Identifying uncontrolled asthma in young children: clinical scores or objective variables?

Objective: Several international asthma guidelines emphasize the importance of assessing asthma control. However, there is limited data on the usefulness of available assessment tools in indicating disease control in young asthmatics. This study investigated the ability of Chinese version of Childhood Asthma Control Test (C-ACT) and other disease-related factors in identifying uncontrolled asthma (UA) in young children. Methods: During the same clinic visit, asthma patients 4 to 11 years of age completed C-ACT and underwent exhaled nitric oxide and spirometric measurements. Blinded to these results, the same investigator assigned Disease Severity Score (DSS) and rated asthma control according to Global Initiative for Asthma. Results: The mean (SD) age of 113 recruited patients was 9.1 (2.0) years, and 35% of them had UA. C-ACT, DSS and forced expiratory volume in 1 second (FEV1) differed among patients with different control status (p \u3c 0.001 for C-ACT and DSS; p = 0.014 for FEV1). Logistic regression confirmed that UA was associated with DSS (p \u3c 0.001), PEF (p = 0.002), C-ACT (p = 0.011), and FEV1 (p = 0.012). By ROC analysis, C-ACT and DSS were the best predictors for UA (p \u3c 0.001), followed by PEF (p = 0.006) and FEV1 (p = 0.007). When analyzed by the Classification and Regression Tree (CART) approach, the sequential use of DSS and C-ACT had 77% sensitivity and 84% specificity in identifying UA. Conclusions: C-ACT is better than objective parameters in identifying young Chinese children with UA

Early introduction of allergenic foods for the prevention of food allergy from an Asian perspective-An Asia Pacific Association of Pediatric Allergy, Respirology & Immunology (APAPARI) consensus statement

10.1111/pai.12820Pediatric Allergy and Immunology29118 - 27PALU

Asthma and atopy are associated with chromosome 17q21 markers in Chinese children

Background: Single‐nucleotide polymorphism (SNP)‐based genome‐wide association study revealed that markers on chromosome 17q21 were linked to childhood asthma but not atopy in Caucasians, with the strongest signal being detected for the SNP rs7216389 in the gene. Such association was unknown in Chinese. This study delineated the allele and genotype frequencies of 10 SNPs at chromosome 17q21, and investigated the relationship between these SNPs and asthma and plasma IgE in southern Chinese children. Methods: Asthmatic children and non‐allergic controls were recruited from pediatric clinics. Their plasma total and aeroallergen‐specific IgE concentrations were measured by immunoassay. Ten SNPs on 17q21 region were genotyped by multiplex SNaPshot™, and their genotype associations with asthma traits analyzed using multivariate regression. Results: 315 patients and 192 controls were enrolled. The allele frequency for C allele of rs7216389 varied significantly from 0.232 in our controls, 0.389 in Han Chinese to 0.536 in Caucasians. Asthma diagnosis was associated with rs11650680 and five other SNPs including rs7216389 (=0.019–0.034), whereas atopy was associated only with rs11650680 (=0.0004). Linear regression revealed the covariates for plasma total IgE to be significant for rs11650680 (=0.008–0.0002). Haplotypic associations were found with atopy and increased plasma total IgE, with the respective odds ratios and 95% confidence intervals for TTTCCGTT haplotype to be 0.21 and 0.09–0.52 (=0.0002) and 0.41 and 0.18–0.90 (=0.025). Conclusion: Childhood asthma and atopy are associated with chromosome 17q21 in Chinese, but such association may involve genes other than in this region

The prevalence of food allergy to hen's egg in schoolchildren in Western Siberia (Russian Federation)

Host-parasite interactio

Association between candidate genes and spirometric variables in Chinese

Background: Asthma is caused by complex interactions between multiple susceptibility genes and environmental factors. Three genes (ARG1, ADRB2 and CRHR2) were reported to be associated with bronchodilator response in Caucasians, whereas NOS1 and NOS3 were important components of the arginase 1 pathway. GSDM1 and TOP2A, located on chromosome 17q21 as a reproducible locus identified by asthma genome-wide association study in other ethnic groups, were also candidate genes for asthma and atopy in our Chinese children. This study investigated the associations between spirometric variables and single-nucleotide polymorphisms (SNPs) of these seven candidate genes. Methods: This study recruited both children (312 cases and 70 controls; aged 6-17 years) and adults (345 cases and 652 controls; aged ≥ 18 years). Spirometry was performed before and 30 minutes following salbutamol inhalation. Their forced expiratory volume in 1-second (FEV1) and forced vital capacity (FVC) were then measured. Thirteen SNPs of ARG1, ADRB2, CRHR2, NOS1, NOS3, GSDM1 and TOP2A were genotyped by TaqMan SNP genotyping assays using ABI Prism 7900HT thermocycler, and their associations with spirometric variables in our subjects were analyzed by multivariate linear regression. Results: All SNPs followed Hardy-Weinberg equilibrium. In our adults, the minor allele of rs3756780 on ARG1 was associated with an additive protective effect against asthma (odds ratio 0.71, 95% confidence interval 0.54-0.93; P=0.013). Multivariate linear regression revealed FEV1 to be associated with SNPs of ARG1, CRHR2, GSDM1 and TOP2A (P=0.002-0.044), whereas FEV1/FVC was associated with SNPs of ARG1 and TOP2A (P=0.021-0.050). No significant association was found between spirometric variables and ADRB2. Among our children, FEV1 reversibility was associated with rs1003929 of CRHR2 and rs1007654 of GSDM1 (P=0.014 and 0.004, respectively). Conclusions: This study identifies discrepant genetic associations for spirometric parameters between Chinese adults and children. Both CRHR2 and GSDM1 are associated with FEV1 in adults and FEV1 reversibility in children, whereas ARG1 and TOP2A are associated with FEV1 and FEV1/FVC only in adults. These findings highlight the importance of these candidate genes in modulating airflow limitation. None of ADRB2, NOS1 or NOS3 is a major gene for spirometric variables in the Chinese population

The EuroPrevall-INCO surveys on the prevalence of food allergies in children from China, India and Russia: the study methodology

P>Background: Very little is known regarding the global variations in the prevalence of food allergies. The EuroPrevall-INCO project has been developed to evaluate the prevalence of food allergies in China, India and Russia using the standardized methodology of the EuroPrevall protocol used for studies in the European Union. The epidemiological surveys of the project were designed to estimate variations in the prevalence of food allergy and exposure to known or suspected risk factors for food allergy and to compare the data with different European countries. Methods: Random samples of primary schoolchildren were recruited from urban and rural regions of China, Russia and India for screening to ascertain possible adverse reactions to foods. Cases and controls were then selected to answer a detailed questionnaire designed to evaluate the possible risk factors of food allergies. Objective evidence of sensitisation including skin-prick test and serum specific IgE measurement was also collected. Results: More than 37 000 children from the three participating countries have been screened. The response rates for the screening phase ranged from 83% to 95%. More than 3000 cases and controls were studied in the second phase of the study. Furthur confirmation of food allergies by double blind food challenge was conducted. Conclusions: This will be the first comparative study of the epidemiology of food allergies in China, India, and Russia using the same standardized methodology. The findings of these surveys will complement the data obtained from Europe and provide insights into the development of food allergy