Manuel Sanchez-Solis

Mediterranean Diet as a Protective Factor for Wheezing in Preschool Children

OBJECTIVE To test the hypothesis that the Mediterranean diet can be a protective factor for current wheezing in preschoolers. STUDY DESIGN Questionnaires were completed by parents of 1784 preschoolers (mean age, 4.08 +/- 0.8 years). Children were stratified according to whether they experienced wheezing (20.0%) or not in the previous year. A Mediterranean diet score was built according to the intake frequency of several foods. RESULTS Age, birth by cesarean section, low birth weight, exposure to livestock during pregnancy, antibiotic use in the first year of life, acetaminophen consumption in the previous 12 months, rhinoconjunctivitis, eczema, parental asthma and tobacco consumption, maternal educational level, maternal age, physical activity, cat at home, and Mediterranean diet were associated with current wheezing but not with obesity. In the multivariate analysis, eczema, rhinoconjunctivitis, paternal asthma, and acetaminophen consumption remained risk factors for current wheezing (adjusted odds ratio [aOR] = 2.35 [95% confidence interval (CI) = 1.2 to 4.8], 2.78 [95% CI =1.3 to 6.1], 3.89 [95% CI = 1.4 to 10.7], and 2.38 [95% CI = 1.2 to 4.6], respectively). Conversely, Mediterranean diet and older age remained protective factors (aOR = 0.54 [95% CI = 0.3 to 0.9] and 0.67 [95% CI = 0.5 to 0.9], respectively). CONCLUSIONS The Mediterranean diet is an independent protective factor for current wheezing in preschoolers, irrespective of obesity and physical activity.

Validity of parent-reported height and weight for defining obesity among asthmatic and nonasthmatic schoolchildren.

Background: The relationship between parent-reported and measured height and weight is not well established in schoolchildren. This relationship has never been studied in asthmatic children. The objective of this study is to test the validity of the parent-reported weight and height for defining obesity by BMI and to know whether the perception of this height and weight changes when the child suffers from asthma. Methods: All classes of children of the target ages of 6–8 years (n = 1,672, participation rate 70.2%) of all schools in four municipalities of Murcia (Spain) were included. Parents were asked about their children’s weight and height using a questionnaire which included the International Study of Asthma and Allergies in Childhood (ISAAC) core questions on asthma. Parents were not aware that their children were going to be weighed and measured within 1 week’s time. Measurements were performed using a rigid stadiometer to the nearest 0.1 cm and a scale to the nearest 0.1 kg. Results: The bias (reported minus real) was, respectively, for nonasthmatics and asthmatics: weight +0.42 kg (95% CI +0.24; +0.59 kg) versus +0.97 kg (+0.50; +1.44 kg), height +2.37 cm (+2.06; +2.68 cm) versus +2.87 cm (+1.87; +3.87 cm); BMI –0.39 kg/m2 (–0.52; –0.23 kg/m2) versus –0.23 kg/m2 (–0.58; +0.13 kg/m2). Diagnostic accuracy of obesity calculated from reported measurements was, respectively, for nonasthmatics and asthmatics: sensitivity 78.0 versus 77.8%, specificity 96.2 versus 94.5%, positive predictive value 77.2 versus 73.7% and negative predictive value 96.4 versus 91.7%. Conclusions: Reported weights and heights had large biases, comparable between parents of both asthmatic and those of nonasthmatic children. However, this information could be reasonably valid for classifying children as obese or nonobese in large epidemiological studies.

