Isle of Wight, United States
Isle of Wight, United States

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Ziyab A.H.,Kuwait University | Karmaus W.,University of Memphis | Kurukulaaratchy R.J.,David Hide Asthma and Allergy Research Center | Zhang H.,University of Memphis | Arshad S.H.,University of Southampton
Journal of Epidemiology and Community Health | Year: 2014

Background Knowledge on the long-term development of adiposity throughout childhood/adolescence and its prenatal determinants and health sequelae is lacking. We sought to (1) identify trajectories of Body Mass Index (BMI) from 1 to 18 years of age, (2) examine associations of maternal gestational smoking and early pregnancy overweight with offspring BMI trajectories and (3) determine whether BMI trajectories predict health outcomes: asthma, lung function parameters (forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) ratio), and blood pressure, at 18 years. Methods The Isle of Wight birth cohort, a population-based sample of 1456 infants born between January 1989 and February 1990, was prospectively assessed at ages 1, 2, 4, 10 and 18 years. Group-based trajectory modelling was applied to test for the presence of latent BMI trajectories. Associations were assessed using log-binomial and linear regression models. Results Four trajectories of BMI were identified: 'normal', 'early persistent obesity', 'delayed overweight', and 'early transient overweight'. Risk factors for being in the early persistent obesity trajectory included maternal smoking during pregnancy (RR 2.16, 95% CI 1.02 to 4.68) and early pregnancy overweight (3.16, 1.52 to 6.58). When comparing the early persistent obesity to the normal trajectory, a 2.15-fold (1.33 to 3.49) increased risk of asthma, 3.2% (0.4% to 6.0%) deficit in FEV1/FVC ratio, and elevated systolic 11.3 mm Hg (7.1 to 15.4) and diastolic 12.0 mm Hg (8.9 to 15.1) blood pressure were observed at age 18 years. Conclusions Maternal prenatal exposures show prolonged effects on offspring's propensity towards overweight-obesity. Distinct morbid BMI trajectories are evident during the first 18 years of life that are associated with higher risk of asthma, reduced FEV1/FVC ratio, and elevated blood pressure. © 2014 by the BMJ Publishing Group Ltd.


Venter C.,University of Portsmouth | Venter C.,David Hide Asthma and Allergy Research Center | Meyer R.,Imperial College London
Proceedings of the Nutrition Society | Year: 2010

Food hypersensitivity (FHS) is the umbrella term used for food allergies that involve the immune system and food intolerances that do not involve the immune system. FHS has a huge impact on quality of life and any dietary advice given should aim to minimise this effect. Despite many advances made in diagnosing and managing patients with FHS, the cornerstone of management still remains avoidance of the relevant food. However, a commonly-presenting dilemma in clinical practice is deciding to what extent the food(s) should be avoided. The level of avoidance required is currently based on the type of FHS the patient has, characteristics of the particular food protein and the natural history of the particular FHS. In addition to management of other FHS, management of cow's milk allergy requires the healthcare professional to choose the appropriate formula. Information required by the patient also includes understanding food labels and issues surrounding cross-contamination. In order to ensure that the diet is nutritionally sound, advice should be given about suitable food choices and following a healthy balanced diet, whilst taking into account the dietary restrictions. Practical issues that need to be addressed include going on holiday, travelling and eating away from home. The dietitian plays a crucial role in this process. At present, there are no standardised documents or protocols for the management of FHS and practices differ within and between countries. If adrenaline auto-injectors are prescribed, correct administration should be demonstrated and reviewed on an ongoing basis. Copyright © The Authors 2009.


