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Journal of Asthma and Allergy 2023Strong associations between early antibiotic exposure and increased risk of childhood allergies have been established. Antibiotics have the potential to induce microbial... (Review)
Review
BACKGROUND
Strong associations between early antibiotic exposure and increased risk of childhood allergies have been established. Antibiotics have the potential to induce microbial dysbiosis that may be linked to allergic conditions. This review examines the limited available evidence on the associations between adult antibiotic use, microbial dysbiosis and atopic conditions.
METHODS
A systematic literature search was conducted using PubMed and Embase for relevant studies, published between 01-01-2000 and 08-17-2022. We searched for associations between antibiotic use, microbial dysbiosis, and allergic conditions in adults, defined as over 13 years of age for the purposes of this review.
RESULTS
Twenty-one studies were analyzed, with the inclusion of four narrative reviews as scarce relevant literature was found when stricter selection criteria were employed. Relevant studies predominantly focused on asthma. Significant microbial differences were observed in most measures between healthy subjects and subjects with allergic conditions. However, no system-wise and strain-wise associations were evident. Notably, at the phyla level, the Bacillota and Pseudomonadota phyla were associated with asthmatics, while the Actinobacteria phylum was linked to healthy controls. Asthmatics tends to reflect upregulation in the Bacillota and Pseudomonadota phyla in both airway and gut microbiomes.
CONCLUSION
No compelling evidence could be found between adult antibiotic exposure, consequent microbial dysbiosis, and allergic conditions in adults. Our review is limited by scarce literature and therefore remains inconclusive. However, potential implications of antibiotic use impacting on allergic conditions justify additional research and heightened pharmacovigilance in this area.
PubMed: 37822520
DOI: 10.2147/JAA.S401755 -
American Journal of Clinical Dermatology Nov 2022Numerous systematic reviews and meta-analyses have examined the effects of probiotics used perinatally on prevention or treatment of atopic disease in infants and... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Numerous systematic reviews and meta-analyses have examined the effects of probiotics used perinatally on prevention or treatment of atopic disease in infants and children. However, to date, no review has examined randomized controlled trials of Lactobacillus rhamnosus, specifically, administered both prenatally and postnatally and its effect over a long period of time.
OBJECTIVE
The objective was to determine if L. rhamnosus either used solely or in conjunction with other probiotics demonstrates a long-term preventive effect on atopic disease in pediatric patients when used perinatally.
METHODS
A systematic review was undertaken to identify those studies where L. rhamnosus was used (either solely or in conjunction with other probiotics). The following databases were searched from the year 2000 through December 8, 2021: PubMed, Cochrane Reviews and Cochrane Central Database of Controlled Trials; systematic reviews were hand searched to identify randomized controlled trials (RCTs). Meta-analytic statistical techniques were then employed. Evaluation of the incidence of atopic eczema was also examined longitudinally based on timeframe. Grading of Recommendations, Assessment, Development and Evaluations (GRADE) assessments were employed to determine the quality of the evidence.
RESULTS
Eleven randomized controlled trials were identified which examined L. rhamnosus in its effect on atopy. Risk of bias was low on the majority of the domains assessed. Meta-analysis of the timeframes ≤ 2 years (RR 0.60, 95% CI 0.47-0.75; p < 0.00001) and 6-7 years (RR 0.62, 95% CI 0.50-0.75; p < 0.00001) demonstrated statistically significant reductions in atopic eczema with use of L. rhamnosus. For the 4 to 5-year (RR 0.74, 95% CI 0.55-1.00; p = 0.05) and 10-11-year (RR 0.68, 95% CI 0.37-1.27; p = 0.23) timeframes there was no statistically significant reduction. GRADE assessment for each timeframe was considered moderate in two, owing to high attrition rates in all of the studies, and low in two due to imprecision.
CONCLUSION
Based on the meta-analysis and GRADE assessments, the use of L. rhamnosus with or without other probiotics appears to have a positive effect in reducing the incidence of atopic eczema in pediatric patients at least out to 7 years. Attrition rates temper these findings.
