The risk of developing food allergy in premature or low birth-weight children.

Researchers know that children born pre-maturely or children born very small, have an immature immune system and immature digestive system.  Despite this, their immune system is able to respond to some things “normally”, for example, vaccines.  Researchers have many questions about how pre-mature and low birth weight infants respond when exposed to food allergens. 

Some researchers have assumed that children born with immature immune and digestive systems are more prone to developing food allergies.

Our Research Question:  Are children born pre-maturely or born with low birth weight more at risk of developing food allergies compared to normal-birth-weight children?

SAGE researchers looked at the health records of all children born in Manitoba in 1995.  Children were divided into groups based on * gestational age and * weight at birth.

Researchers then looked at the number of children in each group that had food allergies. Children who had had a hospital or emergency room admission for food allergy or a prescription for an Epinephrine auto-injector (Epipen or Twinject) before the age of 7 were considered food allergic.

*Gestational age refers to how far along the mother was in her pregnancy at the time of birth (30 weeks, 35 weeks, 40 weeks).  Children born at 37 weeks or less were considered pre-mature.

* Low birth weight refers to children who weigh less than 2500 grams at birth

Findings:

Almost 14 000 children were born in Manitoba in 1995. 

6.3% were born prematurely

4.9 % were born with a low birth weight 

2.06% of the premature/low birth weight children had food allergy by the time they were 7 years old.

The rate of food allergy in the premature/low birth weight group was the same as the rate of food allergy in normal children.

Many doctors have suggested to parents of pre-mature and low birth weigh babies not feed them solids before 6 months of age, milk or eggs before 1 year and peanuts and fish before age 3, believing that this would help prevent the development of food allergies. 

In this study, pre-mature children who ate these food before the recommended age did not have a higher rate of food allergy.

Risk factors for developing food allergy were: having a mother with asthma or food allergies, having a higher income and being a boy.

Conclusion:

Pre-maturity and low birth weight did not increase a child’s risk of developing food allergy. 

Delaying certain foods until a certain age did not decrease the risk of  developing food allergy. More research needs to be done to see if delaying certain foods until later in life increases or decreases the risk of food allergy.

The risk of developing food allergy in premature or low birth-weight children.

Liem JJ, Kozyrskyj AL, Huq SI, Becker AB. J Allergy Clin Immunol. 2007 May;119(5):1203-9. Epub 2007 Mar 26

Depression is more common in girls with non-allergic asthma.

Chronic illnesses increase the risk of depression and anxiety in children and teens.  Children and teens with asthma often suffer from hayfever, food allergies or eczema as well as asthma.  These illnesses affect the child’s quality of life and have been linked to depression.

Depression and anxiety disorders are twice as common in children and teens with asthma. Previous studies have shown that 16.3% of children and teens with asthma have some symptoms of depression or anxiety compared to 8.6 % of children or teens without asthma. 

Obesity rates are higher in children with asthma.  Obesity has also been linked to lower self esteem and depression.

Researchers wanted to know more about the relationship between asthma and depression.

Our Research Questions:

• Are children and teens with asthma at increased risk for depression?
• Is there a difference between having allergic asthma or non-allergic asthma when it comes to depressive symptoms?
• How does the child or teen’s weight affect the risk of depression with asthma?
• What is the relationship between allergic symptoms, asthma and depression?

 Research Findings:

• 431 SAGE study children were seen at 11-14 years of age.
• 1/3 of all children with asthma had some symptoms of depression or anxiety.
• ½ of all children with non-allergic asthma had symptoms of depression or anxiety.

 Depressive symptoms were more frequently seen in girls, in First Nations children, and in children who were overweight.

Boys:  Having allergic asthma or non-allergic asthma did not affect the rate of depressive symptoms in boys. Neither did their weight status.

First Nations boys, however, did have an increased risk of depression.

Girls: 3 factors increased the risk of depressive symptoms for girls in this study:

·         Having non-allergic asthma

·         Being overweight

·         Ethnicity (First Nations)

Girls with non-allergic asthma were more likely have symptoms of depression even if they weren’t overweight.

Having allergic asthma or other allergies (hay fever, eczema or food allergies) did NOT increase the rate of depressive symptoms.

These findings were surprising as researchers expected to see more depression in children with eczema, hay fever or other allergies. 

Researchers believe that the hormone Leptin may be a key factor connecting depression, weight and asthma.  Increased Leptin levels in children have been associated with non-allergic asthma (for girls), weight and depression.  More research needs to be done to better understand the effects of Leptin on the body.

This study did not look at how depressive symptoms change as the children age. It would be helpful to look at how depressive symptoms of children with and without asthma change over a longer period of time.

 Conclusion:

• It is important for doctors and educators to assess the existence of other illnesses, including depression, when assessing asthma.
• Non-allergic asthma is a risk factor for depression in girls. So is being overweight.
• Recognizing and treating depression will help improve a child’s asthma control and quality of life.

 Depression is more common in girls with non-atopic asthma. Bahreinian S, Ball G, Colman I, Becker A, Kozyrskyj A. Chest. 2011 April 7

Delay in diphtheria, pertussis, tetanus, vaccination is associated with a reduced risk of childhood asthma.

Asthma is the most common childhood disease in industrialized countries.  The increase in asthma has occurred along side improvements in hygienic standards and vaccinations.  Vaccines are important as they have prevented much illness and death.  However, researchers wonder if they play a role in the development of asthma.

