Characterisation of atopic and non-atopic wheeze in 10 year old children

Kurukulaaratchy, Ramesh; Fenn, M.; Matthews, S.; Arshad, Syed Hasan

doi:10.1136/thx.2003.010462

Cited by 69 publications

(78 citation statements)

References 26 publications

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“…However, had all children undergone allergic tests at six years, some non-allergic asthmatics could have been considered as having allergic asthma, as sensitisation to inhalant allergens increases with age. Nevertheless, not too much misclassification seems to have happened as the percentage of asthmatic children with allergic asthma (63.5%) was not lower than the one found in other studies [15,16]. Another limitation of the study is the absence of some data, which may help a more subtle interpretation: family allergy risk, smoke exposure and other risk factors.…”

Section: Limitations and Strengthsmentioning

confidence: 69%

Early patterns of wheezing in asthmatic and nonasthmatic children

Garcinuño¹,

Gandarillas²

2013

Eur Respir J

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The aim of this study was to describe the time patterns of wheezing in both asthmatic and nonasthmatic children during the first 36 months of life, and to determine whether there are asthma-related breakpoints in the incidence of wheezing.Data from a historical cohort of children followed from birth to 6 years (SLAM cohort) were used. Wheezing episodes until 36 months and asthma at 6 years were both recorded by a doctor. Monthly mean incidence rate of wheezing and rate ratio were calculated. Joinpoint regression models were built to identify breakpoints in the risk of wheeze.Complete information was available for 3739 children. Wheezing in the first 36 months was more frequent in asthmatic than in nonasthmatic children (rate ratio 2.62, 95% CI 1.81-3.78). Differences were appreciable within the first months and increased steadily thereafter because of a persistently high rate in asthmatic children. No breakpoint in the rate ratio could be identified. Asthmatic children exhibited a onephase curve of incidence and nonasthmatic children exhibited a two-phase curve. However, children with allergic asthma also displayed a two-phase curve.There is no identifiable breakpoint during the first 36 months of life at which the incidence of wheezing in asthmatic children begins to stand out. @ERSpublications Increased wheezing in asthmatic children from birth; different progression patterns for allergic and nonallergic asthma

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Section: Limitations and Strengthsmentioning

confidence: 69%

Early patterns of wheezing in asthmatic and nonasthmatic children

Garcinuño¹,

Gandarillas²

2013

Eur Respir J

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“…The recently published data from the Isle of Wight, UK birth cohort study show that, at the age of 10 yrs, the prevalence of atopic and nonatopic wheeze were similar, but that atopic wheezing was more frequently associated with a diagnosis of asthma and treatment for asthma, whereas nonatopic wheeze was more closely associated with recurrent chest infections before the age of 2 yrs [15]. In the present study, the vast majority of wheeze and active asthma at the age of 10 yrs was nonatopic.…”

Section: Discussionmentioning

confidence: 99%

“…Some authors [15][16][17] have suggested that the role of atopy in childhood asthma has been overestimated, even in Western countries. The fact that wheeze and asthma-like symptoms are frequently associated with atopy does not imply that these two phenomena are related in the individual child.…”

Section: Discussionmentioning

confidence: 99%

Nonatopic asthma is associated with helminth infections and bronchiolitis in poor children

