Helminth infections and allergic diseases: Systematic review and meta-analysis of the global literature

Arrais, Margarete; Maricoto, Tiago; Nwaru, Bright I.; Cooper, Philip J.; Gama, Jorge; Brito, Miguel; Taborda-Barata, Luís

doi:10.1016/j.jaci.2021.12.777

Cited by 11 publications

(10 citation statements)

References 97 publications

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“…Thus, chronic helminth infections may protect from allergic diseases including asthma [ 51 – 54 ]. In such a scenario our results with respect to wheeze and A. lumbricoides could be seen as counter-intuitive, but they are, nevertheless, entirely in accordance with the conclusions drawn by reviews of recent studies on the topic of associations between STH and symptoms of asthma, including those of a systematic nature with meta-analyses [ 26 , 55 , 56 ].…”

Section: Discussionsupporting

confidence: 89%

“…The evidence linking helminth infections with allergic diseases is controversial. While several studies have shown inverse associations between helminths and allergy [22][23][24][25], a recent review suggested that Ascaris lumbricoides infections may increase the risk of bronchial hyperreactivity in participants and of atopy in adults [26]. Notably, helminth elimination as a public health problem is integrated into the WHO roadmap for Neglected Tropical Diseases 2021-2030 [27].…”

Section: Introductionmentioning

confidence: 99%

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Multiple overlapping risk factors for childhood wheeze among children in Benin

et al. 2022

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Background The African continent is currently facing an epidemiological transition characterized by a shift from communicable to non-communicable diseases. Prominent amongst the latter are allergies and asthma. In that context, wheeze has multiple potential contributory factors that could include some of the endemic helminth infections, as well as environmental exposures, such as household air pollution. We sought to determine the relative importance of these risk factors among children in Benin. Methods We included 964 children aged 6–14 years living in the commune of Comé, south–west Benin. All children were participants in the longitudinal monitoring cohort of the DeWorm3 trial designed to evaluate multiple rounds of community mass treatment with albendazole for interruption of the transmission of soil transmitted helminths (STH). We administered a standard ISAAC questionnaire to determine the presence of wheeze. In addition, we assessed exposure to household air pollution and to other potential allergy-inducing factors, dietary intake and anthropometry. Using STH infection status assessed at the pretreatment baseline timepoint, we used multivariate statistical modelling, controlling for covariates, to investigate associations between wheeze and the different factors measured. Results The prevalence of wheezing history was 5.2%, of current wheezing was 4.6% and of severe wheezing was 3.1%, while STH infections were found in 5.6% of children. These profiles did not vary as a function of either age or gender. Infection with Ascaris lumbricoides, but not hookworm species, was significantly associated with both current wheeze (adjusted Odds Ratio (aOR) = 4.3; 95% CI [1.5–12.0]) and severe wheeze (aOR = 9.2; 95% CI [3.1–27.8]). Significant positive associations with current wheeze, independent of each other and of STH infection status, were also found for (i) use of open cookstoves (aOR = 3.9; 95% CI [1.3–11.5]), (ii) use of palm cakes for fire lighting (aOR = 3.4; 95% CI [1.1–9.9]), (iii) contact with domestic animals and/or rodents (aOR = 2.5; 95% CI [1.1–6.0]), (iv) being overweight (aOR = 9.7; 95% CI [1.7–55.9]). Use of open cookstoves and being overweight were also independent risk factors for severe wheeze (aOR = 3.9; 95% CI [1.1–13.7]) and aOR = 10.3; 95% CI [1.8–60.0], respectively). Conclusions Children infected with A. lumbricoides appear to be at elevated risk of wheeze. Deworming may be an important intervention to reduce these symptoms. Improving cooking methods to reduce household air pollution, modifying dietary habits to avoid overweight, and keeping animals out of the house are all additional measures that could also contribute to reducing childrens’ risk of wheeze. Policymakers in LMIC should consider tailoring public health measures to reflect the importance of these different risk factors.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Multiple overlapping risk factors for childhood wheeze among children in Benin

et al. 2022

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“…A systematic review and meta‐analysis of epidemiological studies reported that helminth infections may increase the risk of bronchial hyperreactivity in children and atopy in adults 35 . A murine study demonstrated that infection with helminth parasites may modulate the host immune response to allergic asthma directly or by altering the host gut microbiota 36 .…”

