Common Hematologic, Nutritional, Asthma/Allergic Conditions and Lead Screening/Management.

This article describes hematologic, nutritional, allergic/asthmatic conditions, lead screening, and management of these among immigrants and refugees. Some of these conditions present more frequently or differently in the newcomer population. Early identification and treatment are key to improving health outcomes. Screening and treatment suggested in this article are based on current guidelines and are intended for primary care providers who are caring for refugee and immigrant patients, especially within a medical home. Special considerations include level of education, instruction, demonstration, and cultural humility.

Effect of multi-ethnicity and ancestry on prevalence of allergic disease.

BACKGROUND/PURPOSE: Differences exist among racial and ethnic groups in the prevalence and severity of allergic diseases. However, influence of population admixing on allergic disease has not been studied. We examined the effect of population admixing on the occurrence of allergic disease. METHODS: We reviewed the data of 68,043 adolescents who participated in the 11th Korea Youth Risk Behavior Web-based Survey, which provides a sample that is representative of the entire Korean middle school and high school student population. Multi-ethnic status was determined by using parental country of birth and prevalence of asthma, allergic rhinitis (AR), and atopic dermatitis (AD) was determined by questionnaire. RESULTS: Multi-ethnic adolescents accounted for approximately 0.9% of the total adolescents. Prevalence of asthma was significantly higher in multi-ethnic group than non multi-ethnic group while that of AR and AD was significantly higher in non multi-ethnic group than multi-ethnic group. Parental region of country at birth showed a significant difference in prevalence of allergic disease. Univariate analysis found that urbanity, perceived economic status (PES), parental region of country at birth, and environmental tobacco smoke (ETS) showed a significant odds ratio (OR) in asthma, AR, and AD. Body mass index (BMI) showed a significant OR in asthma and AD. After adjusting for urbanity, PES, BMI and ETS, multiethnicity showed significantly lower OR in AR and AD. CONCLUSION: Population admixing appears to have significant effect on the prevalence of allergic disease. Further study will be needed to clarify the effect of population admixing on prevalence of allergic disease.

Histamine skin reactivity increases with body mass index in Korean children.

OBJECTIVE: Histamine skin prick testing is most commonly used to diagnose immunoglobulin E (IgE)-mediated allergic diseases, and histamine reactivity is used as a standardized positive control in the interpretation of a skin prick test. However, reactivity to histamine differs among individuals for reasons that are poorly understood. The present study aimed to evaluate the potential association between body mass index (BMI) and histamine skin reactivity in children. METHODS: A total of 451 children (246 boys, 205 girls) aged 7-8 years were enrolled in this study. The skin prick test was performed with 26 aeroallergens commonly found in Korea. Other information was collected, including sex, age, BMI, parental allergy history, and parental smoking status. Multivariate analysis was used to confirm the association between histamine skin reactivity and BMI. RESULTS: The histamine wheal size was revealed to be associated with BMI (Spearman's Rho 0.161, p<0.001). This association was confirmed by multivariate analysis, after adjusting for sex, age, parental allergy history, parental smoking status, and allergic sensitization (coefficient B 0.071, 95% confidence interval 0.030-0.112). CONCLUSIONS: Skin responses to histamine were primarily correlated with increased BMI. Further studies are needed to understand the clinical implication of BMI when interpreting the results of skin prick test.

Prematurity, atopy, and childhood asthma in Puerto Ricans.

BACKGROUND: Puerto Rican children share a disproportionate burden of prematurity and asthma in the United States. Little is known about prematurity and childhood asthma in Puerto Rican subjects. OBJECTIVE: We sought to examine whether prematurity is associated with asthma in Puerto Rican children. METHODS: We performed a case-control study of 678 children aged 6 to 14 years with (n = 351) and without (n = 327) asthma living in San Juan, Puerto Rico. Prematurity was defined by parental report for our primary analysis. In a secondary analysis, we only included children whose parents reported prematurity that required admission to the neonatal intensive care unit. Asthma was defined as physician-diagnosed asthma and wheeze in the prior year. We used logistic regression for analysis. All multivariate models were adjusted for age, sex, household income, atopy (≥1 positive IgE level to common allergens), maternal history of asthma, and early-life exposure to environmental tobacco smoke. RESULTS: In a multivariate analysis there was a significant interaction between prematurity and atopy on asthma (P = .006). In an analysis stratified by atopy, prematurity was associated with a nearly 5-fold increased odds of asthma in atopic children (adjusted odds ratio, 4.7; 95% CI, 1.5-14.3; P = .007). In contrast, there was no significant association between prematurity and asthma in nonatopic children. Similar results were obtained in our analysis of prematurity requiring admission to the neonatal intensive care unit and asthma. CONCLUSIONS: Our results suggest that atopy modifies the estimated effect of prematurity on asthma in Puerto Rican children. Prematurity might explain, in part, the high prevalence of atopic asthma in this ethnic group.