Pereira

Sly

Pitrez³

et al. 2007

European Respiratory Journal

101

100

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Asthma is common in urban centres in Latin America, but atopic asthma may not be the main phenotype among children. Helminth infections are highly prevalent in poor populations, and it was hypothesised that they attenuate allergic asthma, whereas other factors are related to the expression of a nonatopic wheeze/asthma phenotype.A total of 1,982 children from Southern Brazil with a mean¡SD age of 10.1¡0.76 yrs completed asthma questionnaires, and 1,011 were evaluated for intestinal parasites and atopy using skinprick tests (SPTs).Wheeze in the previous 12 months was reported by 25.6%, and 9.3% showed current asthma; 13% were SPT-positive and 19.1% were positive for any helminths. Most children with either wheeze or asthma were SPT-negative; however, severe wheeze was more prevalent among the atopic minority. Helminth infections were inversely associated with positive SPT results. Bronchiolitis before the age of 2 yrs was the major independent risk factor for asthma at age 10 yrs; high-load Ascaris infection, a family history of asthma and positive SPT results were also asthma risk factors.Most asthma and wheeze are of the nonatopic phenotype, suggesting that some helminths may exert an attenuating effect on the expression of the atopic portion of the disease, whereas viral bronchiolitis predisposes more specifically to recurrent airway symptoms.KEYWORDS: Allergy, bronchiolitis, helminths, intestinal parasites, nonatopic asthma, wheeze T he increased burden and prevalence of wheeze and asthma since the 1960s are well documented, especially among children living in affluent societies [1]. Asthma in school-age children from developed countries is commonly associated with an atopic phenotype, including bronchial hyperresponsiveness, peripheral blood eosinophilia, increased allergenspecific immunoglobulin (Ig)E levels and positive allergen skin-prick test (SPT) results [2,3]. The International Study of Asthma and Allergies in Childhood (ISAAC) has demonstrated that asthma and asthma-related symptoms are highly prevalent among many of the less-privileged communities in Latin America [4]. These data are seemingly at odds with the so-called hygiene hypothesis, and suggest that the relationship between asthma and the atopic phenotype is less clear in children from developing countries. Data from Africa show that the association of asthma with atopy is stronger in children living in urban rather than rural settings [5].Parasitic infections are common among disadvantaged populations in Africa and Latin America. Recent data from these areas have shown an inverse association between helminth infections and allergy (defined by SPT), and probably an attenuation of asthma-related symptoms [6,7]. A series of studies in rural Ecuador have shown that asthma is not common in a highly parasitised population, and that helminth infections are inversely related to allergen skin test reactivity [8]. This raises the question as to which environmental factors might be responsible for the high prevalence of asthma and asthma-relat...

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“…26 A whole-population birth cohort study showed that BHR to methacholine was only detected in 65% and 23% of 10-year-old children with atopic and nonatopic wheeze, respectively. 27 Factor analysis in this study clearly demonstrated weak correlations between clinical, spirometric, and inflammatory parameters in childhood asthma. These differences can probably be explained by the fact that asthma health status has a number of distinct components.…”

Section: -12mentioning

confidence: 97%

Clinical and Technical Factors Affecting pH and Other Biomarkers in Exhaled Breath Condensate

Leung

Yung

et al. 2005

Pediatric Pulmonology

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Summary. Exhaled breath condensate (EBC) pH appears to be a robust measure of asthma. However, the association between EBC pH and clinical factors and airway inflammatory markers remains unclear. The objectives of this study were to investigate the factors determining EBC pH in asthmatic children, and the reproducibility and effects of collection devices on EBC pH in nine healthy, nonsmoking adults. EBC was collected once from asthmatic children using EcoScreen, and from adults over 3 consecutive days using both RTubes and EcoScreen. EBC pH was measured immediately in non-deaerated samples by microelectrode pH meter. Concentrations of 8-isoprostane, cysteinyl leukotrienes (cys-LT), and leukotriene B4 (LTB 4 ) were measured using enzyme immunoassay. Exhaled nitric oxide concentration (FeNO) was measured by chemiluminescence. Fifty-eight asthmatics (16 intermittent, 12 mild persistent, and 30 moderate-to-severe persistent) were recruited. EBC pH was lower among patients with moderate-to-severe persistent than intermittent asthma (P ¼ 0.046). This marker correlated inversely with disease severity score (r ¼ À0.276, P ¼ 0.036), but not FeNO or other EBC biomarkers. Bland-Altman analyses found pH but not other EBC biomarkers to be reproducible, which were confirmed by its low coefficient of variation (2.7%; range, 0.4-5.2%). There was poor correlation between pH in EBC collected by RTube and EcoScreen (r ¼ 0.059, P ¼ 0.784). Factor analysis selected four factors that explained 67.5% of the total variance, and EBC pH clustered with both cys-LT and LTB 4 . In conclusion, our results suggest that pH in non-deaerated EBC is influenced by asthma severity in children. EBC pH measurement is reproducible, but is dependent on the collection devices used. Pediatr Pulmonol.

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Characterisation of atopic and non-atopic wheeze in 10 year old children

Cited by 69 publications

References 26 publications

Early patterns of wheezing in asthmatic and nonasthmatic children

Early patterns of wheezing in asthmatic and nonasthmatic children

Nonatopic asthma is associated with helminth infections and bronchiolitis in poor children

Clinical and Technical Factors Affecting pH and Other Biomarkers in Exhaled Breath Condensate

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