Studies looking at an association between asthma and vaccinations show mixed results.  Some show that vaccines increase the risk, other show that vaccines decrease the risk and some show no association.  In other studies, researchers found that children have LESS of a risk of developing asthma if vaccines are given later.

Our research question: Does the timing of diphtheria, pertussis (whooping cough), and tetanus vaccinations (DPT) affect the development of asthma in childhood?

Research findings:

The SAGE study examined immunization and health care records of 14,000 children born in Manitoba in 1995 who still live in the   province. This study showed that children who had their first routine vaccination delayed by more than 2 months cut their risk of getting asthma in half.  Nearly 14% of children who received their first shot of diphtheria, pertussis, and tetanus vaccine at 2 months of age developed asthma, compared to 5.9% of children who were vaccinated later. The study also showed that more boys than girls developed asthma (3 boys to 2 girls) and children who developed asthma lived mostly in cities (70%). It is important to note that these children received a different type of DPT vaccine than what is used now. Children have been receiving a new version of the vaccine since late 1997.

What do these results mean?

This study tells us what is happening, but it does NOT tell us WHY it is happening. One of the main reasons children are immunized later than recommended is because the child has a fever or an infection at the time they should receive it. We know that fever or infection during the first year of life can help prevent the development of asthma. It may be that children are protected from asthma due to the fever or the infection and not because the vaccination was given later.

Conclusion:

Delaying the first vaccine (DPT) by 2 months or more is associated with lower rates of asthma in childhood.  The exact cause of the decreased rate of asthma is not clear. It is important to note that children who participated in this study received a different type of DPT vaccine than what given today.  We don't know if the same results would be seen using today’s vaccine.

The results of this study should not be used to spur a change in the province’s vaccination schedule. More research needs to be done on the new vaccine to see if the results are the same. Further research is also needed to see if early life infections are the reason for delayed immunization and protection against the development of asthma. 

The co-author of this study, Dr. Allan Becker, says: “It is important to continue to have your children immunized on the current schedule. The benefits of childhood vaccination far outweigh the risks.  The safety and effectiveness of vaccines have been studied for years. You can not use this study to predict what would happen to today’s children getting immunizations because the vaccination used now is different. There are far fewer side effects now, and even in 1995 when there was a risk of high fever, that risk was far outweighed by the benefits. In countries where immunizations went down or were delayed, childhood illnesses went up. These are serious illnesses that cause major problems and some capable of causing death in children”.

Delay in diphtheria, pertussis, tetanus vaccination is associated with a reduced risk of childhood asthma. McDonald KL, Huq SI, Lix LM, Becker AB, Kozyrskyj AL., J Allergy Clin Immunol. 2008 Mar;121(3):626-31. Epub 2008 Jan 18.

Fast Food Consumption Counters the Protective Effect of Breastfeeding on Asthma in Children?

The recent increases in asthma and allergic diseases is believed to be caused, in part, by changes in our lifestyle, including our diet.

In particular, fast food consumption has increased. Children consumed 5 times more fast food in the 1990s compared to the 1970s.  Fast food has been associated with wheezing in children, especially in boys.  It is not yet known if fast food is also associated with increased asthma.

The rates of prolonged breastfeeding (breastfeeding for more than 3 months) have also increased since the 1970s.  Some studies (but not all) suggest that prolonged breastfeeding is associated with less risk of asthma in children.

Researchers are confused as to why the increase in breastfeeding does not seem to protect children from developing asthma.

Our research questions:

• Why are asthma rates increasing despite the fact that more mothers are breastfeeding longer?
• Why is prolonged breastfeeding not protecting these children from getting asthma?
• Is the protective effect of breastfeeding changed by the increase in fast food?

723 SAGE children participated in this study.  246 with asthma and 477 without asthma.  Participants answered questionnaires asking about breastfeeding and about diet, including eating fast food. 

Children in the “Fast Food Group” were children who ate “burgers/fast food more than once or twice per week” in the past year compared to children who never or only occasionally ate burgers/fast food.

“Prolonged exclusive breastfeeding” was defined as feeding only breast milk for more than 12 weeks.

Findings:

Children with asthma were more likely to consume fast food than children without asthma.

No junk food group: Asthma was less frequent in children who breast fed for more than 12 weeks.  Breast feeding seems to have had a protective effect. 

Junk food eating group: Prolonged breastfeeding was not associated with less asthma. Breastfeeding did not seem to have a protective effect.

Children who often ate fast food and who were not breast fed for long had the highest risk of asthma compared to children who were breast fed for longer and who did not eat fast food as they got older.

Conclusion:

This study does not prove that fast food causes asthma but does show that fast food is associated with asthma in children. 

The increase in breast feeding does not seem to have protected children from developing asthma. The protective effects of breast feeding may be lost when a child eats fast food more than twice per week.

More research is needed to better understand the role of high salt/high fat foods in the development of asthma.

Fast food consumption counters the protective effect of breastfeeding on asthma in children?  Mai XM, Becker AB, Liem JJ, Kozyrskyj AL.  Clin Exp Allergy. 2009 Apr;39(4):556-61. Epub 2009 Jan 22

Ask the Researcher

“I wonder if mothers who are committed to breastfeeding make other lifestyle choices which have a positive outcome on their children’s weight – eg. More likely to walk or bike than drive; healthier food choices, etc.  This was probably taken into account in the surveys, but I can’t remember all the questions.”

