Maternal occupational exposure to asthmogens during pregnancy and risk of asthma in 7-year-old children

BMJ Open 2013;3:e002401 doi:10.1136/bmjopen-2012-002401

• Occupational and environmental medicine

Maternal occupational exposure to asthmogens during pregnancy and risk of asthma in 7-year-old children: a cohort study

1. Berit Hvass Christensen1,2, 
2. Ane Marie Thulstrup2, 
3. Karin Sørig Hougaard3,
4. Lars R Skadhauge4, 
5. Kirsten Skamstrup Hansen5, 
6. Morten Frydenberg6, 
7. Vivi Schlünssen1,2

+Author Affiliations

1. ¹Department of Public Health, Section of Environment, Occupation and Health, Danish Ramazzini Centre, Aarhus University, Aarhus, Denmark
2. ²Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Aarhus, Denmark
3. ³The National Research Center for the Working Environment, Copenhagen, Denmark
4. ⁴Department of Occupational Medicine, Hospital of South-West Jutland, Esbjerg, Denmark
5. ⁵Department of Paediatrics, University Hospital Herlev, Herlev, Denmark
6. ⁶Department of Public Health, Section of Biostatistics, Aarhus University, Aarhus, Denmark

1. Correspondence toDr Vivi Schlünssen; vs@mil.au.dk

• Received 24 November 2012
• Revised 27 February 2013
• Accepted 4 March 2013
• Published 11 April 2013

Abstract

Objectives The objective of this study was to examine whether maternal exposure to asthmogens during pregnancy is associated with the development of asthma in 7-year-old Danish children, taking atopic status and sex into consideration.

Design The study is a prospective follow-up of a birth cohort.

Setting and participants A total of 41 724 women and their children from The Danish National Birth Cohort were categorised according to maternal occupational exposure. Exposure information was obtained by combining job title in pregnancy and 18 months after pregnancy with a commonly used asthma Job Exposure Matrix.

Primary and secondary outcome measures Primary outcome was parent-reported asthma among their 7-year-old children in an internet-based questionnaire. Secondary outcome was asthma among the same children with or without atopic dermatitis and among boys and girls, respectively.

Results Prenatal exposure to low molecular weight (LMW) agents was borderline associated with asthma in children with OR 1.17 (0.95 to 1.44) for children with atopic dermatitis and 1.10 (0.98 to 1.22) for children without. Maternal postnatal exposure was associated with asthma (OR 1.15 (1.04 to 1.28). After mutual adjustment,postnatal exposure (OR 1.13 (0.99 to 1.29) and the combined effects of prenatal and postnatal exposure (OR 1.34 (1.19 to 1.51)) seem to increase the risk of asthma in children. No significant associations were observed for other prenatal or postnatal exposures. The gender of the child did not modify the aforementioned associations.

Conclusions Maternal occupational exposures during pregnancy do not seem to be a substantial risk factor for the development of asthma in 7-year-old children. Maternal prenatal and postnatal exposures to LMW agents may predispose the propensity of the children to develop asthma. Future studies should prioritise the characterisation of the timing of exposure in relation to the birth.

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Diagnostic Performance of Various Tests and Criteria Employed in Allergic Bronchopulmonary Aspergillosis

PLoS One. 2013; 8(4): e61105.

Published online 2013 April 12. doi:  10.1371/journal.pone.0061105

PMCID: PMC3625190

Diagnostic Performance of Various Tests and Criteria Employed in Allergic Bronchopulmonary Aspergillosis: A Latent Class Analysis

Ritesh Agarwal,^1,* Dipesh Maskey,¹ Ashutosh Nath Aggarwal,¹ Biman Saikia,² Mandeep Garg,³ Dheeraj Gupta,¹ andArunaloke Chakrabarti⁴

T. Mark Doherty, Editor

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Abstract

Aim

The efficiency of various investigations and diagnostic criteria used in diagnosis of allergic bronchopulmonary aspergillosis (ABPA) remain unknown, primarily because of the lack of a gold standard. Latent class analysis (LCA) can provide estimates of sensitivity and specificity in absence of gold standard. Herein, we report the performance of various investigations and criteria employed in diagnosis of ABPA.

