Konrad Furmańczyk

Obesity--a risk factor for asthma, but not for atopic dermatitis, allergic rhinitis and sensitization.

OBJECTIVE To analyse the relationship between obesity and overweight and the prevalence of allergic diseases and sensitization, and the impact of gender and place of residence. DESIGN Questionnaire based on those used in ISAAC (International Study of Asthma and Allergies in Childhood) and ECRHS (European Community Respiratory Health Survey). SETTING Our study involved populations of the eight largest cities and one rural region in Poland (each with over 150,000 inhabitants). SUBJECTS The study included 18,617 participants (24·2% aged 6-7 years, 25·4% aged 13-14 years, 50·4% adults aged 20-44 years) in eight cities and one rural area. The out-patient study involved 4783 patients (25·7%); we performed skin prick testing with fifteen aeroallergens. RESULTS Overweight was found in 16·13% of participants (9·11% of 6-7-year-olds, 4·90% of 13-14-year-olds and 25·61% of adults), obesity in 6·41% (7·16%, 2·45% and 8·36%, respectively). In adults, overweight (OR=1·34) and obesity (OR=1·80) increased the prevalence of asthma, especially in women (OR=1·53, OR=2·01). Among 13-14-year-olds the prevalence was higher only in the obese (OR=1·76). Overweight (OR=1·99) and obesity (OR=2·17) affected the incidence of doctor-diagnosed asthma in 6-7-year-olds. Overweight (OR=0·81) and obesity (OR=0·76) reduced the prevalence of allergic rhinitis in men. There was no relationship between BMI and asthma in people from rural areas. Obesity and overweight did not affect the frequency of sensitization to aeroallergens. CONCLUSIONS Overweight and obesity increased the prevalence of symptomatic asthma in adults, especially in women. In 13-14-year-olds, only obesity increased the prevalence of asthma. In children, overweight was associated with increased prevalence of clinically diagnosed and declared asthma and a trend towards atopy. Higher BMI was negatively associated with the prevalence of allergic rhinitis in overweight and obese man. There was no correlation between BMI and sensitization to aeroallergens.

The prevalence of sensitization to inhalant allergens in children with atopic dermatitis.

BACKGROUND The role of sensitization to inhalant allergens in atopic dermatitis (AD) in children is uncertain. The aim of our study was to assess the relationship of AD symptoms with sensitization to aeroallergens in Polish children ages 6-7 and 13-14 years. MATERIAL AND METHOD Epidemiology of Allergic Disorders in Poland is a randomized study with medical examination according to the ECRHS II and the International Study of Asthma and Allergies in Childhood standards in nine selected regions of Poland. We studied 6-7-year-old (n = 4510) and 13-14-year-old children (n = 4721). A total of 1583 children (25%) had a medical examination and a skin-prick test (SPT) with the 15 most common aeroallergens. RESULTS AD was diagnosed in 235 children (8.9%) (8.7%, 6-7-year-old children; 9.0%, 13-14-year-old children; 8.6% boys and 9.1% girls). AD was more frequent in urban versus rural habitants (9.6% versus 3.7%; p < 0.05) and in participants with a positive atopy history versus those without atopy (9.4% versus 5.1%; p < 0.05). Positive SPT was found in 1165 children (43.9%) (38.5% boys, 49.5% girls) and 64.72% with AD versus 41.9% without AD (p < 0.05) and more common in the rural region versus urban setting among 6-7 year-olds (71.8% versus 35.0%; p < 0.05). The most frequent allergic reaction was Dermatophagoides pteronyssinus (13.5%), Dermatophagoides farina (11.7%), and grasses/crop plants (11.8%). The same pattern was seen in participants with and those without AD. Children with AD had more frequent positive SPT for all aeroallergens (p < 0.05). CONCLUSION AD should be more frequent in children with a positive atopy history and in children who live in the city. Aeroallergens play an essential role in pathogenesis of eczema in children. House-dust mites and grass pollen proved to be the most common relevant aeroallergens.