The study did attempt to examine some influences such as gender, economic status, place of residence, family history of asthma etc on breastfeeding rates, obesity and asthma.  However personal lifestyle factors are difficult to tease out. 

The SAGE study, being an epidemiological study, helps researchers identify trends and associations but does not always explain the “why” of the trends.  Your question is appropriate and other lifestyle factors such as diet, activity levels, stress, may well play a role in the outcome.  The exact role they play and the exact mechanism continue to be important questions that researchers are trying to answer.

Should Younger Siblings of Peanut – Allergic Children Be Assessed by an Allergist before Being Fed Peanut?

There has been a dramatic increase in food allergy and other allergic conditions over the past decades.The prevalence of peanut allergy has increased from 0.5% a decade ago to between 1.0 and 1.8% now. Peanut allergy is the most common cause of  life threatening food allergy. Parents with a peanut-allergic child often have a great deal of stress in attempting to ensure a peanut-free environment in the home, school, and play environments to prevent a life-threatening reaction. Parents often wonder if the brother or sister of the peanut allergic child will also have peanut allergy, sometimes asking the doctor to test the child before giving the child peanuts for the first time.

Usually, allergists do not perform testing to foods unless a child has already had an obvious allergic reaction to that food.

Our research question: Is the younger sibling (brother or sister) of a peanut allergic child more likely to have peanut allergy too? 

Should allergy doctors test the younger siblings for peanut allergy even before they eat peanuts?

Findings: 560 SAGE children were contacted to fill out the Sibling Food Allergy survey. 92% completed the survey.

Peanut allergic children: 5.6% (29) of the SAGE children had peanut allergy, and eight children had positive skin tests but were able to eat peanuts.  

There were 44 siblings in this group.  Of those, 8.5% were allergic to peanuts.

Non-peanut allergic children: 94.4% (450) of children were not allergic to peanuts.

There were 853 siblings in this group. 1.3 % were allergic to peanuts.

Using the SAGE birth cohort study, it was shown that a sibling of a peanut-allergic child has a dramatic increased risk of developing peanut allergy (8.5% vs 1.3%). This risk is nearly 7 times greater than those who do not have a sibling with peanut allergy.

Conclusion: The study showed that siblings of peanut allergic children have a significantly increased risk of also developing a peanut allergy. The study recommends that siblings born into a family with a peanut-allergic child be assessed for peanut allergy by a qualified allergist before being fed this food for the first time. Depending how allergic they are, doctors may try to give these children peanuts in the clinic environment in order to watch for and treat reactions .  

Should Younger Siblings of Peanut-Allergic Children Be Assessed by an Allergist before Being Fed Peanut? Liem JJ, Huq S, Kozyrskyj AL, Becker AB. Allergy Asthma Clin Immunol. 2008 Dec 15;4(4):144-9. Epub 2008 Dec

Increased Risk of Childhood Asthma From Antibiotic use in Early Life

The rates of asthma have increased all over the world but especially in industrialized countries with clean water and better health care systems. Several theories are being studied to try to understand the cause of this.

The “Hygiene Hypothesis” stems from a belief that growing up in cleaner environments affects the development of a child’s immune system differently than growing up in an environment with more bacteria. That is why children who grow up in the country or on farms seem to have lower rates of asthma than children who are raised in the city. 

Researchers also think that the presence of microbes in our intestines helps our immune system to develop properly and that the use of antibiotics early in life disturbs the amount of normal gut microbes. This then affects the development of a baby’s immune system. 

Our research questions:

• Does taking antibiotics in the first year of life affect the chances of a child developing asthma by age 7 years?
• Are these results different for children living in the city vs children living in the country?
• Are all antibiotics associated with changes in the rates of asthma?

Antibiotics were divided into 2 groups, Broad spectrum (BS) and Narrow spectrum (NS).

Broad spectrum antibiotics are antibiotics that can kill a large range of different bacteria. Examples of broad-spectrum antibiotics are: Amoxicillin, Ampicillin, Tetracycline, Chloramphenicol, and Ciprofloxacin.

Narrow spectrum antibiotics are active against a select group of bacteria. Examples of Narrow spectrum antibiotics are: Penicillin, Cloxacillin, Cephalexin, Cefadroxil, and Erythromycin.

Researchers also looked at other risk or protective factors and divided groups of children according to: gender, rural vs urban living environment, family income, family history of asthma (mother with asthma) and the number of children in the home.

Findings:

65% of children in the SAGE study received at least one prescription for antibiotics during their first year of life.

- 52% had received a broad spectrum antibiotic only

- 3% had received a narrow spectrum antibiotic only

- 10% had received both types of antibiotics

Illnesses treated with antibiotics include:

- Ear infections (40%)

- Upper respiratory tract infections (28%)
- Lower respiratory tract infections (19%)

- Non-respiratory tract infections (7%)

• The use of Broad Spectrum antibiotics in the first ear of life increased the chances of a child developing asthma by age 7.  The more courses of antibiotics a child had, the higher the chance of getting asthma.

• Children who received more than 4 courses of Broad spectrum antibiotics in the first year were almost twice as likely to get asthma by age 7. 

