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Burden of allergic disease in the UK: Secondary analyses of national databases
Abstract
Although allergy represents an important source of patient morbidity and healthcare utilization, there is little reliable information on the overall disease burden posed by allergic conditions in the UK.
Focusing on the following conditions: allergic rhinitis, anaphylaxis, asthma, conjunctivitis, eczema/dermatitis, food allergy and urticaria/angioedema, we sought to (i) describe the prevalence, incidence and outcomes of allergic disorders; (ii) describe the NHS healthcare burden posed by allergic disorders; (iii) estimate the costs of allergic disorders from a healthcare perspective.
Secondary analyses of data from the Health Survey for England, Scottish Health Survey, International Study of Allergies and Asthma in Childhood, European Community Respiratory Health Survey, Morbidity Statistics from General Practice 1991/1992, Royal College of General Practitioners Weekly Returns Service, Prescribing Analysis and Cost data, Hospital Episodes Statistics and national mortality data.
Thirty-nine percent of children and 30% of adults have been diagnosed with one or more atopic conditions. Six percent of general practice consultations and 0.8% of hospital admissions are for allergic diseases. Treatments for asthma and other allergic disorders currently account for 10% of primary care prescribing costs. Direct NHS costs for managing allergic problems are estimated at over one billion UK pounds per annum.
Allergic disorders are common throughout the UK, affecting males and females of all ages and peoples from all social classes and ethnic groups. They currently represent a substantial burden of morbidity and health service cost.
... 8 Medications for the treatment of allergic conditions have been estimated to account for 11% of the primary care prescribing budget in the United Kingdom (UK). 9 Additional costs have been attributed to the demands of allergic conditions on healthcare services, including general practice consultations, hospital admissions and appointments with dietitians and other specialists. 8,9 Studies have also reported increased incidence of, and susceptibility to, infections in allergic conditions, [10][11][12][13][14][15] ...
... 9 Additional costs have been attributed to the demands of allergic conditions on healthcare services, including general practice consultations, hospital admissions and appointments with dietitians and other specialists. 8,9 Studies have also reported increased incidence of, and susceptibility to, infections in allergic conditions, [10][11][12][13][14][15] ...
... This is consistent with previous research demonstrating the extensive impact of allergic conditions on UK healthcare services and associated costs. 8,9 One study which modelled costs based on data from 1000 infants during their first 12 months from initial presentation estimated a £25.6 million cost to the National Health Service (NHS), 8 year. 9 In the present study, GP contacts may have been documented as read-codes relating to the reason for, or outcome of, the contact, such as the diagnosis or medication prescription. ...
Background:
Cow's milk allergy (CMA) is one of the most common food allergies among children. Whilst avoidance of cow's milk protein is the cornerstone of management, further treatment of symptoms including those affecting the gastrointestinal, skin and respiratory systems plus other allergic comorbidities, maybe required. This study aimed to quantify the wider economic impact of CMA and its management in the United Kingdom (UK).
Methods:
We conducted a retrospective matched cohort study on children with CMA (diagnosis read code and/or hypoallergenic formula prescription for ≥3 months) examining healthcare data (medication prescriptions and healthcare professional contacts) from case records within The Health Improvement Network (A Cegedim Proprietary Database) in the UK. A comparative cost analysis was calculated based on healthcare tariff and unit costs in the UK.
Results:
6998 children (54% male; mean observation period 4.2 years) were included (n = 3499 with CMA, mean age at diagnosis 4.04 months; n = 3499 matched controls without CMA). Compared to those without CMA, medications were prescribed to significantly more children with CMA (p < 0.001) at a higher rate (p < 0.001). Children with CMA also required significantly more healthcare contacts (p < 0.001) at higher rate (p < 0.001) compared to those without CMA. CMA was associated with additional potential healthcare costs of £1381.53 per person per year.
Conclusion:
The findings of this large cohort study suggest that CMA and its associated co-morbidities presents a significant additional healthcare burden with economic impact due to higher prescribing of additional medications. Further research into management approaches that may impact these clinical and economic outcomes of CMA is warranted.
... The amount of smooth muscle in the airways can be affected by vitamin D as well. The average age of the 86 kids Gupta et al. (19) studied was 11.6. This included 36 kids with severe, therapy-resistant asthma, 26 kids with mild asthma, and 24 kids without asthma. ...
... In 19 patients with severe, therapy-resistant asthma with usable endobronchial biopsy specimens, Airway smooth muscle mass was inversely associated to vitamin D levels. Consistent with prior research showing that vitamin D can inhibit the production of airway smooth muscles, this has implications for airway remodeling (19) . Lack of vitamin D has been linked to an increase in asthma symptoms, according to the research. ...
... Asthma is a major cause of morbidity and mortality around the world and it adversely affects patients' quality of life (QoL) [4][5][6][7][8]. The resource use and costs associated with the management of asthma are significant [9][10][11][12][13][14], and it is widely accepted that the societal costs associated with asthma are likely to be much higher than direct costs [15]. The cost of the disease depends on the degree of severity and is highly associated with disease control [16]. ...
... In 2010, the number of visits of asthma patients to physician offices in the US was estimated at 14.2 million, the number of visits to hospital outpatient departments was 1.3 million, and the visits to emergency departments was 1.8 million [9][10][11]. In the UK, it is estimated that annual direct costs to the NHS for treating and caring for asthma patients are at least £750 million [12]. ...
... Allergic disorders are common throughout the United Kingdom (UK) and currently represent a substantial burden of morbidity and cost for the National Health Service (NHS). Thirty-nine percent of children and 30% of adults are affected by one or more atopic condition, accounting for 36% of general practice consultations and 0.8% of hospital admissions (Gupta et al. 2004). Treatments for asthma and other allergic disorders currently account for 10% of primary care prescribing costs and over one billion UK pounds per annum of NHS costs (Gupta et al. 2004). ...
... Thirty-nine percent of children and 30% of adults are affected by one or more atopic condition, accounting for 36% of general practice consultations and 0.8% of hospital admissions (Gupta et al. 2004). Treatments for asthma and other allergic disorders currently account for 10% of primary care prescribing costs and over one billion UK pounds per annum of NHS costs (Gupta et al. 2004). ...
p> Allergic asthma is the result of a Th2-mediated immune response against allergens, with Th2 cytokines, such as IL-4, IL-5 and II,-13 playing a crucial role. T helper cells are thought to be able to cross-regulate each other and a number of possible treatments for allergic disorders have been tested in order to either potentiate Thl responses or block Th2 cytokines or their receptors. In my thesis I have sought to inhibit Th2 cytokine responses and, thereby, modulate allergic responses, using either cytokine inhibitors or microbial agents which are known to down-regulate cytokine responses.
I have tested a soluble form of IL-4 receptor (sIL-4R) with the aim of blocking IL-4 and preventing the signalling cascade leading to cell activation and gene transcription. Recombinant human IL-4 caused an increase in IL-5 production by PBMC which peaked at 20 nM. sIL-4R caused a significant concentration-dependent inhibition of IL-5 secretion. The extent of inhibition with sIL-4R was comparable to that achieved by using anti IL-4 and IL-4R antibodies. Th2 down-regulation was not secondary to reduced survival of PBMC as tested in proliferation assays. Soluble IL-4R exerted a differential effect on Th2 and Th1 cytokines at low concentrations. It caused a significant (p<0.05) inhibition of Der p -induced release of IL-5 at 1 µg/ml, without affecting IFN- γ production. A 2.6-fold increase in IFN- γ concentration was observed only when sIL-4R was used at 10 µg/ml, suggesting that inhibition of Th2 cytokines is not necessarily associated with promotion of Thl responses.
To test the hypothesis that the non-pathogenic Mycobacterium vaccae could reduce airway inflammation and the asthmatic reaction in vivo following allergen challenge and the Th2 response of ex vivo challenged PBMC, I conducted a clinical trial where an M. vaccae extract, SRL172, was administered intradermally. M. vaccae was able to cause a reduction in the late asthmatic response (LAR). During the LAR, the mean maximum fall in FEV1 was 35.8% [16.5-66.7%] in subjects receiving SRL172 and 29.5% [16.9-39.4%] in subjects receiving placebo. In a subgroup of patients with mild asthma, M. vaccae caused a mean 47.2% relative reduction in the AUC of the LAR (p=0.026). However, the difference between treatment groups did not achieve statistical significance. Similarly, no difference was found in the early asthmatic response, (expressed as maximum % fall in either FEV1 or AUC) and in PC20FEV1 between the two treatment groups (p=0.98). Sputum analysis showed no difference in the differential cell count or in the levels of ECP and tryptase. Studies on peripheral blood mononuclear cells (PBMC) of these patients showed showed a trend towards reduction in IL-5 synthesis in vitro and serum IgE levels three weeks post-treatment with M. vaccae (p=0.07) but not placebo. </p
... Apart from the incidence, disease severity, and prognosis, therapeutic responses may also differ by these age groups (6,7). Moreover, it is well recognized that allergic diseases are more common during childhood (8,9). ...
... In this study, we compared pharmacotherapy practices of primary care physicians for unspecified allergy indications in children versus adults. We observed that allergic diseases were rather managed by combination therapies mostly with secondgeneration antihistamines with higher prescription rates of With a wide spectrum from dermatitis to asthma or allergic rhinitis to anaphylaxis, allergic conditions have been reported to mostly affect the pediatric population (8,9). Contrarily, our study showed a slight predominance of adults with a prescription containing an allergy diagnosis. ...
Objective: Allergic diseases are conditions that are frequently encountered in primary care, and different drug groups can be used in their treatment. This study aimed to compare the use of drugs in allergy in children and adults applied to primary care. Methods: We analyzed prescriptions written by those who were selected by systematic sampling (n=1431) among family physicians serving in İstanbul between January 1 and December 31, 2016. Among these, single-diagnosis prescriptions containing “T78.4-allergy, unspecified” were included in the study, and the prescriptions were divided into those written to children (<18 years old) and adults (≥18 years old). The demographic characteristics of the patients and drug details in the prescriptions were compared according to the groups.
Results: A total of 37,042 prescriptions with a single diagnosis of allergy were identified, and 55.9% of which were for adults. Allergy diagnosis was higher in men (52.4%) among children and in females (67.7%) among adults. Antihistamines (85.3% and 83.4%, p<0.001), systemic steroids (5.4% and 1.6%, p<0.001), and inhalants (1.8% and 1.3%; p<0.001) were more likely prescribed to adults, whereas topical drugs were prescribed more in children (51.7% and 42.7%, p<0.01). Monotherapy was more preferred in children (45.8%) than in adults (41.6%, p<0.0001). Although antihistamine monotherapy was similar in these groups, topical drug monotherapy was used more in children (10.3%) than in adults (5.6%). Prescriptions with first-generation antihistamines were higher in adults (6.8%) than in children (5.4%; p<0.001). Desloratadine was the most commonly encountered drug in the prescriptions of both pediatric and adult patients (21.2% and 10.3%, respectively).
Conclusion: The study revealed that antihistamines, mostly second-generation agents, are frequently preferred. Apart from the higher prescription of systemic corticosteroids for adults and topical drugs for children, it is understood that the pharmacological management of allergic conditions in primary care shows overall similarities in both age groups.
... In the UK around 26% of adults are affected by allergic rhinitis, commonly known as hay fever (Bauchau & Durham, 2004). This leads to significant costs, for example, allergic diseases (including allergic rhinitis, asthma, and eczema) in the UK result in a direct cost of over £1 billion per annum to the NHS (Gupta et al., 2004). A common cause of these allergies is from pollen released from grasses, trees and weeds. ...
