An update on prevalence and risk of snus and nicotine replacement therapy during pregnancy and breastfeeding.

AIM: In parallel with falling smoking rates, use of the oral moist tobacco product snus increases among women in reproductive age. We report an update on prevalence and effects of maternal use of snus and nicotine replacement therapy (NRT) during pregnancy and breastfeeding. METHODS: A literature search of human studies in Medline, PubMed and EMBASE was conducted from September 2016 to May 2018, with stepwise screening of abstracts and subsequent relevant full-text papers for inclusion in Scandinavian and English languages. RESULTS: Based on three studies, the prevalence of snus use in pregnancy was up to 3.4% in the first trimester and 2.1% in the third trimester. In 12 studies, we found increased risk of several adverse effects, especially preterm delivery, stillbirth and small for gestational age associated with maternal snus use during pregnancy. Knowledge on effects of NRT during pregnancy was conflicting and inconclusive in 10 studies. We did not identify any studies on prevalence or potential health effects of snus or NRT during breastfeeding. CONCLUSION: Few studies with updated data on the prevalence and adverse health effects of maternal use of snus and NRT during pregnancy were found. No studies during breastfeeding were identified.

Can early skin care normalise dry skin and possibly prevent atopic eczema? A pilot study in young infants.

BACKGROUND: Atopic eczema (AE) affects approximately 20% of children in Northern countries. Onset during early infancy is common and is characterised by altered skin barrier, increased water loss and defective lipid layer. Restoration of skin barrier by emollients and/or oil baths is an important part of AE treatment, but its role in preventing xerosis and AE is unknown. The present pilot study aimed to assess if xerosis, and possibly AE, could be reduced at six months of age by early introduction of frequent oil baths/facial fat cream in infants with dry skin. METHODS: A controlled intervention pilot study included 56 six-week-old infants with xerosis, but not AE. Skin quality score ranging from 0 (normal skin) to 4 (probable AE), was assessed at inclusion, three and six months of age, with skin quality at six months as main outcome. One well baby clinic was recruited for intervention, frequent skin care (oil bath (0.5 dl) and facial fat cream, five well baby clinics recruited for observation only. RESULTS: The intervention group (n=24) had more often normal skin (75%) at six months than the observation group (37.5%) (p<0.001), and less often probable AE (4.0 vs. 19.0%, respectively, ns). Oil baths were performed regularly, 2-4 up to 5-7 times/week in the intervention group, vs. fewer oil baths with sparse volume of oil in the observation group. No adverse reactions were reported. CONCLUSION: Regular oil baths in infants seem to reduce xerosis and may possibly reduce atopic eczema.

Do allergic families avoid keeping furry pets?

UNLABELLED: Studies addressing the relationship between pet keeping and development of asthma and allergies may be influenced by pet avoidance in families with a history of allergic disease. Following a cohort of 1019 children in Oslo till 10 years of age, we studied the association of pet keeping with socio-economic factors and allergic disease in the family. A family history of asthma and rhinoconjunctivitis was not significantly associated with pet ownership at birth or with pet removal by 10 years. Acquiring cats and dogs was less likely if the child had allergic rhinoconjunctivitis, whereas no association was seen with asthma (in any family member). Single parenthood increased the likelihood of acquiring a cat, smoking parents more often had cats or dogs, and having older siblings was associated with keeping dogs and other furry pets. Among 319 families reporting pet avoidance, 70% never had pets, 8% had given up pets, and 22% avoided a particular type of pet only. Twenty-four per cent of the parents failed to retrospectively report pet keeping during the child's first year of life. Overall, allergic rhinitis, but not asthma was associated with actual pet avoidance, whereas the strongest predictors for keeping pets were found to be socio-economic factors. PRACTICAL IMPLICATIONS: Allergic disease in a child most often does not lead to the removal of the family's furry pet. Pet avoidance is associated with allergic symptoms, but not asthma. Socio-economic factors like parental education, single parenthood and smoking affects the families' decisions on pet keeping, including the type of pets the families will avoid or acquire. The large recall error demonstrated points to the need for prospective data regarding pet keeping.

A TLR2 polymorphism is associated with type 1 diabetes and allergic asthma.

Type 1 diabetes (T1D) and allergic asthma are immune-mediated diseases. Pattern recognition receptors are proteins expressed by cells in the immune system to identify microbial pathogens and endogenous ligands. Toll-like receptors (TLRs) and CD14 are members of this family and could represent a molecular link between microbial infections and immune-mediated diseases. Diverging hypotheses regarding whether there exists a common or inverse genetic etiology behind these immune-mediated diseases have been presented. We aimed to test whether there exist common or inverse associations between polymorphisms in the pattern recognition receptors TLR2, TLR4 and CD14 and T1D and allergic asthma. Eighteen single nucleotide polymorphisms (SNPs) were genotyped in TLR2 (2), TLR4 (12) and CD14 (4) in 700 T1D children, 357 nuclear families with T1D children and 796 children from the 'Environment and Childhood Asthma' study. Allele and haplotype frequencies were analyzed in relation to diseases and in addition transmission disequilibrium test analyses were performed in the family material. Both T1D and allergic asthma were significantly associated with the TLR2 rs3804100 T allele and further associated with the haplotype including this SNP, possibly representing a susceptibility locus common for the two diseases. Neither TLR4 nor CD14 were associated with T1D or allergic asthma.

