Peak nasal inspiratory flow in children with allergic rhinitis. Is it related to the quality of life?

INTRODUCTION AND OBJECTIVES: Allergic rhinitis (AR) is the most common allergic disease in childhood. Nasal obstruction is a typical symptom of AR, however, its quantification by clinical examination is difficult. To provide an objective assessment of nasal patency, the peak nasal inspiratory flow (PNIF) is used. Symptoms of AR have a noticeable impact on the quality of life. The aim of this study was to assess which factors may have an impact on PNIF values and to evaluate the possible relationships between PNIF and QoL in children with AR. PATIENTS AND METHODS: We recruited patients aged 6-17 years (n = 208, 89 girls and 119 boys) with AR. All children underwent PNIF measurements. Parents and children completed KINDL-R generic questionnaires, to assess the quality of life of the children. RESULTS: The average PNIF value was 98.9 ±â€¯37.4 L/min. A very strong (p < 0.001) relationship between the PNIF value and height, age and weight of the child was observed. The sex of the patient has no influence on the PNIF value. We showed that PNIF values significantly increased with each attempt. The children assessed their QoL at 45.6 ±â€¯8.5 points in the KINDL-R questionnaire and the parents rated their children's QoL at 73.7 ±â€¯10.7 points. We observed a weak negative correlation between PNIF and the QoL based on the parents' assessment and the child's self-assessment. CONCLUSIONS: PNIF values depend mostly on height, but also on the child's age and weight. A learning effect (significant increase in PNIF upon each attempt) was shown. Higher PNIF does not improve the QoL.

Microbiome in the primary prevention of allergic diseases and bronchial asthma.

Tremendous progress in the ability to identify and test the function of microorganisms in recent years has led to a much better understanding of the role of environmental and host microbiome in the development of immune function, allergic sensitization and asthma. In this review, the most recent findings on the relationships between environmental microbiota, respiratory, intestinal microbiome, the consequences of early-life microbial exposure type and gut-lung microbial axis and the development of asthma and atopy are summarized. The current perspective on gut and airway microbiome manipulation for the primary prevention of allergic diseases and asthma is also discussed.

Changes in the prevalence of cigarette smoking and quitting smoking determinants in adult inhabitants of rural areas in Poland between 2003 and 2012.

OBJECTIVES: We investigate trends in the prevalence of cigarette smoking among adults at all ages in two time points 9 years apart in two neighbouring rural populations and examine social and respiratory health determinants of quitting smoking. STUDY DESIGN: Repeated cross-sectional study. METHODS: Two cross-sectional surveys were conducted in the same rural area of lower Silesia in Poland in 2003 and 2012. A total of 1328 (91% of adult eligible individuals) in 2003 and 1449 (92% of eligible) in 2012 adult inhabitants were surveyed, 908 people (560 villagers and 348 town inhabitants) participated in both surveys. Participants completed a questionnaire on smoking behaviour, education level and respiratory diseases. RESULTS: Current smoking was higher in the villages than the town, among men than women and those with a middle level of education. The prevalence of current smokers decreased over time, although this decline was much more pronounced in the town than in the villages (30.2% vs 23% and 35.5% vs 33.7%, respectively). Men were more likely to stop smoking than women both in villages and in town. The prevalence of current smokers among village women even increased between the two surveys from 27.6% to 29.3%. Respiratory diseases did not influence quitting smoking. CONCLUSIONS: The degree of decreasing trend in smoking prevalence varied considerably within neighbouring populations. It was mainly seen in the town and among younger people. Men and those better educated were more willing to quit smoking. The discrepancies between two close rural populations indicates the need for an individual approach when designing programs of tobacco control.

Changes in atopy prevalence and sibship effect in rural population at all ages.

BACKGROUND: We examined the associations of family size and birth order with atopy prevalence in rural Poland at two time periods. METHODS: Two cross-sectional surveys were conducted in the same villages and a small town of lower Silesia at an interval of 9 years. In 2003, 1700 (88% of eligible individuals), and in 2012, 1730 (86%) inhabitants aged 5 years or more completed a questionnaire and had a skin prick test for atopy. RESULTS: There was an inverse association between family size and atopy in the village population in 2003; the prevalence of atopy was the highest for those with no siblings (15.2%) and decreased to 5.4% for those with three and more siblings (OR = 0.22; 0.07-0.66). In contrast, there was little or no such protective effect in the town population where the prevalence of atopy was much higher (7.3% in the villages, 20.0% in the town). Nine years later, the prevalence of atopy had increased in the village to be similar to that in the town (19.6% and 19.9% respectively), and the protective effects of family size and birth order in the villages were much weaker (OR = 0.64; 95% CI 0.33-1.27 for three or more siblings). Both protective effects were strongest among children. CONCLUSIONS: The protective effects of family size and birth order on atopy were much stronger in children than in adults and among those living in a village. They largely disappeared with the steep increase in atopy prevalence at all ages; this followed environmental changes on the village farms.

Consumption of unpasteurized milk and its effects on atopy and asthma in children and adult inhabitants in rural Poland.