Pollen allergies affect a large proportion of the UK population, resulting in significant socio-economic costs to the country. The existing Met Office pollen forecast, produced manually, provides a single daily level for 16 UK administrative regions. A new pollen modelling system using the Met Office Numerical Atmospheric-dispersion Modelling Environment (NAME) dispersion model is presented. Initial developments are for the three taxa which are the most allergenic across the UK population: birch, oak and grass. Pollen grain emission maps have been estimated using species distribution modelling methods. The timing of the pollen season is controlled within NAME by an accumulated temperature sum parametrisation, while pollen release is estimated with short-term meteorological dependencies based on precipitation, wind speed, vapour pressure deficit and a diurnal cycle. When examined as hindcasts, the performance of NAME (verified against pollen observations independent of those used in model development) is comparable with the Copernicus Atmosphere Monitoring Service ensemble median prediction for birch and grass. NAME Daily Pollen Index predictions show an improved correlation coefficient (0.58, 0.61) compared to the existing manual forecast (0.53, 0.59) for the years 2022 and 2023, respectively. The NAME model provides taxa-specific outputs at high temporal (hourly) and spatial (0.05°) resolutions, which will eventually transform the level of detail in a future forecast system and therefore be of significantly greater use to the public and health professionals for managing pollen risks.
... Allergic disorders are common throughout the world, affecting all genders, ages, social classes, and ethnic groups. 27 As highly ubiquitous conditions, they contribute to the prevalence of morbidity and mortality cases worldwide. Management and control of these conditions can be influenced, by among other things, the presence of comorbid conditions. ...
Born in 470 BC, Socrates was a classical Greek philosopher regarded as the first moral philosopher and founder of Western ethical thought. According to Plato, Socrates’ contemporaries called him atopos, typically translated as strange or absurd, but meaning out of place, without a place, or placeless for his nuanced thoughts and ideas.1 2300 years later, the term atopy describes the atopic family of diseases: atopic dermatitis (AD), allergic asthma (AA), hay fever, food allergy and allergic rhinitis (AR). By the end of the 19th century, scientists noticed that immune responses cause adverse reactions in specific instances. The concept that immune responses cause the disease seemed irreconcilable with the protective function of immunity; consequently, they were grouped as hypersensitivity reactions. Certain human illnesses belonging to the hypersensitivities group, now known as allergies, were ultimately classified in the early 20th century.
... [5,6] Atopic dermatitis is the most common chronic inflammatory skin disease with a recurrent course, characterized by the presence of typical eczema-like skin lesions and intense itching. [7] The rising level of air pollution, as well as the increasing number of patients struggling with atopic dermatitis [8,9,10] have contributed to the conduct of numerous studies in recent years. Therefore, due to the current relevance and prevalence of the problem, the aim of this study was to review the available literature indicating the existence of a relationship between environmental pollution and the occurrence or exacerbation of atopic dermatitis, and to elucidate the mechanisms underlying this process. ...
Introduction and purpose The rising level of air pollution is currently a serious worldwide problem. Airborne pollutants, such as PM, O3, CO, NOx, SO₂, and heavy metals, negatively impact the entire body, contributing to the dysfunction of many systems. The aim of this study was to review the literature on the impact of selected air pollutants on the development or exacerbation of atopic dermatitis, and to elucidate the mechanisms responsible for this. Materials and methods The literature available in PubMed and Google Scholar databases was reviewed using the keywords: “air pollution”, “atopic dermatitis”, “skin lesions”. Description of the state of knowledge Available studies have provided information on the significant impact of air pollution on the development and exacerbation of atopic dermatitis. Air pollutants can induce skin changes through various mechanisms, such as damage to the epidermal barrier, disruption of skin microflora, oxidative stress, initiation of inflammatory responses, or activation of the aryl hydrocarbon receptor pathway. Conclusions Reducing air pollution is crucial for improving overall public health and decreasing the incidence of many diseases, including atopic dermatitis. Further research is needed to deepen the understanding of the relationship between air pollution and atopic dermatitis, as well as the mechanisms responsible for it, and to develop effective strategies for protecting the skin from pollutants.
... In the UK around 26% of adults are affected by allergic rhinitis, commonly known as hay fever (Bauchau & Durham, 2004). This leads to signi cant costs, for example allergic diseases (including allergic rhinitis, asthma, and eczema) in the UK result in a direct cost of over £1 billion per annum to the NHS (Gupta et al., 2004). A common cause of these allergies is from pollen released from grasses, trees and weeds. ...
Allergic rhinitis, often caused by allergies from grass, tree or weed pollen, affects a large proportion of the UK population, and leads to significant costs to the National Health Service. The existing UK pollen forecast, produced manually, provides a single daily level for each of 16 regions. We present here an implementation of a pollen modelling capability within the Met Office Numerical Atmospheric-dispersion Modelling Environment (NAME) dispersion model. This will provide taxa-specific outputs at high temporal (hourly) and spatial (5 km) resolutions, which will eventually transform the level of detail in a future forecast system and therefore be of significantly greater use to the public and health professionals for managing pollen risks. Initial developments are for the three taxa which are the most allergenic across the UK population: birch, oak and grass. Pollen grain emission maps have been estimated using species distribution modelling methods. The timing of the pollen season is controlled within NAME by an accumulated temperature sum parametrisation, while pollen release is estimated with short term meteorological dependencies based on precipitation, wind speed and the vapour pressure deficit, along with a diurnal cycle. We show that, when run in hindcast mode, NAME performance (verified against pollen observations) is comparable with the Copernicus Atmosphere Monitoring Service ensemble median prediction for birch and grass. Evaluation of NAME for simulating the UK Daily Pollen Index shows an improved correlation coefficient compared to the existing manual forecast.
... Аллергические заболевания у детей представляют собой группу состояний, которые снижают качество жизни как персонально, так и на уровне семьи и ложатся тяжелым социально-экономическим бременем на общество и государство [1][2][3]. Не менее серьезными социально-экономическими последствиями обладают когнитивные, эмоциональные и поведенческие расстройства детского возраста [4,5]. ...
The publication is devoted to the review of accumulated data on the relationship of respiratory allergopathology with neuropsychiatric disorders in childhood. The immediacy of the problem is due to the mutual influence of allergic and neuropsychiatric conditions combined in a child on the course of these diseases. According to research, the connection of respiratory allergic diseases with disorders of neurodevelopment, in particular with attention deficit and hyperactivity disorder and autism spectrum disorders, is clearly manifested, and the first publications on the connection with speech and other mild cognitive impairments have appeared. At the same time, the formation of depression, suicidal behavior, and anxiety disorders in respiratory allergopathology is being actively studied. It is assumed that the close relationship between nervous and immune regulation provides a high correlation of allergic and neuropsychiatric pathological conditions, although cause-and-effect relationships have not yet been precisely established. In this regard, it becomes relevant to introduce into clinical practice monitoring of cognitive status, neuropsychic development and possible symptoms of anxiety, depression and suicidal thoughts in the treatment of children with respiratory allergic diseases. Timely detection of violations will make it possible to provide specialized interventions at an early stage in order to achieve a favorable treatment result in the long term.
... Allergies affect people's quality of life, impacting their work and personal lives; in addition, the treatments for allergies bear a heavy burden on healthcare systems across the globe. It has been reported that it costs the NHS over GBP one billion per annum [2]. However, the underlying mechanism of how an allergy develops is still poorly understood. ...
Allergies affect approximately 10–30% of people worldwide, with an increasing number of cases each year; however, the underlying mechanisms are still poorly understood. In recent years, extracellular vesicles (EVs) have been suggested to play a role in allergic sensitization and skew to a T helper type 2 (Th2) response. The aim of this review is to highlight the existing evidence of EV involvement in allergies. A total of 22 studies were reviewed; 12 studies showed EVs can influence a Th2 response, while 10 studies found EVs promoted a Th1 or Treg response. EVs can drive allergic sensitization through up-regulation of pro-Th2 cytokines, such as IL-4 and IL-13. In addition, EVs from MRSA can induce IgE hypersensitivity in mice towards MRSA. On the other hand, EVs can induce tolerance in the immune system; for example, pre-exposing OVA-loaded EVs prevented OVA sensitization in mice. The current literature thus suggests that EVs play an essential role in allergy. Further research utilizing human in vitro models and clinical studies is needed to give a reliable account of the role of EVs in allergy.
... appear prevalent with age. One British study demonstrated that the prevalence of multiple allergic diseases is 11% for children aged 2-15 years (Gupta et al., 2004). Furthermore, atopic dermatitis, asthma, and allergic rhinitis often co-occur in the same individual. ...
Previous studies have suggested that vitamin D has a protective effect on allergic diseases, while an individual's sex may have a moderating effect on the relationship between vitamin D and allergic‐related immunity. This study aimed to determine the role of vitamin D in children with coexisting allergic diseases in the context of sex differences and to explore the behavioral profiles of these patients. We recruited a total of 103 children with atopic diseases and divided them into four groups: males with one allergic disease (MA1, n = 20), males with two or more allergic diseases (MA2, n = 26), females with one allergic disease (FA1, n = 30), and females with two or more allergic diseases (FA2, n = 27). We measured serum calcium levels using the colorimetric method and serum 25‐OH vitamin D total levels using electrochemiluminescence immunoassay. We found that MA2 had significantly lower vitamin D levels than MA1 and FA2. The levels of IgE were negatively correlated with vitamin D in females, whereas the levels of IgE were not significantly correlated with vitamin D in males. Furthermore, serum IgE was significantly correlated with children's adaptive skills, and different sexes were associated with different aspects of adaptive skills. Our findings suggest a protective role of vitamin D in the development of one allergic disease against the coexistence of allergic diseases in males, as well as extend the evidence for sex differences in immunity by demonstrating a sex‐different correlation between IgE and vitamin D and the relationship between IgE and children's adaptive skills.
... A nemszteroid gyulladáscsökkentők (NSAID-ok) a fokozott leukotriénaktiváción keresztül és az allergén könnyebb felszívódása miatt okozhatnak anafilaxiát. Az anafilaxia újbóli előfordulási veszélyét 1 : 12-re becsülik [10]; más forrásból 2,6-3,6/100 fő/év kiújulási arányt jelentettek (USA) [11,12]. 1998 óta az Egyesült Királyságban az anafilaxia miatti kórházi kezelések 174%-os növekedéséről számolnak be (4,2-11,5 felvételi arány 100 000 lakosra vetítve), főleg a táplálék által kiváltott anafilaxia következményeként [6]. ...
Anaphylaxis is a generalized, severe, life-threatening reaction, mostly with an allergic origin. Triggers are usually drugs, insect bites, poisons, contrast material and food. It is caused by various mediators (histamine, prostaglandins, leukotrienes etc.) released from mast cells, basophilic granulocytes. Histamine plays a central role in its creation. Immediate recognition and specific treatment instantaneously are essential for successful treatment. In severe conditions, the clinical features are very similar, regardless of their allergic/non-allergic origin. The incidence can vary over time and between patient populations. Its incidence is extremely variable, approximately 1/10 000 anaesthesia. Most studies cite neuromuscular blocking agents as the most common causative factor. In England, the results of the 6th National Audit Project revealed that the most common causes were antibiotics (1/26 845), followed by neuromuscular junction blocking drugs (1/19 070), chlorhexidine (1/127 698), and Patent Blue paint (1/6863). It occurs within 5 minutes in 66% of cases, 6-10 minutes in 17%, 11-15 minutes in 5%, 16-30 minutes in 2%, but usually within 30 minutes. Antibiotic allergy is a growing problem, especially to teicoplanin (16.4/100 000) and co-amoxiclav (8.7/100 000). The risk of anaphylactic shock should not be a determining factor in choosing the type of muscle relaxant drug. The patient's anaesthesia classification, physical condition, obesity, use of beta-blockers and ACE inhibitors influence the clinical characteristics. The initial symptoms can be extremely varied in terms of the effectiveness of the treatment, early recognition and commencement of therapy are the keys to success. Asking about a preoperative allergy history can reduce the risk and incidence of anaphylaxis. Orv Hetil. 2023; 164(22): 871-877.
