Lydia Nikasinovic

Risk factors and characteristics of respiratory and allergic phenotypes in early childhood

BACKGROUND Unsupervised approaches can be used to analyze complex respiratory and allergic disorders. OBJECTIVE We investigated the respiratory and allergic phenotypes of children followed in the Pollution and Asthma Risk: An Infant Study (PARIS) birth cohort. METHODS Information on respiratory and allergic disorders, medical visits, and medications was collected during medical examinations of children at 18 months of age; biomarker data were also collected (total and allergen-specific IgE levels and eosinophilia). Phenotypes were determined by using latent class analysis. Associated risk factors were determined based on answers to questionnaires about environmental exposures. RESULTS Apart from a reference group, which had a low prevalence of respiratory symptoms or allergies (n=1271 [69.4%]), 3 phenotypes were identified. On the basis of clinical signs of severity and use of health care resources, we identified a mild phenotype (n=306 [16.7%]) characterized by occasional mild wheeze and 2 severe phenotypes separated by atopic status. The atopic severe phenotype (n=59 [3.2%]) included 49 (83%) children with wheezing and was characterized by a high prevalence of atopy (61% with allergenic sensitization) and atopic dermatitis (78%). In contrast, atopy was rare among children with the nonatopic severe phenotype (n=195 [11%]); this group included 88% of the children with recurrent wheezing. Risk factors for respiratory disease included parental history of asthma, male sex, siblings, day care attendance, exposure to tobacco smoke or molds, indoor renovations, and being overweight, although these factors did not have similar affects on risk for all phenotypes. CONCLUSION Atopy should be taken into account when assessing the risk of severe exacerbations (that require hospital-based care) in wheezing infants; precautions should be taken against respiratory irritants and molds and to prevent children from becoming overweight.

Does allergic rhinitis exist in infancy? Findings from the PARIS birth cohort.

To cite this article: Herr M, Clarisse B, Nikasinovic L, Foucault C, Le Marec A‐M, Giordanella J‐P, Just J, Momas I. Does allergic rhinitis exist in infancy? Findings from the PARIS birth cohort. Allergy 2011; 66: 214–221.

Passive smoking is a major determinant of exhaled nitric oxide levels in allergic asthmatic children

To cite this article: Laoudi Y, Nikasinovic L, Sahraoui F, Grimfeld A, Momas I, Just J. Passive smoking is a major determinant of exhaled nitric oxide levels in allergic asthmatic children. Allergy 2010; 65: 491–497.

Influence of host and environmental factors on wheezing severity in infants: findings from the PARIS birth cohort.

Determinants of wheezing severity are poorly documented in infants.

Bronchial obstructive phenotypes in the first year of life among Paris birth cohort infants.

As the natural history of respiratory and allergic manifestations is unclear, our ongoing Paris birth cohort study prospectively assesses the onset of these symptoms in early childhood. Data were collected by five questionnaires sent at regular intervals during the first year of life. Partitioning around medoids (PAM) was used to classify infants according to their bronchial obstructive symptoms. A polytomous logistic regression was performed to assess the eventual predictable power of various respiratory events and perinatal factors. Results are given for 2698 infants. Atopic dermatitis occurred in 17.9% of infants. The main respiratory symptoms in infancy were wheeze in the chest (22%), dyspnoea responsible for sleep disturbance (23.7%), nocturnal dry cough (14.5%) and shortness of breath (4.2%). The PAM method identified three groups of infants. Apart from the G0 group of infants mostly asymptomatic, two distinct clinical phenotypes (G1 and G2: 8.7% and 23.5% of total infants respectively) emerged. G2 was defined by severe bronchial obstructive disorders as all cases of dyspnoea with sleep disturbance were included in this group, while all infants assigned in G1 suffered from nocturnal dry cough. G2 group infants had significantly higher rates of respiratory events while a parental history of asthma, symptoms suggestive of rhino‐conjunctivitis and birth season clearly differentiated the G1 group. Finally, G1 and G2 group infants should be closely followed up as they are expected to develop allergic and asthmatic phenotypes, possibly in relation to environmental and behavioural risk factors.