• Children most at risk of the effects of antibiotics were children living in the country and children who DID NOT have a dog in the home when they were babies. A possible explanation for this is that children who live in the city and who do not have a dog already have lower levels of bacteria in their gut and that taking antibiotics does not change that much.  In essence, children who are naturally exposed to higher levels of bacteria (eg: those who live on farms or who have pets) have the most to lose. The amount of bacteria in their gut changes more dramatically with antibiotics and their immune system changes accordingly.

• Children whose mothers did not have asthma also seemed more sensitive to the effects of antibiotics. The reason for this is not understood but may have to do with some inherited genetic difference.

Conclusion: Use of antibiotics in early childhood puts all children at higher risk of getting asthma by age 7 years. Some children are more at risk of this than others. The exact reasons for this are not yet clear. 

Broad spectrum antibiotics seem to increase the risk the most.  More studies need to be done to understand this better. In the mean time, it is suggested that frequent use of Broad spectrum antibiotics be avoided as much as possible in the first year of life.  Doctors continue to be advised to only use antibiotics when absolutely necessary.

Increased risk of childhood asthma from antibiotic use in early life.Kozyrskyj AL, Ernst P, Becker AB. Chest. 2007 Jun;131(6):1753-9. Epub 2007 Apr

Infrequent milk consumption plus being overweight may have great risk for asthma in girls.

It is believed that the dramatic increase in childhood asthma and allergies in the past 25 years is caused by changes in our lifestyle including the North American diet. Children, and in particular teen girls, drink 36% less milk than they did 20 years ago.

• Some studies suggest that drinking milk is associated with lower rates of asthma. 
• Drinking milk has also been associated with better weight in children.
• Being overweight is associated with more asthma symptoms in children.

 Our research questions:

• What role does low milk consumption play in the development of asthma in children 8-10 years old? 
• What role does being overweight play in the rate of asthma?
• Does the combination of low milk consumption AND overweight together increase the risk of asthma more than each component alone?

 Children were divided into 2 groups Those with asthma and those without.

Each of these two groups was further divided into 2 more groups: Low milk consumption (drinking milk less than 2 times per week) and Regular milk consumption (drinking milk more than 2 times per week).

Overweight was defined as having a Body Mass Index of greater than 85% of the average for the child’s age.

Findings:

• Over all, children who drank little milk were more likely to be overweight.
•  Children with asthma ate fast foods more often than the children without asthma.
•  Girls with asthma tended to drink milk less often than girls who did not have asthma. This was not seen in boys with asthma. 

• Girls with asthma had a higher incidence of being overweight than girls without asthma.  
• Girls who drank little milk and were overweight were even more likely to have asthma.  This was true weather the girl lived an other-wise healthy lifestyle or not (eg, no smokers in the home, being active, eating fish and other foods with Vitamin D). 

• The number of boys who were overweight was the same for boys with or without asthma.

Conclusion: Drinking milk more often was associated with healthier weight. Not drinking milk regularly was associated with a higher incidence of asthma in girls. This was especially true if the girl drank little milk AND was overweight.  Girls who have a healthy weight and drink milk regularly have a lower incidence of asthma.

The reason for this is unclear and the researchers want to continue to study this to understand how diet and weight play a role in asthma.

Infrequent milk consumption plus being overweight may have great risk for asthma in girls. Mai XM, Becker AB, Sellers EA, Liem JJ, Kozyrskyj AL. Allergy. 2007 Nov;62(11):1295-301

The Relationship of Breast-feeding, Overweight, and Asthma in Preadolescents

Breast feeding has many advantages.  It has been shown to improve the physical and emotional health of both the mother and the infant.  The longer a baby has breast milk, the better the health outcomes.

Children who are breastfed for shorter periods of time (less than 3 months) seem to be at increased risk of being overweight once they get older.

Children who are overweight have an increased risk for developing asthma.

Our research question: Are children who were only breast fed for a short amount of time AND who were overweight more likely to have asthma?  If so, what environmental and genetic traits did being overweight and having asthma share?

Findings:

• Children who were not breastfed or only breastfed for a short amount of time (less than 3 months) were slightly more likely to have asthma at age 8-10 years.

• Children who were not breastfed or breast fed for less than 3 months were more likely to be overweight by age 8-10years.

• Children who were not breast fed or breast fed for less than 3 months AND were overweight had the highest risk of asthma.  This was especially true in boys and in children whose mothers have asthma. 

• Being overweight may be a consequence of little or no breastfeeding and may increase the risk of asthma in susceptible children (those with a family history of asthma for example).

• This association may be due to a hormone called Leptin. Leptin plays a role in controlling food intake, which helps maintain good body weight. Leptin may also affects a child’s immune response.  Levels of Leptin are higher in children who are breast fed. This may lead to better weight control and less asthma.

• Obesity in a mother is one of the strongest risk factors for a child being obese.  It is also associated with difficulty breastfeeding.  However, a mother being obese does not increase the risk of a child having asthma.

Conclusion: Doctors and nurses have long been encouraging women to breastfeed for as long as they can.  This study gives doctors, nurses, teachers and prenatal educators more reasons to continue to help and encourage mothers to breastfeed as long as they can.