... However, this study emphasizes on a need for further, detailed studies to establish relation of asthma, its associated risk factors with with frequency of atopoic dermatitis and allergic rhinitis. A study was conducted Gupta et al (15) on British population and reported prevalence of allergy diseases up to 11% in children of age below 10 years and 10% in age of 15 years. Simpson et al (16) conducted a study and reported incidence of allergy diseases and reported highest incidence in population of older age. ...
Objective: To examine the incidence of the atopic dermatitis and allergic rhinitis in adult known patients of bronchial asthma. Study Design: cross-sectional study Place and Duration of Study: This study was conducted at the department of Medicine, CMH hospital, Nowshera, from January 2021 to September 2021. Materials and Methods: A total of 100 patients suffering from bronchial asthma were included in this study and patient that had history of COPD were excluded from the study. They were interviewed by an independent researcher. The age, gender, smoking status, residence, exposure to animals /livestock and the duration of asthma was noted in a predefined proforma. The frequency of asthma was calculated and the degree of asthma was also classified. SPSS version 24 was used for data analysis and cutoff for significance was p≤0.05. Results: Out of total patients, 39 (39.0%) were suffered with atopic dermatitis and 61 (61.0%) and 72 (72.0%) suffered from allergic rhinitis. The average age in atopic dermatitis and non-atopic dermatitis patients was almost equal, (p=0.882). Males were most common in atopic dermatitis patients as 33 (84.6%) and females were most common in 61 (100.0%) in non-atopic dermatitis patients, (p<0.001). Smoking was the most common 38 (97.4%) in atopic dermatitis patients, (p<0.001). All the atopic dermatitis patients lived in urban area, (p<0.001). Further, all the atopic dermatitis patients had animal livestock, (p<0.001). Atopic dermatitis patients was most common in allergic rhinitis, Asthma class and Allergic rhinitis class, (p<0.001). Conclusion: There is a higher prevalence of atopic dermatitis and allergic rhinitis in patients that are treated as bronchial asthma patients. Further studies are needed to ascertain the risk factors associated with atopic dermatitis, allergic rhinitis and bronchial asthma.
... É uma patologia que consome uma parte significativa do tempo e do financiamento, tanto nos cuidados de saúde primários como nos secundários. 7 É uma doença multifatorial, com fatores genéticos e ambientais, contribuindo para diferentes extensões da doença em diferentes indivíduos e populações. 8 É uma doença crónica e, portanto, para uma gestão eficaz da mesma é necessário reconhecer e reduzir os fatores desencadeantes (como certos alergénios ou substâncias irritantes) e insistir na aplicação frequentemente de emolientes. ...
A dermatite atópica é uma das doenças inflamatórias crónicas dermatológicas mais comuns. Ao longo dos anos tem surgido alguma evidência quanto ao envolvimento dos leucotrienos na fisiopatologia da dermatite atópica, existindo já relatos do uso do montelucaste nesta patologia. O objetivo desta revisão é avaliar a evidência quanto à eficácia do uso de montelucaste na melhoria sintomática da dermatite atópica. Da pesquisa bibliográfica realizada resultaram 56 artigos, dos quais 3 cumpriam os critérios de inclusão previamente definidos. Após análise dos artigos considera-se não existir evidência da eficácia do montelucaste na melhoria sintomática da dermatite atópica pelos achados inconsistentes entre os ensaios. São necessários mais estudos, multicêntricos, com amostras maiores e metodologia clara, que clarifiquem a eficácia do montelucaste, os efeitos adversos e os benefícios a longo prazo.
... [45][46][47] To avoid problems such as stitch abscesses, all oral and maxillofacial surgeons should reconsider using silk sutures for blood vessels in case of high ligation in surgeries of oral SCC right away. [48] Simultaneously, current knowledge regarding the risks of silk sutures must be extensively communicated through reporting on the stitch abscess recurrence following surgery of oral cancer, including dental surgical procedures. There were no studies that assessed the awareness of management strategies among dental students. ...
Stitch abscesses are abscesses that develop following surgical procedures as a result of suture infections. Because of nonabsorbable sutures, the material reacts with connective tissue, generating adhesions around the stitch. The use of this type of material increases the risk of infection. The aim of this study was to establish awareness on the management strategy of suture stitch abscess among dental students. An online survey consisting of ten questions about suture stitch abscess along with sociodemographic factors was circulated among equal numbers of 2nd years, 3rd years, final years, and compulsory rotatory residential internship (CRRI). The data obtained from the questionnaire were transferred to Microsoft Excel and imported to SPSS software for statistical analysis. Interns are more aware about the complications and management strategy of suture stitch abscesses compared to others. Awareness on the management strategy of suture stitch abscess is important, and it helps to reduce the side effects to improve the outcomes. Educating the risk factors, signs and symptoms, and management strategy is the best way to help raise awareness.
... Equally it has been postulated that obsessive cleanliness and a lack of exposure to extrinsic allergens early in life may be a factor. 2,3 The classical seasonal hay fever patient is easy to spot. There is often a background history of previous eczema or asthma and the patient presents with variable blockage, nasal irritation, mucous discharge and paroxysmal sneezing. ...
... In many Western countries, diseases such as asthma and atopic dermatitis and allergic rhinitis have been increasing in the last 50-60 years and constitute a significant burden on the society and health systems (11)(12)(13)(14)(15). It is thought that the frequency of food allergy has increased in the past 10-20 years with atopic diseases and this situation is due to many different risk factors (16)(17)(18)(19)(20). ...
Besin alerjisinin prevelansı bilinmemekle birlikte son yıllarda giderek arttığı tahmin edilmektedir. Genel olarak besin alerjileri pediatrik yaş grubunda erişkine oranla daha sık görülür. Çalışmamızda; polikliniğimizde gıda alerjisi tanısı olan hastalarımızın, doğal seyri, tolerans gelişimi ve toleransa etki eden faktörleri belirlemeyi hedefledik. Ocak 2013-Ocak 2016 yılı arasında polikliniğimizde Besin Alerjisi tanısı alan hastaların dosyaları retrospektif olarak incelendi. Hastaların cinsiyetleri, ilk semptom yaşı, anne sütü alma süresi, ailede atopi öyküsü, çoklu besin alerjisi, ek alerjik hastalık varlığı ve klinik bulguları değerlendirildi. Hastaların prik test sonuçları, total IgE, spesifik IgE, düzeyleri ve tolerans geliştirme durumları değerlendirildi. 319 hastanın 184’ü erkek (%57.7) idi. Hastaların 127’sinde (%39.8) ailede atopi öyküsü ve 71’inde (%22.3) çoklu besin alerjisi mevcuttu. Hastalarda görülen en sık semptom, %65.8 gastrointestinal sistem, %21 cilt bulguları, %6.3 solunum bulgularıydı. Hastaların semptom yaşı 5.8 ± 9,7 ay; tanı yaşı 6.6 ± 9.08 aydı. Hastaların yıllara göre tolerans geliştirme oranları; Birinci yıl 287 (%87,1) ikinci yıl 19’unda (%5,9) üçüncü yıl 9’unda (% 2,8) olarak saptandı. En sık alerjen gıda inek sütü (%71,3), yumurta (%17,6), fıstık (2,8), fındık (%2,04) olmakla beraber diğer gıdalar çilek, kakao, şeftali, buğday, soya, balık olarak saptandı. Çalışmamızda ilk yılda annenin sigara kullanımı ile besin alerjilerinde tolerans gelişimi arasında anlamlı fark saptanmıştır. Non Ig E aracılı besin alerjisi olanlar ve tek besine karşı alerjen olan hastalarda ilk yılda tolerans gelişimi anlamlı oranda faza saptanmıştır.
... Three of the studies reported trends for both any FA and specific FA. One study reported the trends of hospital admission rate for FA [55][56][57] , while one study reported trends for doctor-diagnosed peanut allergy 76 . ...
Food allergy (FA) is increasingly reported in Europe, however, the latest prevalence estimates were based on studies published a decade ago. The present work provides the most updated estimates of the prevalence and trends of FA in Europe. Databases were searched for studies published between 2012 and 2021, added to studies published up to 2012. In total, 110 studies were included in this update. Most studies were graded as moderate risk of bias. Pooled lifetime and point prevalence of self‐reported FA were 19.9% (95% CI 16.6–23.3) and 13.1% (95% CI 11.3–14.8), respectively. The point prevalence of sensitization based on specific IgE (slgE) was 16.6% (95% CI 12.3–20.8), skin prick test (SPT) 5.7% (95% CI 3.9–7.4), and positive food challenge 0.8% (95% CI 0.5–0.9). While lifetime prevalence of self‐reported FA and food challenge positivity only slightly changed, the point prevalence of self‐reported FA, sIgE and SPT positivity increased from previous estimates. This may reflect a real increase, increased awareness, increased number of foods assessed, or increased number of studies from countries with less data in the first review. Future studies require rigorous designs and implementation of standardized methodology in diagnosing FA, including use of double‐blinded placebo‐controlled food challenge to minimize potential biases.
... Research Involvement and Engagement (2022) 8:45 Background Hay fever is the most common allergic disease-affecting approximately 30 million people in Japan, with future prevalence projected to increase [1,2]. This can be inferred from clinical practice, as hay fever is one of the most common reasons for hospital visits, which ultimately increases personal and societal medical costs [3,4]. In addition to its detrimental effect on quality of life (QoL), its negative impact on work productivity-including the various metrics of presenteeism and absenteeism-leads to economic losses on a global scale [5][6][7]. ...
Background:
Smartphones are being increasingly used for research owing to their multifunctionality and flexibility, and crowdsourced research using smartphone applications (apps) is effective in the early detection and management of chronic diseases. We developed the AllerSearch app to gather real-world data on individual subjective symptoms and lifestyle factors related to hay fever. This study established a foundation for interactive research by adopting novel, diverse perspectives accrued through implementing the principles of patient and public involvement (PPI) in the development of our app.
Methods:
Patients and members of the public with a history or family history of hay fever were recruited from November 2019 to December 2021 through a dedicated website, social networking services, and web briefing according to the PPI Guidebook 2019 by the Japan Agency for Medical Research and Development. Nine opinion exchange meetings were held from February 2020 to December 2021 to collect opinions and suggestions for updating the app. After each meeting, interactive evaluations from PPI contributors and researchers were collected. The compiled suggestions were then incorporated into the app, establishing an active feedback loop fed by the consistently interactive infrastructure.
Results:
Four PPI contributors (one man and three women) were recruited, and 93 items were added/changed in the in-app survey questionnaire in accordance with discussions from the exchange meetings. The exchange meetings emphasized an atmosphere and opportunity for participants to speak up, ensuring frequent opportunities for them to contribute to the research. In March 2020, a public website was created to display real-time outcomes of the number of participants and users' hay-fever-preventative behaviors. In August 2020, a new PPI-implemented AllerSearch app was released.
Conclusions:
This study marks the first research on clinical smartphone apps for hay fever in Japan that implements PPI throughout its timeline from research and development to the publication of research results. Taking advantage of the distinct perspectives offered by PPI contributors, a step was taken toward actualizing a foundation for an interactive research environment. These results should promote future PPI research and foster the establishment of a social construct that enables PPI efforts in various fields.
... highlighted what we have known from UK-based studies for a decade, namely that primary care providers have limited training, expertise and confidence in allergy care and that demand for specialist allergy service far outweighs supply capabilities. [2][3][4][5] Primary and secondary care allergy pathways are inadequate, leading to poor referral processes, avoidable delays in management of allergic diseases and poor patient outcomes. 6,7 Specialist allergy care provision is patchy, but where it exists, evidence suggests that there are often unnecessary referrals to secondary care for conditions that could be dealt with in primary care settings. ...
Introduction:
It is now widely acknowledged that there are serious shortcomings in allergy care provision for patients seen in primary care. We sought to assess the feasibility of delivering and evaluating a new nurse-led allergy service in primary care, measured by recruitment, retention and estimates of the potential impact of the intervention on disease-specific quality of life.