BACKGROUND: Consumption of unpasteurized cow's milk has been identified as a possible protective factor for atopy and asthma. Most studies have been conducted among children and in farming populations. We investigated the effects of consumption of unpasteurized milk in early life on atopy, asthma, and rhinitis in village and town inhabitants in a region of Poland and assessed whether any protective effects of milk consumption differed according to place of residence and farming status. METHODS: We surveyed the inhabitants (aged >5 years) of a small town and seven nearby villages in southwest Poland (n = 1700, response rate 88%). Participants (or their parents for those <16 years of age) completed a questionnaire on farm exposures and symptoms of asthma and rhinitis. In particular, information was collected on unpasteurized milk consumption in early life. Atopy was assessed using skin prick tests. RESULTS: Consumption of unpasteurized milk in the first year of life was inversely associated with atopy and asthma both among town and village inhabitants - town: adjusted odds ratio (aOR) for atopy 0.46 [95% confidence interval (CI) 0.37-0.52] asthma 0.51 (0.32-0.74); villages: atopy 0.59 (0.44-0.70) and asthma 0.59 (0.42-0.74). For atopy, the protective effect was more clearly seen among nonfarmers (0.42; 0.34-0.46) than in farmers (0.82; 0.54-1.11). For doctor-diagnosed hay fever and current rhinitis symptoms, the protective effect was only observed among town inhabitants and/or nonfarmers. CONCLUSIONS: Early-life exposure to unpasteurized milk may protect against atopy, asthma, and related conditions, independently of place of residence and farming status, and in both children and adults.

Asthma and allergies: is the farming environment (still) protective in Poland? The GABRIEL Advanced Studies.

BACKGROUND: Evidence exists that a farming environment in childhood may provide protection against atopic respiratory disease. In the GABRIEL project based in Poland and Alpine regions of Germany, Austria and Switzerland, we aimed to assess whether a farming environment in childhood is protective against allergic diseases in Poland and whether specific exposures explain any protective effect. METHODS: In rural Poland, 23 331 families of schoolchildren completed a questionnaire enquiring into farming practices and allergic diseases (Phase I). A subsample (n = 2586) participated in Phase II involving a more detailed questionnaire on specific farm exposures with objective measures of atopy. RESULTS: Farming differed between Poland and the Alpine centres; in the latter, cattle farming was prevalent, whereas in Poland 18% of village farms kept ≥1 cow and 34% kept ≥1 pig. Polish children in villages had lower prevalences of asthma and hay fever than children from towns, and in the Phase II population, farm children had a reduced risk of atopy measured by IgE (aOR = 0.72, 95% CI 0.57, 0.91) and skin prick test (aOR = 0.65, 95% CI 0.50, 0.86). Early-life contact with grain was inversely related to the risk of atopy measured by IgE (aOR = 0.66, 95% CI 0.47, 0.92) and appeared to explain part of the farming effect. CONCLUSION: While farming in Poland differed from that in the Alpine areas as did the exposure-response associations, we found in communities engaged in small-scale, mixed farming, there was a protective farming effect against objective measures of atopy potentially related to contact with grain or associated farm activities.

Opinions of children about participation in medical genetic research.

AIMS: The objective was to evaluate children's opinions about their participation in a large research project. METHODS: Polish children between 6 and 14 years of age completed a questionnaire about their participation in the Polish Gabriel study (which aims to identify genetic and environmental causes of asthma). In total 706 questionnaires were collected. RESULTS: Children's main motivation for participation was wanting to know whether they were healthy or not. Most children could think of no reasons to reconsider participation. Children aged 6-10 years might reconsider participating because they did not know what was going to happen. A third of the children were not informed by anybody about the study. Especially the youngest children indicated a need for a tailored letter (42%). The youngest children were less often asked for their opinion about participation. All children preferred that both parents and children are asked for consent or assent. Children who were not informed or not asked for their opinion seemed less emotionally involved in the study. CONCLUSION: While researchers and parents tend to focus their information provision to older children and include them in decision-making, especially the younger children expressed a need for more tailored information and involvement in their participation in research.

Atopy and asthma in rural Poland: a paradigm for the emergence of childhood respiratory allergies in Europe.

BACKGROUND: We hypothesized that, in south-west Poland, a 'rural' protective effect on atopy and respiratory allergies would be most pronounced among children but that at all ages would be stronger among those with a rural background. METHODS: A cross-sectional survey of the inhabitants (age >5 years, n = 1657) of Sobotka, a town of 4000 people in south-west Poland: and seven neighbouring villages. We measured and analysed responses to skin prick tests (atopy) and to a standard questionnaire (asthma and hayfever). RESULTS: Atopy was very uncommon (7%) among villagers at all ages but not among townspeople (20%, P < 0.001); the differences were most marked among those aged under 40 years. Asthma and hayfever were similarly distributed, both being very rare among villagers. The differences appear to be explained by the cohort effect of a communal move away from rural life. This interpretation is supported by an ecological correlation (rho = -0.59) between rural populations and childhood wheeze in 22 European countries. CONCLUSION: The very striking differences in the prevalence of allergy between these two neighbouring communities of central Europe reflect the pan-continental population movements that may have been responsible for the emergence of childhood allergies in Europe.