To read the published article, go to: The relationship of breast-feeding, overweight, and asthma in preadolescents.Mai XM, Becker AB, Sellers EA, Liem JJ, Kozyrskyj AL. J Allergy Clin Immunol. 2007 Sep;120(3):551-6. Epub 2007 Jun 21

Continued Exposure to Maternal Distress in Early Life is Associated with an Increased Risk of Childhood Asthma

Evidence is emerging that a mother’s stress in early life plays a role in the development of childhood asthma. Increase in chronic stress of women has matched the rising rate of asthma in the Western world. Stress is a well-known cause of worsening asthma in children. Research suggests that a mother’s stress in early life may lead to the development of asthma in kids. Parenting difficulties in the first year of life have been associated with asthma at ages 6-8.

A child’s nervous and immune system reacts to stress in a way that increases the development of asthma.  These stress responses are exaggerated in children if the mother’s stress was present when she was pregnant. Others have identified that depression in a mother, is especially “toxic” and can lead to the development of asthma. Depressed mothers demonstrate less affection and fewer responses to infant cues. Their infants spend more time fussing and crying, and exhibit more stress behaviours compared with infants of mothers who are not depressed.

Our research questions:

• Does a mother’s stress increase the chances of a child developing asthma? 

• Is this different for children who are more prone to getting asthma (because of someone in the family has asthma) compared to children who are not?

Findings: The SAGE Study assessed the risk of asthma at age 7 in relation to their mother’s level of stress in the first year of life and onward.

• Among the 13, 907 children born in Manitoba in 1995, 18.9% were exposed to significant maternal distress during their first year of life.

• 8.3% of the children who were exposed to a lot of maternal stress during the first year of life had asthma at 7 years of age. Only 6.2% of the children who were not exposed to maternal stress had asthma. Seventy-five percent of children with asthma received their first diagnosis of asthma after the age of one year.

• A mother’s stress did increase the rate of asthma in childhood.  The more stress the mother had, the higher the risk to the child. The children most at risk were those whose mothers had long term stress. These children had 1.6 times higher risk of asthma at age 7 years.

Children whose mother had short term stress (for example only during the first few months after birth) were NOT at an increased risk of having asthma.

• A mother having asthma, being a boy, living in the city, and the number of times a child had to see a doctor were all associated with a higher risk for asthma in children. 

Having more children in the family was associated with a lower risk of asthma.

• Even children whose mothers did NOT have asthma, had a higher risk of developing asthma if their mother was under significant prolonged stress during their first years of life.

Conclusion:. Exposure to long term maternal stress, starting from birth, is associated with an increased risk of getting asthma for kids.  The possible reasons for this are complex. More research needs to be done to better understand this relationship.

Definitions:

Current asthma at age 7 was defined as at least two physician visits for asthma, one asthma hospitalization, or two prescriptions for any asthma drug in the year after the child’s 7^th birthday.

Maternal distress was determined on the basis of physician visits, hospitalizations, or prescription medications for depression or anxiety during the first year of life and afterward. 

To see the original research article, see:

Continued exposure to maternal distress in early life is associated with an increased risk of childhood asthma. Kozyrskyj AL, Mai XM, McGrath P, Hayglass KT, Becker AB, Macneil B. Am J Respir Crit Care Med. 2008 Jan 15;177(2):142-7. Epub 2007 Oct 11.

Allergies: Why we get them

Good morning! We invite you to follow this link to read an interesting article posted by CBC News.

http://license.icopyright.net/user/viewFreeUse.act?fuid=MTMwMzg4MjQ=

Have a great day!

Transient Tachypnea of the Newborn May be an early Clinical Manifestation of wheezing symptoms.

Tachypnea means rapid breathing.  Some newborns have a disorder called “Transient Tackypnea of the Newborn (TTN)”.  This means that the baby has episodes of rapid breathing starting shortly after birth.  This usually normalizes within 2-5 days. TTN occurs more frequently in babies born by cesarean, babies born pre-term (before their due date) and in male babies.  For the most part, TTN resolves well without long term effects.  Some studies have shown a higher rate of wheezing problems in preschool children who had TTN at birth.

Research question:  Is TTN associated with increased risk of wheezing problems in children in early life?  What factors play a role in the increased risk?

Researchers analyzed the records of all children born at term in Manitoba in 1995.

They looked at their birth records as well as records of children diagnosed with a wheezing related respiratory illness in the first 7 years of life.  This includes seeing the doctor or hospital for acute bronchitis or bronchiolitis, chronic bronchitis, asthma or a prescription for asthma medications.

Findings:

2.4 % of children born in Manitoba in 1995 developed TTN at birth. 

Children who had TTN were more likely to have wheezing problems in early life.  These wheezing problems may be longer term than originally thought and may develop into asthma.

Risk factors for developing TTN are:

• birth weight greater than 4500gm (10 lbs)
• being male child
• living in urban (city) environment
• babies born by cesarean section
• mother with asthma

Children whose mothers have asthma are more at risk of developing TTN.  These children are also genetically more at risk of developing asthma. TTN may therefore be the first indication of asthma rather than a cause of asthma.

Certain chemicals are released in the baby during vaginal delivery that helps clear the lungs of fluid. The surge in this chemical is absent during a cesarean section, possibly leading to TTN.

Environmental factors may also play a role in the increased risk.  Most children admitted to the intensive care with TTN had also received antibiotics for 48 hours.  Early antibiotic use changes the normal bacteria in the baby’s intestines, putting them at increased risk for developing allergies.  

Conclusion: TTN is associated with higher risk of asthma. TTN may therefore be an early sign of asthma. It is possible that the combination of genetic risk (mother with asthma) and an environmental change (use of antibiotics, cesarean birth) together increases the risk of asthma.