Methods:
Mixed-methods evaluation of a nurse-led primary care-based allergy clinic in Edinburgh, UK undertaken during the period 2017-2021 with a focus on suspected food allergy and atopic eczema in young children, allergic rhinitis in children and young people, and suspected anaphylaxis in adults. Prior to March 2020, patients were seen face-to-face (Phase 1). Due to COVID-19 pandemic restrictions, recruitment was halted between March-August 2020, and a remote clinic was restarted in September 2020 (Phase 2). Disease-specific quality of life was measured at baseline and 6-12 weeks post intervention using validated instruments. Quantitative data were descriptively analysed. We undertook interviews with 16 carers/patients and nine healthcare professionals, which were thematically analysed.
Results:
During Phase 1, 426/506 (84%) referred patients met the eligibility criteria; 40/46 (87%) of Phase 2 referrals were eligible. Males and females were recruited in approximately equal numbers. The majority (83%) of referrals were for possible food allergy or anaphylaxis. Complete data were available for 338/426 (79%) patients seen in Phase 1 and 30/40 (75%) in Phase 2. Compared with baseline assessments, there were improvements in disease-specific quality of life for most categories of patients. Patients/carers and healthcare professionals reported high levels of satisfaction, this being reinforced by the qualitative interviews in which convenience and speed of access to expert opinion, the quality of the consultation, and patient/care empowerment were particularly emphasised.
Conclusion:
This large feasibility trial has demonstrated that it is possible to recruit, deliver and retain individuals into a nurse-led allergy clinic with both face-to-face and remote consultations. Our data indicate that the intervention was considered acceptable to patients/carers and healthcare professionals. The before-after data of disease-specific quality of life suggest that the intervention may prove effective, but this now needs to be confirmed through a formal randomised controlled trial.
Trial registration:
ClinicalTrials.gov reference NCT03826953.
... The choice of specific corticosteroid is determined by various factors such as accuracy of diagnosis, age, socioeconomic status of the patients, personal experienced of the clinician etc. due to these factors it is difficult to make any specific recommendation and hence drug utilization study on continuous basis are essential to provide the clinician an appropriately to review and make appropriate revision in the management of their patients. This study is an effort made in this direction ( 7,8,9) . The choice of specific corticosteroid is determined by various factors such as accuracy of diagnosis, age, socioeconomic status of the patients and personal experienced of the clinician. ...
Background: The choice of specific corticosteroid is determined by various factors such as accuracy of diagnosis, age, socioeconomic status of the patients and personal experienced of the clinician. Drug therapy is considered to be a major component of patient's management in health care setting, including primary health care. Although the benefits gained by patient from pharmacological intervention are valuable. Methods: Specific Designed Questionnaire based proforma were designed for the study Results: Total 100 Prescription were analyzed to judge the pattern of corticosteroid therapy. Maximum patients were male (52). maximum patients were from age group 21-40 yr. The present study showed Betamethasone was prescribed in 55% of prescription. Methyl prednisolone in 22.5%, Betamethasone Valerate 8.33%, Clobetasol Propionate 7.5% and Hydrocortisone 6.67% respectively. Average no. of drug prescribed were 2.95. Topical preparation of Corticosteroid was most common prescribed drug. Conclusion: Our results provide some suggestion for professional groups for developing clinical guideline. In summary we have found that clinician mostly prescribed topical corticosteroids, which have high glucocorticoid potency and low mineralocorticoid potency. They rarely use injectable and oral preparation to avoid systemic side effect. Prescription by brand name was matter of concern.
... The choice of specific corticosteroid is determined by various factors such as accuracy of diagnosis, age, socioeconomic status of the patients, personal experienced of the clinician etc. due to these factors it is difficult to make any specific recommendation and hence drug utilization study on continuous basis are essential to provide the clinician an appropriately to review and make appropriate revision in the management of their patients. This study is an effort made in this direction ( 7,8,9) . The choice of specific corticosteroid is determined by various factors such as accuracy of diagnosis, age, socioeconomic status of the patients and personal experienced of the clinician. ...
Background: The choice of specific corticosteroid is determined by various factors such as accuracy of diagnosis, age, socioeconomic status of the patients and personal experienced of the clinician. Drug therapy is considered to be a major component of patient's management in health care setting, including primary health care. Although the benefits gained by patient from pharmacological intervention are valuable. Methods: Specific Designed Questionnaire based proforma were designed for the study Results: Total 100 Prescription were analyzed to judge the pattern of corticosteroid therapy. Maximum patients were male (52). maximum patients were from age group 21-40 yr. The present study showed Betamethasone was prescribed in 55% of prescription. Methyl prednisolone in 22.5%, Betamethasone Valerate 8.33%, Clobetasol Propionate 7.5% and Hydrocortisone 6.67% respectively. Average no. of drug prescribed were 2.95. Topical preparation of Corticosteroid was most common prescribed drug. Conclusion: Our results provide some suggestion for professional groups for developing clinical guideline. In summary we have found that clinician mostly prescribed topical corticosteroids, which have high glucocorticoid potency and low mineralocorticoid potency. They rarely use injectable and oral preparation to avoid systemic side effect. Prescription by brand name was matter of concern.
... The atopic conditions asthma, eczema, allergic rhinitis, anaphylaxis, conjunctivitis, food allergy and urticaria/angioedema collectively affect over one in three children in the United Kingdom and are estimated to cost the NHS over £1 billion per annum. 1 The United Kingdom has one of the highest rates of allergic disease and whilst the prevalence of hay fever and eczema has plateaued or decreased, 2 in contrast admissions for anaphylaxis, food allergy, urticaria and angioedema have increased significantly. 2 4 This was based on data from the BSACI website clinic finding service, but this is neither complete nor up to date. 5 We have therefore undertaken the first comprehensive survey of every UK hospital to establish which are providing a paediatric allergy service and what that service consists of. The intention of the survey is to also act as a repository so that health professionals and patients and their families can identify the location of services appropriate to their needs. ...
Background:
Comprehensive national assessments of paediatric allergy services are rarely undertaken, and have never been undertaken in the United Kingdom. A 2006 survey estimated national capacity at 30,000 adult or paediatric new allergy appointments per year and identified 58 hospital clinics offering a paediatric allergy service.
Objective:
The UK Paediatric Allergy Services Survey was the first comprehensive assessment of UK paediatric allergy service provision.
Methods:
All 450 UK hospitals responded to a survey. Paediatric allergy services are provided in 154 lead hospitals with 75 further linked hospitals. All 154 lead paediatric allergy services completed a detailed questionnaire between February 2019 and May 2020.
Results:
The 154 paediatric allergy services self-define as secondary (126/154, 82%) or tertiary (28/154, 18%) level services. The annual capacity is 85,600 new and 111,400 follow-up appointments. Fifty-eight percent (85/146) of services offer ≤10 new appointments per week (no data provided from 8 services-2 no response, 6 unknown) and 50% (70/139) of the services undertaking challenges undertake ≤2 food or drug challenges per week (no data from 3 challenge services). Intramuscular adrenaline is rarely used during challenges-median annual frequency 0 in secondary services and 2 in tertiary services. Allergen-specific immunotherapy is offered in 39% (60/154) of services, with 71% (41/58) of these centres treating ≤10 patients per annum (no data from 2 immunotherapy services). The 12 largest services see 31% of all new paediatric allergy appointments, undertake 51% of new immunotherapy patient provision and 33% of food or drug challenges. Seventy percent (97/126) of secondary and all tertiary services are part of a regional paediatric allergy network. Only nine services offer immunotherapy for any food (3 for peanut), 10 drug desensitization and 18 insect venom immunotherapy.
Conclusions:
There has been a fourfold increase in paediatric allergy clinics and an approximately sevenfold increase in new patient appointment numbers in the United Kingdom over the past 15 years. Most services are small, with significant regional variation in availability of specific services such as allergen immunotherapy. Our findings emphasize the need for national standards, local networks and simulation training to ensure consistent and safe service provision.
... It affects 15-20% of children and 1-3% of adults in developed countries. 5 The extent and severity of eczema is measured using the SCORAD (Severity Scoring of Atopic Dermatitis) index. 6 Dermatitis was estimated to affect 245 million people globally in 2015 or 3.34% of the world population. ...
Dermatitis also known as eczema, is inflammation of the skin, typically characterized by itchiness, redness and a rash. Dermatitis was estimated to affect 245 million people globally in 2015 or 3.34% of the world population. In Nepal, studies from different parts of the country have reported the prevalence of dermatitis between 15.9 to 39.2%. Severe dermatitis with repeated scratching and rubbing of the face predisposes the patient to various ocular complications. A hospital-based, cross-sectional, descriptive study was conducted to assess the overall frequency and type of ophthalmological complications among patients with dermatitis at a tertiary care hospital in Kathmandu. A total of 91 patients were enrolled for this study. The minimum age was 5 years and maximum was 78 years, with the mean of 30.48 with a standard deviation of ± 20.28. The upper and lower limits for estimated mean age were 34.63 years to 26.33 years at 95% confidence interval. Seventy-one (78.0%) of all patients had ocular manifestations, many of them had more than one manifestation. Females outnumbered the males (41.8%; 36.3%) with respect to the occurrence of ocular manifestations in dermatitis. The commonest ocular manifestations were blepharitis in 35 (38.5%) patients, followed by eyelid eczema in 13 (14.3%) patients, allergic conjunctivitis in 5 (5.5%) and patients with other manifestations. Based on professional classification, over one fourth of the participants were students accounting for 44.0%, followed by homemakers accounting for 23.1% and shopkeepers accounting for 11.1%, respectively. A statistically significant association was observed with the ocular manifestation in relation to gender (p value=0.03) and occupation (p value=0.03). However, no association was observed between ocular manifestation with duration of dermatitis (p value=0.65), type of dermatitis (p value=0.94), personal and family history of allergy/atopy (pvalues=0.26; 0.58, respectively).
... The increasing incidence of eczema is paralleled by an increasing incidence of attention deficit hyperactivity disorder (ADHD) (1). Both eczema and ADHD are non-communicable diseases that carry a substantial economic burden and adversely affect quality of life (2,3). Eczema is one of the earliest manifestations of allergic disease and affects approximately 20% of children; it generally manifests as dry and itchy skin on the face, elbow, and knee folds (4,5). ...
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.
Clinical Trial Registration
[ https://clinicaltrials.gov/ct2/show/NCT01174875 ], identifier [NCT01174875].
... In spite of the fact that allergy, in one of its many guises, is the reason for an estimated 6% of consultations, the primary care clinician has often received little or no training at either undergraduate or postgraduate level concerning this disease area. 1,2 There is clearly a need to upskill healthcare professionals working in primary care. 3 To date, there are two publications which have identified the core skills required for primary care practitioners with a further one for professions allied to health, but in general, there is no sign of these being implemented, although for the first time, allergy is included as part of the postgraduate curriculum for primary care in the United Kingdom. ...
Most patients presenting with allergies are first seen by primary care health professionals. The perceived knowledge gaps and educational needs were recently assessed in response to which the LOGOGRAM Task Force was established with the remit of constructing pragmatic flow diagrams for common allergic conditions in line with an earlier EAACI proposal to develop simplified pathways for the diagnosis and management of allergic diseases in primary care. To address the lack of accessible and pragmatic guidance, we designed flow diagrams for five major clinical allergy conditions: asthma, anaphylaxis, food allergy, drug allergy, and urticaria. Existing established allergy guidelines were collected and iteratively distilled to produce five pragmatic and accessible tools to aid diagnosis and management of these common allergic problems. Ultimately, they should now be validated prospectively in primary care settings.
... 9 Medications are usually associated with side effects such as nausea and vomiting, respiratory distress and addiction. 10 This has led to the popularity of traditional approaches. 11 Mothers are often concerned about medication, as they affect their health or breastfeeding, caesarean section • olive oil • pain intensity • randomised controlled trial • topical application • wound • wound care • wound healing and seek alternative and complementary therapies. ...
