Background
The natural course of childhood asthma and allergy is complex and not fully understood. We aimed to identify phenotypes based upon the time course of respiratory/allergic symptoms ...throughout preschool years.
Methods
As part of the PARIS cohort, symptoms of wheezing, dry night cough, rhinitis and dermatitis were collected annually from birth to age 4 years. K‐means clustering was used to group into phenotypes children with similar symptoms trajectories over the study period. Associations of phenotypes with IgE sensitization and risk factors were studied using multinomial logistic regression.
Results
Besides a group with low prevalence of symptoms considered as reference (n = 1236, 49.0%), four distinct respiratory/allergic phenotypes were identified: two transient transient rhinitis phenotype (n = 295, 11.7%), transient wheeze phenotype (n = 399, 15.8%), without any relation with IgE sensitization, and two persistent cough/rhinitis phenotype (n = 284, 11.3%), dermatitis phenotype (n = 308, 12.2%), associated with IgE sensitization. Transient rhinitis phenotype was only associated with tobacco smoke exposure, which could irritate the airways. Transient wheeze phenotype was related to male sex and contact with other children (older siblings, day care attendance). Lastly, risk factors for both IgE‐associated phenotypes encompassed parental history of allergy, potential exposure to allergens and stress, known to be associated with the development of allergic diseases.
Conclusion
This study provides evidence for the existence of different respiratory/allergic phenotypes before school age. The fact that they differ in terms of sensitization and risk factors reinforces the plausibility of distinct phenotypes, potentially linked to irritation and infections for the transient phenotypes and to allergy for the persistent phenotypes.
This study aimed to measure in French children personal exposure concentrations of black carbon (BC) and ultrafine particles (UFP) and to quantify the contribution of different microenvironments ...(home, school, places of extracurricular activities, transport) to their total exposure. It was conducted on 96 9‐year‐old children from the PARIS birth cohort. BC and UFP were continuously measured by portable devices (microAeth® AE51 and DiSCmini®) for a minimum of 24 hours, while participating families simultaneously filled in a space‐time‐activities‐budget questionnaire. BC exposure concentration was higher during trips (principally metro/train and bus), while UFP exposure concentration was higher during indoor activities (mainly eating at restaurants) and in trips. The most important UFP peaks were measured at home, especially during cooking. Home and school together accounted for much of the total exposure, 83.8% for BC and 85.3% for UFP. The contribution of transport to total exposure was 12.4% for BC and 9.7% for UFP, while extracurricular activities were responsible for 3.8% and 5% of the total exposure to BC and UFP, respectively.
Summary
Background
Determinants of wheezing severity are poorly documented in infants.
Objectives
To study the determinants of wheezing severity in infants aged 18 months followed‐up in the PARIS ...(« Pollution and Asthma Risk : an Infant Study ») birth cohort.
Methods
Data on wheezing disorders, medical visits and medications, as well as biological markers of atopy, were collected during a medical examination at age 18 months. Severe wheeze was defined as wheeze that required inhaled corticosteroid and/or hospital‐based care. Environmental exposures were assessed prospectively with regular questionnaires. Risk factors for wheeze in the first 18 months of life were assessed by multivariate regression models.
Results
Participation in the medical examination concerned 48.2% of the original cohort. Prevalence of wheeze was 560/1879 (35.7%) and was influenced by male gender, parental history of asthma, siblings, daycare attendance, heavy parental smoking at home, and carpet covered floor in the child's bedroom. Being overweight increased the risk of wheeze by 62% (OR = 1.62, 95%CI 1.13–2.32). In addition, trends towards an increased risk of wheeze were found in infants exposed to daily use of cleaning sprays and to renovation activities. Conversely, the presence of a cat reduced the risk of wheeze (OR = 0.65, 95%CI 0.47–0.89), without any evidence of healthy‐pet keeping effect. Severe wheeze concerned 286 of the wheezers (42.7%). The prevalence of severe wheeze was related to atopy, and risk of severe wheeze was in particular increased in infants having eosinophilia (OR = 1.76, 95%CI 1.21–2.55) or being sensitized to ≥ 2 allergens (OR = 1.88, 95%CI 1.13–3.14).
Conclusions and Clinical Relevance
Whilst risk factors for wheeze before 18 months of age are factors related to infections, indoor air pollution, and being overweight, the severity of wheeze is mainly due to the atopic status of the child. We suggest that atopy should be further considered in the assessment of wheezing severity in infants.