Topics: Child; Databases, Factual; Dermatitis, Atopic; Female; Humans; Infant; Lacticaseibacillus rhamnosus; Pregnancy; Probiotics; Randomized Controlled Trials as Topic
PubMed: 36161401
DOI: 10.1007/s40257-022-00723-x -
European Journal of Pediatrics Aug 2023The "Atopy Patch Test" (APT) has been proposed as a diagnostic tool for food allergies (FA), especially in children with FA-related gastrointestinal symptoms. However,... (Meta-Analysis)
Meta-Analysis Review
The "Atopy Patch Test" (APT) has been proposed as a diagnostic tool for food allergies (FA), especially in children with FA-related gastrointestinal symptoms. However, its diagnostic accuracy is debated, and its usefulness is controversial. The aim of this systematic review was to evaluate the APT diagnostic accuracy compared with the diagnostic gold standard, i.e., the oral food challenge (OFC), in children affected by non-IgE mediated gastrointestinal food allergies, including the evaluation in milk allergic subgroup. Both classical non-IgE mediated clinical pictures and food induced motility disorders (FPIMD) were considered. The search was conducted in PubMed and Scopus from January 2000 to June 2022 by two independent researchers. The patient, intervention, comparators, outcome, and study design approach (PICOS) format was used for developing key questions, to address the APT diagnostic accuracy compared with the oral food challenge (OFC). The quality of the studies was assessed by the QUADAS-2 system. The meta-analysis was performed to calculate the pooled sensitivity, specificity, DOR (diagnostic odds ratio), PLR (positive likelihood ratio), and NLR (negative likelihood ratio) with their 95% confidence intervals (CI). Out of the 457 citations initially identified via the search (196 on PubMed and 261 on Scopus), 37 advanced to full-text screening, and 16 studies were identified to be included in the systematic review. Reference lists from relevant retrievals were searched, and one additional article was added. Finally, 17 studies were included in the systematic review. The analysis showed that APT has a high specificity of 94% (95%CI: 0.88-0.97) in the group of patients affected by FPIMD. Data showed a high pooled specificity of 96% (95% CI: 0.89-0.98) and the highest accuracy of APT in patients affected by cow's milk allergy (AUC = 0.93). Conclusion: APT is effective in identifying causative food in children with food-induced motility disorders. What is Known: • Atopy patch test could be a useful diagnostic test for diagnosing food allergy, especially in children with food allergy-related gastrointestinal symptoms. What is New: • Atopy patch test may be a useful tool in diagnosing non IgE food allergy, especially in children with food-induced gastrointestinal motility disorders and cow's milk allergy.
Topics: Female; Animals; Cattle; Child; Humans; Patch Tests; Milk Hypersensitivity; Sensitivity and Specificity; Food Hypersensitivity; Hypersensitivity, Immediate; Allergens; Gastrointestinal Diseases
PubMed: 37249680
DOI: 10.1007/s00431-023-04994-2 -
Clinical and Translational Allergy Jun 2023Atopic dermatitis and food allergy are two frequently concomitant manifestations of the presence of atopy. A substantial number of studies have been published on the... (Review)
Review
BACKGROUND
Atopic dermatitis and food allergy are two frequently concomitant manifestations of the presence of atopy. A substantial number of studies have been published on the association of birth order and sibship size (number of siblings) with atopic dermatitis, food allergy, and atopy. The present work is the first systematic synthesis of the existing literature on this topic.
METHODS
Fifteen databases were searched. Screening, data extraction, and quality assessment were performed by independent pairs. Comparable numerical data were statistically synthesized using random-effects robust variance estimation.
RESULTS
In total, 114 studies were included out of 8819 papers obtained from database searches. Birth order ≥2 versus 1 was associated with lower risk of ever atopic dermatitis (pooled risk ratio [RR] 0.91, 95% CI 0.84-0.98), current food allergy (RR 0.77, 95% CI 0.66-0.90), and positive skin prick test (SPT) to common aeroallergens (RR 0.86, 95% CI 0.77-0.97). Sibship size ≥2 versus 1 was associated with decreased risk of current atopic dermatitis (RR 0.90, 95% CI 0.83-0.98), ever atopic dermatitis (RR 0.92, 95% CI 0.86-0.97), and positive SPT to common aeroallergens (RR 0.88, 95% CI 0.83-0.92). No putative associations were seen regarding atopy assessed through allergen-specific immunoglobulin E with common allergens.