Life style and home environment are associated with racial disparities of asthma and allergy in Northeast Texas children.

A high prevalence and racial disparities in asthma and allergy have been observed in American children. This study aimed to identify risk factors for asthma and allergy among children, and their contribution to racial disparities in allergy prevalence. A population-based cross-sectional study was carried out among children aged 1-8 years in Northeast Texas 2008-2009. The health conditions, life style and home environment of 3766 children were surveyed by parental questionnaires through e.g. daycares, elementary school, and medical clinics. Among participants who indicated their ethnicity, 255 were Mexican-Americans, 178 Afro-Americans and 969 Caucasians. Afro-American children had a significantly higher prevalence of asthma and eczema. Caucasian had the highest prevalence of rhinitis. Compared to Mexican-American children, Afro-American and Caucasian children were breast fed shorter time, more often went to day care center, had pets and environmental tobacco smoke exposure at home more often. For all children, being at a day care center, being exposed to dampness and environmental tobacco smoke at home were strong risk factors for asthma and allergy. Central air conditioning system was associated with an increased prevalence of wheeze among Mexican-American children, while pets were associated with an increased risk of rhinitis among Afro-American and Caucasian children. Caucasian children were generally not healthier than relatively poor Mexican-American children. Differences in the prevalence of asthma and allergy between races cannot be explained by socioeconomic status only. Life style and home environmental exposures are important risk factors for asthma and allergy in Northeast Texas children.

Racial differences in chronic immune stimulatory conditions and risk of non-Hodgkin's lymphoma in veterans from the United States.

PURPOSE: To examine underlying etiologic factors that may explain the racial disparity in non-Hodgkin's lymphoma (NHL) incidence patterns. PATIENTS AND METHODS: We assessed immune-related conditions and risk of developing NHL among more than 4 million hospitalized US veterans including 9,496 patients with NHL (7,999 white patients and 1,497 black patients) with up to 26 years of follow-up. We used time-dependent Poisson regression to estimate rate ratios (RRs) and 95% CIs for NHL risk among patients with a history of specific autoimmune diseases, infections, and allergies compared with patients without such history, adjusting for attained age, calendar year, race, number of hospital visits, and time between study entry and exit. RESULTS: Patients with infectious conditions had an increased risk of developing NHL (RR, 1.2; 95% CI, 1.1 to 1.2), particularly for gastrohepatic, genital, and systemic infectious conditions. Patients with autoimmune disease were generally more likely to develop NHL than patients without autoimmune disease, especially for conditions that typically present with detectable autoantibodies with systemic involvement (RR, 2.0; 95% CI, 1.8 to 2.2). Allergies were also associated with increased risk (RR, 1.4; 95% CI, 1.3 to 1.5). Although the risk of NHL was lower for blacks than whites (RR, 0.87; 95% CI, 0.82 to 0.92), blacks had a slightly higher risk of NHL associated with infections than whites (likelihood ratio test, P = .002) and a tendency toward higher risk associated with allergies (likelihood ratio test, P = .05). Risks associated with autoimmune conditions were similar by race (likelihood ratio test, P = .5). CONCLUSION: The observed difference in NHL risk by race supports a role for race-related differences in genes regulating immune/inflammatory response.

Associations of ECP (eosinophil cationic protein)-gene polymorphisms to allergy, asthma, smoke habits and lung function in two Estonian and Swedish sub cohorts of the ECRHS II study.