Venter C.,University of Portsmouth | Venter C.,David Hide Asthma and Allergy Research Center | Arshad S.H.,David Hide Asthma and Allergy Research Center | Arshad S.H.,University of Southampton | Arshad S.H.,Southampton General Hospital
Current Opinion in Allergy and Clinical Immunology | Year: 2012

Purpose of Review: It is well known that many aspects of food allergy are lacking sufficient research and publication. Practising evidence-based medicine in this field is, therefore, a particular challenge. Internationally, there is considerable variation in practices and no agreed treatment pathways. The time was right to review the evidence and seek the views of experts in the field, industry and food allergic individuals to develop guidance for clinical practice and to plan future research. The purpose of this review was to summarize points of agreement and discrepancy in the recently published Diagnosis and Rationale for Action against Cow's Milk Allergy, US NIAID and UK NICE guidelines. Recent Findings: The publication of the three guideline documents on food allergies gives clinicians, scientists, industry, governments and patients the opportunity to review the information in a concise format and appreciate the role of clinical expertise in decision making. The guidelines covered all aspects of food allergy: prevalence and natural history, diagnosis, management and treatment and other aspects such as vaccinations. Summary: The guidelines summarized not only our current evidence base but also gaps in our knowledge. Use of these guidelines would facilitate high quality standardized care and indicate the direction of future research. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Venkataraman D.,University of Southampton | Venkataraman D.,James Cook University | Soto-Ramirez N.,University of Memphis | Kurukulaaratchy R.J.,David Hide Asthma and Allergy Research Center | And 7 more authors.
Journal of Allergy and Clinical Immunology | Year: 2014

Background: Filaggrin is an epidermal protein that has a role in skin barrier function. Filaggrin loss-of-function (FLG-LOF) mutations are a significant risk factor for eczema and atopy, but their association with food allergy (FA) is less clear. Objective: We explored the longitudinal relationship between 3 common FLG-LOF mutations and FA using the Isle of Wight birth cohort. Methods: FA diagnosis was based on recognized allergic reactions within 4 hours after exposure to known food allergens. Food allergen sensitization (FAS) was identified by using skin prick tests conducted between 1 and 18 years of age to a range of food allergens. Three FLG mutations were genotyped in 1150 (79%) of 1456 children. The temporal relationships between FA, FAS, and eczema in children with FLG mutations were explored by using path analysis with total, direct, and indirect effect models. Results: There was a significant total effect of FLG-LOF mutations on the risk of FA in later childhood at the ages of 10 (odds ratio, 31.46; 95% CI, 2.86 to >100) and 18 (odds ratio, 4.25; 95% CI, 1.55-11.61) years. Path analysis showed that there was no direct effect of FLG-LOF mutations on FA at any age; however, an indirect effect was found on FA at all ages through eczema and FAS in the earlier years. Conclusion: FLG-LOF mutations are associated with FA in older children through eczema and FAS during early childhood. Our results highlight a biologically plausible pathway, which suggests that skin barrier function is important in the development and persistence of FA. © 2014 American Academy of Allergy, Asthma & Immunology.


Ziyab A.H.,Kuwait University | Karmaus W.,University of Memphis | Kurukulaaratchy R.J.,David Hide Asthma and Allergy Research Center | Zhang H.,University of Memphis | Arshad S.H.,University of Southampton
Journal of epidemiology and community health | Year: 2014

BACKGROUND: Knowledge on the long-term development of adiposity throughout childhood/adolescence and its prenatal determinants and health sequelae is lacking. We sought to (1) identify trajectories of Body Mass Index (BMI) from 1 to 18 years of age, (2) examine associations of maternal gestational smoking and early pregnancy overweight with offspring BMI trajectories and (3) determine whether BMI trajectories predict health outcomes: asthma, lung function parameters (forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) ratio), and blood pressure, at 18 years.METHODS: The Isle of Wight birth cohort, a population-based sample of 1456 infants born between January 1989 and February 1990, was prospectively assessed at ages 1, 2, 4, 10 and 18 years. Group-based trajectory modelling was applied to test for the presence of latent BMI trajectories. Associations were assessed using log-binomial and linear regression models.RESULTS: Four trajectories of BMI were identified: 'normal', 'early persistent obesity', 'delayed overweight', and 'early transient overweight'. Risk factors for being in the early persistent obesity trajectory included maternal smoking during pregnancy (RR 2.16, 95% CI 1.02 to 4.68) and early pregnancy overweight (3.16, 1.52 to 6.58). When comparing the early persistent obesity to the normal trajectory, a 2.15-fold (1.33 to 3.49) increased risk of asthma, 3.2% (0.4% to 6.0%) deficit in FEV1/FVC ratio, and elevated systolic 11.3 mm Hg (7.1 to 15.4) and diastolic 12.0 mm Hg (8.9 to 15.1) blood pressure were observed at age 18 years.CONCLUSIONS: Maternal prenatal exposures show prolonged effects on offspring's propensity towards overweight-obesity. Distinct morbid BMI trajectories are evident during the first 18 years of life that are associated with higher risk of asthma, reduced FEV1/FVC ratio, and elevated blood pressure. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.


