Determinants of Allergic Sensitization, Asthma and Lung Function: Results from a Cross-Sectional Study in Italian Schoolchildren

Prenatal smoking exposure and early-life respiratory infections are major determinants of asthma during childhood. We investigate the factors influencing allergic sensitization (AS), asthma, and lung function in children and the balance between individual and environmental characteristics at different life stages. 1714 children aged 7–16 years and living in southern Italy were investigated using a parental questionnaire, skin prick tests, and spirometry. We found 41.0% AS prevalence: among children without parental history of asthma, male sex, maternal smoking during pregnancy (MatSmoke), and acute respiratory diseases in the first two years of life (ARD2Y) were significant risk factors for AS. MatSmoke was associated (OR = 1.79) with ARD2Y, and this association was influenced by sex. ARD2Y was, in turn, a significant risk factor (OR = 8.53) for childhood current asthma, along with AS (OR up to 3.03) and rhinoconjuctivitis (OR = 3.59). Forced mid-expiratory flow (FEF25–75%) was negatively affected by ARD2Y, with a sex-related effect. Thus, males exposed to MatSmoke had significantly lower FEF25–75% than unexposed males. Despite the difficulty of discriminating among the complex interactions underlying the development of allergic respiratory diseases, ARD2Y appears to strongly influence both asthma and lung function during childhood. In turn, ARD2Y is influenced by prenatal exposure to tobacco smoke with a sex-dependent effect.

[1]  C. Fischbacher,et al.  Impact of maternal smoking on early childhood health: a retrospective cohort linked dataset analysis of 697 003 children born in Scotland 1997–2009 , 2019, BMJ Open.

[2]  D. Newcomb,et al.  Sex Bias in Asthma Prevalence and Pathogenesis , 2018, Front. Immunol..

[3]  R. Wood‐Baker,et al.  Childhood predictors of lung function trajectories and future COPD risk: a prospective cohort study from the first to the sixth decade of life. , 2018, The Lancet. Respiratory medicine.

[4]  H. Moll,et al.  A population-based prospective cohort study examining the influence of early-life respiratory tract infections on school-age lung function and asthma , 2017, Thorax.

[5]  M. Moustaki,et al.  The Role of Sensitization to Allergen in Asthma Prediction and Prevention , 2017, Front. Pediatr..

[6]  L. Morawska,et al.  Effects of in utero and Postnatal Exposure to Secondhand Smoke on Lung Function by Gender and Asthma Status: The Seven Northeastern Cities (SNEC) Study , 2017, Respiration.

[7]  L. Bacharier,et al.  Early-life respiratory infections and asthma development: role in disease pathogenesis and potential targets for disease prevention , 2016, Current opinion in allergy and clinical immunology.

[8]  J. Gern,et al.  The contributions of allergic sensitization and respiratory pathogens to asthma inception , 2016, Journal of Allergy and Clinical Immunology.

[9]  M. Wickman,et al.  Parental smoking and development of allergic sensitization from birth to adolescence , 2015, Allergy.

[10]  G. Viegi,et al.  The Burden of Rhinitis and Rhinoconjunctivitis in Adolescents , 2014, Allergy, asthma & immunology research.

[11]  D. Cavallo,et al.  Airborne Particulate Matter in School Classrooms of Northern Italy , 2013, International journal of environmental research and public health.

[12]  Wai-ming Lee,et al.  Evidence for a Causal Relationship Between Allergic Sensitization and Rhinovirus Wheezing in Early Life , 2012, Pediatrics.

[13]  S. Stanojevic,et al.  Multi-ethnic reference values for spirometry for the 3–95-yr age range: the global lung function 2012 equations , 2012, European Respiratory Journal.

[14]  M. Bell,et al.  Effects of Ambient Pollen Concentrations on Frequency and Severity of Asthma Symptoms Among Asthmatic Children , 2012, Epidemiology.

[15]  G. Roberts,et al.  The influence of gender and atopy on the natural history of rhinitis in the first 18 years of life , 2011, Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology.

[16]  Stefania La Grutta,et al.  Proportional Venn diagram and determinants of allergic respiratory diseases in Italian adolescents , 2011, Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology.

[17]  G. Williams,et al.  Maternal smoking during and after pregnancy and lung function in early adulthood: a prospective study , 2009, Thorax.

[18]  S. Willich,et al.  Maternal smoking increases risk of allergic sensitization and wheezing only in children with allergic predisposition: longitudinal analysis from birth to 10 years , 2009, Allergy.

[19]  M. Worm,et al.  Impact of gender on asthma in childhood and adolescence: a GA2LEN review , 2007, Allergy.

[20]  G. Wennergren,et al.  The impact of pre‐ and post‐natal smoke exposure on future asthma and bronchial hyper‐responsiveness , 2007, Acta paediatrica.

[21]  S. Johnston,et al.  Early-life respiratory viral infections, atopic sensitization, and risk of subsequent development of persistent asthma , 2007, Journal of Allergy and Clinical Immunology.

[22]  D. Strachan,et al.  Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC Phases One and Three repeat multicountry cross-sectional surveys , 2006, The Lancet.

[23]  A. Biggeri,et al.  Changes in Prevalence of Asthma and Allergies Among Children and Adolescents in Italy: 1994–2002 , 2006, Pediatrics.

[24]  J. Hankinson,et al.  Standardisation of spirometry , 2005, European Respiratory Journal.

[25]  D. Fabian,et al.  The global burden of asthma: executive summary of the GINA Dissemination Committee Report , 2004, Allergy.

[26]  P. Merkus,et al.  Adverse health effects of prenatal and postnatal tobacco smoke exposure on children , 2003, Archives of disease in childhood.

[27]  J. Stocks,et al.  INVITED REVIEW SERIES: TOBACCO AND LUNG HEALTH The effect of parental smoking on lung function and development during infancy , 2003 .

[28]  G. Marks,et al.  Parental smoking and respiratory tract infections in children. , 2001, Paediatric respiratory reviews.

[29]  F. Kauffmann,et al.  Gender differences in airway behaviour over the human life span , 1999, Thorax.

[30]  A. Litonjua,et al.  The FEF25-75/FVC ratio is associated with methacholine airway responsiveness. The normative aging study. , 1999, American journal of respiratory and critical care medicine.

[31]  K. Carlsen,et al.  In utero exposure to cigarette smoking influences lung function at birth. , 1997, The European respiratory journal.

[32]  R. Pauwels,et al.  GLOBAL STRATEGY FOR ASTHMA MANAGEMENT AND PREVENTION , 1996 .

[33]  D. Strachan,et al.  International Study of Asthma and Allergies in Childhood (ISAAC): rationale and methods. , 1995, The European respiratory journal.

[34]  A. Frew,et al.  Position Paper: Allergen standardization and skin tests , 1993 .

[35]  E. Skobeloff,et al.  The influence of age and sex on asthma admissions. , 1992, JAMA.

[36]  F. Speizer,et al.  The effect of maternal smoking during pregnancy on early infant lung function. , 1992, The American review of respiratory disease.

[37]  A. Ferguson.  Persisting airway obstruction in asymptomatic children with asthma with normal peak expiratory flow rates. , 1988, The Journal of allergy and clinical immunology.

[38]  W. Thurlbeck.  Postnatal human lung growth. , 1982, Thorax.

[39]  Position paper: Allergen standardization and skin tests. The European Academy of Allergology and Clinical Immunology. , 1993, Allergy.

[40]  W. Morgan,et al.  Initial airway function is a risk factor for recurrent wheezing respiratory illnesses during the first three years of life. Group Health Medical Associates. , 1991, The American review of respiratory disease.