Is the effect of prenatal paracetamol exposure on wheezing in preschool children modified by asthma in the mother

Background: There seems to be an association between paracetamol consumption during late pregnancy and the prevalence of wheezing in infancy and childhood. The aim of the present study is to determine whether the aforementioned association is modified by the presence of asthma in the mother. Methods: A total of 1,741 children aged 3–5 years from an epidemiological survey performed in the province of Murcia (Spain) were included in the analysis. Data on paracetamol consumption (never, at least once during pregnancy or at least once per month during pregnancy), wheezing symptoms in the offspring (according to the International Study of Asthma and Allergies in Childhood protocol) and the presence of asthma in the mother, together with other known risk factors for asthma, were obtained by means of a questionnaire. Results: The mean age of the children was 4.08 ± 0.8 years and 51.1% were males. The overall prevalence of current wheezing was 20.2%. The frequency of paracetamol usage was similar among asthmatic and non-asthmatic mothers, and only a small proportion of them took this drug at least once a month (13.8% of asthmatics and 11.0% of non-asthmatics). Compared to the mothers who never took paracetamol, there was a significant association between the mother having taken paracetamol at least once per month during pregnancy and the offspring suffering from wheezing at preschool age, but only among non-asthmatic mothers (odds ratio 1.94, 95% confidence interval 1.34–2.79 vs. odds ratio 1.05, 95% confidence interval 0.21–5.08). This association was maintained after controlling for potential confounders (odds ratio 1.74, 95% confidence interval 1.15–2.61). Conclusions: The frequent usage of paracetamol during pregnancy is associated with the prevalence of wheezing in offspring during preschool years. Asthma in the mother might modify this association.

Olive oil during pregnancy is associated with reduced wheezing during the first year of life of the offspring

To test the hypothesis that consuming Mediterranean diet and using olive oil for cooking/dressing salads during pregnancy might be associated with less wheezing during the first year of the offsprings life.

Evolucion de la mortalidad por asma en España, 1960-2005

BACKGROUND AND OBJECTIVE No data have been published on trends in asthma mortality in Spain between 1960 and 2005. The aim of this study was to trace these trends for both the general population and the 5- to 34-year age group in Spain. MATERIAL AND METHODS The data on asthma mortality for the general population and by age and sex were obtained from the Spanish National Institute of Statistics and used to calculate the asthma mortality rates per 100 000 inhabitants. RESULTS The overall asthma mortality rate per 100 000 inhabitants was 9.36 in 1960 and 2.22 in 2005, showing a reduction from 12.26 to 0.96 in males and from 6.58 to 3.44 in females. In the 5- to 34-year age group, the mortality rate for both sexes ranged from 0.4 to 0.1, showing great variability over time. CONCLUSIONS Asthma mortality decreased in the period analyzed, but less in women than in men. The trend and rates in Spain are similar to those of most countries for which data are available.

Phadiatop compared to skin-prick test as a tool for diagnosing atopy in epidemiological studies in schoolchildren.

The validity of the PhadiatopTM test as compared to the skin‐prick test (SPT) for diagnosing atopy in the epidemiological field has not been studied in schoolchildren. The aim of the present study was to evaluate its validity for classifying schoolchildren 9–12 yr old into atopics and non‐atopics. A total of 621 children whose parents authorized both a SPT and a blood extraction from all children participating in the phase II of the International Study of Allergies in Children (ISAAC) in Cartagena (Spain) were included in the analysis. A positive SPT was that with at least a wheal having a maximum diameter of 3 mm, once the negative value had been subtracted. PhadiatopTM was performed according to the manufacturer instructions. Diagnostic tests using SPT as the gold standard were calculated for the whole group of children and also for those with asthma or rhinoconjunctivitis and for children without any of them. The results of the tests were: sensitivity 85.0% (95% CI 82.2–87.8%), specificity 85.5% (95%CI 82.7–88.3%), positive predictive value 72.7% (95%CI 69.0–76.1%), negative predictive value 92.7% (95%CI 90.6–94.7%) and accuracy 85.3% (95%CI 82.3–88.0%). The results improved among the symptomatic groups. PhadiatopTM can be used as a valid alternative to SPT in the epidemiological setting to diagnose atopy.

