Biomedical subjects
Isabella Annesi-Maesano
Publications and source records attributed to Isabella Annesi-Maesano.
Allergic rhinitis and its consequences on quality of sleep: An unexplored area.
BACKGROUND: Allergic rhinitis (AR) is common and has been shown to impair social life and sleep. Patients with severe symptoms may have more sleep disturbances than those with a mild form of the disease, but this has never been assessed using a validated tool. The objective of our study was to assess, in patients with AR, whether duration and severity of AR are associated with sleep impairment. METHODS: A nationwide controlled cross-sectional epidemiological study was carried out. A representative sample of 260 French ear, nose, and throat and allergy specialists enrolled 591 patients with AR of at least 1 year's duration. Sleep disorders, sleep quality, and AR were assessed using validated tools (Sleep Disorders Questionnaire, Epworth Sleepiness Scale, and Score for Allergic Rhinitis). The severity of AR was assessed using the Allergic Rhinitis and its Impact on Asthma classification. RESULTS: All dimensions of sleep were impaired by AR, particularly by the severe type. Sleep was significantly more impaired in patients with severe AR than in those with the mild type. The duration of AR (intermittent or persistent) had no effect on sleep. CONCLUSION: These data underline the close relationship between AR and sleep and highlight the need for clinicians, particularly general practitioners, to be attentive in this respect.
Natural rubber latex allergy among health care workers: a systematic review of the evidence.
BACKGROUND: Natural rubber latex is a recognized allergen, but a recent meta-analysis failed to find any association between latex exposure and allergy in health care workers (HCWs). OBJECTIVES: A meta-analysis was carried out under the auspices of the French National Regulatory Authority to assess the allergic risk induced by latex gloves in HCWs. METHODS: The risk of work-related exposure to latex for the development of latex allergy was assessed. Prevalence and incidence rates of latex sensitization or allergy were compared in HCWs and in the general population. Exposure-response relationships were assessed in HCWs. RESULTS: Latex allergy was found in 4.32% (range, 4.01% to 4.63%) of HCWs and in 1.37% (range, 0.43% to 2.31%) of the general population. Latex-positive skin prick test responses ranged from 2.1% to 3.7% in the general population and from 6.9% to 7.8% for the HCWs. HCWs exposed to latex showed an increased risk of hand dermatitis (odds ratio [OR], 2.46; 95% CI, 2.11-2.86), asthma or wheezing (OR, 1.55; 95% CI, 1.15-2.08), rhinoconjunctivitis (OR, 2.73; 95% CI, 1.97-3.81), and at least one generic symptom (OR, 1.27; 95% CI, 1.09-1.47). Sensitization to latex was significantly associated with asthma and rhinoconjunctivitis. By contrast, exposure to latex was not associated with a significantly increased risk of positive skin prick test responses to latex (OR, 1.47; 95% CI, 0.94-2.30). CONCLUSION: HCWs have an increased risk of sensitization and allergic symptoms to latex. CLINICAL IMPLICATIONS: Prevention of latex allergy in HCWs is needed.
[Asthma epidemiology].
Asthma is excessively common among the individuals (up to 10% in adults and 35% in children). Asthma is differently distributed in the world. Asthma incidence is 1%/y in average. Children are at greater risk of asthma than adults, which could be due to a cohort effect. Severe asthma is reported by 1-3% of the general population (children and adults respectively). Recent population-based data show that the asthma prevalence increase observed worldwide in the past 30 years has now stopped in industrialised countries. Such phenomenon has been paralleled by an increase in the use of asthma medications. The development and phenotypic expression of asthma depends on a complex interaction between genetic and environmental factors. Gene-environment interactions already in early life should be explored to understand asthma epidemiological evolution.
Does childhood immunization against infectious diseases protect from the development of atopic disease?
The argument of whether early immunization against infections promotes allergy or protects from it is presently under debate. The relationship between childhood immunization and the development of atopic diseases (asthma, allergic rhinitis and eczema) was examined in a population-based sample of 718 adolescents by taking individual data drawn from personal paediatric records on the schedule and the type of vaccination into account. Atopic diseases were determined using a standardized questionnaire. After adjustment for sex, age, father's socioeconomic status and active smoking, adolescents having been vaccinated (n = 694) had a significant lower risk to suffer from asthma or atopic diseases than non-vaccinated adolescents did (n = 24) [odds ratio (OR) = 0.30; 95% CI: 0.10, 0.92]. The relationship did not depend on the disease against which the vaccine was used as prophylaxis, the observance of the vaccination schedule or the number of inoculations. A higher protection was observed in the case of live attenuated vaccines (oral poliomyelitis and bacilli Camille-Guerin; OR = 0.26; 95% CI: 0.08, 0.83). These results, in agreement with previous ecological data, support the hypothesis that early vaccines could promote Th1 proliferation in response to the infectious agent contained in it, which inhibits the enhancement of atopic manifestations. Further studies are needed to confirm the phenomenon.
[Epidemiology of asthma and allergies. The prevalence of allergies increases worldwide, and asthma has reached his highest-ever prevalence in Europe: why?].
