Systematic Review on the Definition of Allergic Diseases in Children: The MeDALL Study

Pinart, Mariona; Albang, Richard; Maier, Dieter; Durán-Tauleria, Enric; Mena, Guillermo; Gimeno‐Santos, Elena; Solà, Iván; Garcia‐Aymerich, Judith; Guerra, Stefano; Stein, Renato T.; Benet, Marta; Carlsen, Kai‐Håkon; Herr, Marie; Jacquemin, Bénédicte; Momas, Isabelle; Pin, Isabelle; Rancière, Fanny; Smit, Henriëtte A.; Varraso, Raphäelle; Bonfill, Xavier; Keil, Thomas; Bousquet, Jean; Antó, Josep M.

doi:10.1159/000442414

Cited by 19 publications

(24 citation statements)

References 72 publications

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“…This finding may also reflect greater stability of IgE responses versus the more transient and heterogeneous nature of asthma across the life course. 44 …”

Section: Discussionmentioning

confidence: 99%

Early-life farm exposures and adult asthma and atopy in the Agricultural Lung Health Study

House

Wyss

Hoppin

et al. 2017

Journal of Allergy and Clinical Immunology

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Background Previous studies, mostly from Europe, suggest that early-life farming exposures protect against childhood asthma and allergy; few data exist on asthma and allergy in adults. Objective We sought to examine associations between early-life farming exposures and current asthma and atopy in an older adult US farming population. Methods We analyzed data from 1746 farmers and 1555 spouses (mean age, 63) from a case-control study nested within the Agricultural Health Study. Current asthma and early-life farming exposures were assessed via questionnaires. We defined atopy based on specific IgE > 0.70 IU/mL to at least 1 of 10 allergens measured in blood. We used logistic regression, adjusted for age, sex, race, state (Iowa or North Carolina), and smoking (pack years), to estimate associations between early-life exposures and asthma (1198 cases and 2031 noncases) or atopy (578 cases and 2526 noncases). Results Exposure to the farming environment in utero and in early childhood had little or no association with asthma but was associated with reduced odds of atopy. The strongest association was seen for having a mother who performed farm activities while pregnant (odds ratio, 0.60; 95% CI, 0.48–0.74) and remained significant in models with correlated early-life exposures including early childhood farm animal contact and raw milk consumption. Conclusions In a large US farming population, early-life farm exposures, particularly maternal farming activities while pregnant, were strongly associated with reduced risk of atopy in adults. These results extend previous work done primarily on childhood outcomes and suggest that protective associations of early-life farming exposures on atopy endure across the life course.

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“…This finding may also reflect greater stability of IgE responses versus the more transient and heterogeneous nature of asthma across the life course. 44 …”

Section: Discussionmentioning

confidence: 99%

Early-life farm exposures and adult asthma and atopy in the Agricultural Lung Health Study

House

Wyss

Hoppin

et al. 2017

Journal of Allergy and Clinical Immunology

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“…Individuals have periods of apparent remission followed by recurrence, highlighting the importance of longitudinal follow‐up of individual patients in the determination of persistence . Thirdly, recall bias is another significant problem in relation to ‘outgrown’ AD, with many adult patients not remembering that they had AD in their childhood or not recognizing the diagnosis due to the specific terminology used in questionnaires, such as ‘eczema’, ‘itchy rash’ or ‘atopic dermatitis’ …”

Section: The Challenge Of Identifying Patients Who Will ‘Outgrow’ Atomentioning

confidence: 99%

Disease trajectories in childhood atopic dermatitis: an update and practitioner's guide

