia-Pacific region: a systematic literature review

Introduction: Varicella is a highly contagious infection that can lead to serious complications, particularly in high-risk groups; however, it is vaccine preventable. Disease awareness and understanding of the disease burden can strongly influence vaccine coverage. This review provides insight into the current epidemiology and the importance of varicella from both public health and economic perspectives across the Asia-Pacific (APAC) region. Areas covered: A systematic literature review was conducted to identify studies on the incidence, seroprevalence, fatality rate and complication rate of varicella. Economic burden studies were also captured. Altogether, 125 studies were identified across the region; these were supplemented by government reports (gray data). Reported vaccine coverage varied from 2.8% to 97%; a key influencing factor was inclusion of the varicella vaccine in national immunization programs. In general, varicella incidence in the unvaccinated population was highest in children ≤5 years old and seroprevalence increased with age. Economic analyses highlighted the cost-saving potential of vaccination programs, especially from a societal perspective. Expert opinion: Varicella-related data varied greatly across the APAC region, highlighting the need to better understand the burden of varicella in this area, and particularly identified the need for better surveillance and reporting

A Case of Serious Adverse Reaction Following Rabies Vaccination

Introduction . Rabies is one of the most deadly infectious disease. We present a challenging case of an adverse reaction following rabies vaccine in a child. Case Summary . A 10-year-old girl was bitten by a stray dog in Bali and was prescribed rabies post-exposure prophylaxis. She developed breathlessness, abdominal cramps, and lips and eyes swelling 30 minutes after the second dose of rabies vaccine. The subsequent vaccine was successfully administered as a graded challenge with premedication. The final dose was administered in entirety under close observation. She developed transient hypotension 30 minutes later, which spontaneously resolved. Conclusion . There were multiple challenges in the care of this pediatric patient who was potentially exposed to rabies and experienced systemic adverse events during the course of post-exposure prophylaxis. A thorough clinical assessment should be made to weigh benefits versus risks of proceeding with rabies vaccination, bearing in mind that the disease is deadly

Atopic dermatitis trajectories to age 8 years in the GUSTO cohort.

Background:The heterogeneity of childhood atopic dermatitis (AD) underscores the need to understand latent phenotypes that may inform risk stratification and disease prognostication.Objective:To identify AD trajectories across the first 8 years of life and investigate risk factors associated with each trajectory and their relationships with other comorbidities.Methods:Data were collected prospectively from 1152 mother-offspring dyads in the Growing Up in Singapore Towards healthy Outcomes (GUSTO) cohort from ages 3 months to 8 years. AD was defined based on parent-reported doctor's diagnosis. An unsupervised machine learning technique was used to determine AD trajectories.Results:Three AD trajectories were identified as follows: early-onset transient (6.3%), late-onset persistent (6.3%) and early-onset persistent (2.1%), alongside a no AD/reference group (85.2%). Early-onset transient AD was positively associated with male gender, family history of atopy, house dust mite sensitization and some measures of wheezing. Early-onset persistent AD was associated with antenatal/intrapartum antibiotic use, food sensitization and some measures of wheezing. Late-onset persistent AD was associated with a family history of atopy, some measures of house dust mite sensitization and some measures of allergic rhinitis and wheezing.Conclusion and Clinical Relevance:Three AD trajectories were identified in this birth cohort, with different risk factors and prognostic implications. Further work is needed to understand the molecular and immunological origins of these phenotypes.<br/

Atopic dermatitis trajectories to age 8 years in the GUSTO cohort.

Background:The heterogeneity of childhood atopic dermatitis (AD) underscores the need to understand latent phenotypes that may inform risk stratification and disease prognostication.Objective:To identify AD trajectories across the first 8 years of life and investigate risk factors associated with each trajectory and their relationships with other comorbidities.Methods:Data were collected prospectively from 1152 mother-offspring dyads in the Growing Up in Singapore Towards healthy Outcomes (GUSTO) cohort from ages 3 months to 8 years. AD was defined based on parent-reported doctor's diagnosis. An unsupervised machine learning technique was used to determine AD trajectories.Results:Three AD trajectories were identified as follows: early-onset transient (6.3%), late-onset persistent (6.3%) and early-onset persistent (2.1%), alongside a no AD/reference group (85.2%). Early-onset transient AD was positively associated with male gender, family history of atopy, house dust mite sensitization and some measures of wheezing. Early-onset persistent AD was associated with antenatal/intrapartum antibiotic use, food sensitization and some measures of wheezing. Late-onset persistent AD was associated with a family history of atopy, some measures of house dust mite sensitization and some measures of allergic rhinitis and wheezing.Conclusion and Clinical Relevance:Three AD trajectories were identified in this birth cohort, with different risk factors and prognostic implications. Further work is needed to understand the molecular and immunological origins of these phenotypes.<br/