Up to 10% of adults and 35% of children worldwide suffer from asthma. The incidence of asthma is also higher in children than in adults, possibly owing to a "cohort" effect. Recent population-based studies show that the increase in the prevalence of asthma noted worldwide in the past 30 years has started to subside in industrialised countries. This phenomenon has been accompanied by a parallel increase in the use of asthma medications. Possible explanations for this increase include the "hygiene hypothesis", which implicates diminished exposure to microbial pathogens but was recently challenged by new biological and immunological findings. Asthma might result from the interactions between individual and environmental factors (diet, air pollution, etc.), but further investigations are needed to understand the precise pathophysiological mechanisms of asthma.
Clustering patterns of LOD scores for asthma-related phenotypes revealed by a genome-wide screen in 295 French EGEA families.
A genome-wide scan for asthma phenotypes was conducted in the whole sample of 295 EGEA families selected through at least one asthmatic subject. In addition to asthma, seven phenotypes involved in the main asthma physiopathological pathways were considered: SPT (positive skin prick test response to at least one of 11 allergens), SPTQ score being the number of positive skin test responses to 11 allergens, Phadiatop (positive specific IgE response to a mixture of allergens), total IgE levels, eosinophils, bronchial responsiveness (BR) to methacholine challenge and %predicted FEV(1). Four regions showed evidence for linkage (P</=0.001): 6q14 for %FEV(1), 12p13 for IgE, 17q22-q24 for SPT and 21q21 for both SPTQ and %FEV(1). Nine other regions indicated smaller linkage signals (0.001<P</=0.005). While most of these regions have been reported by previous asthma and lung function screens, 6q14 appears to be a new region potentially linked to %FEV(1). To determine which of these various asthma phenotypes are more likely to share common genetic determinants, a principal component analysis was applied to the genome-wide LOD scores. This analysis revealed clustering of LODs for asthma, SPT and Phadiatop on one axis and clustering of LODs for %FEV(1), BR and SPTQ on the other, while LODs for IgE and eosinophils appeared to be independent from all other LODs. These results provide new insights into the potential sharing of genetic determinants by asthma-related phenotypes.
Early life factors related to clinical manifestations of atopic disease but not to skin-prick test positivity in young children.
The relative influence of early life events in the development of IgE-mediated allergy is still undetermined. We investigated early life factors in relation to skin-prick test positivity (SPT) and clinical manifestations of atopic disease in a population-based sample of 201 Italian children (3 months-5 years), after considering their interactions with known determinants of allergy. Among them, 143 children had SPT performed to common allergens. Threatened abortions, general anesthesia at delivery, prematurity, birthweight < 2500 g, maternal smoking, dampness and gas heating exposure were all significantly related to an increased risk of frequent rhinitis in the absence of cold (18%). In utero smoking, threatened abortions, fetal health complications, infantile colic, maternal smoking in childhood (satisfactorily correlated with maternal expired CO during the survey) and respiratory infections were all independent determinants of frequent wheezing (23%). Doctor's diagnosis of asthma (3%) was related to in utero smoking, being born in spring, infantile colic and respiratory infections. A simultaneous exposure to in utero smoking and infantile colic put the infants to a fourfold higher risk of frequent wheezing and to a ninefold risk of asthma, respectively. Having a pet and washing blankets at < 60 degrees C were inversely related to frequent wheezing. Data confirmed also that maternal phenotype influences the inheritance of atopic disease. No event, except a low intake of fruit (< 3/week), was significantly associated with positive SPT (20%) or eczema. Besides allergic sensitization, other events, which occur early in life, seem critical to the development of IgE-mediated allergy.
Perinatal events, vitamin D, and the development of allergy.
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Epidemiologic study of the genetics and environment of asthma, bronchial hyperresponsiveness, and atopy.
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[Air pollution and the lung: epidemiological approach].
Epidemiological evidence has concurred with clinical and experimental evidence to correlate current levels of ambient air pollution, both indoors and outdoors, with respiratory effects. In this respect, the use of specific epidemiological methods has been crucial. Common outdoor pollutants are particulate matter, nitrogen dioxide, carbon monoxide, volatile organic compounds and ozone. Short-term effects of outdoor air pollution include changes in lung function, respiratory symptoms and mortality due to respiratory causes. Increase in the use of health care resources has also been associated with short-term effects of air pollution. Long-term effects of cumulated exposure to urban air pollution include lung growth impairment, chronic obstructive pulmonary disease (COPD), lung cancer, and probably the development of asthma and allergies. Lung cancer and COPD have been related to a shorter life expectancy. Common indoor pollutants are environmental tobacco smoke, particulate matter, nitrogen dioxide, carbon monoxide, volatile organic compounds and biological allergens. Concentrations of these pollutants can be many times higher indoors than outdoors. Indoor air pollution may increase the risk of irritation phenomena, allergic sensitisation, acute and chronic respiratory disorders and lung function impairment. Recent conservative estimates have shown that 1.5-2 million deaths per year worldwide could be attributed to indoor air pollution. Further epidemiological research is necessary to better evaluate the respiratory health effects of air pollution and to implement protective programmes for public health.