Transient tachypnea of the newborn may be an early clinical manifestation of wheezing symptoms. Liem JJ, Huq SI, Ekuma O, Becker AB, Kozyrskyj AL. J Pediatr. 2007 Jul;151(1):29-33.

Ask the Researcher: Sulphite Allergy

Have you ever done any research on asthma and sulphite allergies? Have you heard of these two being related?

Sulphite sensitivity has been extensively studied.  Although rare, it is more frequently associated with severe asthma. Sulphite allergy is rarely associated with a rash. An allergist can help determine if symptoms are caused by a sulphite allergy by doing a "sulphite challenge".  During a sulphite challenge, the allergist will give the patient some foods with sulphite and observe the patient's response. This can help identify the casue of the symptoms the patient is experiencing.

Asthma is not Enough: Continuation of Smoking Among Parents with an Asthmatic Child

Exposure to environmental tobacco smoke (ETS) is associated with poor asthma control in children, frequent asthma exacerbations, increased rates of hospital use and reduced rates of recovery after asthma exacerbations. Passive smoke exposure has been shown to increase airway sensitivity in asthmatic children. On diagnosis of asthma in a child, parents are educated to decrease ETS exposure to their children. The amount of smoking in the general population has decreased significantly over the past decade.

Research question: Are parents likely to stop smoking once they know their child has asthma?

In 2002-2003, the SAGE survey was sent to 12, 556 households with children born in 1995 in Manitoba. The survey focused on the health of the child and the child’s family, including whether or not a child had asthma and if smokers were present in the home in 1995 and in 2002/2003.

Findings: A total of 1151 surveys indicated that a smoker was in the home in 1995 when their child was born. In 2002/2003, the prevalence of smoking in the home had decreased from 32.2% to 23.4% and was similar for participants living in both urban and rural locations.

Just over 12% of households reported that their child had asthma in 2002/2003. Among this group, 40% had someone who smoked in 1995.

Homes with an asthmatic child were more likely to have a smoker present in 1995 and in 2002/2003. Parents of asthmatic children were less likely to quit smoking or smoke outside.

Conclusion: Parents of a child with asthma who participated in the study were not more likely to change their smoking behaviour than parents without an asthmatic child. Many parents continue to smoke in spite of having children with asthma. Parental smoking behaviour did not change if there was a positive family history of asthma, if they lived in a rural or urban location, or if they were from a low-or high-income household.  Having a child with asthma is not enough to motivate a parent to quit smoking.

Asthma is not enough: continuation of smoking among parents with an asthmatic child.Liem JJ, Kozyrskyj AL, Benoit CM, Becker AB. Can Respir J. 2007 Sep;14(6):349-53

Dr. Becker talks about the SAGE Study

Happy World Asthma Day! 

Why not celebrate with Dr. Becker, one of the lead investigators of the SAGE study?  Watch this short video that describes the goals and some findings of this very important research.

Stay tuned for more events related to World Asthma Day.

Normalization Strategies of Children With Asthma

Asthma rates have increased dramatically in the past 40 years.  12% of Canadian children now live with this chronic disease. Chronic asthma can psychologically affect children.  Children have reported having feelings of  anger, fear, frustration, guilt, loneliness and anxiety. Exploring one’s self-identity is an important task of early adolescence. Children want to be considered “normal”, and be treated by their peers as such.  Living with a chronic illness may affect how children view themselves and their health.

Research Question: How do older children and adolescents perceive living with a chronic illness?  What strategies do they use to help them cope with asthma and “feel normal”?

Researchers interviewed 22 boys and girls 11 years of age. 7 children had mild asthma, 9 had moderate asthma and 6 had severe asthma. Questions were designed to have kids describe their experiences of living with asthma and compare their health to that of their peers.  Children were also asked how they would describe asthma to a friend who had been recently diagnosed?

Findings:

• All children but one acknowledged that asthma had an impact on their  life at least some times and to varying degrees.
• Children describe asthma attacks as painful, “it takes your breath away”, affecting their ability to complete or participate in an event.
• Asthma also affects children emotionally. Some girls said that asthma made them feel different or weird and that asthma was scary. One boy felt that asthma prevented him from getting good marks in gym which made him feel horrible.  
• Asthma sometimes stops children from doing what other kids can do.  These feelings were  motivation for developing strategies to minimize the impact and normalize their life.

What do children do to “normalize” asthma?

• 16 children saw their health as just the same and pretty good.
• 6 children saw their health as all right, but not perfect, due to asthma attacks.
• Many emphasized their abilities and minimized their differences.
• All mention wheezing and coughing but then tend to say “it’s really not that hard to live with” – children look at the activities they can and do take part in rather than those they don’t.
• Children take pride in participating in all activities, at time finding ways to adapt their participation (playing goal).
• Children don't necessariy change their activities but may decrease their physical exertion during an activity.
• All view medications as an important part of managing asthma and permitting participation in activities. 

Conclusion: Children with asthma see themselves as different but develop normalization strategies to fit in with their peers. Children see the use of medication as a means of achieving normalcy.

Understanding a young’s person’s desire to integrate with peers and live as normally as possible could help provide a more holistic dimension to care.  Also asking questions about normalization strategies may help uncover true asthma control.  The desire to keep up with peers may be a way to motivate a young person to follow measures required to maintain asthma control.

