Association between immunization coverage and atopy in children with or without family history of atopic disease

Background Atopic diseases are determined by the interaction between genetic and environmental factors. The possible effects of immunization, as one of environmental factors, on atopy remain a matter of controversy. Objective We conducted an observational clinical epidemiology to find out the protective effect of high vaccination coverage to atopy in children. Methods During January through March 2006, 150 of749 children at Garuda, Padasuka, and Babakan Sari Primary Health Care in Bandung were randomized from group with and without family history of atopic disease. Atopy derived from skin prick test and total serum lgE was evaluated. Atopy was defined as a positive skin test to any of the eight allergens tested. The immunizations were recorded from Kartu Menuju Sehat (KMS). Statistical analyses included Chi square to compare prevalence, independent T-test and Mann-Whitney to compare mean. Results Atopy was found in 28.2% of284 subjects, of which 32.4% with and 23.9% without a family history of atopic disease. The median of total serum lgE level was higher in children with family history of atopic disease and in atopy children. Children were grouped according to total dose of basic immunizations (0-17 and 2: 18) based on Program Pengembangan Imunisasi (PPI). There was nonsignificant association between total doses of immunization and atopy. Even though no statistically significant, the cumulative immunization doses were inversely related to the median of total serum IgE level. Conclusions The immunization coverage has not decreased atopy risk

The association between duration of breastfeeding and atopy in children with or without family history of atopic disease

Background Atopic diseases (AD) are the most common chronic diseases in childhood, and their incidence has a tendency to increase recently. Tendency to have atopy could be triggered by many factors originated in early life, including time of breastfeeding cessation. Objective To determine the association between exclusive and duration of breastfeeding and atopy in children with or without family history of atopic disease. Methods This was an observational clinical epidemiology study performed at Babakansari, Padasuka, Garuda Primary Health Care Center in Bandung from January to March 2006. One hundred fifty of 749 children were randomized from group with and without family history of AD. They underwent skin prick tests and total serum IgE level analysis. Atopy was defined as a positive skin prick test to any of the eight allergens tested. History of exclusive and duration of breastfeeding was obtained from their parents. Significance tests for contingency tables were on the basis of x 2 test for association odds ratio with 95% confidence interval. Results Atopy was found in 28.2% of children, of whom 32.4% with and 23.9% without family history of AD. Children exclusively breastfed exhibited a reduced risk of atopy (5.8% v 35.3%, OR=0.11, 95%CI= 0.03;0.34, P<0.001). The difference of atopy was strongly significant between children who had exclusive breastfeeding and those without exclusive breastfeeding whether or not the subjects had family history of AD (P<0.001). There was a highly significant risk reduction for atopy related to prolonged breastfeeding (=6 months) (OR=0.37, 95%CI = 0.19 to 0.72, P=0.001). The difference of atopy was strongly significant between children who had prolonged breastfeeding and short breastfeeding duration whether or not the subjects had family history of AD (P<0.001) Conclusions Exclusive and prolonged breastfeeding decrease atopy in children with as well as without family history of AD

The association between fever in the first year of life and atopy in children with or without family history of atopic disease

Background The role of repeated infection in early life in the development of childhood atopy is still controversy. Fever in the first year of life which is frequently associated with infections might decrease atopy. Objective The aim of this study was to investigate the association between fever in the first year of life and atopy in children. Methods This was an observational clinical epidemiology study performed at Puskesmas Garuda, Padasuka, and Babakan Sari, Bandung, from January to March 2006. From 749 children, we randomly chose 150 subjects each from group with and without family history of atopic disease. Skin prick test and measurement of total serum immunoglobulin (Ig) E were performed on each children. Atopy was defined as the skin prick test result was positive to >1 allergen. The number of fever episodes in the first year of life was based on parents report. The relationship between fever and atopy was analyzed using Mantel Haenszel. Results From 284 subjects, atopy was found in 28.2% of children, of which 32.4% with and 23.9% without a family history of atopic disease. Generally there was no significant association between fever and atopy. There was only decreased odds ratio with increased fever episodes and trend analysis showed this decrease was significant (P=0.01). The significant association between fever and atopy were found only in group without family history of atopic disease (P=0.03, OR=0.43, CI 95% 0.18;1.01). Conclusion There is a relationship between fever and atopy in children without family history of atopic disease

Stunting as a Risk Factor for Asthma: The Role of Vitamin D, Leptin, IL-4, and CD23+