Objective
This study was performed to determine the effect of olive cream on the severity of pain and healing of caesarean section wounds.
Method
This study is a parallel randomised clinical trial that was conducted on women who had caesarean sections at Ayatollah Taleghani Hospital in Arak, Iran. Women were assigned to intervention, placebo and control groups by a block randomisation method. Women in the intervention and placebo groups were asked to use olive cream and placebo cream, respectively, twice a day from the second day after surgery to the tenth day. The wound healing score and pain intensity score were assessed using the REEDA and VAS scales, respectively, before and at the end of the intervention.
Results
The intervention group consisted of 34 women, the placebo group of 34 women and the control group of 35 women. We found a statistically significant difference between the intervention and placebo groups, intervention and control groups, and placebo and control groups in terms of the pain intensity (p<0.05 in all three cases). Also, we found a statistically significant difference between the intervention and placebo groups, and intervention and control groups in terms of the scores of wound healing on the tenth day after surgery (p<0.05 in both cases).
Conclusion
Olive cream can be effective in relieving pain and enhancing caesarean section wound healing, and since no specific side effects were reported, the use of olive cream is recommended.
... 25% of the population 4 while in the United States and the United Kingdom, SAR affects 20% of adults and 40% of children. 2,[4][5][6][7] SAR symptoms pose as a major clinical problem and socioeconomic burden that impair quality of life of the patients due to sleep disturbance, poorer work performance and school grades. 8,9 Allergic inflammation can be classified into 2 phases, early and late phase. ...
Allergen immunotherapy (AIT) is an effective treatment for allergic rhinitis, inducing long-term clinical tolerance to the sensitising allergen. Clinical tolerance induction can be achieved when AIT is administered for at least three years. AIT is associated with the modulation of innate and adaptive immune systems. This comprises of inhibiting of IgE-dependent activation of mast cells and basophils in the local target organ, suppression of Th2 cells, immune deviation towards Th1 cells, induction of T and B regulatory cells and production of allergen neutralising antibodies. However, recent developments in our understanding of underpinning mechanisms of AIT have revealed that immunotherapy administered either by SCIT or SLIT induces immune regulation through novel cell targets and molecular mechanisms. This comprehensive review discusses how immune tolerance driven by SCIT and SLIT is associated with the induction of a novel regulatory subset of innate lymphoid cells, suppression of pro-inflammatory Th2, Th2A and T follicular helper cells, drive Th2 cell exhaustion and differential expression of nasal and systemic antibodies IgA. Uncovering the underpinning mechanisms of successful AIT and immune tolerance will allow the development of targeted therapeutics for allergic rhinitis with and without asthma.
... The prevalence of allergic diseases is constantly increasing in the last decades especially in high developed countries. 1 Though the exact pathogenesis of allergic disorders is not yet defined, it appears that genetic and environmental factors play a role in their development. 2 In addition to physical discomfort, chronic allergic disorders in early childhood may cause mental and behavioral problems. ...
Background: Previous studies reported controversial results regarding the association between allergic disorders and ADHD/ASD. The aim of this article is to investigate whether allergic disorders are associated with ADHD/ASD in a large cohort of pediatric patients. Methods: A retrospective study using the pediatric (0-18 year) database (ICD-9-CM codes) of Clalit Health Services during the years (2000-2018). Diagnosis of all disorders was made by specialist physicians. Results: 117,022 consecutive non-selective allergic children diagnosed with one or more allergic disorder (asthma, rhinitis. conjunctivitis, skin, food, or drug allergy) and 116,968 non-allergic children were enrolled to our study. The mean follow-up period was 11±6 years. The presence of allergic disorders in early childhood (mean age of allergic diagnosis 4.5± 4.3 years) in boys as well as in girls, significantly increased the risk to develop ADHD (O.R 2.45, CI 2.39-2.51; P<0.0001), ASD (O.R 1.17, CI 1.08-1.27; P<0.0001) or both ADHD+ASD (O.R 1.5, CI 1.35-1.79; P<0.0001). Children with more than one allergic comorbidity revealed a much higher risk. In a multivariable analysis (adjusted for age at study entry, number of yearly visits and gender) the risk of allergic children to develop ADHD and ADHD+ASD, but not ASD alone, remained significantly higher. Conclusion: Allergic disorder in early childhood significantly increased the risk to develop ADHD, and to a less extend ASD, in later life.
... Allergic rhinitis imposed a substantial burden on patients daily life and work performance which is consistent with other studies. [9,10,11,12] Physical findings may be observed in many patients with AR. Our study shows that 33% patients had eye-swelling, 26% mouth breathing, 25% dark circles, 7% nasal crease and 9% other findings like reddened eyes and face, puffy face etc. ...
Allergic rhinitis is a common respiratory disorder which may prompt the patients to seek medical help. The aim of this study was to determine the proportion and risk factors of Allergic rhinitis. This is a hospital-based prospective case-control study done at a tertiary care hospital over a period of 6 months. About 150 AR patients were enrolled and analyzed. In this study proportion of allergic rhinitis cases per the total population in the specified time period and the risk factors is determined using a specially designed proforma that were filled using patient case records and direct interview of the patient. From our observation, it was found that 180 Allergic rhinitis cases came to the ENT outpatient department of a tertiary care hospital. Majority of the patients had all four classic symptoms of AR sneezing (100%), nasal discharge (65.3%), nasal itching (52%), and nasal obstruction (62.6%). A large proportion of patients that consulted the physician had moderate-severe AR based on ARIA severity classification. We have also assessed the role of genetics in the development of Allergic rhinitis which shows a positive correlation with 60.6% of patients having first degree relatives with AR. The quality of life in allergic rhinitis patients was improved after effective counseling.
... Cow's milk protein allergy (CMPA) is one of the most common food allergies in children, typically diagnosed in the first year of life with an estimated prevalence of around 2-5% of infants in Europe [1][2][3][4]. Analysis of National Health Service (NHS) records showed that, overall, allergic conditions account for 12.5 million GP consultations and 183,000 admitted bed days annually in the UK, costing over £1bn [5], with additional direct and indirect household costs [6]. Moreover, the impact of CMPA on quality of life is substantial, with anxiety, frustration and social limitation being prominent issues for families [7,8]. ...
Cow’s milk protein allergy (CMPA) is associated with dysbiosis of the infant gut microbiome, with allergic and immune development implications. Studies show benefits of combining synbiotics with hypoallergenic formulae, although evidence has never been systematically examined. This review identified seven publications of four randomised controlled trials comparing an amino acid formula (AAF) with an AAF containing synbiotics (AAF-Syn) in infants with CMPA (mean age 8.6 months; 68% male, mean intervention 27.3 weeks, n = 410). AAF and AAF-Syn were equally effective in managing allergic symptoms and promoting normal growth. Compared to AAF, significantly fewer infants fed AAF-Syn had infections (OR 0.35 (95% CI 0.19–0.67), p = 0.001). Overall medication use, including antibacterials and antifectives, was lower among infants fed AAF-Syn. Significantly fewer infants had hospital admissions with AAF-Syn compared to AAF (8.8% vs. 20.2%, p = 0.036; 56% reduction), leading to potential cost savings per infant of £164.05–£338.77. AAF-Syn was associated with increased bifidobacteria (difference in means 31.75, 95% CI 26.04–37.45, p < 0.0001); reduced Eubacterium rectale and Clostridium coccoides (difference in means −19.06, 95% CI −23.15 to −14.97, p < 0.0001); and reduced microbial diversity (p < 0.05), similar to that described in healthy breastfed infants, and may be associated with the improved clinical outcomes described. This review provides evidence that suggests combining synbiotics with AAF produces clinical benefits with potential economic implications.
... In addition to affecting patient and parental quality of life, frequent hospital visits, general practice appointments and emergency care attendances are associated with high cost to the NHS (Fleming et al., 2019;Gupta, Sheikh, Strachan, & Anderson, 2004;Mukherjee et al., 2016). ...
Non-adherence to inhaled corticosteroids (ICS) is a key barrier in asthma management. However, few studies have explored patterns of non-adherence and the reasons for variations in adherence in young people with problematic asthma. The aim of this thesis is to explore the potentially modifiable determinants of non-adherence in young people with problematic severe asthma in a tertiary care setting. This PhD comprises a systematic review of interventions to improve adherence in children with asthma; an analysis of patterns of non-adherence; a qualitative study of patients with poor adherence; and an adaptation study of the Beliefs About Medicine Questionnaire (BMQ). Each of these informs identification of interventions to improve adherence. The review found that current interventions have limited effectiveness, with only half of the included trials able to improve ICS adherence (9/18). More complex interventions, tailored to the patient, which addressed both perceptions and practical aspects of non-adherence were more likely to be effective. Secondary analysis of electronic adherence data from this population (n=93) identified adherence patterns which have implications for intervention development. The interview study (n=20) identified perceptual determinants (e.g. poor understanding of asthma and ICS) and practical determinants (e.g. no routine and forgetfulness) of non-adherence. These findings informed an adaption of the BMQ to identify beliefs underlying treatment non-adherence in this population; initial piloting (n=30) revealed high overall internal reliability but further research is needed to validate the questionnaire. This PhD highlights the need for a tailored intervention for non-adherent young people with problematic asthma which addresses perceptual and practical barriers to adherence. The PhD identified new barriers to adherence including key differences between adults and young children. A belief-based questionnaire could be used to identify modifiable beliefs for inclusion in a tailored intervention addressing both perceptual and practical barriers for adherence to ICS.
... Both allergic diseases and neurodevelopmental disorders are non-communicable diseases (NCDs) that pose a serious economic burden and impact quality of life (1)(2)(3)(4). Allergic diseases typically start early in childhood, with atopic dermatitis (AD) being one of the earliest to manifest in the first few years of life, followed by allergic rhinitis (AR) and asthma (5). ...
Both allergic diseases and neurodevelopmental disorders are non-communicable diseases (NCDs) that not only impact on the quality of life and but also result in substantial economic burden. Immune dysregulation and inflammation are typical hallmarks in both allergic and neurodevelopmental disorders, suggesting converging pathophysiology. Epidemiological studies provided convincing evidence for the link between allergy and neurodevelopmental diseases such as attention-deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). Possible factors influencing the development of these disorders include maternal depression and anxiety, gestational diabetes mellitus, maternal allergic status, diet, exposure to environmental pollutants, microbiome dysbiosis, and sleep disturbances that occur early in life. Moreover, apart from inflammation, epigenetics, gene expression, and mitochondrial dysfunction have emerged as possible underlying mechanisms in the pathogenesis of these conditions. The exploration and understanding of these shared factors and possible mechanisms may enable us to elucidate the link in the comorbidity.
... Furthermore, they are responsible for a huge economic burden on the healthcare systems of low-and middle-income countries, as well as countries that are more affluent. [2][3][4][5] According to the Global Asthma Network, currently there are 334 million people living with asthma worldwide, 6 whilst the World Allergy Association estimates that globally: 10%-30% of people have allergic rhinitis; 20% of children and 2%-10% of adults have atopic eczema; and 240-550 million people have food allergies. 7 The increase in prevalence of allergic diseases over the past few decades coincides with a global increase in the practice of mass vaccination, thereby leading to the hypothesis that childhood vaccination may increase the risk of allergic diseases. ...
Background and Objective
As the rise in prevalence of allergic diseases worldwide corresponds in time with increasing infant vaccination, it has been hypothesized that childhood vaccination may increase the risk of allergic disease. We aimed to synthesize the literature on the association between childhood vaccination and allergy.
Design
We searched the electronic databases PubMed and EMBASE (January 1946‐January 2018) using vaccination and allergy terms.