CONCLUSION
The presence of siblings and being second-born or later may decrease the lifetime risk of atopic dermatitis and food allergy, albeit marginally. Similar association was seen with SPT sensitization. However, significant protection was not found for IgE sensitization.
PubMed: 37357553
DOI: 10.1002/clt2.12270 -
International Journal of Environmental... Nov 2018In the last decade, studies investigating greenspace have highlighted several benefits to human health. However, the effect of greenspace on allergies and atopic...
In the last decade, studies investigating greenspace have highlighted several benefits to human health. However, the effect of greenspace on allergies and atopic sensitization in children was not clear. While several studies have investigated this link, the evidence has not been systematically synthesized. We conducted a systematic search of eight databases. Study characteristics and findings were extracted from five articles covering 11 cohorts published between 2012 and 2016, and study quality assessments were performed. Due to significant heterogeneity, meta-analysis was not conducted. Findings were not consistent, possibly due to variations in exposure measurements, study populations and location, the specific allergens tested, and inclusion of confounders. Protective effects from greenspace were reported in four cohorts, while two cohorts showed an increase in sensitization related to greenspace. The other five cohorts found no significant effect of greenspace on atopic sensitization. There is limited understanding of the contributions of greenspace to specific allergens. Future research should consider amount and type of greenspace, as well as the specific allergens tested.
Topics: Adolescent; Allergens; Child; Gardens; Humans; Hypersensitivity; Hypersensitivity, Immediate; Immunoglobulin E; Parks, Recreational
PubMed: 30428525
DOI: 10.3390/ijerph15112539 -
Frontiers in Nutrition 2022Allergic diseases are type I hypersensitivity reactions mediated by various allergens. The most common allergic diseases include allergic rhinitis, allergic asthma,...
BACKGROUND
Allergic diseases are type I hypersensitivity reactions mediated by various allergens. The most common allergic diseases include allergic rhinitis, allergic asthma, allergic dermatitis, and allergic conjunctivitis. The incidence of allergic diseases has been increasing in the recent past, and allergen avoidance and adoption of desensitization treatment can significantly decrease the incidence of allergic diseases. Previous studies have explored the association between vitamin A supplementation and allergic diseases; however, the results are inconsistency. The aim of the present study was to evaluate the association between vitamin A supplementation and allergic diseases, with a focus on atopy and wheezing.
METHODS
Articles reporting randomized controlled trials (RCTs) on the association of vitamin A supplementation and allergic diseases were retrieved from PubMed, Embase, Web of science, and China National Knowledge Infrastructure database from inception of to November 15, 2021. STATA 12.0 software was used for meta-analysis, sensitivity analysis and analysis of publication bias.
RESULTS
Seven studies comprising 2201 participants met the inclusion criteria and were included in the meta-analysis. The findings showed that vitamin A supplementation was associated with increased risk of atopy in young females compared with the placebo [RR = 1.70, 95% confidence interval (1.20, 2.41), = 0.171, = 43.4% fixed effect model]. The frequency of delayed atopy among adults was associated with vitamin A supplementation (MD = 0.46, 95% CI = 0.04, 0.88). Analysis showed no significant association between vitamin A supplementation with incidence of wheezing in children [RR = 1.40, 95% CI (0.49, 3.98), = 0.018, = 82.1% random effect model]. Sensitivity and publication bias analysis showed that each individual study did not affect the combined results and there was no significant publication bias among the studies.
CONCLUSION
The findings showed that vitamin A supplementation is associated with increased risk of atopy but no correlation was observed with the incidence of wheezing. The results of this meta-analysis provide evidence for effective management of fibrosis. More studies should be conducted to verify the results.