Methods

Consecutive subjects with asthma underwent all the following investigations Aspergillus skin test, IgE levels (total and A.fumigatus specific), Aspergillus precipitins, eosinophil count, chest radiograph, and high-resolution computed tomography (HRCT) of the chest. We used LCA to estimate the performance of various diagnostic tests and criteria in identification of ABPA.

Results

There were 372 asthmatics with a mean age of 35.9 years. The prevalence of Aspergillus sensitization was 53.2%. The sensitivity and specificity of various tests were Aspergillus skin test positivity (94.7%, 79.7%); IgE levels>1000 IU/mL (97.1%, 37.7%); A.fumigatus specific IgE levels>0.35 kUA/L (100%, 69.3%); Aspergillus precipitins (42.7%, 97.1%); eosinophil count>1000 cells/µL (29.5%, 93.1%); chest radiographic opacities (36.1%, 92.5%); bronchiectasis (91.9%, 80.9%); and, high-attenuation mucus (39.7%, 100%). The most accurate criteria was the Patterson criteria using six components followed by the Agarwal criteria. However, there was substantial decline in accuracy of the Patterson criteria if components of the criteria were either increased or decreased from six.

Conclusions

A.fumigatus specific IgE levels and high-attenuation mucus were found to be the most sensitive and specific test respectively in diagnosis of ABPA. The Patterson criteria remain the best diagnostic criteria however they have good veridicality only if six criteria are used.

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Exp Ther Med. 2013 April; 5(4): 1174–1178.

Published online 2013 January 23. doi:  10.3892/etm.2013.922

PMCID: PMC3628114

Gender and age affect the levels of exhaled nitric oxide in healthy children

HAN ZHANG,^* LINHUA SHU,^* XUXU CAI, ZHIJIA WANG, XUYONG JIAO, FEN LIU, PING HOU, LI WANG, LISHEN SHAN, NING CHEN, and YUNXIAO SHANG

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Abstract

Asthma is a chronic inflammatory disorder of the lung and diagnosis is difficult in children. The measurement of fractional exhaled nitric oxide (FeNO) may be useful in the diagnosis and monitoring of treatments. A number of factors affect FeNO levels and their influence varies across countries and regions. This study included 300 healthy students, aged from 6 to 14 years, who participated voluntarily. A comprehensive medical survey was used and measurements of FeNO levels and spirometric parameters were recorded in Shenyang, China. We observed that the median FeNO was 11 ppb (range, 8–16 ppb) in children from the northern areas of China. For males, the median level was 13 ppb (range, 9–18 ppb) and the median level was 10 ppb (range, 8–14 ppb) for females. There was a significant difference between males and females (P= 0.007) and age was correlated with FeNO (R²= 0.6554), while weight, height, body mass index (BMI), forced vital capacity (FVC), forced expiratory volume (FEV1), FEV1/FVC and peak expiratory flow (PEF) had no correlation with FeNO. In conclusion, the median FeNO is 11 ppb (range, 8–16 ppb) in male and female healthy children from northern areas of China and is affected by gender and age.

Keywords: exhaled nitric oxide, healthy children, gender, age

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PLoS One. 2013; 8(4): e60247.

Published online 2013 April 4. doi:  10.1371/journal.pone.0060247

PMCID: PMC3617219

Asthma Management in Pregnancy

Rachel A. Charlton,^1,* Annie Hutchison,¹ Kourtney J. Davis,² and Corinne S. de Vries¹

Philippa Middleton, Editor

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Abstract

Background

Asthma is common during pregnancy, however research is limited regarding the extent and timing of changes in asthma management associated with pregnancy.

Objective

To determine the prevalence of asthma during pregnancy and identify changes in treatment and asthma exacerbation rates associated with pregnancy, while controlling for seasonal influences.

Methods

Pregnant women with asthma were identified from the UK General Practice Research Database between 2000 and 2008. For each woman asthma medication prescribed during the study period was identified; for each product combination the British Thoracic Society medication-defined asthma treatment step was identified. Asthma exacerbations were identified during pregnancy and in the corresponding 12 months prior. Analyses of changes in asthma treatment and exacerbation rates during pregnancy relative to the corresponding period 12 months prior, to control for seasonality, were stratified by trimester and asthma treatment intensity level.