Norwegian adolescents with asthma are physical active and fit.

BACKGROUND: Evidence regarding habitual physical activity levels and aerobic fitness of asthmatic compared to nonasthmatic children and adolescents is contradictory, and it is unclear if low physical activity levels can contribute to asthma development. The present study therefore aimed to determine whether adolescents with asthma have reduced physical activity levels and aerobic fitness, or increased energy intake and body fat compared to controls. METHODS: From the environment and childhood asthma study in Oslo, 174 (13- to 14-year old) adolescents, 95 (66 boys) with and 79 (41 boys) without asthma performed maximal running on a treadmill with oxygen consumption measurement (aerobic fitness) and had the sum of four skinfolds and waist circumference recorded (body fat), followed by wearing an activity monitor and registering diet for four consecutive days. Asthma was defined by at least two of the following three criteria fulfilled: (1) dyspnoea, chest tightness and/or wheezing; (2) a doctor's diagnosis of asthma; (3) use of asthma medication. Participants with asthma used their regular medications. RESULTS: Neither aerobic fitness, total energy expenditure nor hours in moderate to very vigorous intensity physical activity during week and weekend differed between adolescents with and without asthma. Energy intake and body fat was similar in both groups. CONCLUSIONS: Total energy expenditure, aerobic fitness and hours in moderate to very vigorous intensity physical activity were not reduced and energy intake and body fat measured with skinfolds not increased among Norwegian adolescents with asthma.

Severity of obstructive airways disease by age 2 years predicts asthma at 10 years of age.

BACKGROUND: Predicting school-age asthma from obstructive airways disease (OAD) in early life is difficult, even when parental and children's atopic manifestations are taken into consideration. OBJECTIVE: To assess if the severity of OAD in the first 2 years of life predicts asthma at 10 years of age. METHODS: From a nested case control study within the Environment and Childhood Asthma study, 233 2-year-old subjects with recurrent (> or = 2 episodes) bronchial obstruction (rBO+) and 216 subjects without bronchial obstruction (rBO-) underwent clinical examination, parental interview, treadmill test and metacholine bronchial hyperresponsiveness (BHR) measurement at 10 years. A severity score at 2 years was calculated by frequency, persistence of bronchial obstruction and hospital admissions because of OAD. MAIN OUTCOMES: Current asthma at 10 years (asthma with symptoms and/or asthma medication during the past year and/or positive treadmill test). Secondary outcome was metacholine BHR at 10 years. RESULTS: Compared with rBO- subjects, adjusted odds ratio (95% CI) of current asthma among rBO+ was 7.9 (4.1, 15.3), and among rBO+ with a severity score of > 5, 20.2 (9.9, 41.3). In receiver operated characteristic analysis, positive and negative predictive values demonstrated the applicability and value of the score, with an optimal cut-off at severity score 5. Children with severity score > 5 had severe BHR more often (PD20 metacholine < 1 micromol) than children with a lower or 0 score (p = 0.0041). CONCLUSION: Using a simple scoring system, a high severity score of OAD by 2 years of age is a strong risk factor for, and may predict, current asthma at 10 years of age.

Acid suppression does not change respiratory symptoms in children with asthma and gastro-oesophageal reflux disease.

BACKGROUND: Epidemiological studies have shown an association between gastro-oesophageal reflux disease (GORD) and asthma, and oesophageal acid perfusion may cause bronchial constriction. However, no causative relation has been proven. AIM: To assess whether acid suppression would lead to reduced asthma symptoms in children with concomitant asthma and GORD. METHODS: Thirty eight children (mean age 10.8 years, range 7.2-16.8; 29 males) with asthma and a reflux index > or =5.0 assessed by 24 hour oesophageal pH monitoring were randomised to 12 weeks of treatment with omeprazole 20 mg daily or placebo. The groups were similar in age, gender, mean reflux index, and asthma severity. Primary endpoints were asthma symptoms (daytime wheeze, symptoms at night, in the morning, and during exercise) and quality of life (PAQLQ). Secondary endpoints were changes in lung function and the use of short acting bronchodilators. At the end of the study a repeated pH study was performed to confirm the efficacy of acid suppression. RESULTS: The change in total symptom score did not differ significantly between the omeprazole and the placebo group, and decreased by 1.28 (95% CI -0.1 to 2.65) and 1.28 (95% CI -0.72 to 3.27) respectively. The PAQLQ score increased by 0.62 (95% CI 0.29 to 0.95) in the omeprazole group compared to 0.50 (95% CI 0.29 to 0.70) in the placebo group. Change in lung function and use of short acting bronchodilators were similar in the groups. The acid suppression was adequate (reflux index <5.0) under omeprazole treatment. CONCLUSION: Omeprazole treatment did not improve asthma symptoms or lung function in children with asthma and GORD.