Biomedical subjects
E Von Mutius
Publications and source records attributed to E Von Mutius.
Presentation of new GINA guidelines for paediatrics. The Global Initiative on Asthma.
The Global Initiative on Asthma (GINA) has provided guidelines for the management of children with asthma. For a step-wise approach to therapy, asthma is divided into four categories based on severity of symptoms: intermittent, mild persistent, moderate persistent, and severe persistent asthma. Long-term preventive therapy is distinguished from quick relief therapy in each group. Although these guidelines are clear and simple there have been few studies on asthma therapy for infants. Moreover, the existence of different wheezing phenotypes with varying pathogenic mechanisms hampers the interpretation of these studies. Transient wheezers have stopped wheezing by the age of 3 years and there is no relationship to atopy or a family history of asthma. In contrast, persistent wheezers continue to wheeze from the first year of life throughout school-age and have a high risk of atopy. Although they have normal lung function at birth, persistent wheezers develop significant decrements in lung function by the age of 6 years. Whether these impairments are amenable to prevention by early initiation of anti-inflammatory therapy remains to be seen. At present, there are no disease markers to identify the different wheezing phenotypes in infancy, although eosinophil counts and measurements of eosinophil cationic protein in serum may prove to be helpful in distinguishing these conditions.
Exposure and allergic sensitization to cockroach allergen in East Germany.
BACKGROUND: Some studies suggest that the prevalence of sensitization to cockroach allergens may be higher in the United States than in Europe, but there are no comparable data from population-based studies. OBJECTIVES: To determine the prevalence of allergic sensitization to German cockroach (GCR) in German schoolchildren and to assess its clinical relevance; and to determine the exposure to the major GCR allergen Bla g 2 in non-selected homes and nurseries. METHODS: The prevalence of allergic sensitization to GCR and other allergens was determined by measurement of specific IgE and skin-prick tests in a cross-sectional study of 2993 children aged 5-11 years in Dresden, Germany. The prevalence of atopic disease was determined by questionnaire, and pulmonary function and bronchial hyperresponsiveness to hypertonic saline were measured. Bla g 2 exposure was determined on floors of 187 kitchens and 47 nurseries by a commercial sandwich ELISA. RESULTS: One hundred and twenty-seven (4.2%) of the children had specific IgE (> 0.7 kU/L) against GCR. Among children with current wheeze, 8.4% were GCR-sensitized. Compared to data from the United States, the prevalence of sensitization to cockroach was similar in children without asthma (3.9%), but less frequent in asthmatic children from Dresden (6.1%). After adjustment for positive reactions to other allergens (SX1 test) no significant impact of GCR sensitization on wheeze or other symptoms and diagnoses was found. Bla g 2 was detected in 29% of the kitchens and 43% of the nurseries. None of these sites had exposure levels above the proposed threshold for causing disease of 80 ng/g dust. CONCLUSION: The data suggest that allergic sensitization to GCR is less frequent in asthmatics from Dresden, Germany than in US cities. The data indicate that GCR sensitization is not an independent risk factor for asthma and other atopic diseases in 5-11-year-olds from this city.
Reduced risk of hay fever and asthma among children of farmers.
BACKGROUND: The prevalence of atopic diseases is on the rise. Traditional lifestyles may be associated with a reduced risk of atopy. OBJECTIVES: To test the hypothesis that children living on a farm have lower prevalences of atopic diseases. To identify differences in living conditions between farmers and other families which are associated with the development of atopic conditions. DESIGN: Cross-sectional survey among children entering school (aged 5-7 years). A written questionnaire including the ISAAC core questions and asking for exposures on a farm and elsewhere was administered to the parents. SETTING: School health entry examination in two Bavarian districts with extensive farming activity. SUBJECTS: 10 163 children. MAIN OUTCOME MEASURES: The prevalence of doctor's diagnoses and symptoms of hay fever, asthma and eczema as assessed by parental report. RESULTS: Farmers' children had lower prevalences of hay fever (adjusted odds ratio = 0. 52, 95% CI 0.28-0.99), asthma (0.65, 0.39-1.09), and wheeze (0.55, 0. 36-0.86) than their peers not living in an agricultural environment. The reduction in risk was stronger for children whose families were running the farm on a full-time basis as compared with families with part-time farming activity. Among farmers' children increasing exposure to livestock was related to a decreasing prevalence of atopic diseases (aOR = 0.41, 95% CI 0.23-0.74). CONCLUSIONS: Factors related to environmental influences on a farm such as increased exposure to bacterial compounds in stables where livestock is kept prevent the development of allergic disorders in children.
Statistical/design methods.
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Month of birth and allergic disease at the age of 10.
The relationship between month of birth and asthma, hay fever and skin sensitization to mixed grass pollen was analysed in a population-based cross-sectional study in Munich and Bavaria 1989-1990 of 6535 10-year-old children. The relative risk of developing atopic disease is calculated by comparing the prevalence in a single month with the prevalence of all other months. A slightly increased risk of developing allergic skin sensitization for grass pollen (n = 1128) was found for February (odds ratio, 1.3, 95% confidence interval 1.0-1.6), May (1.4, 1.1-1.8) and June (1.3, 1.0-1.6). For hay fever (n = 379) an increase was found for May (1.5, 1.0-2.1) and for allergic asthma (n = 277) for August (1.4, 1.0-2.1). A protective effect was observed for certain months of birth; September for allergic sensitization (0.8, 0.6-1.0), October for and November for hay fever (0.6, 0.3-0.9). The occurrence of hay fever and positive prick test is explained by the seasonal variation of atmospheric grass pollen and the peak in August of asthmatic patients by house dust. Date of birth appears therefore to slightly influence the risk of developing an allergic sensitization and allergic diseases.