Allergic diseases in children: a modern view on the problem
DOI:
https://doi.org/10.15574/PP.2024.97.84Keywords:
allergic diseases, children, bronchial asthma, allergic rhinitis, atopic dermatitis, food allergyAbstract
Aim: review of modern data of scientific medical literature regarding the prevalence, comorbidity, risk factors, features of pathogenesis, diagnosis, principles of treatment and prevention of allergic diseases in children.
In recent years, the number of allergic diseases (ADs) has been increasing, especially among children. Approximately 20% of the world's population suffers from these diseases. Comorbid ADs are quite common. Thus, in 67–85% of children, allergic rhinitis is combined with bronchial asthma. Children with atopic dermatitis are diagnosed with allergic rhinitis in 61,8% of cases, and bronchial asthma in 29,4% of cases. The risk of developing bronchial asthma or allergic rhinitis is higher in children with food polysensitization, and infants and young children with atopic dermatitis have a high risk of developing both food allergy and asthma and allergic rhinitis. According to modern data, most ADs have common causal mechanisms. In the development and progression of asthma and allergic rhinitis and atopic dermatitis, the hypotheses of mechanistic damage of the epithelial barrier and biodiversity, related to each other, are considered. In ADs, mechanisms related to allergen-specific immunoglobulin E and non-allergic coexisting mechanisms play an important role. In addition, views on the formation of the sequence of the development of ADs ("allergic march") from the perspective of multimorbidity and phenotyping are increasingly expanding. Pathogenetic treatment of ADs is aimed at controlling the chronic T-helper 2, caused by the inflammatory process in target organs. Secondary and tertiary prevention of ADs in the early stages improves the quality of life of patients and improves the course of atopic conditions.
Conclusions. The prevalence of ADs in modern conditions is pandemic in nature. The hypothesis of mechanical damage to the epithelial barrier is significant in the development of ADs. ADs, in particular in children, can be combined, creating multi- and comorbid conditions, and aggravate the course of these diseases. Timely diagnosis of ADs is important, and a personalized approach to the treatment and prevention of ADs is considered the most rational.
References
Abdel-Gadir A, Stephen-Victor E, Gerber GK, Noval Rivas M, Wang S, Harb H et al. (2019). Microbiota therapy acts via a regulatory T cell MyD88/RORγt pathway to suppress food allergy. Nat Med. 25(7): 1164-1174. https://doi.org/10.1038/s41591-019-0461-z; PMid:31235962 PMCid:PMC6677395
Ahn K. (2023). The Effect of Prebiotics on Atopic Dermatitis. Allergy Asthma Immunol Res. 15(3): 271-275. https://doi.org/10.4168/aair.2023.15.3.271; PMid:37188483 PMCid:PMC10186120
Bousquet J, Melén E, Haahtela T, Koppelman GH et al. (2023). Rhinitis associated with asthma is distinct from rhinitis alone: The ARIA-MeDALL hypothesis. Allergy. 78(5): 1169-1203. https://doi.org/10.1111/all.15679; PMid:36799120
Bousquet J, Toumi M, Sousa-Pinto B et al. (2022). The Allergic Rhinitis and Its Impact on Asthma (ARIA) Approach of Value-Added Medicines: As-Needed Treatment in Allergic Rhinitis. 10-11: 2878-2888. https://doi.org/10.1016/j.jaip.2022.07.020; PMid:35934308
Buratynska AA, Umanets TR, Lapshin VF, Antipkin YuG. (2019). Eosinophilic esophagitis in children - current state of the problem. Pediatria Polska - Polish Journal of Paediatrics. 94 (6): 373-378. https://doi.org/10.5114/polp.2019.92971.