PubMed: 36466392
DOI: 10.3389/fnut.2022.984161 -
Journal of Asthma and Allergy 2022To summarize the current evidence regarding the prevalence of Allergic rhinitis (AR) and its symptoms, triggers, and impact on the quality of life of the Saudi... (Review)
Review
OBJECTIVE
To summarize the current evidence regarding the prevalence of Allergic rhinitis (AR) and its symptoms, triggers, and impact on the quality of life of the Saudi population.
METHODS
A Computerized Search in MEDLINE via PubMed, MEDLINE Core database, Scopus, and Web of Science was conducted using relevant keywords. A two-stage screening process, data extraction, and quality assessment were conducted by four independent reviewers. Comprehensive Meta-analysis was used for all statistical analyses (CMA; USA: version 3.3.070).
RESULTS
Sixteen articles (n= 31,990 patients) were included. The overall estimated prevalence of AR was 21.2%, 95% CI (12.8-33.1%). Males had a higher prevalence of AR than females (31.7% vs 27.1%), although the difference was not significant (OR=1.24, 95% CI: 0.78-1.953; p=0.356). Children and adolescents exhibited a lower prevalence of AR than adults (13.7% vs 31.1%). Urban AR prevalence was much greater than rural (38.4% vs 13.0%). Asthma, atopic dermatitis, and eczema are all associated with AR. The most common signs and symptoms of AR were headache 33.9%, watery discharge 28.6%, sneezing 24.6%, itchy nose, runny nose 22.2%, nasal obstruction or congestion 22.0%, loss of smell 21.9%, and wheezing 17.2%. The most prevalent triggers of AR were perfume 36.8%, dust 27.3%, air conditioning 23.4%, weather or temperature changes 17.8%, air pollution 14.5%, drugs or chemicals 13.8%, tobacco 10.8%, atopy 10.3%, and insects 10.2%.
CONCLUSION
The overall prevalence of AR in Saudi Arabia is 21.2%. The prevalence of AR was comparable in both males and females. However, it was higher in adults than in children and adolescents, and in urban areas than rural areas. Asthma, atopic dermatitis, and eczema co-occurrence with AR are common. AR has a negative impact on the quality of life of the patients in the form of interference with daily activities, sleep problems, difficulty of breath, and school absenteeism.
PubMed: 36582219
DOI: 10.2147/JAA.S391142 -
Clinical and Experimental Allergy :... Feb 2020While chronic inflammation is a well-established risk factor for malignancy, studies evaluating the relationship between allergic inflammation and cancer have revealed... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
While chronic inflammation is a well-established risk factor for malignancy, studies evaluating the relationship between allergic inflammation and cancer have revealed conflicting results. Here, we aimed to assess the association between allergic inflammation in the lung (asthma), skin (eczema) or oesophagus (eosinophilic oesophagitis; EoE) and cancer at the organ site.
DESIGN
We conducted a systematic review of the literature to identify observational studies (case-control, cohort and cross-sectional) evaluating the association between asthma and lung cancer, eczema and skin cancer, or EoE and oesophageal cancer. Random-effects meta-analysis was performed to define pooled estimates of effects.
DATA SOURCES
PubMed, EMBASE and Web of Science.
ELIGIBILITY CRITERIA FOR SELECTION
Included studies evaluated the incidence of cancer.
RESULTS
Thirty-two studies met the inclusion criteria, 27 in the lung, four in the skin and one in the oesophagus. Meta-analysis of the three studies with prospective data collection of asthma diagnosis revealed a positive association with incident lung cancer (OR 1.27, 95% CI 1.09-1.44); however, this result was not consistently supported by the larger dataset of retrospective studies (OR 1.37, 95% CI 0.90-1.83). Overall, studies in the lung displayed significant heterogeneity (I 98%, P < .0001), but no significant effect modification on the association between asthma and lung cancer was identified for the variables of sex, smoking or study design. Meta-analysis could not be applied to the four papers reviewed in the skin, but three suggested an association between eczema and non-melanoma skin cancer, while the remaining study failed to identify an association between melanoma and eczema. A single study meeting inclusion criteria showed no association between EoE and oesophageal malignancy.