Section: Discussionmentioning

confidence: 99%

Allergic disease and sensitization disparity in urban and rural China: A EuroPrevall‐INCO study

Zheng

Zhao

et al. 2022

Pediatric Allergy Immunology

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Background: Studies in comparison with allergic diseases and sensitization between rural and urban environments in westernized countries might be biased and not adequately reflect countries undergoing rapid transition.Methods: A total of 5542 schoolchildren from urban area and 5139 from rural area were recruited for the EuroPrevall-INCO survey. A subsequent case-control sample with 196 children from urban area and 202 from rural area was recruited for a detailed face-to-face questionnaire and assessment of sensitization. Skin prick tests and serum-specific IgE measurements were used to assess sensitizations against food and aeroallergens. Logistic regression analysis was used to determine associations between risk/protective factors, food adverse reactions (FAR), allergic diseases, and sensitizations.Results: Prevalence of self-reported allergic diseases, including asthma (6.6% vs.2.5%), rhinitis (23.2% vs.5.3%), and eczema (34.1% vs.25.9%), was higher in urban than in rural children. Urban children had a significantly higher prevalence of FAR and related allergic diseases, and lower food/inhalation allergen sensitization rate, than those of rural children. In urban children, frequent changing places of residency (odds ratio 2.85, 95% confidence interval: 1.45-5.81) and antibiotic usage (3.54, 1.77-7.32) in early life were risk factors for sensitization, while sensitization and family history of allergy were risk factors for allergic diseases. In rural children, exposure to rural environments in early life was protective against both allergen sensitizations (0.46, 0.21-0.96) and allergic diseases (0.03, 0.002-0.19). Conclusion:We observed a disparity in rates of allergic diseases and allergen sensitization between rural and urban children. In addition to family history, the development of allergic diseases and allergen sensitization were associated with specific urban/rural environmental exposures in early life.

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“…Schistosomiasis has been regarded as a protective factor against atopy and asthma [41,42], depending on the parasite burden and chronicity of the infection [43]. However, some studies have shown that anti-schistosome IgE is positively associated with specific sensitization (e.g., to mites or cockroaches) and allergic diseases [3,44,45]. In addition, in vivo models have used sensitization and challenge with Schistosoma eggs to induce type-2 inflammation [46], suggesting the presence of components with allergenic activity.…”

Section: Schistosoma Sppmentioning

confidence: 99%

The Relationship of Parasite Allergens to Allergic Diseases

Caraballo

Llinás-Caballero

2023

Curr Allergy Asthma Rep

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Purpose of Review Helminth infections modify the natural history of allergic diseases, by either decreasing or increasing their symptoms. Several helminth components are involved in the increasing of the allergic response and symptoms, overcoming the concomitant immunosuppression of helminthiases. However, the role of individual IgE-binding molecules in this process remains to be defined. Recent Findings We updated the list of helminth allergens and IgE-binding molecules, their effects on asthma presentation, and their impact on allergy diagnosis. Data from genetic and epigenetic studies of ascariasis are analyzed. A new species-specific A. lumbricoides allergen has been discovered, with potential use in molecular diagnosis. Summary Most helminth IgE-binding components are not officially classified as allergens in the WHO/IUIS database, although there is evidence of their influence increasing allergic manifestations. Further immunological characterization of these components is needed to better understand their mechanisms of action and evaluate the ways in which they can influence the diagnosis of allergy.

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Helminth infections and allergic diseases: Systematic review and meta-analysis of the global literature

Cited by 11 publications

References 97 publications

Multiple overlapping risk factors for childhood wheeze among children in Benin

Multiple overlapping risk factors for childhood wheeze among children in Benin

Allergic disease and sensitization disparity in urban and rural China: A EuroPrevall‐INCO study

The Relationship of Parasite Allergens to Allergic Diseases

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