Ziyab A.H.,University of South Carolina | Ziyab A.H.,Kuwait University | Karmaus W.,University of South Carolina | Holloway J.W.,University of Southampton | And 4 more authors.
Journal of the European Academy of Dermatology and Venereology | Year: 2013

Background Loss-of-function variants within the filaggrin gene (FLG) are associated with a dysfunctional skin barrier that contributes to the development of eczema. Epigenetic modifications, such as DNA methylation, are genetic regulatory mechanisms that modulate gene expression without changing the DNA sequence. Objectives To investigate whether genetic variants and adjacent differential DNA methylation within the FLG gene synergistically act on the development of eczema. Methods A subsample (n = 245, only females aged 18 years) of the Isle of Wight birth cohort participants (n = 1456) had available information for FLG variants R501X, 2282del4 and S3247X and DNA methylation levels for 10 CpG sites within the FLG gene. Log-binomial regression was used to estimate the risk ratios (RRs) of eczema associated with FLG variants at different methylation levels. Results The period prevalence of eczema was 15.2% at age 18 years and 9.0% of participants were carriers (heterozygous) of FLG variants. Of the 10 CpG sites spanning the genomic region of FLG, methylation levels of CpG site 'cg07548383' showed a significant interaction with FLG sequence variants on the risk for eczema. At 86% methylation level, filaggrin haploinsufficient individuals had a 5.48-fold increased risk of eczema when compared to those with wild type FLG genotype (P-value = 0.0008). Conclusions Our novel results indicated that the association between FLG loss-of-function variants and eczema is modulated by DNA methylation. Simultaneously assessing the joint effect of genetic and epigenetic factors within the FLG gene further highlights the importance of this genomic region for eczema manifestation. © 2012 European Academy of Dermatology and Venereology.


Soto-Ramirez N.,University of Memphis | Ziyab A.H.,University of South Carolina | Karmaus W.,University of Memphis | Zhang H.,University of South Carolina | And 5 more authors.
Journal of Epidemiology | Year: 2013

Background: In settings in which diseases wax and wane, there is a need to measure disease dynamics in longitudinal studies. Traditional measures of disease occurrence (eg, cumulative incidence) do not address change or stability or are limited to stable cohorts (eg, incidence) and may thus lead to erroneous conclusions. To illustrate how different measures can be used to detect disease dynamics, we investigated sex differences in the occurrence of asthma and wheezing, using a population-based study cohort that covered the first 18 years of life. Methods: In the Isle of Wight birth cohort (n = 1456), prevalence, incidence, cumulative incidence, positive and negative transitions, and remission were determined at ages 1 or 2, 4, 10, and 18 years. Latent transition analysis was used to simultaneously identify classes of asthma and wheezing (related phenotypes) and characterize transition probabilities over time. Trajectory analysis was used to characterize the natural history of asthma and wheezing. Results: Regarding time-specific changes, positive and negative transition probabilities were more informative than other measures of associations because they revealed a sex switchover in asthma prevalence (P < 0.05). Transition probabilities were able to identify the origin of a sex-specific dynamic; in particular, prior wheezing transitioned to asthma at age 18 years among girls but not among boys. In comparison with latent transition analysis, trajectory analysis did not directly identify a switchover in prevalence among boys and girls. Conclusions: In longitudinal analyses, transition analyses that impose minimal restrictions on data are needed in order to produce appropriate information on disease dynamics. © 2013 Nelís Soto-Ramírez et al.