Methods
Two authors selected papers according to the inclusion criteria. Pooled effects across studies were estimated using random‐effects meta‐analysis. Due to inadequate number of homogeneous publications on newer and underused vaccines, meta‐analysis was limited to allergic outcomes following administration of (Bacillus Calmette‐Guérin) BCG, measles or pertussis vaccination. The review was prospectively registered in the PROSPERO systematic review registry (NO: CRD42017071009).
Results
A total of 35 publications based on cohort studies and 7 publications based on randomized controlled trials (RCTs) met the inclusion criteria. RCTs: From 2 studies, early vaccination with BCG vaccine was associated with a reduced risk of eczema (RR = 0.83; 95% CI = 0.73‐0.93; I² = 0%) but not food allergy or asthma. No association was found between pertussis vaccine and any allergic outcome based on a single RCT.
Cohort studies
Childhood measles vaccination was associated with a reduced risk of eczema (RR = 0.65; 95% CI = 0.47‐0.90, I² = 0.0%), asthma (RR = 0.78; 95% CI = 0.62‐0.98, I² = 93.9%) and, with a similar, statistically non‐significant reduction in sensitization (RR = 0.78; 95% CI = 0.61‐1.01, I² = 19.4%).
Conclusions
We found no evidence that childhood vaccination with commonly administered vaccines was associated with increased risk of later allergic disease. Our results from pooled analysis of both RCTs and cohort studies suggest that vaccination with BCG and measles vaccines were associated with a reduced risk of eczema.
Objective
To compare the cost, healthcare utilization, and outcomes between skin and serum-specific IgE (sIgE) allergy testing.
Methods
This retrospective cohort study used IBM® MarketScan claims data, from which commercially insured individuals who initiated allergy testing between January 1 and December 31, 2018 with at least 12 months of enrollment data before and after index testing date were included. Cost of allergy testing per patient was estimated by testing pattern: skin only, sIgE only, or both. Multivariable linear regression was used to compare healthcare utilization and outcomes, including office visits, allergy and asthma-related prescriptions, and emergency department (ED) and urgent care (UC) visits between skin and sIgE testing at 1-year post testing (α = 0.05).
Results
The cohort included 168,862 patients, with a mean (SD) age of 30.8 (19.5) years; 100,666 (59.7%) were female. Over half of patients (56.4%, n = 95,179) had skin only testing, followed by 57,291 patients with sIgE only testing and 16,212 patients with both testing. The average cost of allergy testing per person in the first year was 426–433) in patients with skin only testing, 183–190) in patients with sIgE only testing, and 522–542) in patients with both testing. At 1-year follow-up post testing, there were slight increases in allergy and asthma-related prescriptions, and notable decreases in ED visits by 17.0–17.4% and in UC visits by 10.9–12.6% for all groups (all p < 0.01). Patients with sIgE-only testing had 3.2 fewer allergist/immunologist visits than patients with skin-only testing at 1-year follow-up (p < 0.001). Their healthcare utilization and outcomes were otherwise comparable.
Conclusions
Allergy testing, regardless of the testing method used, is associated with decreases in ED and UC visits at 1-year follow-up. sIgE allergy testing is associated with lower testing cost and fewer allergist/immunologist visits, compared to skin testing.
Food allergy (FA) is an increasing global public health concern. Little is known about FA counsel in primary care clinics. The objective of this study is to describe the characteristics of FA in primary care clinics. It also aims to report the national primary care physicians’ current knowledge and practices. An electronic cross-sectional questionnaire was distributed to primary care physicians working at the Ministry of Health primary care clinics, across Kuwait’s’ 6 health districts, between May and June 2023. The questionnaire was made of 3 sections: participants’ demographic, FA counsel characteristics, participants’ knowledge and practices during FA counsel, and 37 variable tools. Eight-seven percent of primary care physicians counseled a patient with FA within the last 12 months. Most FA patients were children and infants. Approximately 2 out of 10 primary physicians counseled > 1 FA case/week. Prevalence of clinical presentation was: angioedema (23%), many skin hives (21%), few skin hives (19%), and mouth itch (9.4%). Prevalence of allergens was; peanuts (46%), shellfish (37%), eggs (36%), and tree nuts (36%), respectively. The mean of primary care physicians’ correct answers about FA was 58% and only 26% of primary care physicians acquired a sufficient amount of knowledge about FA, scoring above 67%. Their Knowledge scores about FA: clinical presentation 7 ± 1.6, diagnostic tests 2 ± 1, treatment 2.6 ± 1, and prevention 3 ± 1. In practice, correct treatment was offered by 30% of physicians, and 55% made the right referrals 86% are longing for training about FA. FA is a common counsel in primary care clinics. The most common FA presentation is a severe allergic reaction in the pediatric population. The current primary care physicians have insufficient knowledge about counseling FA and long for further training. Collectively, protocols and training for FA counseling should be launched in primary care.
Background
Previous studies have reported an association between warm temperature and asthma hospitalisation. They have reported different sex-related and age-related vulnerabilities; nevertheless, little is known about how this effect has changed over time and how it varies in space. This study aims to evaluate the association between asthma hospitalisation and warm temperature and investigate vulnerabilities by age, sex, time and space.
Methods
We retrieved individual-level data on summer asthma hospitalisation at high temporal (daily) and spatial (postcodes) resolutions during 2002–2019 in England from the NHS Digital. Daily mean temperature at 1 km×1 km resolution was retrieved from the UK Met Office. We focused on lag 0–3 days. We employed a case–crossover study design and fitted Bayesian hierarchical Poisson models accounting for possible confounders (rainfall, relative humidity, wind speed and national holidays).
Results
After accounting for confounding, we found an increase of 1.11% (95% credible interval: 0.88% to 1.34%) in the asthma hospitalisation risk for every 1°C increase in the ambient summer temperature. The effect was highest for males aged 16–64 (2.10%, 1.59% to 2.61%) and during the early years of our analysis. We also found evidence of a decreasing linear trend of the effect over time. Populations in Yorkshire and the Humber and East and West Midlands were the most vulnerable.
Conclusion
This study provides evidence of an association between warm temperature and hospital admission for asthma. The effect has decreased over time with potential explanations including temporal differences in patterns of heat exposure, adaptive mechanisms, asthma management, lifestyle, comorbidities and occupation.
A considerable amount of scientific results and experience are available recently from a wide range of disciplines in the scientific literature. Similarly, the agricultural literature has also been accumulated valuable knowledge, especially in the last decades. However, the researchers investigating different disciplines using a highly diverse methodology, these results are often serving only a single focus on a specific scientific issue without generalizing the results into a broader scientific context. The meta-analysis is a relatively new statistical approach that provides a valid and objective statistical comparison of the independent scientific results. Therefore, the meta-analysis can be an effective tool for exploring or predicting new scientific relationships or patterns and suggesting relevant topics for further investigations. In the present review, we introduce the statistical approach of the meta-analytic and its relevance in agriculture research.
Background
Previous studies have found an association between warm temperature and asthma hospitalisation. They have reported different sex- and age-related vulnerabilities, nevertheless little is known about how this effect has changed over time and how it varies in space. This study aims to evaluate the association between asthma hospitalisation and warm temperature and investigate vulnerabilities by age, sex, time, and space.
Methods
We retrieved individual-level data on summer asthma hospitalisation at high temporal (daily) and spatial (postcodes) resolution during 2002-2019 in England from the NHS Digital. Daily mean temperature at 1km x 1km resolution was retrieved from the UK Met Office. We focused on lags 0-3 days. We employed a case-cross over study design and fitted Bayesian hierarchal Poisson models accounting for possible confounders (rainfall, relative humidity, wind speed, national holidays, and recurrent hospitalisations).
Results
After accounting for confounding, we found a 0.85% (95% Credible Interval: 0.64% to 1.07%) increase in the asthma hospitalisation risk for every 1°C increase in the ambient summer temperature. The effect was highest for males aged 15-65 (2.44%, 1.99% to 2.90%). During 2002-2007 we observed a 2.23% (1.86% to 2.60%) increase in hospitalisation risk per 1°C increase in temperature, whereas inconclusive evidence for the periods 2008-2013 and 2014-2019. Populations in Yorkshire and the Humber and East Midlands were the most vulnerable.
Conclusion
This study provides evidence of an association between warm temperature and hospital admission for asthma, which was attenuated over time suggesting adaptive mechanisms to heat exposure or differences in lifestyle, comorbid conditions, and occupation over time.
Background:
Eczema and food allergy are common health conditions that usually begin in early childhood and often occur in the same people. They can be associated with an impaired skin barrier in early infancy. It is unclear whether trying to prevent or reverse an impaired skin barrier soon after birth is effective for preventing eczema or food allergy.
Objectives:
Primary objective To assess the effects of skin care interventions such as emollients for primary prevention of eczema and food allergy in infants. Secondary objective To identify features of study populations such as age, hereditary risk, and adherence to interventions that are associated with the greatest treatment benefit or harm for both eczema and food allergy.
Search methods:
We performed an updated search of the Cochrane Skin Specialised Register, CENTRAL, MEDLINE, and Embase in September 2021. We searched two trials registers in July 2021. We checked the reference lists of included studies and relevant systematic reviews, and scanned conference proceedings to identify further references to relevant randomised controlled trials (RCTs). SELECTION CRITERIA: We included RCTs of skin care interventions that could potentially enhance skin barrier function, reduce dryness, or reduce subclinical inflammation in healthy term (> 37 weeks) infants (≤ 12 months) without pre-existing eczema, food allergy, or other skin condition. Eligible comparisons were standard care in the locality or no treatment. Types of skin care interventions could include moisturisers/emollients; bathing products; advice regarding reducing soap exposure and bathing frequency; and use of water softeners. No minimum follow-up was required.
Data collection and analysis:
This is a prospective individual participant data (IPD) meta-analysis. We used standard Cochrane methodological procedures, and primary analyses used the IPD dataset. Primary outcomes were cumulative incidence of eczema and cumulative incidence of immunoglobulin (Ig)E-mediated food allergy by one to three years, both measured at the closest available time point to two years. Secondary outcomes included adverse events during the intervention period; eczema severity (clinician-assessed); parent report of eczema severity; time to onset of eczema; parent report of immediate food allergy; and allergic sensitisation to food or inhalant allergen.
Main results:
We identified 33 RCTs comprising 25,827 participants. Of these, 17 studies randomising 5823 participants reported information on one or more outcomes specified in this review. We included 11 studies, randomising 5217 participants, in one or more meta-analyses (range 2 to 9 studies per individual meta-analysis), with 10 of these studies providing IPD; the remaining 6 studies were included in the narrative results only. Most studies were conducted at children's hospitals. Twenty-five studies, including all those contributing data to meta-analyses, randomised newborns up to age three weeks to receive a skin care intervention or standard infant skin care. Eight of the 11 studies contributing to meta-analyses recruited infants at high risk of developing eczema or food allergy, although the definition of high risk varied between studies. Durations of intervention and follow-up ranged from 24 hours to three years. All interventions were compared against no skin care intervention or local standard care. Of the 17 studies that reported information on our prespecified outcomes, 13 assessed emollients. We assessed most of the evidence in the review as low certainty and had some concerns about risk of bias. A rating of some concerns was most often due to lack of blinding of outcome assessors or significant missing data, which could have impacted outcome measurement but was judged unlikely to have done so. We assessed the evidence for the primary food allergy outcome as high risk of bias due to the inclusion of only one trial, where findings varied based on different assumptions about missing data. Skin care interventions during infancy probably do not change the risk of eczema by one to three years of age (risk ratio (RR) 1.03, 95% confidence interval (CI) 0.81 to 1.31; risk difference 5 more cases per 1000 infants, 95% CI 28 less to 47 more; moderate-certainty evidence; 3075 participants, 7 trials) or time to onset of eczema (hazard ratio 0.86, 95% CI 0.65 to 1.14; moderate-certainty evidence; 3349 participants, 9 trials). Skin care interventions during infancy may increase the risk of IgE-mediated food allergy by one to three years of age (RR 2.53, 95% CI 0.99 to 6.49; low-certainty evidence; 976 participants, 1 trial) but may not change risk of allergic sensitisation to a food allergen by age one to three years (RR 1.05, 95% CI 0.64 to 1.71; low-certainty evidence; 1794 participants, 3 trials). Skin care interventions during infancy may slightly increase risk of parent report of immediate reaction to a common food allergen at two years (RR 1.27, 95% CI 1.00 to 1.61; low-certainty evidence; 1171 participants, 1 trial); however, this was only seen for cow's milk, and may be unreliable due to over-reporting of milk allergy in infants. Skin care interventions during infancy probably increase risk of skin infection over the intervention period (RR 1.33, 95% CI 1.01 to 1.75; risk difference 17 more cases per 1000 infants, 95% CI one more to 38 more; moderate-certainty evidence; 2728 participants, 6 trials) and may increase the risk of infant slippage over the intervention period (RR 1.42, 95% CI 0.67 to 2.99; low-certainty evidence; 2538 participants, 4 trials) and stinging/allergic reactions to moisturisers (RR 2.24, 95% 0.67 to 7.43; low-certainty evidence; 343 participants, 4 trials), although CIs for slippages and stinging/allergic reactions were wide and include the possibility of no effect or reduced risk. Preplanned subgroup analyses showed that the effects of interventions were not influenced by age, duration of intervention, hereditary risk, filaggrin (FLG) mutation, chromosome 11 intergenic variant rs2212434, or classification of intervention type for risk of developing eczema. We could not evaluate these effects on risk of food allergy. Evidence was insufficient to show whether adherence to interventions influenced the relationship between skin care interventions and eczema or food allergy development.