Abstract
Background
As early feeding practices may be related with allergy at older age, we aimed to investigate infant-feeding profiles in the first year of life and their determinants in the PARIS ...(Pollution and Asthma Risk: an Infant Study) cohort.
Methods
This study included 3446 infants. Feeding data was collected using standardized questionnaires at 1, 3, 6, 9 and 12 months. At each time, we considered 6 variables such as (i) breastfeeding (no, mixed, exclusive), consumption of formula (no, yes): (ii) regular formula, (iii) hypoallergenic, (iv) with pre-/probiotics, or (v) extensively hydrolyzed/soya, as well as (vi) solid foods introduction (no, yes: 0, 1, ≥2 allergenic foods). Children with similar feeding profiles over the first year of life were grouped together using multidimensional longitudinal cluster analysis. Socio-demographic and health determinants of these profiles were examined using multinomial logistic regression models.
Results
Five distinct profiles were identified. Profile 1 (45%) included children mainly fed with regular formula. Children from Profile 2 (27%) were exclusively breastfed during the first 3 months. Children from the other three profiles were moderately breastfed and differed regarding the type of formula consumed: pre-/probiotics for Profile 3 (17%), hypoallergenic for Profile 4 (7%), or extensively hydrolyzed/soya for Profile 5 (4%). Profiles did not seem to differ regarding timing of solid foods introduction, except Profile 5 starting later. Compared to Profile 1, children from Profiles 2 to 5 were more likely to have parental history of allergy and higher family socioeconomic status (SES). Profile 5 appeared to be influenced by early health outcomes such as eczema or food reactions.
Conclusions
We identified different early feeding profiles. Parental history of allergy, SES and early health outcomes seem to be important determinants of these profiles. Associations of these profiles with the development of allergic disease will be studied.
Key messages
These results are important to better understand early-life feeding practices and their contributors.
Their possible role in helping to prevent allergic diseases in later life will be further studied.
Data about non-dietary exposure to different chemical classes of pesticides are scarce, especially in France. Our objective was to assess residential pesticide exposure of non-occupationally exposed ...adults, and to compare it with occupational exposure of subjects working indoors. Twenty unexposed persons, five gardeners, seven florists and nine veterinary workers living in Paris area were recruited. Nineteen residences, two greenhouses, three florist shops and three veterinary departments were then sampled. Thirty-eight insecticides, herbicides and fungicides were measured in indoor air with an air sampler for 24 h, and on hands by wiping them with isopropanol-wetted swabs. After extraction, samples were analysed by gas and high-performance liquid chromatography. Seventeen different pesticides were detected at least once in indoor air and twenty-one on the hands. An average of 4.2
±
1.7 different pesticides was detected per indoor air sample. The organochlorines lindane, α-endosulfan and α-HCH were the most frequently detected compounds, in 97%, 69% and 38% of the samples, respectively. The organophosphates dichlorvos and fenthion, the carbamate propoxur and the herbicides atrazine and alachlor were detected in more than 20% of the air samples. Indoor air concentrations were often low, but could reach 200–300 ng/m
3 in residences for atrazine and propoxur. Propoxur levels significantly differed between the air of veterinary places and other places (Kruskal–Wallis test,
p
<
0.05) and dieldrin levels between residences and workplaces (
p
<
0.05). There was a greater number of pesticides on hands than in air, with an average of 6.3
±
3.3 different pesticides detected per sample, the most frequently detected being malathion, lindane and trifluralin, in more than 60% of the subjects. Maximal levels (up to 1000–3000 ng/hands) were observed either in the general population or in workers, depending on the pesticide. However, no significant difference was observed between workers and general population handwipe pesticide levels. As expected, gardeners were exposed to pesticides sprayed in greenhouses. Florists and veterinary workers, whose pesticide exposure had not been described until now, were also indirectly exposed to pesticides used for former pest control operations. Overall, general population was exposed to more various pesticides and at levels sometimes higher than in occupational places. The most frequent pesticides in residences were not the same as in US studies but levels were similar. These preliminary results need to be confirmed in a greater number of residences from different parts of the country, in order to better assess pesticide exposure of the general population and its influencing factors.
