Effects of early-life exposure to allergens and bacteria on recurrent wheeze and atopy in urban children

BackgroundWheezing illnesses cause major morbidity in infants and are frequent precursors to asthma.ObjectiveWe sought to examine environmental factors associated with recurrent wheezing in inner-city environments.MethodsThe Urban Environment and Childhood Asthma study examined a birth cohort at high risk for asthma (n = 560) in Baltimore, Boston, New York, and St Louis. Environmental assessments included allergen exposure and, in a nested case-control study of 104 children, the bacterial content of house dust collected in the first year of life. Associations were determined among environmental factors, aeroallergen sensitization, and recurrent wheezing at age 3 years.ResultsCumulative allergen exposure over the first 3 years was associated with allergic sensitization, and sensitization at age 3 years was related to recurrent wheeze. In contrast, first-year exposure to cockroach, mouse, and cat allergens was negatively associated with recurrent wheeze (odds ratio, 0.60, 0.65, and 0.75, respectively; P ≤ .01). Differences in house dust bacterial content in the first year, especially reduced exposure to specific Firmicutes and Bacteriodetes, was associated with atopy and atopic wheeze. Exposure to high levels of both allergens and this subset of bacteria in the first year of life was most common among children without atopy or wheeze.ConclusionsIn inner-city environments children with the highest exposure to specific allergens and bacteria during their first year were least likely to have recurrent wheeze and allergic sensitization. These findings suggest that concomitant exposure to high levels of certain allergens and bacteria in early life might be beneficial and suggest new preventive strategies for wheezing and allergic diseases

Comorbidity and risk indicators for alcohol use disorders among persons with anxiety and/or depressive disorders Findings from the Netherlands Study of Depression and Anxiety (NESDA)

AbstractIntroductionThis study examines comorbidity of alcohol abuse and alcohol dependence as well as its risk indicators among anxious and/or depressed persons, also considering temporal sequencing of disorders.MethodsBaseline data from the Netherlands Study of Depression and Anxiety (NESDA) were used, including 2329 persons with lifetime DSM-IV anxiety (social phobia, generalized anxiety disorder, panic disorder, and agoraphobia) and/or depressive (major depressive disorder and dysthymia) disorders and 652 controls. Lifetime diagnoses of DSM-IV alcohol abuse and dependence were established, as well as information about socio-demographic, vulnerability, addiction-related and anxiety/depression-related characteristics. Temporal sequencing of disorders was established retrospectively, using age of onset.ResultsOf persons with combined anxiety/depression 20.3% showed alcohol dependence versus 5.5% of controls. Prevalence of alcohol abuse was similar across groups (±12%). Independent risk indicators for alcohol dependence among anxious and/or depressed persons were male gender, vulnerability factors (family history of alcohol dependence, family history of anxiety/depression, openness to experience, low conscientiousness, being single, and childhood trauma), addiction-related factors (smoking and illicit drug use) and early anxiety/depression onset. Persons with secondary alcohol dependence were more neurotic, more often single and lonelier, while persons with primary alcohol dependence were more often male and more extravert.DiscussionAlcohol dependence, but not abuse, is more prevalent in anxious and/or depressed persons. Persons with comorbid alcohol dependence constitute a distinct subgroup of anxious and/or depressed persons, characterized by addiction-related habits and vulnerability. However, considerable variation in characteristics exists depending on temporal sequencing of disorders. This knowledge may improve identification and treatment of those anxious and/or depressed patients who are additionally suffering from alcohol dependence