Holloway J.W.,Inflammation and Immunity | Holloway J.W.,University of Southampto | Holloway J.W.,Southampton General Hospital | Arshad S.H.,Inflammation and Immunity | And 2 more authors.
Journal of Allergy and Clinical Immunology | Year: 2010

Clinical practice reminds us that there is considerable variability in the course of asthma over time. Treatment of patients with asthma would be considerably improved if one could accurately predict the likely course of disease over the life course. Recently, with the advent of the era of genome-wide association studies, there has been a monumental shift in our understanding of the genetic factors that underlie inherited susceptibility to asthma. Genes have been identified that modulate many aspects of the natural history of asthma, such as susceptibility to atopy, altered lung development, and susceptibility to more severe disease. Heritability studies have even suggested a role for genetic factors in remission of asthma. However, although the discovery of novel genetic factors underlying disease susceptibility has undoubtedly improved our understanding of disease pathogenesis, whether these advances have improved the ability to predict the natural history in individual patients is questionable, and the application of genetic testing to clinical practice remains some way off. (J Allergy Clin Immunol 2010;126:200-9.) © 2010 American Academy of Allergy, Asthma & Immunology.


Arshad S.H.,David Hide Asthma and Allergy Research Center | Arshad S.H.,University of Southampton | Karmaus W.,University of South Carolina | Raza A.,David Hide Asthma and Allergy Research Center | And 8 more authors.
Journal of Allergy and Clinical Immunology | Year: 2012

Background: The parent-of-origin effect is important in understanding the genetic basis of childhood allergic diseases and improving our ability to identify high-risk children. Objective: We sought to investigate the parent-of-origin effect in childhood allergic diseases. Methods: The Isle of Wight Birth Cohort (n = 1456) has been examined at 1, 2, 4, 10, and 18 years of age. Information on the prevalence of asthma, eczema, rhinitis, and environmental factors was obtained by using validated questionnaires. Skin prick tests were carried out at ages 4, 10, and 18 years, and total IgE measurement was carried out at 10 and 18 years. Parental history of allergic disease was assessed soon after the birth of the child, when maternal IgE levels were also measured. Prevalence ratios (PRs) and their 95% CIs were estimated, applying log-linear models adjusted for confounding variables. Results: When stratified for sex of the child, maternal asthma was associated with asthma in girls (PR, 1.91; 95% CI, 1.34-2.72; P =.0003) but not in boys (PR, 1.29; 95% CI, 0.85-1.96; P =.23), whereas paternal asthma was associated with asthma in boys (PR, 1.99; 95% CI, 1.42-2.79; P <.0001) but not in girls (PR, 1.03; 95% CI, 0.59-1.80; P =.92). Maternal eczema increased the risk of eczema in girls (PR, 1.92; 95% CI, 1.37-2.68; P =.0001) only, whereas paternal eczema did the same for boys (PR, 2.07; 95% CI, 1.32-3.25; P =.002). Similar trends were observed when the effect of maternal and paternal allergic disease was assessed for childhood atopy and when maternal total IgE levels were related to total IgE levels in children at ages 10 and 18 years. Conclusions: The current study indicates a sex-dependent association of parental allergic conditions with childhood allergies, with maternal allergy increasing the risk in girls and paternal allergy increasing the risk in boys. This has implications for childhood allergy prediction and prevention. © 2012 American Academy of Allergy, Asthma & Immunology.


PubMed | Karolinska Institutet, Regional Health Service Lazio Region, Libra Foundation, University of Plymouth and 211 more.
Type: | Journal: Clinical and translational allergy | Year: 2017

The Allergic Rhinitis and its Impact on Asthma (ARIA) initiative commenced during a World Health Organization workshop in 1999. The initial goals were (1) to propose a new allergic rhinitis classification, (2) to promote the concept of multi-morbidity in asthma and rhinitis and (3) to develop guidelines with all stakeholders that could be used globally for all countries and populations. ARIA-disseminated and implemented in over 70 countries globally-is now focusing on the implementation of emerging technologies for individualized and predictive medicine. MASK [MACVIA (

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