Results

The prevalence of treated asthma in pregnancies resulting in a delivery was 8.3%. From 14,141 pregnancies, in 12,828 women with asthma, 68.4% received prescriptions for a short-acting β₂-agonist and 41.2% for inhaled corticosteroids; 76.5% were managed with asthma treatment Step 1 or 2. Poor persistence to inhaled corticosteroids, defined as a gap of up to 60 days between prescriptions, was common. In 45.0% of pregnancies, an increase in average treatment step was observed whereas in 25.6% the treatment step decreased. Treatment intensity remained the same in 29.5% of pregnancies. Exacerbations occurred in 4.8% of pregnancies compared to 5.9% in the same season the year before (p<0 .001="" p="">

Conclusion

Exacerbation rates during pregnancy were slightly lower than in the year before. However, treatment patterns and exacerbation rates in this study suggest asthma control during pregnancy is variable, and women may require close monitoring especially in those with evidence of poor control before pregnancy.

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• Int J Health Sci (Qassim) >
• v.6(2); Jun 2012 >
• PMC3616948

Int J Health Sci (Qassim). 2012 June; 6(2): 194–202.

PMCID: PMC3616948

Impact of Allergic Rhinitis on Quality of Life in Patients with Bronchial Asthma

Maha M. Elkholy,⁽¹⁾ Mahmoud Hassan Khedr,⁽¹⁾ Ashraf Halawa,⁽²⁾ and Ayman Elbaramawy⁽¹⁾

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Abstract

Allergy and asthma can reduce HRQOL as a result of profound physical and psychosocial complications. Most patients with asthma also suffer from rhinitis, which also impairs quality of life. However, the impact of allergic rhinitis on asthmatic patients has not been investigated.

Objective

To assess Quality of life (QOL) in asthmatic patients and assess relative burden of allergic rhinitis on asthmatics’ QOL.

Patients and Methods

we analysed HRQOL questionnaire (SF-36) answers of 219 patients (118 allergic rhinitis, 79 asthma and 22 asthma with allergic rhinitis) and controls (30 healthy individuals), in addition to analysis of questionnaire scores according to patients’ characteristic including gender, BMI and duration of symptoms. Moreover, pulmonary function test were done for all patients and control.

Results

HRQOL parameters were significantly lower in females more than males and in patients with BMI>25 if compared with those with BMI<25 .="" 3="" affected="" all="" allergic="" alone="" although="" among="" and="" are="" asthma.="" asthmatic="" asthmatics="" between="" bodily="" both="" by="" compared="" control="" correlation="" denoting="" detected="" difference="" diseases.="" emotional.="" except="" fev1="" for="" found="" functioning="" group="" groups="" have="" health="" higher="" highly="" hrqol="" if="" in="" is="" isolated="" life="" lower="" markedly="" mcs="" mental="" moreover="" no="" of="" only="" or="" p="" pain="" parameters="" patients="" pcs="" physical="" positive="" quality="" r="0.949," rhinitis.="" rhinitis="" role-physical="" role="" score="" scores.="" scores="" severity="" significant="" significantly="" statistically="" sub-scales="" subjects="" tended="" than="" that="" the="" those="" to="" was="" were="" with="" without="" worse="">

Conclusions

Allergic rhinitis has a limited role in reduction of HRQOL. HRQOL is markedly reduced in patients with asthma with or without rhinitis than in those with allergic rhinitis only; this could be related to the severity of asthma more than the presence of associated allergic rhinitis. These findings indicated that allergic rhinitis does not seem to further impair quality of life in subjects with asthma. We recommend that patients with bronchial asthma with or without allergic rhinitis in need of great help from physicians and social workers to improve their physical and mental health. Moreover, further studies with larger populations and longer duration are needed in order to determine the extent to which asthma and rhinitis comorbidities are associated in HRQOL.

Keywords: asthma, allergic rhinitis, HRQOL, SF-36 questionnaire

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• Case Rep Med >
• v.2013; 2013 >
• PMC3622308

Case Rep Med. 2013; 2013: 610726.