CONCLUSIONS
The current data cannot exclude the possibility of an association between atopy and malignancy the lung, skin and oesophagus. The relationship between allergy and cancer should be explored further in prospective studies that any association identified between these conditions has the potential for significant public health implications.
Topics: Asthma; Dermatitis, Atopic; Eosinophilic Esophagitis; Humans; Inflammation; Neoplasms
PubMed: 31743536
DOI: 10.1111/cea.13537 -
BioMed Research International 2016Irreversible airway obstruction (IAO) is a subtype of asthma and relates to poorer prognosis in some asthma patients. However, the prevalence and risk factors for IAO... (Meta-Analysis)
Meta-Analysis Review
Irreversible airway obstruction (IAO) is a subtype of asthma and relates to poorer prognosis in some asthma patients. However, the prevalence and risk factors for IAO are unknown. A systematic review regarding controlled clinical studies (cohort, case-control studies) on IAO asthma in adult and/or children affected by asthma/early wheeze was performed. Eighteen papers were identified in this study. It was reported that the incidence of IAO at random effects or fixed effects in severe asthma and nonsevere asthma was 0.54 (95% CI: 0.45-0.62) and 0.16 (95% CI: 0.12-0.20), respectively. In IAO asthma, the pooled odds ratio (OR) related to smoking exposure was 2.22 (95% CI: 1.82-2.73), the OR for male, smoking, and fractional exhaled nitric oxide (FENO) was 2.22 (95% CI: 1.82-2.7), 1.79 (95% CI: 1.46-2.19), and 2.16 (95% CI: 1.05-4.43), respectively, suggesting these factors increase the risk of IAO. However, a decreased OR in IAO asthma was observed due to rhinitis (OR = 0.31, 95% CI: 0.24-0.40), atopy (OR = 0.584, 95% CI: 0.466-0.732), and atopic dermatitis (OR = 0.60, 95% CI: 0.42-0.85), indicating these factors are associated with reduced risk of IAO. IAO in asthma is associated with gender, smoking, FENO, rhinitis, atopy, and atopic dermatitis.
Topics: Adult; Airway Obstruction; Asthma; Child, Preschool; Dermatitis, Atopic; Female; Humans; Male; Nitric Oxide; Rhinitis; Risk Factors; Tobacco Smoke Pollution
PubMed: 27119087
DOI: 10.1155/2016/9868704 -
Allergy Jan 2016A growing number of studies suggest that maternal stress during pregnancy promotes atopic disorders in the offspring. This is the first systematic review to address... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
A growing number of studies suggest that maternal stress during pregnancy promotes atopic disorders in the offspring. This is the first systematic review to address prenatal maternal stress (PNMS) and the subsequent risk of atopy-related outcomes in the child.
METHODS
The review was performed in accordance to the PRISMA criteria. We searched and selected studies in PubMed, Scopus, Embase and PsychINFO until November 2014.
RESULTS
Sixteen (with 25 analyses) of 426 identified articles met the review criteria. Five main PNMS exposures (negative life events, anxiety/depression, bereavement, distress and job strain) and five main atopic outcomes (asthma, wheeze, atopic dermatitis, allergic rhinitis and IgE) were assessed across the studies. Overall, 21 of the 25 analyses suggested a positive association between PNMS and atopic outcomes. Of the 11 exposure-response analyses reported, six found statistically significant trends.
CONCLUSION
This systematic review suggests a relationship between maternal stress during pregnancy and atopic disorders in the child. However, the existing studies are of diverse quality. The wide definitions of often self-reported stress exposures imply a substantial risk for information bias and false-positive results. Research comparing objective and subjective measures of PNMS exposure as well as objective measures for atopic outcome is needed.
Topics: Child; Child, Preschool; Female; Humans; Hypersensitivity, Immediate; Infant; Maternal Exposure; Odds Ratio; Pregnancy; Prenatal Exposure Delayed Effects; Stress, Physiological; Stress, Psychological
PubMed: 26395995
DOI: 10.1111/all.12762