BACKGROUND: The Eosinophil Cationic Protein (ECP) is a potent multifunctional protein. Three common polymorphisms are present in the ECP gene, which determine the function and production of the protein. The aim was to study the relationship of these ECP gene polymorphisms to signs and symptoms of allergy and asthma in a community based cohort (The European Community Respiratory Health Survey (ECRHS)). METHODS: Swedish and Estonian subjects (n = 757) were selected from the larger cohort of the ECRHS II study cohort. The prevalence of the gene polymorphisms ECP434(G>C) (rs2073342), ECP562(G>C) (rs2233860) and ECP c.-38(A>C) (rs2233859) were analysed by DNA sequencing and/or real-time PCR and related to questionnaire-based information of allergy, asthma, smoking habits and to lung functions. RESULTS: Genotype prevalence showed both ethnic and gender differences. Close associations were found between the ECP434(G>C) and ECP562(G>C) genotypes and smoking habits, lung function and expression of allergic symptoms. Non-allergic asthma was associated with an increased prevalence of the ECP434GG genotype. The ECP c.-38(A>C) genotypes were independently associated to the subject being atopic. CONCLUSION: Our results show associations of symptoms of allergy and asthma to ECP-genotypes, but also to smoking habits. ECP may be involved in impairment of lung functions in disease. Gender, ethnicity and smoking habits are major confounders in the evaluations of genetic associations to allergy and asthma.

Allergy and ACP1 genetic polymorphism.

The ACP1 (acid phosphatase locus 1) gene encodes a highly polymorphic low molecular weight protein tyrosine phosphatase (LMPTP) involved in the modulation of various signal transduction pathways including T-cell receptor. Previous studies suggest an association of this enzyme with allergic disorders. The aim of this study was to review our previous data and to confirm the association by further observations. Two new independent samples of individuals were studied from the population of Rome. ACP1 genotype was determined and history of allergic disorders was recorded. All allergic subjects had at least one positive prick test. Three-way contingency table analyses were performed by a log linear model. In all samples studied from different populations (Italian, English, and Chinese for a total of 958 subjects) we found that the proportion of allergic subjects was higher among genotypes with low enzymic activity than among genotypes with high activity. Concentration of IgE was negatively correlated with ACP1 enzymic activity. Carriers of ACP1 genotypes associated with low enzymic activity may be more susceptible to allergic disorders.

The cysteinyl-leukotriene type 1 receptor polymorphism 927T/C is associated with atopy severity but not with asthma.

BACKGROUND: The cysteinyl-leukotriene receptor type 1 (CysLT1) mediates the bronchoconstrictor and pro-inflammatory actions of cysteinyl-leukotrienes (LTC4, LTD4, LTE4) in asthma and is the molecular target of the lukast class of oral anti-leukotriene drugs. We screened the CYSLTR1 gene on chromosome Xq13-21 for coding region polymorphisms, and investigated their associations with allergy and asthma. METHODS: Solid-phase chemical cleavage was used to screen polymorphisms in the coding region of CYSLTR1. A TaqMan allelic discrimination assay was used to genotype a 927T/C SNP and oligonucleotide ligation assays were used to genotype the previously reported 617T/C and 898G/A SNPs of CYSLTR1 in 341 asthmatic families from the UK. Associations with asthma diagnosis, atopic status, serum-specific IgE and severity of allergy and asthma were examined. RESULTS: Family-based association tests showed that the 927 T allele was associated with atopy severity, especially in female subjects, but not with asthma diagnosis or severity, atopic status, bronchial hyper-responsiveness to methacholine or forced expiratory volume in 1 s. CONCLUSION: Mutation screening identified only one polymorphism, 927T/C, in the coding region of the CysLT1 receptor. This polymorphsim is predictive of atopy severity, but not associated with asthma.

Caesarean section delivery and the risk of allergic disorders in childhood.