Published online 2013 March 27. doi:  10.1155/2013/610726

PMCID: PMC3622308

Exercise-Induced Anaphylaxis: A Case Report and Review of the Diagnosis and Treatment of a Rare but Potentially Life-Threatening Syndrome

Nathan T. Jaqua, ^{1 ,*} Matthew R. Peterson, ¹ and Karla L. Davis ²

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Abstract

A 24-year-old male Marine with an uncomplicated medical history and a long history of strenuous, daily exercise presented to the emergency department after experiencing anaphylactic shock while running. Symptoms resolved following administration of intramuscular diphenhydramine, ranitidine, intravenous methylprednisolone, and intravenous fluids. On followup in the allergy clinic, a meticulous clinical history was obtained which elucidated a picture consistent with exercise-induced anaphylaxis. He had experienced diffuse pruritus and urticaria while exercising on multiple occasions over the last three years. His symptoms would usually increase as exercise continued. Prior to the first episode, he regularly exercised without symptoms. Exercise-induced anaphylaxis is a rare but potentially life-threatening syndrome that requires a careful clinical history and is a diagnosis of exclusion. Treatment is primarily exercise avoidance. Prophylactic mediations are inconsistently effective but are empirically used. Successful treatment with omalizumab was recently reported in a case of refractory exercise-induced anaphylaxis.

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Insect bite reactions

REVIEW ARTICLE
Year : 2013  |  Volume : 79  |  Issue : 2  |  Page : 151-164

Insect bite reactions

Sanjay Singh, Baldeep Kaur Mann
Department of Dermatology and Venereology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India

Date of Web Publication

22-Feb-2013

Correspondence Address:
Sanjay Singh
C-23, Swastik Towers, Lanka, Varanasi-221005, Uttar Pradesh
India

DOI: 10.4103/0378-6323.107629

Abstract

Insects are a class of living creatures within the arthropods. Insect bite reactions are commonly seen in clinical practice. The present review touches upon the medically important insects and their places in the classification, the sparse literature on the epidemiology of insect bites in India, and different variables influencing the susceptibility of an individual to insect bites. Clinical features of mosquito bites, hypersensitivity to mosquito bites Epstein-Barr virus NK (HMB-EBV-NK) disease, eruptive pseudoangiomatosis, Skeeter syndrome, papular pruritic eruption of HIV/AIDS, and clinical features produced by bed bugs, Mexican chicken bugs, assassin bugs, kissing bugs, fleas, black flies, Blandford flies, louse flies, tsetse flies, midges, and thrips are discussed. Brief account is presented of the immunogenic components of mosquito and bed bug saliva. Papular urticaria is discussed including its epidemiology, the 5 stages of skin reaction, the SCRATCH principle as an aid in diagnosis, and the recent evidence supporting participation of types I, III, and IV hypersensitivity reactions in its causation is summarized. Recent developments in the treatment of pediculosis capitis including spinosad 0.9% suspension, benzyl alcohol 5% lotion, dimethicone 4% lotion, isopropyl myristate 50% rinse, and other suffocants are discussed within the context of evidence derived from randomized controlled trials and key findings of a recent systematic review. We also touch upon a non-chemical treatment of head lice and the ineffectiveness of egg-loosening products. Knockdown resistance (kdr) as the genetic mechanism making the lice nerves insensitive to permethrin is discussed along with the surprising contrary clinical evidence from Europe about efficacy of permethrin in children with head lice carrying kdr-like gene. The review also presents a brief account of insects as vectors of diseases and ends with discussion of prevention of insect bites and some serious adverse effects of mosquito coil smoke.

Keywords: Arthropod, bite, insect, mosquito, papular urticaria, pediculosis, permethrin, spinosad

How to cite this article: Singh S, Mann BK. Insect bite reactions. Indian J Dermatol Venereol Leprol 2013;79:151-64

How to cite this URL: Singh S, Mann BK. Insect bite reactions. Indian J Dermatol Venereol Leprol [serial online] 2013 [cited 2013 Apr 17];79:151-64. Available from: http://www.ijdvl.com/text.asp?2013/79/2/151/107629

In this article

Abstract

Introduction

Epidemiology in ...

Mosquito Bites

Hypersensitivity...

Eruptive Pseudoa...

Skeeter Syndrome

Papular Pruritic...

Black Flies

Blandford Flies

Horse Flies

Louse Flies

Tsetse Fly

Midges

Bugs

Fleas

Thrips

Papular Urticaria

Pediculosis

Insects as Vecto...

Acknowledgment

References

Article Figures

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