Onset and persistence of respiratory/allergic symptoms in preschoolers: new insights from the PARIS birth cohort

The natural course of childhood asthma and allergy is complex and not fully understood. We aimed to identify phenotypes based upon the time course of respiratory/allergic symptoms throughout preschool years.

Dry night cough as a marker of allergy in preschool children: the PARIS birth cohort.

Early detection of children at risk for developing allergy is an important challenge. Our first analyses in infants from the Pollution and Asthma Risk: an Infant Study (PARIS) birth cohort suggested that dry night cough was associated with parental‐reported allergic disorders. The aim of the present study was to refine this finding by investigating the time course of dry night cough from birth to age 4 yr in relation to blood markers of atopy and allergic morbidity.

Cough and dyspnoea may discriminate allergic and infectious respiratory phenotypes in infancy.

To cite this article: Rancière F, Clarisse B, Nikasinovic L, Just J, Momas I. Cough and dyspnoea may discriminate allergic and infectious respiratory phenotypes in infancy. Pediatr Allergy Immunol 2012: 23: 367–375.

Can early household exposure influence the development of rhinitis symptoms in infancy? Findings from the PARIS birth cohort.

BACKGROUND Allergic rhinitis (AR) has become the most prevalent chronic allergic disorder in childhood, and the role of environment has been questioned, particularly in early life. OBJECTIVE To investigate the risk factors for rhinitis symptoms in infants included in the PARIS (Pollution and Asthma Risk: an Infant Study) birth cohort. METHODS Infants were invited to participate at age 18 months in a health examination conducted by a pediatrician. Allergic rhinitis was defined as the presence of rhinitis symptoms (runny nose, blocked nose, sneezing in the absence of a cold) combined with biological atopy (elevated total immunoglobulin E [IgE], specific IgE, or eosinophilia) and nonallergic rhinitis (NAR) as symptoms without biological atopy. Information about indoor exposures and lifestyle was collected during a telephone interview when the child was 1 month of age. Risk factors for AR and NAR were studied by using a polytomous regression model. RESULTS The prevalence of AR and NAR was 70/1,850 (3.8%) and 99/1,850 (5.4%), respectively. Allergic rhinitis and NAR did not share similar risk factors. Male sex (odds ratio [OR] = 1.99 [1.19-3.32]), parental history of AR (OR = 1.89 [1.16-3.08]), low socioeconomic class (OR = 2.23 [1.05-4.72] for low vs high level), and the presence of cockroaches in the home (OR = 3.15 [1.67-5.96]) were risk factors for AR. Conversely, the presence of particle-board furniture less than 12 months old in the childs bedroom was associated with an increased risk of NAR (OR = 1.87 [1.21-2.90]). CONCLUSIONS This study should raise awareness about the impact of indoor exposures, particularly with regard to cockroaches and particle-board furniture, because they could influence the occurrence of noninfectious rhinitis.

Épidémiologie des allergies respiratoires chez le nourrisson

Resume Introduction Les allergies respiratoires ont fait l’objet de nombreux travaux epidemiologiques au cours de la petite enfance, periode critique pour le developpement du systeme immunitaire. L’analyse d’une trentaine d’etudes epidemiologiques s’interessant aux enfants de moins de trois ans en population generale permet de degager quelques tendances malgre l’heterogeneite des definitions cliniques de l’asthme et de la rhinite allergique utilisees. Etat des connaissances L’asthme diagnostique par un medecin concerne 5 % des enfants âges de deux ans. Si un tiers des enfants sifflent au cours d’une infection respiratoire avant 3 ans, seuls 7 % sifflent en dehors d’un episode infectieux. La toux, equivalent d’asthme, et les symptomes d’obstruction bronchique touchent respectivement 15 % et 9 % des enfants avant deux ans. Quant a la rhinite allergique, sa prevalence a deux ans varie de 1 a 30 % selon l’exigence de la definition utilisee. Perspectives Les definitions des allergies respiratoires chez le nourrisson deviennent plus elaborees, integrant l’histoire personnelle et familiale d’allergie et les traitements ; la recherche se tourne desormais vers l’evaluation du risque de persistance des symptomes dans laquelle les marqueurs biologiques d’atopie semblent prometteurs. Conclusion Une meilleure definition des allergies respiratoires a cet âge devrait aider la recherche epidemiologique.