Normalization strategies of children with asthma. Protudjer JL, Kozyrskyj AL, Becker AB, Marchessault G. Qual Health Res. 2009 Jan;19(1):94-104. Epub 2008 Nov 7.

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Diagnosing Asthma in Children: What is the role of Bronchoprovocation testing?

Asthma is more common in boys than in girls during childhood.  After puberty, asthma is more common in girls. Many children who have wheezing in the preschool years do not go on to have asthma by school age. Because asthma can be so different from child to child in this age group, diagnosing asthma can be difficult.  This leads to both over diagnosis AND under diagnosis of asthma.

Asthma usually starts before the age of 6 and can be divided into 3 categories:

Transient (temporary) early wheezers,  non-allergic wheezers, and true persistent asthma.  In the 6-11 year age group, the number of children with asthma but no allergies decreases and the number of children with asthma AND allergies increases.

Airway hyperresponsiveness (AHR) is an important symptom of asthma.  AHR means the airways are extra sensitive and tighten when stimulated.  Airways can be stimulated using exercise or chemicals that are inhaled such as histamine or methacholine. Stimulating airways in this manner to see how sensitive they are is called “bronchoprovocation testing”. 

Bronchoprovocation testing using “methacholine”is safe and often used to help confirm or diagnose asthma in school age children. In this test, patients inhale increasing amounts of methacholine. A breathing test is done before every increase to see if their airways have reacted by tightening.  This test is called a "Methacholine challenge" (MCH).

Our research questions:

• Does measuring Airway Hyper-responsiveness through MCH help physicians diagnose asthma? 
• How accurate are the results?  Do most children with asthma have a positive MCH?  Do most children without asthma have a negative MCH?
• Does gender or allergic status influence the results of MCH testing?

Findings:

• 228 children with asthma participated – 151 children had allergic asthma, 77 non-allergic asthma.
• 197 “healthy” children participates. (no asthma, no allergies, no rhinitis (hayfever))

All children performed a MCH test then the results were analyzed.

Using MCH to diagnose asthma in non-allergic school age children (especially boys) is not useful.  In this group of non-allergic children, every time a test is “positive”, there is a 50-50 chance that it is actually a true positive.  Half the time, when the test is “positive”, the child does not actually have asthma.

MCH testing was more useful to confirm a diagnosis of asthma in school age children who have allergies.

Conclusion: Asthma often changes in the school age child with allergies playing a bigger role in the kids with persistent asthma. The best way to diagnoses asthma in this age group is through a detailed history of symptoms, including the presence of allergies.

When interpreting the results of a MCH, it is very important to take note of a child’s gender and the presence of allergies.  In a male child without allergies, the results of a MCH test alone cannot be used to diagnose asthma.

Diagnosing asthma in children: what is the role for methacholine bronchoprovocation testing?  Liem JJ, Kozyrskyj AL, Cockroft DW, Becker AB. Pediatr Pulmonol. 2008 May;43(5):481-9

Questions and answers from the Respiratory Educators Web conferance

Did you know that Asthma Educators across Canada are interested in knowing what was learned through the SAGE study?  Last Thursday, RESPTrec^© (managed by the Lung Associations of Manitoba and Saskatchewan) invited Dr. Becker to present at a web seminar for asthma educators across Canada.
Dr. Becker presented some of the SAGE research findings.  Asthma Educators also had many good questions.  Here is a summary of some of their questions and the answers.

FAQ from Resp Trec Web Ex

1 - Are the rates of asthma the same for children who live in the city and children who live in the country?

No, there is a higher incidence of asthma in city vs. country kids.  14% of children who live in the city have asthma, 10% of children who live in the country have asthma.

2 - How do breast feeding and a child’s weight affect the risk of developing asthma?

Breastfeeding for less than 3 months does not increase risk.

Overweight alone does not increase risk.

BUT the combination of little breastfeeding AND overweight increases risk significantly, especially if the mother has asthma

3 - Is there any research on the use of probiotics?

There is some research regarding the use or probiotics being done in Sweden – their findings show that taking probiotics during pregnancy and while breastfeeding may have some effect on the development of eczema but has no effect on the development of asthma.

4 - Prolonged maternal stress was a risk factor for the development of asthma in children. Is there any research indicating the risk if the pregnancy was planned vs. unplanned?

Weather the pregnancy was planned or not was not asked.  What we do know, is that there is an increased incidence of asthma if the mother is young vs. an older mother.

5 - Does it make a difference if the child was born by cesarean section of vaginally?

There is an increase incidence of asthma in children born by cesarean section (25% increase risk).  The reasons for this are not yet clear.

6 - What about the role that Vitamin D can play?

Vitamin D insufficiency may play a role in the development of wheezing in early childhood but we DON’T KNOW if this leads to asthma.

7 - Does the DAD having asthma play a role in the child’s risk of developing asthma?

Parents having asthma is a risk factor that increases the child’s chance of having asthma.  In the preschool years, it seems that Mom’s asthma has a bigger influence on whether or not the young child will develop asthma.

In the school age years, Dad’s asthma plays a bigger role.

Children’s Perceptions of Healthful Eating and Physical Activity

Obesity has tripled in Canadian children in recent decades. Healthful behaviours have numerous benefits. Little research exists on young people’s perceptions of healthful eating and physical activity.

Our research question: “What do ‘healthful eating’ and ‘physical activity’ mean to children 11 to 12 years old?”

