Tomas Lind

Development and comorbidity of eczema, asthma and rhinitis to age 12 : data from the BAMSE birth cohort

Allergy‐related diseases are a public health issue, but knowledge on development and comorbidity among children is scarce. The aim was to study the development of eczema, asthma and rhinitis in relation to sex and parental allergy, in a population‐based cohort, during childhood.

Mortality Related to Air Pollution with the Moscow Heat Wave and Wildfire of 2010

Background: Prolonged high temperatures and air pollution from wildfires often occur together, and the two may interact in their effects on mortality. However, there are few data on such possible interactions. Methods: We analyzed day-to-day variations in the number of deaths in Moscow, Russia, in relation to air pollution levels and temperature during the disastrous heat wave and wildfire of 2010. Corresponding data for the period 2006–2009 were used for comparison. Daily average levels of PM10 and ozone were obtained from several continuous measurement stations. The daily number of nonaccidental deaths from specific causes was extracted from official records. Analyses of interactions considered the main effect of temperature as well as the added effect of prolonged high temperatures and the interaction with PM10. Results: The major heat wave lasted for 44 days, with 24-hour average temperatures ranging from 24°C to 31°C and PM10 levels exceeding 300 &mgr;g/m3 on several days. There were close to 11,000 excess deaths from nonaccidental causes during this period, mainly among those older than 65 years. Increased risks also occurred in younger age groups. The most pronounced effects were for deaths from cardiovascular, respiratory, genitourinary, and nervous system diseases. Continuously increasing risks following prolonged high temperatures were apparent during the first 2 weeks of the heat wave. Interactions between high temperatures and air pollution from wildfires in excess of an additive effect contributed to more than 2000 deaths. Conclusions: Interactions between high temperatures and wildfire air pollution should be considered in risk assessments regarding health consequences of climate change.

Exposure to Air Pollution from Traffic and Childhood Asthma Until 12 Years of Age.

Background: There are limited prospective data on long-term exposure to air pollution and effects on childhood respiratory morbidity. We investigated the development of asthma and related symptoms longitudinally over the first 12 years of life in relation to air pollution from road traffic. Methods: The Swedish birth cohort BAMSE (Children, Allergy, Milieu, Stockholm, Epidemiological Survey) includes 4089 children who were followed up with repeated questionnaires and blood samples for up to 12 years of age. Residential, daycare, and school addresses, time-activity patterns, emission databases, and dispersion models were used to estimate individual exposure to particulate matter with aerodynamic diameter <10 &mgr;m (PM10) and nitrogen oxides (NOx) from traffic. Results: Overall, the data suggested possible associations between exposure to air pollution during the first year of life and asthma and wheezing in children up to 12 years of age. Asthma risks seemed to be particularly increased in children age 8 to 12 years; the overall odds ratio was 2.0 (95% confidence interval = 1.1–3.5), and for nonallergic asthma, the odds ratio was 3.8 (0.9–16.2) for a 5th to 95th percentile increase in time-weighted average exposure to PM10 (corresponding to 7.2 µg/m3). Results were similar using exposure to traffic-NOx. Conclusions: We found modest positive associations between air pollution exposure from traffic during infancy and asthma in children during the first 12 years of life, with stronger effects suggested for nonallergic asthma.

Short-term effects of air pollution on out-of-hospital cardiac arrest in Stockholm

BACKGROUND Although ozone (O3) and other pollutants have been associated with cardiovascular morbidity and mortality, the effects of O3 on out-of-hospital cardiac arrest (OHCA) have rarely been addressed and existing studies have presented inconsistent findings. The objective of this study was to determine the effects of short-term exposure to air pollution including O3 on the occurrence of OHCA, and assess effect modification by season, age, and gender. METHODS AND RESULTS A total of 5973 Emergency Medical Service-assessed OHCA cases in Stockholm County 2000-10 were obtained from the Swedish cardiac arrest register. A time-stratified case-crossover design was used to analyse exposure to air pollution and the risk of OHCA. Exposure to O3, PM2.5, PM10, NO2, and NOx was defined as the mean urban background level during 0-2, 0-24, and 0-72 h before the event and control time points. We adjusted for temperature and relative humidity. Ozone in urban background was associated with an increased risk of OHCA for all time windows. The respective odds ratio (confidence interval) for a 10 µg/m(3) increase was 1.02 (1.01-1.05) for a 2-h window, 1.04 (1.01-1.07) for 24-h, and 1.05 (1.01-1.09) for 3 day. The association with 2-h O3 was stronger for events that occurred outdoors: 1.13 (1.06-1.21). We observed no effects for other pollutants and no effect modification by age, gender, or season. CONCLUSION Short-term exposure to moderate levels of O3 is associated with an increased risk of OHCA.