Authors' conclusions:
Based on low- to moderate-certainty evidence, skin care interventions such as emollients during the first year of life in healthy infants are probably not effective for preventing eczema; may increase risk of food allergy; and probably increase risk of skin infection. Further study is needed to understand whether different approaches to infant skin care might prevent eczema or food allergy.
Background
Previous studies reported controversial results regarding the association between allergic disorders and attention deficit hyperactivity disorder (ADHD)/autism spectrum disorder (ASD). The aim of this article was to investigate whether allergic disorders are associated with ADHD/ASD in a large cohort of pediatric patients.
Methods
A retrospective study using the pediatric (0–18 year) database (ICD‐9‐CM codes) of Clalit Health Services during the years (2000–2018). Diagnosis of all disorders was made by specialist physicians.
Results
A total of 117 022 consecutive non‐selective allergic children diagnosed with one or more allergic disorder (asthma, rhinitis, conjunctivitis, skin, food, or drug allergy) and 116 968 non‐allergic children were enrolled to our study. The mean follow‐up period was 11 ± 6 years. The presence of allergic disorders in early childhood (mean age of allergic diagnosis 4.5 ± 4.3 years) in boys as well as in girls significantly increased the risk to develop ADHD (O.R 2.45, CI 2.39–2.51; p < .0001), ASD (O.R 1.17, CI 1.08–1.27; p < .0001), or both ADHD + ASD (O.R 1.5, CI 1.35–1.79; p < .0001). Children with more than one allergic comorbidity revealed a much higher risk. In a multivariable analysis (adjusted for age at study entry, number of yearly visits, and gender), the risk of allergic children to develop ADHD and ADHD + ASD, but not ASD alone, remained significantly higher.
Conclusion
Allergic disorder in early childhood significantly increased the risk to develop ADHD, and to a less extend ASD, in later life.
Objectives. To estimate the prevalence of current asthma-like symptoms and current allergic diseases among preschool children and to determine the risk factors. Materials and methods. Cross-sectional study included children aged 3-6 years. The study was conducted in 5 towns of Altai region. Prevalence of allergic diseases was assessed using the Russian version of the ISAAC questionnaire. Results. According to questionnaire the prevalence of current asthma-like symptoms was 11,1%, current allergic rhinoconjunctivitis - 7,5%, current atopic dermatitis -12,3%. Out of 3205 children asthma was diagnosed in 0,9%, allergic rhinoconjunctivitis - in 3%, atopic dermatitis - in 7,9%. Family history of allergic diseases increases risk of development of the current asthma-like symptoms twice (OR=2,11; 95% CI=1,66-2,68), current allergic rhinoconjunctivitis by 2,8 times (OR=2,85; 95% CI=2,16-3,75), current atopic dermatitis by 4,6 times (OR=4,62; 95% CI=3,69-5,77). The male sex increases risk of the development of current asthma-like symptoms by 2,6 times (OR=2,63; 95% CI=1,17-5,93), current allergic rhinoconjunctivitis by 1,3 times (OR=1,35; 95% CI=1,03-1,76), smoking of parents on the first year of life of the child increases risk of development of current asthma-like symptoms by 1,6 times (OR=1,61; 95% CI=1,15-2,24), breastfeeding duration less than 6 months increases the risk of development of current atopic dermatitis by 1,6 times (OR=1,62; 95% CI=1,26-2,09; p
Anaphylaxis is a life-threatening emergency. Hannah Kramer and Rebecca Batt explain how correct diagnosis, avoidance and patient education are fundamental in reducing risk
Anaphylaxis is a serious systemic hypersensitivity reaction that is usually rapid in onset and can cause death. It is an immune-mediated reaction, which typically occurs when a person is exposed to a trigger, for example a food, drug, or insect sting. This article aims to assist with the recognition of symptoms and to guide management of anaphylaxis in primary care. Beyond the acute, the practice nurse can play a key role in helping patients to manage their allergies in the long-term, particularly for those who are most vulnerable. Patients should be supported in understanding how best to avoid their triggers, in managing their emergency medication, and in the importance of good asthma control.
Rationale
The Environmental Exposure Unit (EEU), a controlled allergen exposure model of allergic rhinitis (AR), has traditionally utilized seasonal allergens. We sought to clinically validate the use of house dust mite (HDM), a perennial allergen, in the HDM-EEU, a specially designed facility within the larger EEU.
Methods
Forty-four HDM-allergic and eleven non-allergic participants were screened and deemed eligible for one of two 3-h exposure sessions in the HDM-EEU. Participants were exposed to a modest or higher HDM target, with blood and nasal brushing samples collected before and after allergen exposure. Symptomatic data, including Total Nasal Symptom Score (TNSS), Total Ocular Symptom Score (TOSS), Total Rhinoconjunctivitis Symptom Score (TRSS), and Peak Nasal Inspiratory Flow (PNIF) were collected at baseline, every 30 min until 3 h, on an hourly basis for up to 12 h, and at 24 h following the onset of HDM exposure.
Results
The modest and higher HDM target sessions respectively featured cumulative total particle counts of 156,784 and 266,694 particles (2.5–25 µm), Der f 1 concentrations of 2.67 ng/m ³ and 3.80 ng/m ³ , and Der p 1 concentrations of 2.07 ng/m ³ and 6.66 ng/m ³ . Allergic participants experienced an increase in symptoms, with modest target participants plateauing at 1.5 to 2 h and achieving a mean peak TNSS of 5.74 ± 0.65, mean peak TOSS of 2.47 ± 0.56, and mean peak TRSS of 9.16 ± 1.32. High HDM-target allergics reached a mean peak TNSS of 8.17 ± 0.71, mean peak TOSS of 4.46 ± 0.62, and mean peak TRSS of 14.08 ± 1.30 at 3 h. All allergic participants’ symptoms decreased but remained higher than baseline after exiting the HDM-EEU. Sixteen participants (37.2%) were classified as Early Phase Responders (EPR), eleven (25.6%) as protracted EPR (pEPR), seven (16.3%) as Dual Phase Responders (DPR), and nine (20.9%) as Poor Responders (PR). Allergic participants experienced significant percent PNIF reductions at hours 2 and 3 compared to healthy controls. Non-allergics were asymptomatic during the study period.
Conclusions
The HDM-EEU is an appropriate model to study HDM-induced AR as it can generate clinically relevant AR symptoms amongst HDM-allergic individuals.
Background:
Eczema and food allergy are common health conditions that usually begin in early childhood and often occur together in the same people. They can be associated with an impaired skin barrier in early infancy. It is unclear whether trying to prevent or reverse an impaired skin barrier soon after birth is effective in preventing eczema or food allergy.
Objectives:
Primary objective To assess effects of skin care interventions, such as emollients, for primary prevention of eczema and food allergy in infants Secondary objective To identify features of study populations such as age, hereditary risk, and adherence to interventions that are associated with the greatest treatment benefit or harm for both eczema and food allergy.
Search methods:
We searched the following databases up to July 2020: Cochrane Skin Specialised Register, CENTRAL, MEDLINE, and Embase. We searched two trials registers and checked reference lists of included studies and relevant systematic reviews for further references to relevant randomised controlled trials (RCTs). We contacted field experts to identify planned trials and to seek information about unpublished or incomplete trials.
Selection criteria:
RCTs of skin care interventions that could potentially enhance skin barrier function, reduce dryness, or reduce subclinical inflammation in healthy term (> 37 weeks) infants (0 to 12 months) without pre-existing diagnosis of eczema, food allergy, or other skin condition were included. Comparison was standard care in the locality or no treatment. Types of skin care interventions included moisturisers/emollients; bathing products; advice regarding reducing soap exposure and bathing frequency; and use of water softeners. No minimum follow-up was required.
Data collection and analysis:
This is a prospective individual participant data (IPD) meta-analysis. We used standard Cochrane methodological procedures, and primary analyses used the IPD dataset. Primary outcomes were cumulative incidence of eczema and cumulative incidence of immunoglobulin (Ig)E-mediated food allergy by one to three years, both measured by the closest available time point to two years. Secondary outcomes included adverse events during the intervention period; eczema severity (clinician-assessed); parent report of eczema severity; time to onset of eczema; parent report of immediate food allergy; and allergic sensitisation to food or inhalant allergen.
Main results:
This review identified 33 RCTs, comprising 25,827 participants. A total of 17 studies, randomising 5823 participants, reported information on one or more outcomes specified in this review. Eleven studies randomising 5217 participants, with 10 of these studies providing IPD, were included in one or more meta-analysis (range 2 to 9 studies per individual meta-analysis). Most studies were conducted at children's hospitals. All interventions were compared against no skin care intervention or local standard care. Of the 17 studies that reported our outcomes, 13 assessed emollients. Twenty-five studies, including all those contributing data to meta-analyses, randomised newborns up to age three weeks to receive a skin care intervention or standard infant skin care. Eight of the 11 studies contributing to meta-analyses recruited infants at high risk of developing eczema or food allergy, although definition of high risk varied between studies. Durations of intervention and follow-up ranged from 24 hours to two years. We assessed most of this review's evidence as low certainty or had some concerns of risk of bias. A rating of some concerns was most often due to lack of blinding of outcome assessors or significant missing data, which could have impacted outcome measurement but was judged unlikely to have done so. Evidence for the primary food allergy outcome was rated as high risk of bias due to inclusion of only one trial where findings varied when different assumptions were made about missing data. Skin care interventions during infancy probably do not change risk of eczema by one to two years of age (risk ratio (RR) 1.03, 95% confidence interval (CI) 0.81 to 1.31; moderate-certainty evidence; 3075 participants, 7 trials) nor time to onset of eczema (hazard ratio 0.86, 95% CI 0.65 to 1.14; moderate-certainty evidence; 3349 participants, 9 trials). It is unclear whether skin care interventions during infancy change risk of IgE-mediated food allergy by one to two years of age (RR 2.53, 95% CI 0.99 to 6.47; 996 participants, 1 trial) or allergic sensitisation to a food allergen at age one to two years (RR 0.86, 95% CI 0.28 to 2.69; 1055 participants, 2 trials) due to very low-certainty evidence for these outcomes. Skin care interventions during infancy may slightly increase risk of parent report of immediate reaction to a common food allergen at two years (RR 1.27, 95% CI 1.00 to 1.61; low-certainty evidence; 1171 participants, 1 trial). However, this was only seen for cow's milk, and may be unreliable due to significant over-reporting of cow's milk allergy in infants. Skin care interventions during infancy probably increase risk of skin infection over the intervention period (RR 1.34, 95% CI 1.02 to 1.77; moderate-certainty evidence; 2728 participants, 6 trials) and may increase risk of infant slippage over the intervention period (RR 1.42, 95% CI 0.67 to 2.99; low-certainty evidence; 2538 participants, 4 trials) or stinging/allergic reactions to moisturisers (RR 2.24, 95% 0.67 to 7.43; low-certainty evidence; 343 participants, 4 trials), although confidence intervals for slippages and stinging/allergic reactions are wide and include the possibility of no effect or reduced risk. Preplanned subgroup analyses show that effects of interventions were not influenced by age, duration of intervention, hereditary risk, FLG mutation, or classification of intervention type for risk of developing eczema. We could not evaluate these effects on risk of food allergy. Evidence was insufficient to show whether adherence to interventions influenced the relationship between skin care interventions and risk of developing eczema or food allergy.