Exercise-induced asthma in children : a comparative study of free and treadmill running

BACKGROUND Exercise is one of the most common precipitating factors of acute asthmatic crises in childhood. Although it has been described as more frequent among children, this is probably due to their more abundant physical activity. Nevertheless, it also occurs at other ages. OBJECTIVE The aim of this study is to assess possible differences in postexercise spirometry after treadmill and free running provocation tests. METHODS We compared the results obtained in a treadmill test performed by 30 asthmatic children and 30 healthy children with the results obtained with these same children in a free running test, keeping similar environmental conditions (temperature and humidity), exercise intensity (assessed by heart rate), and airway status at the time of the test. RESULTS Seventy-three percent of the patients had positive treadmill tests and 63.3% had positive free running tests. For the spirometric parameters studied, there were no significant differences in the percent decrease in postexercise performance after either of the provocation tests. For FEV1, which is the most sensitive diagnostic parameter, the sensitivity was 53.3% in treadmill running and 56.7% in free running, with a specificity of 100% in both tests. CONCLUSIONS If environmental conditions, exercise intensity, and airway status are controlled at the time of the test, treadmill and free running can be used indistinctly as asthma-inducing exercises.

Lung function among infants born preterm, with or without bronchopulmonary dysplasia.

Both healthy preterm infants and those with bronchopulmonary dysplasia (BPD) have poor lung function during childhood and adolescence, although there is no evidence whether prematurity alone explains the reduction in lung function found in BPD infants. Our study seeks to know if lung function, measured in infancy by means of rapid thoracic compression with raised volume technique, is different between preterm infants with and without BPD.

HLA-DRB1 and HLA–DQB1 genes on susceptibility to and protection from allergic bronchopulmonary aspergillosis in patients with cystic fibrosis

Allergic bronchopulmonary aspergillosis (ABPA) is a hypersensitivity pulmonary disease that affects both patients with cystic fibrosis (CF) and those with asthma. HLA‐DRB1 alleles have previously been associated with ABPA–CF susceptibility; however, HLA‐DQB1 allele associations have not been clearly established. The aim of the present study was to investigate HLA class II associations in patients with ABPA–CF and determine their roles in susceptibility or protection. Patients with ABPA–CF, patients with CF without ABPA, patients with asthma without ABPA (AST), and healthy controls were included in this study. DNA was extracted by automatic extractor. HLA‐DRB1 and ‐DQB1 genotyping was performed by the Luminex PCR‐SSOP method (One Lambda, Canoga Park, CA, USA). Allele specific PCR‐SSP was also performed by high‐resolution analysis (One Lambda). Statistical analysis was performed with SSPS and Arlequin software. Both HLA‐DRB1*5:01 and ‐DRB1*11:04 alleles occurred with greater frequency in patients with ABPA–CF than in those with AST and CF and control subjects, corroborating previously published data. On the other hand, analysis of haplotypes revealed that almost all patients with ABPA–CF lacking DRB1*15:01 or DRB1*11:04 carry either DRB1*04, DRB1*11:01, or DRB1*07:01 alleles. In the HLA‐DQB1 region, the HLA‐DQB1*06:02 allele occurred more frequently in patients with ABPA–CF than in those with AST and CF and healthy controls, whereas HLA‐DQB1*02:01 occurred less frequently in patients with ABPA–CF. These data confirm that there is a correlation between HLA‐DRB1*15:01, –DRB1*11:04, DRB1*11:01, –DRB1*04 and –DRB1*07:01 alleles and ABPA–CF susceptibility and suggest that HLA‐DQB1*02:01 is an ABPA–CF resistance allele.

Early exposure to acetaminophen and allergic disorders.

Purpose of reviewTo summarize the data related to the association between acetaminophen and allergic diseases, and to try to establish a conclusion regarding the extent to which the association is unbiased and what its strength might be. Recent findingsSeveral studies have shown an association between acetaminophen use during pregnancy and allergic diseases in the offspring. Furthermore, this association has also been found between early exposure and recent exposure to the drug and several allergic conditions. However, other studies did not confirm those associations. Taken together, the available data suggest an unbiased but weak association between acetaminophen consumption and asthma/wheezing. Additional studies are needed to definitely confirm the association with rhinitis, eczema and sensitization. SummaryAlthough the use of acetaminophen is weakly associated with asthma/wheezing, the widespread use of the drug might have important public health implications. Thus, controlled studies to definitely establish not only causality but also the magnitude in which acetaminophen might increase allergic disorders are needed.