The Prevalence of Asthma and Declared Asthma in Poland on the Basis of ECAP Survey Using Correspondence Analysis

Results of epidemiological and public health surveys are often presented in the form of cross-classification tables. It is sometimes difficult to analyze data described in this way and to understand relations between variables. Graphical methods such as correspondence analysis are more convenient and useful. Our paper describes an application of correspondence analysis to epidemiological research. We apply the basic concepts of correspondence analysis like profiles, chi-square distance to medical data concerning prevalence of asthma. We aim at describing the relationship between asthma, region, and age. The data presented in this paper come from Epidemiology of Allergy in Poland (ECAP) survey in years 2006–2008. Correspondence analysis shows that there is a fundamental difference in the structure of age groups for people with symptoms compared to those who have declared asthma (regardless of the level of symptoms of asthma and the level of declaration). The variable which best differentiates declared asthma in all regions is “wheezing and whistling.” Correspondence analysis also shows significant differences between locations. Our analyses are performed in the R package “ca”.

Specificity and sensitivity assessment of selected nasal provocation testing techniques

Introduction Nasal provocation testing involves an allergen-specific local reaction of the nasal mucosa to the administered allergen. Aim To determine the most objective nasal occlusion assessment technique that could be used in nasal provocation testing. Material and methods A total of 60 subjects, including 30 patients diagnosed with allergy to common environmental allergens and 30 healthy subjects were enrolled into the study. The method used in the study was a nasal provocation test with an allergen, with a standard dose of a control solution and an allergen (5,000 SBU/ml) administered using a calibrated atomizer into both nostrils at room temperature. Early-phase nasal mucosa response in the early phase of the allergic reaction was assessed via acoustic rhinometry, optical rhinometry, nitric oxide in nasal air, and tryptase levels in the nasal lavage fluid. Results In estimating the homogeneity of the average values, the Levene’s test was used and receiver operating characteristic curves were plotted for all the methods used for assessing the nasal provocation test with an allergen. Statistically significant results were defined for p < 0.05. Of all the objective assessment techniques, the most sensitive and characteristic ones were the optical rhinometry techniques (specificity = 1, sensitivity = 1, AUC = 1, PPV = 1, NPV = 1). Conclusions The techniques used showed significant differences between the group of patients with allergic rhinitis and the control group. Of all the objective assessment techniques, those most sensitive and characteristic were the optical rhinometry.

Probiotics: Myths or facts about their role in allergy prevention

BACKGROUND The hygiene hypothesis proposed by Strachan in the 1980s clearly emphasized the role of microorganisms in atopy prevention. OBJECTIVES The study objective was to assess the preventive role of probiotics in patients with allergic rhinitis, bronchial asthma, atopic dermatitis, and/or food allergy. MATERIAL AND METHODS The methods used in the study were the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaires for 6-7- and 13-14-year-olds and the European Community Respiratory Health Survey II (ECRHS II) questionnaire targeted for the 20-44 age group. The study was conducted as part of the cross-sectional Epidemiology of Allergic Diseases in Poland study conducted in 9 Polish regions (8 urban: Warszawa, Lublin, Białystok, Gdańsk, Poznań, Wrocław, Katowice, Kraków, and the rural regions of Zamojski and Krasnostawski counties). The study material was a group of patients diagnosed with food allergy (n = 407), atopic dermatitis (n = 311), allergic rhinitis (n = 1.353), bronchial asthma (n = 505), and healthy volunteers (n = 2,403). RESULTS Genetic factors play an important role in the allergy development. A family history positive for chronic skin disorders increased the risk of atopic dermatitis and food allergies (OR = 1.456, CI = 1.14-1.85, p = 0.002; and OR = 1.378, CI = 1.05-1.81, p = 0.02, respectively). The consumption of products containing live bacterial cultures showed no preventive effects in any of the evaluated disorders in early childhood. Conversely, over the age of 14 years, probiotic formulations exhibit health-promoting effects and may lower the risk of allergic diseases. CONCLUSIONS The use of probiotics in the Polish population showed no protective effect in the first years of life. The changes in dietary habits introduced during late adolescence demonstrated significantly greater preventive effects of live bacterial cultures against the development of allergic diseases.