Authors' conclusions:
Skin care interventions such as emollients during the first year of life in healthy infants are probably not effective for preventing eczema, and probably increase risk of skin infection. Effects of skin care interventions on risk of food allergy are uncertain. Further work is needed to understand whether different approaches to infant skin care might promote or prevent eczema and to evaluate effects on food allergy based on robust outcome assessments.
People with food hypersensitivities experience adverse reactions when eating certain foods and thus need to adapt their diet. When dining out, the challenge is greater as people entrust the care of their allergy, intolerance, or celiac disease, in the hands of staff who might not have enough knowledge to appropriately care for them. This interview study explored how people with food hypersensitivities avoid reactions while eating out, to inspire future digital technology design. Our findings show the social and emotional
impact of food hypersensitivities and how people practically cope by investigating restaurants’ safety precautions, correcting orders, or even educating restaurants’ staff.We discuss our findings against the experiences of other people living with chronic conditions and offer design opportunities for digital technologies to enhance dining out experiences of people with food hypersensitivities.
To investigate variations in the prevalence of self reported symptoms, diagnosis, and treatment of asthma in 12-14 year old children.
Self completion questionnaire.
Great Britain.
All pupils aged 12-14 years in a stratified cluster sample of 93 large mixed secondary schools in 1995.
Self reported prevalence of symptoms, diagnosis, and treatment of asthma at four geographical levels.
27,507 questionnaires were completed (85.9% response rate). The national 12 month prevalence of any wheezing, speech limiting wheeze, four or more attacks of wheeze, and frequent night waking with wheeze was 33.3% (n = 9155), 8.8% (2427), 9.6% (2634), and 3.7% (1023) respectively. The prevalence of ever having had a diagnosis of asthma was 20.9% (5736). In total, 19.8% (5438/27,507) of pupils reported treatment with anti-asthma drugs in the past year, but, of pupils reporting frequent nocturnal wheeze in the past year, 33.8% (342/1012) had no diagnosis of asthma and 38.6% (395/1023) denied receiving inhaler therapy. The 12 month prevalence of wheeze was highest in Scotland (36.7%, 1633/4444), but in England and Wales there was no discernible north-south or east-west gradient. Wheeze prevalence was slightly higher in non-metropolitan areas (35.0%, 6155/17,605) than in metropolitan areas (30.3%, 3000/9902). The prevalence of self reported asthma diagnosis and inhaler use showed no discernible national, regional, north-south, or east-west geographical pattern but was higher in non-metropolitan areas.
Prevalence of self reported symptoms, diagnosis, and treatment of asthma was high among 12-14 year olds throughout Great Britain with little geographical or urban-rural variation. Underdiagnosis and undertreatment were substantial.
Asthma is a common chronic disorder which may be increasing in prevalence. However, little is known of its distribution and determinants. The European Community Respiratory Health Survey (ECRHS) is a multicentre survey of the prevalence, determinants and management of asthma. This paper presents a descriptive account of the variation in self-reported attacks of asthma and asthma symptoms across Europe, and in part fulfils the first aim of the study. A screening questionnaire, including seven questions relating to the 12 month prevalence of symptoms of asthma, was distributed to representative samples of 20-44 year old men and women in 48 centres, predominantly in Western Europe. The median response rate to the questionnaire was 75% but, after removing from the denominator those who were the wrong age, were known to have moved out of the area, or had died, it was 78% (range 54-100). The prevalence of all symptoms varied widely. Although these were generally lower in northern, central and southern Europe and higher in the British Isles, New Zealand, Australia and the United States, there were wide variations even within some countries. Centres with a high prevalence of self-reported attacks of asthma also reported high prevalences of nasal allergies and of waking at night with breathlessness. The use of asthma medication was more common where wheeze and asthma attacks were more frequent. In most centres in The Netherlands, Sweden, New Zealand and the United Kingdom over 80% of those with a diagnosis of asthma were currently using asthma medication. In Italy, France and Spain the rate was generally less than 70%. These data are the best evidence to date that geographical differences in asthma prevalence exist, are substantial and are not an artefact of the use of noncomparable methods.
There have been few studies of the population prevalence of allergic rhinitis and atopic eczema, and although hundreds of asthma-prevalence studies have been done in various parts of the world, they have seldom used standard approaches. An exception is the European Community Respiratory Health Survey (ECRHS), 1–3 which involved surveys of asthma and allergic-rhinitis prevalence in adults aged 20–44 years in 48 centres in 22 countries, although only nine centres in six countries were outside of western Europe. The ECRHS suggested that there were regional risk factors for asthma and allergic rhinitis in western Europe, but it did not comprehensively assess the global patterns. For children, the largest standard studies of the prevalences of asthma, allergic rhinitis, or atopic eczema have involved at most four countries. 4–6 Thus, in some respects, the epidemiology of asthma and other allergic disorders is currently similar to that of cancer epidemiology in the 1950s and 1960s, when the international patterns of the incidence of cancer were studied. 7 These studies revealed striking international differences that gave rise to many new hypotheses, tested in further epidemiological studies that identified previously unknown risk factors for cancer. These risk factors may not have been in the hypotheses investigated if the initial international comparisons had been confined to few western countries. More specifically, Rose 8,9 has noted that whole populations may be exposed to risk factors for disease (eg, high exposure to house-dust-mite allergen) and the patterns may be apparent only when comparisons are made between, rather than within, populations. Therefore, we carried out systematic, standardised, international comparisons of the prevalence of asthma and allergies to generate new hypotheses and to investigate existing hypotheses in the International Study of Asthma and Allergies in Childhood (ISAAC). The detailed findings for the prevalence and severity of the symptoms of asthma, allergic rhinoconjunctivitis, and atopic eczema in children aged 6–7 years and 13–14 years will be reported elsewhere. Here, we give an overview of the findings for children aged 13–14 years (the age-group that was studied by all participating centres), assess the relationship between the findings for the three disorders, and discuss the potential for future ecological and case-control studies. Methods Phase one of the ISAAC programme 10 used a simple standard approach at minimum cost in as wide a range of centres and countries as possible, based on school populations to ensure Summary Background Systematic international comparisons of the prevalences of asthma and other allergic disorders in children are needed for better understanding of their global epidemiology, to generate new hypotheses, and to assess existing hypotheses of possible causes. We investigated worldwide prevalence of asthma, allergic rhinoconjunctivitis, and atopic.
Background
Systematic international comparisons of the prevalences of asthma and other allergic disorders in children are needed for better understanding of their global epidemiology, to generate new hypotheses, and to assess existing hypotheses of possible causes. We investigated worldwide prevalence of asthma, allergic rhinoconjunctivitis, and atopic.
Methods
We studied 463 801 children aged 13–14 years in 155 collaborating centres in 56 countries. Children self-reported, through one-page questionnaires, symptoms of these three atopic disorders. In 99 centres in 42 countries, a video asthma questionnaire was also used for 304 796 children.
Findings
We found differences of between 20-fold and 60-fold between centres in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and atopic eczema, with four-fold to 12-fold variations between the 10th and 90th percentiles for the different disorders. For asthma symptoms, the highest 12-month prevalences were from centres in the UK, Australia, New Zealand, and Republic of Ireland, followed by most centres in North, Central, and South America; the lowest prevalences were from centres in several Eastern European countries, Indonesia, Greece, China, Taiwan, Uzbekistan, India, and Ethiopia. For allergic rhinoconjunctivitis, the centres with the highest prevalences were scattered across the world. The centres with the lowest prevalences were similar to those for asthma symptoms. For atopic eczema, the highest prevalences came from scattered centres, including some from Scandinavia and Africa that were not among centres with the highest asthma prevalences; the lowest prevalence rates of atopic eczema were similar in centres, as for asthma symptoms.
Interpretation
The variation in the prevalences of asthma, allergic rhinoconjunctivitis, and atopic-eczema symptoms is striking between different centres throughout the world. These findings will form the basis of further studies to investigate factors that potentially lead to these international patterns.
Anecdotal evidence suggests that the incidence of acute anaphylaxis is increasing.1 Reasons for this supposed increase are poorly understood although a number of factors associated with the “Western lifestyle” have been implicated, such as changes in diet and the increasing use of therapeutic drugs. We investigated trends in hospital admissions for acute anaphylaxis using routinely collected national hospital discharge statistics from 1991-2 to 1994-5.
The hospital episode statistics database captures information on every admission to NHS hospitals in England. One primary diagnosis code and up to six secondary codes are recorded, the latter providing information on aetiology. We looked at hospital discharges occurring between 1 April 1991 and 31 March 1995 in which the primary ICD-9 (international classification of diseases, ninth revision) code was anaphylaxis (either anaphylactic shock (ICD-9 code 995.0) or anaphylactic shock due to …
A study was undertaken to determine trends in the incidence of new episodes of asthma presented to general practitioners participating in the Weekly Returns Service of the Royal College of General Practitioners, comprising 92 practices with a registered population of approximately 680 000 persons well distributed throughout England and Wales. These practices monitor the morbidity presented at every consultation, distinguishing between new episodes of illness and ongoing consultations.
Age specific weekly rates of new episodes of asthma (and of acute bronchitis) presenting to the general practitioners over the years 1989-98 were examined in four week blocks and analysed by multiple regression, separating secular from seasonal trends.
Quadratic trends in episodes of asthma were evident in each of the age groups with peaks in 1993/4. Corresponding analyses for acute bronchitis disclosed similar trends generally peaking in the winter of 1993/4. Mean weekly incidence data (all ages combined) decreased in all quarters since 1993. Regional analysis (North/Central/South) showed similar decreases.
There has been a gradual decrease in the incidence of asthma episodes and of acute bronchitis presenting to general practitioners since 1993. The trend of an increase before 1993 followed by a decrease cannot be explained by changes in the patterns of health care usage or diagnostic preference of doctors.
Epidemiological studies indicate that the prevalence of allergic disorders such as allergic rhinitis, asthma, and eczema have increased during recent decades in many Western countries.1 Although anecdotal reports suggest that the prevalence of systemic allergic conditions may also be changing, only limited evidence exists to support this assertion.2 We report on trends in admissions for anaphylaxis, angio-oedema, food allergy, and urticaria, analysed by using national hospital discharge statistics from 1990-1 to 2000-1.
We obtained hospital admissions data from the hospital episode statistics system.3 This database records episodes of care after admission to hospital and assigns a primary diagnosis on discharge based on the international classification of diseases (ICD).4 Data are available by financial year (1 April-31 March). Diagnoses were classified using the ninth revision (ICD-9) up to March 1995 and using the tenth revision (ICD-10) thereafter. …
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Declining incidence of episodes of asthma
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Worldwide variation in prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and atopic eczema
- International Study of Asthma and Allergies in Childhood
Fall in prevalence of symptoms of asthma hayfever and eczema in secondary school children in the UK from
- Andersonhr Rugglesr Strachandp