To cite this article: Herr M, Clarisse B, Nikasinovic L, Foucault C, Le Marec A-M, Giordanella J-P, Just J, Momas I. Does allergic rhinitis exist in infancy? Findings from the PARIS birth cohort. ...Allergy 2011; 66: 214-221. ABSTRACT: Background: Early onset of allergic rhinitis (AR) is poorly described, and rhinitis symptoms are often attributed to infections. This study analyses the relations between AR-like symptoms and atopy in infancy in the PARIS (Pollution and Asthma Risk: an Infant Study) birth cohort. Methods: Data on AR-like symptoms (runny nose, blocked nose, sneezing apart from a cold) were collected using a standardized questionnaire administered during the health examination at age 18 months included in the follow-up of the PARIS birth cohort. Parental history of allergy and children's atopy blood markers (blood eosinophilia ≥470 eosinophils/mm³, total immunoglobulin E ≥45 U/ml and presence of allergen-specific IgE) were assessed. Associations were studied using multivariate logistic regression models adjusted for potential confounders. Results: Prevalence of AR-like symptoms in the past year was 9.1% of the 1850 toddlers of the study cohort. AR-like symptoms and dry cough apart from a cold were frequent comorbid conditions. Parental history of AR in both parents increased the risk of suffering from AR-like symptoms with an OR 2.09 (P = 0.036). Significant associations were found with the presence of concurrent biological markers of atopy, especially blood eosinophilia and sensitization to house dust mite (OR 1.54, P = 0.046 and OR 2.91, P = 0.042) whereas there was no relation with sensitization to food. Conclusions: These results support the hypothesis that AR could begin as early as 18 months of life. Suspicion of AR should be reinforced in infants with parental history of AR or biological evidence of atopy, particularly blood eosinophilia and sensitization to inhalant allergens.
Traffic‐related air pollution (TRAP) exposure during childhood is associated with asthma; however, the contribution of the different TRAP pollutants in each microenvironment (home, school, ...transportation, others) in asthmatic and non‐asthmatic children is unknown. Daily (24‐h) personal black carbon (BC), ultrafine particle (UFP), and alveolar lung‐deposited surface area (LDSA) individual exposure measurements were obtained from 100 children (29 past and 21 current asthmatics, 50 non‐asthmatics) aged 9±0.7 years from the INMA‐Sabadell cohort (Catalonia, Spain). Time spent in each microenvironment was derived by the geolocation provided by the smartphone and a new spatiotemporal map‐matching algorithm. Asthmatics and non‐asthmatics spent the same amount of time at home (60% and 61%, respectively), at school (20% and 23%), on transportation (8% and 7%), and in other microenvironments (7% and 5%). The highest concentrations of all TRAPs were attributed to transportation. No differences in TRAP concentrations were found overall or by type of microenvironment between asthmatics and non‐asthmatics, nor when considering past and current asthmatics, separately. In conclusion, asthmatic and non‐asthmatic children had a similar time‐activity pattern and similar average exposures to BC, UFP, and LDSA concentrations. This suggests that interventions should be tailored to general population, rather than to subgroups defined by disease.
Summary
Background
Occupational contact urticaria (OCU) is an occupational contact dermatitis that can cause serious health consequences and disability at work.
Objectives
To describe OCU and its ...temporal trends by the main causal agents and activity sectors in a nationwide scheme in France.
Methods
Using data from the French National Network for Occupational Disease Vigilance and Prevention (RNV3P), we described OCU reported during the period 2001–10 and analysed the temporal trends of OCU and OCU attributed to the most frequent agents over the study period. Trends analyses were supported by reporting odds ratios using a logistic regression model with reference to 2001, or with time as a continuous variable.
Results
During the study period, 251 cases of OCU were reported in RNV3P, half of which were due to natural rubber latex, in particular in the health and social work activity sector (HSW). The number of these cases declined significantly over the study period (19% per year), and particularly after 2006. Conversely, the other causes of OCU did not decrease.
Conclusions
Using surveillance data from a French national network, this study has found that there was a significant decline in OCU due to natural rubber latex, particularly in the HSW, when powdered latex gloves were banned from French hospitals. Our results show the effectiveness of this preventive measure, and suggest that this practice should be extended to other sectors.
What's already known about this topic?
Contact urticaria is known to be a frequent cause of occupational dermatosis, but statistics on occupational contact urticaria (OCU) are scarce.
What does this study add?
For the first time, temporal trends in OCU were studied over a 10‐year period using data from the French RNV3P network.
The results show the effectiveness of latex exposure prevention measures for healthcare workers and the need for these measures to be extended to other sectors to reduce OCU in the workplace.
Linked Comment: Chowdhury, Br J Dermatol 2015; 173: 1364–65.
Plain language summary available online
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