Extent of protective or allergy-inducing effects in cats and dogs

OBJECTIVE The study aimed to assess the effect of fur-bearing pets, including cats and dogs, on the health of individuals with allergic conditions. MATERIAL AND METHODS The study group comprised 18,617 individuals (16,562 from urban and 2,055 from rural areas). The tool used in the study was the European Community Respiratory Health Survey (ECRHS) and International Study of Asthma and Allergies in Childhood (ISAAC) study questionnaire, adapted to European conditions (Middle and Eastern Europe) and used as part of the study Implementation of a System for the Prevention and Early Detection of Allergic Diseases in Poland. RESULTS The factors determining the keeping of fur-bearing pets in a household included a larger living space and the number of cigarettes smoked, which were observed especially in urban settings. The keeping of fur-bearing animals in rural areas acts preventively against allergic conditions, while in urban areas, these animals were a factor clearly aggravating symptoms of bronchial asthma - the risk of cough (OR 1.921; CI 10-3.36; P=0.02) and wheezing (OR 2.60; CI 1.22-5.54; P=0.01). CONCLUSIONS Fur-bearing animals kept in rural settings exhibit preventive effects on the development of allergies; whereas in urban areas they exacerbate allergic symptoms, especially the symptoms of bronchial asthma.

Allergies in urban versus countryside settings in Poland as part of the Epidemiology of the Allergic Diseases in Poland (ECAP) study – challenge the early differential diagnosis

Introduction The incidence of allergies depends on a number of factors, including adopting an urban “western” lifestyle, genetic predispositions, and different regions of residence. Aim To compare the prevalence of allergic conditions (seasonal allergic rhinitis (SAR) and perennial allergic rhinitis (PAR), bronchial asthma (BA), atopic dermatitis (AD)) in a group of countryside versus urban residents in Poland. Material and methods The prevalence of allergic conditions in urban versus countryside settings was assessed using the translated and approved questionnaire developed for international ECRHS II and ISAAC studies. Respondents were selected via random multistage sampling, with proportionate stratified sampling, and the Polish Resident Identification Number (PESEL) as the basis. A total of 18,617 respondents took part in the study. Subsequently, approximately 25% of the subjects underwent outpatient assessments: skin-prick, lung function, peak nasal inspiratory flow (PNIF) tests, as well as history-taking. Results Allergic rhinitis (AR) proved to be the most common condition in the entire study population. Children residing in the countryside were twice more likely to be diagnosed with BA (8.33% vs. 4%; p < 0.05). Conversely, in the adult subgroup, BA was more commonly observed in urban areas. Whereas reported symptom rates were much higher in AR and AD patients, symptomatic BA was proportionately lower with respect to the official diagnoses (underdiagnosed BA phenomenon). Atopic dermatitis was considerably more common in the metropolitan population. One factor that significantly correlated with allergic diseases was a positive family history. Conclusions Inhabitants of metropolitan areas are to a greater extent predisposed to allergic conditions. One factor significantly contributing to allergies is genetic predisposition. Given the scale of the problem, there is an urgent need to implement measures for early prevention and diagnosis of allergies to minimize distant health effects.

The effect of selected risk factors, including the mode of delivery, on the development of allergic rhinitis and bronchial asthma

Introduction Cesarean section affects the process of colonization by bacteria transferred from the mother’s skin and hospital bacteria, which in turn contributes to development of allergic conditions. Aim To assess selected risk factors, including the mode of delivery, parity, and the role of genetic factors for the development of allergic rhinitis and bronchial asthma. Material and methods The study was conducted in 18,617 respondents aged 6–7, 13–14, and 20–44 years who completed the ECRHS II and ISSAC questionnaires. Thirty percent of the study population underwent complementary assessments in the form of skin-prick tests, serum IgE levels, lung function tests, and peak nasal inspiratory flow (PNIF). The study is a part of the Epidemiology of Allergic Disorders in Poland (ECAP) study conducted in 8 areas in Poland (Warsaw, Lublin, Bialystok, Gdansk, Poznan, Wroclaw, Katowice, Krakow, and two rural areas – Zamosc and Krasnystaw counties). Results Respondents diagnosed with allergic rhinitis were at a significantly higher risk of inheriting the allergic condition if their mother (OR = 2.17; 95% CI: 1.98–2.39, p = 2.00 × 10–16) or father (OR = 2.20; 95% CI: 1.96–2.47; p = 2.00 × 10–16) suffers from this allergy. Conversely, in the group diagnosed with bronchial asthma, the highest risk of an inherited allergy was observed in situations where maternal (OR = 2.00; 95% CI: 1.57–2.55; p = 1.69 × 10–5) or paternal (OR = 1.94; 95% CI: 1.42–2.66; p = 3.61 × 10–5) grandparent was affected. Moreover, the risk of developing allergic rhinitis depended on the mode of delivery: i.e. it was higher for a Cesarean section (OR = 1.20; 95% CI: 1.01–1.43; p = 0.04) than vaginal delivery (OR = 0.88; 95% CI: 0.78–0.99; p = 0.03). The higher the number of siblings, the lower the risk of allergic rhinitis. Conclusions Allergy risk factors, especially those predisposing to allergic rhinitis, include not only genetic factors but also the mode of delivery: vaginal delivery or Cesarean section.