Irvine

Mina‐Osorio

2019

Br J Dermatol

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SummaryBackgroundAtopic dermatitis (AD) is a heterogeneous disease with a multifactorial aetiology and complex pathophysiology. This heterogeneity translates into different trajectories of disease progression with respect to severity, persistence and risk of development of atopic comorbidities. Determining which possible disease trajectories or comorbidities any individual child might develop is challenging in clinical practice. Tools that help identify paediatric patients at higher risk of disease progression would greatly aid clinicians.MethodsWe reviewed recent cohort studies to synthesize and simplify the epidemiological data to try to identify shared clinically relevant characteristics that may help physicians estimate the risk of disease progression in paediatric patients with AD.ResultsDespite the variability in data collection and methods of analysis and their limitations, there are common patterns of early‐childhood AD that may aid in the estimation of risk for disease progression. Factors associated with risk of AD progression include younger age of onset, family history of atopy, greater AD severity, filaggrin mutations, urban environment and polysensitization and/or allergic multimorbidity. Based on these factors, we provide a practitioner's guide for identifying, counselling and/or referring infants and children with AD at potentially higher risk of developing persistent AD and atopic comorbidities. We also present clinical scenarios to illustrate how these data relate to real‐life situations.ConclusionsUseful insights are provided for physicians and patients to inform them better about the risk of AD progression and to help guide care pathways for the paediatric population with AD. What's already known about this topic? The complex pathophysiology of atopic dermatitis (AD) translates into a heterogeneous clinical presentation and trajectories of disease progression.Although the consensus is that most paediatric patients with AD will eventually ‘outgrow’ the disease or follow the longitudinal trajectory known as the ‘atopic march’, a significant proportion will develop persistent AD and/or other atopic conditions.No known factors conclusively predict the risk of progression or development of comorbidities. What does this study add? Recent analyses of data from large cohorts of paediatric patients with AD have suggested the existence of potentially discrete clusters of patients who present with relatively common AD phenotypes.These studies have shed some light onto the factors associated with risk of progression, which we review in this article.A practitioner's guide with clinical scenarios is provided to help identify patients at high risk of progression to determine whether a patient should be monitored and/or would require specialist referral.

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“…The review showed that studies reporting the phenotypes of IgE‐associated diseases in children are heterogeneous and often lack objective measures. The knowledge on multimorbidity was mostly restricted to links between asthma and rhinitis .…”

Section: Novel Findingsmentioning

confidence: 99%

Paving the way of systems biology and precision medicine in allergic diseases: the Me DALL success story

Bousquet

Antó

Akdiş

et al. 2016

Allergy

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MeDALL (Mechanisms of the Development of ALLergy; EU FP7‐CP‐IP; Project No: 261357; 2010–2015) has proposed an innovative approach to develop early indicators for the prediction, diagnosis, prevention and targets for therapy. MeDALL has linked epidemiological, clinical and basic research using a stepwise, large‐scale and integrative approach: MeDALL data of precisely phenotyped children followed in 14 birth cohorts spread across Europe were combined with systems biology (omics, IgE measurement using microarrays) and environmental data. Multimorbidity in the same child is more common than expected by chance alone, suggesting that these diseases share causal mechanisms irrespective of IgE sensitization. IgE sensitization should be considered differently in monosensitized and polysensitized individuals. Allergic multimorbidities and IgE polysensitization are often associated with the persistence or severity of allergic diseases. Environmental exposures are relevant for the development of allergy‐related diseases. To complement the population‐based studies in children, MeDALL included mechanistic experimental animal studies and in vitro studies in humans. The integration of multimorbidities and polysensitization has resulted in a new classification framework of allergic diseases that could help to improve the understanding of genetic and epigenetic mechanisms of allergy as well as to better manage allergic diseases. Ethics and gender were considered. MeDALL has deployed translational activities within the EU agenda.

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Systematic Review on the Definition of Allergic Diseases in Children: The MeDALL Study

Cited by 19 publications

References 72 publications

Early-life farm exposures and adult asthma and atopy in the Agricultural Lung Health Study

Early-life farm exposures and adult asthma and atopy in the Agricultural Lung Health Study

Disease trajectories in childhood atopic dermatitis: an update and practitioner's guide

Paving the way of systems biology and precision medicine in allergic diseases: the Me DALL success story

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