Findings: Children understood  the concept and benefits of healthy eating but it was not a top-of-mind concern.  A small group of children spoke of how this information was reinforced at home, through discussions of what they ought to eat or having nutritious food available.

Boys spoke mainly of food choices based on taste, especially foods eaten away from home. Girls also spoke of taste, but they contrasted this talk with the need to limit certain items for health and physical appearance…….”I don’t want to get too fat”.

Children thought that healthful eating was less fun than eating High-fat High-sugar foods (HFHS) and associated these foods with social times.

Kids also understood that being active is an important part of being healthy. Kids considered physical activity to be a wide range of activities, not only organized or team sports. Nearly all of the children spoke with pride and excitement about participating in a sports group. Most boys and girls described physical activity as an easier way to be healthy because “it’s a lot more fun” and “cuz I can play sports any day”. Nearly 50% of boys and girls spoke of healthful eating as something that they “should”, “gotta,” or “have to” do because it is “good for you” and “you should eat healthier”.

Conclusion: Children think that physical activity is an easier and more fun way to be healthy than healthful eating. Children feel conflicting pressures about healthy eating and physical activity. One solution children have developed in relation to these pressures is to eat High Fat High Salt (HFHS) foods with friends and nutritious foods at home. Another contradictory pressure, which only girls noted, was pressure to eat HFHS foods versus pressure to stay slim. 

Children’s labeling of foods as “healthy” or “bad, but good”, and physical activity as “fun”, tells us how they feel about the role of food and activity in their lives. Since children make situation-specific food choices, nutrition and physical education should stress that a balanced diet can incorporate all foods when physical activity is present. Such education is important because healthful eating is not a priority of adolescents. Understanding this can enhance communication among parents, educators, and young people.

Children's Perceptions of Healthful Eating and Physical Activity. Protudjer JL, Marchessault G, Kozyrskyj AL, Becker AB. Can J Diet Pract Res. 2010 Spring;71(1):19-23.

Body Image and Dieting Attitudes

Body dissatisfaction and a desire to be thin are so prevalent in young girls that these are recognized as a “normative discontent”. Adolescents, especially females, are bombarded with messages from the media about thinness, images of so-called beauty, and ways to achieve a lower body weight. These images, combined with a society that places a high value on physical beauty, send mixed messages to teenagers and may result in unhealthy, frequently unnecessary attempts to lose weight. Peers, as well as parents, can influence a child’s body image, body dissatisfaction, and eating or dieting habits. The primary aim of this investigation was to assess differences in body image and dieting concerns in  preadolescent boys and girls across the body-weight spectrum.  

Our research question: Do girls express more concern with body size, do they report more dieting, and do they receive more advice than boys regarding dieting?

565 preadolescent children who were enrolled in the SAGE study took part in this research. 10  and 11  year old children completed questionnaires focused on weight, dieting, and body image concerns. Height and weight were also measured. Of the 565 children, 15.8% were obese and 17.5% were overweight.

Findings: Overall, 39% of the 565 preadolescent children in this sample wanted to be thinner. This latter finding reinforces other reports that children in this age group, especially girls, desire a body size that is smaller than their current one.

Boys perceived themselves to be larger, and they were more concerned than girls about weighing too little.

Approximately 25% of the children reported receiving frequent advice from mothers, fathers, or friends about weight, exercise, and/or food restriction. Contrary to our research question, girls did not report this more often.

Conclusion: Our results indicate that weight is an important concern for 10 and 11 year old boys and girls. Educational programs and interventions for children, parents, and others who work with children should focus on overall health by encouraging healthful eating and activity patterns, body acceptance, and family involvement, rather than directly on body weight. Parents, caregivers, and children’s peers should be aware that their comments may play a role in a child’s body image. Education promoting body acceptance, a healthy body image, and healthy lifestyles for this age group may encourage healthy habits and beliefs before adolescence. Further research is needed to understand what dieting means to young children.

 

Body image and dieting attitudes among preadolescents. Bernier CD, Kozyrskyj AL, Benoit C, Becker AB, Marchessault G. Can J Diet Pract Res. 2010 Fall;71(3):122

Welcome to the new SAGE blog!

Welcome to SAGEnet. We are happy to finally launch this blog to help keep SAGE participants updated about research results. You will see that much has been learned about asthma AND other child related issues.  Check in on us often as we summarize articles that have been published in medical journals.  We hope you enjoy reading and learning more about asthma!

What have we learned?- March 24th, 2011

Dr. Kozyrskyj Ph.D. (Community Health Sciences) 
is analyzing much of the data using health records.

Join us on Thursday, March 24th, 2011 from 7 - 9 pm at Canad Inns, Polo Park. Come meet the some of the researchers involved in the SAGE study and hear the results. This time you ask the questions! Door prizes available to be won.......ipad and an itouch. Let us know you are coming by email at jstvincent@hsc.mb.ca or at 787-4593.

Our first SAGE Cafe was a great success. 60 people were present to hear the different researchers share their findings. Interesting questions were asked with good discussion.  See the "Frequently Asked Questions" tab to see some of them. Congratulations to the winners of the Itouch, Ipad and gift certificates.  We hope to host our next SAGE Cafe in the Brandon area.  Stay tuned for more details.





Dr. Sellers captures the teens' attention by explaining
the reasons for doing some of the tests. 



Dr. Becker presents this Blog!