Wpływ wybranych czynników środowiskowych na maksymalny przepływ nosowy wdechowy w świetle projektu ECAP (Epidemiologia Chorób Alergicznych w Polsce)

Celem niniejszej pracy była próba określenia wpływu wybranych czynników/parametrów na wynik maksymalnego przepływu nosowego wdechowego (PNIF, ang. peak nasal inspiratory flow) w badanej populacji polskiej projektu Epidemiologia Chorób Alergicznych w Polsce (ECAP). Materiał/metody: Badaną populację stanowiła grupa dzieci w wieku 6-7 lat (n=1123), młodzieży w wieku 13-14 lat (n=1136) oraz dorosłych (n=1876) zamieszkałych w siedmiu dużych polskich miastach. W badaniu posłużono się pomiarem maksymalnego przepływu nosowego wdechowego (PNIF). Do oceny wpływu wybranych czynników na wartości PNIF wykorzystano przetłumaczone i walidowane kwestionariusze opracowane na potrzeby światowych badań ECRHS II (European Community Respiratory Health Survey II) i ISAAC (International Study of Asthma and Allergies in Childhood). Wyniki: Określone warunki wewnątrz gospodarstwa domowego, m.in. ogrzewanie węglem, drewnem lub piecem gazowym, istotnie zwiększają przekrwienie błony śluzowej nosa. W grupie biernych palaczy PNIF był niższy niż w grupie czynnych palaczy. Wskaźnik PNIF malał wraz ze wzrostem liczby domowników palących papierosy. Wnioski: Wybrane czynniki środowiska.

Nasal patency in Poles in the light of research as part of the project on Epidemiology of Allergic Diseases in Poland.

OBJECTIVE The aim of this study was to estimate the reference values for nasal inspiratory flow in the study population in Poland as part of the project on Epidemiology of Allergic Diseases in Poland (ECAP). MATERIALS AND METHOD The study subjects were a group of 4,137 people: 1,136 children aged 6-7 years (561 girls and 575 boys), 1,123 adolescents aged 13-14 years (546 girls, 577 boys) and 1,878 adults (1,145 women, 733 men), residing in seven large Polish cities. The method used in the study was the measurement of the peak nasal inspiratory flow (PNIF) using a special mask for rhinomanometry tests, with a measurement scale of 20-350 L/min. Measurements were conducted twice: once before and once after nasal mucosa vasoconstriction with a 0.1% xylometazoline (Xylometazolinum) solution. RESULTS Nasal patency rates increased with age in healthy subjects (children aged 6-7 years: 75.95 L/min; teenagers aged 13-14 years: 91.44 L/min and adults: 97.13 L/min (P<0.05). Similarly significant correlations were observed in the study group based on the region of residence (P<0.05). A moderate correlation was observed between PNIF and height as well as weight (with correlation coefficients r=0.51, P<0.05; and r=0.49, P<0.05, respectively). Interestingly, the observed difference in nasal vasoconstriction varied considerably between study subgroups with respect to the pre-determined criteria of age, gender, place of residence, and clinical diagnosis (allergic rhinitis vs. healthy controls), with the mean rates of 25-28%. CONCLUSIONS Any attempt to determine reference values for a given study population should include a number of variables, such as age, height, body weight, which can noticeably affect study results.