Stunting, which results from chronic malnutrition, is common in children from low- and middle-income countries. Several studies have reported an association between obesity and asthma. However, only a handful of studies have identified stunting as a significant risk factor for wheezing, a symptom of asthma, although the underlying mechanism remains unclear. This article aimed to review possible mechanisms underlying asthma in stunted children. Overall, changes in diet or nutritional status and deficiencies in certain nutrients, such as vitamin D, can increase the risk of developing asthma. Vitamin D deficiency can cause linear growth disorders such as stunting in children, with lower levels of 25(OH)D found in underweight and stunted children. Stunted children show a decreased lean body mass, which affects lung growth and function. Low leptin levels during undernutrition cause a Th1&ndash;Th2 imbalance toward Th2, resulting in increased interleukin (IL)-4 cytokine production and total immunoglobulin E (IgE). Studies in stunted underweight children have also found an increase in the proportion of the total number of B cells with low-affinity IgE receptors (CD23+). CD23+ plays an important role in allergen presentation that is facilitated by IgE to T cells and strongly activates allergen-specific T cells and the secretion of Th2-driving cytokines. Stunted children present with low vitamin D and leptin levels, impaired lung growth, decreased lung function, and increased IL-4 and CD23+ levels. All of these factors may be considered consequential in asthma in stunted children

The Association between Vitamin D, Interleukin-4, and Interleukin-10 Levels and CD23+ Expression with Bronchial Asthma in Stunted Children

Children with stunted growth have an increased risk of wheezing, and studies have shown that low levels of vitamin D and interleukin (IL)-10, along with increased IL-4 levels and CD23+ expression, are present in stunted and asthmatic children. To date, it is not known whether these factors are related to the incidence of asthma in stunted children. This case-control study investigated the association between vitamin D, IL-4, and IL-10 levels and CD23+ expression with bronchial asthma in stunted children. The study included 99 children aged 24–59 months, i.e., 37 stunted-sthmatic children (cases), 38 stunted children without asthma, and 24 non-stunted children with asthma. All children were tested for their 25(OH)D levels using chemiluminescent immunoassay (CLIA), IL-4 and IL-10 levels were measured through enzyme-linked immunosorbent assay (ELISA) testing, and CD23+ expression was measured through flow cytometry bead testing. The data were analyzed using chi-squared, Kruskal-Wallis, and Mann-Whitney tests. The results showed that stunted asthmatic children had a higher incidence of atopic family members than those without asthma. Additionally, stunted asthmatic children had a higher prevalence of vitamin D deficiency (48.6%) than the control group (44.7% and 20.8%). Furthermore, stunted asthmatic children had significantly lower levels of 25(OH)D [20.55 (16.18–25.55), p = 0.042] and higher levels of IL-4 [1.41 (0.95–2.40), p = 0.038], although there were no significant differences in IL-10 levels and CD23+ expression. The study concluded that low vitamin D and high IL-4 levels are associated with bronchial asthma in stunted children, while IL-10 and CD23+ do not show a significant association

Strategies and future opportunities for the prevention, diagnosis, and management of cow milk allergy

The prevalence of food allergy has increased over the last 20-30 years, including cow milk allergy (CMA) which is one of the most common causes of infant food allergy. International allergy experts met in 2019 to discuss broad topics in allergy prevention and management of CMA including current challenges and future opportunities. The highlights of the meeting combined with recently published developments are presented here. Primary prevention of CMA should start from pre-pregnancy with a focus on a healthy lifestyle and food diversity to ensure adequate transfer of inhibitory IgG- allergen immune complexes across the placenta especially in mothers with a history of allergic diseases and planned c-section delivery. For non-breastfed infants, there is controversy about the preventive role of partially hydrolyzed formulae (pHF) despite some evidence of health economic benefits among those with a family history of allergy. Clinical management of CMA consists of secondary prevention with a focus on the development of early oral tolerance. The use of extensive Hydrolysate Formulae (eHF) is the nutrition of choice for the majority of non-breastfed infants with CMA; potentially with pre-, probiotics and LCPUFA to support early oral tolerance induction. Future opportunities are, among others, pre- and probiotics supplementation for mothers and high-risk infants for the primary prevention of CMA. A controlled prospective study implementing a step-down milk formulae ladder with various degrees of hydrolysate is proposed for food challenges and early development of oral tolerance. This provides a more precise gradation of milk protein exposure than those currently recommended