BACKGROUND: The composition of the intestinal flora in young children, if unfavourable, may increase the susceptibility to allergic disorders. Beneficial intestinal microbes originate from the maternal vaginal tract and thus are more likely to be transferred during vaginal births than during Caesarean sections (C-sections). OBJECTIVE: To determine whether children born by C-section have a different risk of allergic disorders compared with those delivered vaginally. We also tested the hypothesis that the risk of allergic disorders is highest for children born after 'repeat C-sections'. METHODS: A retrospective cohort study of 8,953 children aged 3-10 years. Children diagnosed with allergic rhinoconjunctivitis (AR), asthma, atopic dermatitis (AD), or food allergies were identified from the Kaiser Permanente Northwest Region electronic records. The children's sex, birth weight, birth order, postnatal exposure to antibiotics as well as the mothers' age, ethnicity, education, marital status, smoking status during pregnancy, and use of asthma or hayfever medications were identified through the mothers' medical records or through the Oregon Birth Registry. RESULTS: The risk of being diagnosed with AR was significantly higher in the children born by C-section than in those delivered vaginally: adjusted odds ratio (OR)=1.37%, 95% confidence interval (CI)=1.14-1.63. Delivery by C-section was also associated with the subsequent diagnosis of asthma (OR=1.24%, 95% CI=1.01-1.53); this association was gender specific, with a positive association restricted to girls (OR for asthma in girls: OR=1.53%, 95% CI=1.11-2.10; in boys: OR=1.08%, 95% CI=0.81-1.43). There was no significant association between mode of delivery and AD. If children born in a 'repeat C-section' were considered separately the risk of being diagnosed with AR increased further (OR=1.78%, 95% CI=1.34-2.37). The same increase was noted for asthma in girls (OR=1.83%, 95% CI=1.13-2.97) but not in boys. CONCLUSION: Caesarean sections may be associated with an increased risk of developing AR in childhood.

Polymorphisms of the IL-4, TNF-alpha, and Fcepsilon RIbeta genes and the risk of allergic disorders in at-risk infants.

Polymorphisms in the TNF-alpha (A-308G), IL-4 (C-589T), and Fcalpha RIbeta (E237G) genes have been associated with asthma and related phenotypes. To determine the predictive value of these polymorphisms we have assessed their relative risk (RR) for the development of atopy, asthma, and rhinitis in a high-risk infant population that is being followed longitudinally from birth. DNA was extracted and genotyped for 373 infants and 572 parents for each polymorphism. Phenotypic data were collected for atopy and allergic diseases in the infants at 12 mo of age. The prevalence of these phenotypes in the 281 white infants was compared in each genotypic group. There were no differences in the prevalence of any phenotype between genotypes of the TNF-alpha and Fcalpha RIbeta polymorphisms. However, we found that the IL4-589*T allele was associated with "probable" asthma (RR = 4.1) and that homozygotes for the IL4-589*T allele had an increased risk for the development of rhinitis (RR = 2.4). Using the transmission disequilibrium test, an association of IL4-589*T with atopy was found. We conclude that IL-4-589*T, but not TNF-alpha-308*2 or Fcalpha RIbeta*G, is a risk factor for the development of atopy, asthma, and rhinitis by 12 mo of age.

Algunas característica epidemiológicas del asma en una región tropical

Para determinar algunas características epidemiológicas del asma en la costa caribe colombiana, se examinaron cuatro mil personas de Cartagena para establecer la prevalencia de esta enfermedad y los registros de defunciones ocurridas desde 1986 hasta 1990 en dos departamentos representativos del sector geográfico (Bolivar y Atlántico), con el fin de investigar la tendencia de la tasa de mortalidad por asma en ese período. Además, se investigó la importancia del asma entre otras enfermedades alérgicas haciendo un estudio poblacional con los pacientes que asistieron a un consultorio de alergias en Cartagena, en el cual se obtuvieron las frecuencias de las enfermedades alérgicas por la que consultaron. Los resultados mostraron una prevalencia de asma acumulativa y puntual de 8.8 por ciento y 12.2 por ciento respectivamente y una tasa de mostalidad en ascenso con valores que van desde 0.74 en 1986 hasta 1.62 en 1990. Setenta por ciento de la población general afectada por asma tenían menos de 15 años de edad y en la consulta de alergias se observó que el asma era la segunda enfermedad más frecuente después de la rinitis. Los datos de estos estudios sugieren que la frecuencia de asma es alta, la mortalidad por dicha enfermedad no es muy diferente a la encontrada en otros sitios y la distribución de las enfermedades alérgicas muestra un predominio de los procesos respiratorios.