Maternal body mass index in early pregnancy and offspring asthma, rhinitis and eczema up to 16 years of age

Maternal obesity has been linked to offspring asthma; however, other allergy‐related diseases, as well as the association beyond early school age, are largely unstudied.

Breastfeeding, asthma, and allergy: a tale of two cities

To cite this article: Brew BK, Kull I, Garden F, Almqvist C, Bergström A, Lind T, Webb K, Wickman M, Marks GB. Breastfeeding, asthma, and allergy: a tale of two cities. Pediatric Allergy Immunology 2012: 23: 75–82.

Childhood Allergies Affect Health-Related Quality of Life

Objective. The majority of studies investigating the effects of allergy on the children’s health-related quality of life (HRQoL) address one particular allergic disease, using a disease-specific HRQoL instrument. This work aims to assess the comparative impact on HRQoL of several allergic conditions of childhood (asthma, rhinitis, eczema, and food hypersensitivity) in a large, population-based sample of Swedish 8-year-olds. Methods. Data were obtained from a Swedish birth cohort (BAMSE). At the 8-year follow-up, parents of 3236 children completed the standardized generic HRQoL instrument EQ-5D and reported on the children’s symptoms of asthma, rhinitis, eczema, and food hypersensitivity. Information on allergic sensitization and lung function was available for a sub-sample of the children (n = 2370 and 2425, respectively). Results. Children in the study population had a median EQ visual analog scale (VAS) of 98 (Inter Quartile Range, IQR, 90–100). The median EQ VAS was significantly lower in children with allergic diseases. Children with asthma had the lowest median EQ VAS (90, IQR 85–98) and reported the highest prevalence of problems of “pain or discomfort” (18.2%, compared to 5.5% in children without asthma). Frequent wheezing and effort-induced wheezing were associated with high prevalence of problems of “anxiety or depression” (23.3% and 15.4%, respectively). Conclusions. Swedish 8-year-olds enjoy a good HRQoL, which though is significantly impacted by allergic diseases and particularly by asthma. Asthma symptoms are important determinants of HRQoL and symptom control should be a major goal in asthma management.

The link between parental allergy and offspring allergic and nonallergic rhinitis.

Parental allergy‐related disease increases the risk for rhinitis, but it remains unknown how different phenotypes of parental allergy affect this risk. The aim of this study was to investigate how parental hay fever, asthma, and eczema affect the risk of allergic rhinitis (AR) and nonallergic rhinitis (NAR) at 8 years of age.

Asthma during adolescence impairs health-related quality of life.

Clinical ImplicationsAsthma during adolescence impairs health-related quality of life, especially if the asthma is uncontrolled. To use questions about health-related quality of life (HRQoL) and markers associated with asthma control in the clinic can identify adolescents with an increased risk for impaired HRQoL.

Traffic-related air pollution exposure and incidence of stroke in four cohorts from Stockholm.

We investigated the risk of stroke related to long-term ambient air pollution exposure, in particular the role of various exposure time windows, using four cohorts from Stockholm County, Sweden. In total, 22,587 individuals were recruited from 1992 to 2004 and followed until 2011. Yearly air pollution levels resulting from local road traffic emissions were assessed at participant residences using dispersion models for particulate matter (PM10) and nitrogen oxides (NOX). Cohort-specific hazard ratios were estimated for time-weighted air pollution exposure during different time windows and the incidence of stroke, adjusted for common risk factors, and then meta-analysed. Overall, 868 subjects suffered a non-fatal or fatal stroke during 238,731 person-years of follow-up. An increment of 20 μg/m3 in estimated annual mean of road-traffic related NOX exposure at recruitment was associated with a hazard ratio of 1.16 (95% CI 0.83–1.61), with evidence of heterogeneity between the cohorts. For PM10, an increment of 10 μg/m3 corresponded to a hazard ratio of 1.14 (95% CI 0.68–1.90). Time-window analyses did not reveal any clear induction-latency pattern. In conclusion, we found suggestive evidence of an association between long-term exposure to NOX and PM10 from local traffic and stroke at comparatively low levels of air pollution.