Celebi-Sozener Z, Ozdel-Ozturk B, Cerci P et al. (2022). Epithelial barrier hypothesis: effect of the external exposome on the microbiome and epithelial barriers in allergic disease. Allergy. 77: 1418-1449. https://doi.org/10.1111/all.15240; PMid:35108405 PMCid:PMC9306534
Cephus JY, Gandhi VD, Shah R, Brooke Davis J, Fuseini H, Yung JA et al. (2021). Estrogen receptor-α signaling increases allergen-induced IL-33 release and airway inflammation. Allergy. 76(1): 255-268. https://doi.org/10.1111/all.14491; PMid:32648964 PMCid:PMC7790897
Dhar A, Haboubi HN, Attwood SE et al. (2022). British Society of Gastroenterology (BSG) and British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) joint consensus guidelines on the diagnosis and management of eosinophilic oesophagitis in children and adults. 71: 1459-1487. https://doi.org/10.1136/gutjnl-2022-327326; PMid:35606089 PMCid:PMC9279848
Dharma C, Lefebvre DL, Tran MM et al. (2018). Patterns of allergic sensitization and atopic dermatitis from 1 to 3 years: effects on allergic diseases. Clin Exp Allergy. 48(1): 48-59. https://doi.org/10.1111/cea.13063; PMid:29143385
Fiocchi A, Cabana MD, Mennini M. (2022). Current Use of Probiotics and Prebiotics in Allergy. J Allergy Clin Immunol Pract. 10(9): 2219-2242. https://doi.org/10.1016/j.jaip.2022.06.038; PMid:35792336
Fontanella S, Frainay C, Murray CS, Simpson A, Custovic A. (2018). Machine learning to identify pairwise interactions between specific IgE antibodies and their association with asthma: a cross-sectional analysis within a population-based birth cohort. PLoS Med. 15(11): e1002691. https://doi.org/10.1371/journal.pmed.1002691; PMid:30422985 PMCid:PMC6233916
Gandhi VD, Cephus JY, Norlander AE, Chowdhury NU et al. (2022). Androgen receptor signaling promotes Treg suppressive function during allergic airway inflammation. J Clin Invest. 132(4): e153397. https://doi.org/10.1172/JCI153397; PMid:35025767 PMCid:PMC8843736
Global Initiative for Asthma. (2023). Global Strategy for Asthma Management and Prevention. URL: www.ginasthma.org.
Güngör D, Nadaud P, LaPergola CC, Dreibelbis C et al. (2019). Infant milk-feeding practices and food allergies, allergic rhinitis, atopic dermatitis, and asthma throughout the life span: a systematic review. Am J Clin Nutr. 109; Suppl 7: 772S-799S. Erratum in: Am J Clin Nutr. 110(4):1041. https://doi.org/10.1093/ajcn/nqy283; PMid:30982870 PMCid:PMC6500928
Guttman-Yassky E, Zhou L, Krueger JG. (2019). The skin as an immune organ: tolerance versus effector responses and applications to food allergy and hypersensitivity reactions. J Allergy Clin Immunol. 144: 362-374. https://doi.org/10.1016/j.jaci.2019.03.021; PMid:30954522
Han M, Rajput C, Hershenson MB. (2019). Rhinovirus attributes that contribute to asthma development. Immunol Allergy Clin North Am. 39(3): 345-359. https://doi.org/10.1016/j.iac.2019.03.004; PMid:31284925 PMCid:PMC6624084
Hill, DA, Spergel JM. (2018). The atopic march: Critical evidence and clinical relevance. Ann. Allergy Asthma Immunol. 120: 131-137. https://doi.org/10.1016/j.anai.2017.10.037; PMid:29413336 PMCid:PMC5806141
Khan SJ, Dharmage SC, Matheson MC, Gurrin LC. (2018). Is the atopic march related to confounding by genetics and early-life environment? A systematic review of sibship and twin data. Allergy. 73(1): 17-28. https://doi.org/10.1111/all.13228; PMid:28618023
Laidlaw TM, Mullol J, Woessner KM, Amin N, Mannent LP. (2021). Chronic Rhinosinusitis with nasal polyps and asthma. J Allergy Clin Immunol Pract. 9(3):1133-1141. https://doi.org/10.1016/j.jaip.2020.09.063; PMid:33065369
Lemonnier N, Melen E, Jiang Y et al. (2020). A novel whole blood gene expression signature for asthma, dermatitis, and rhinitis multimorbidity in children and adolescents. Allergy. 75: 3248-3260. https://doi.org/10.1111/all.14314; PMid:32277847 PMCid:PMC9302020
Li Q, Zhou Q, Zhang G, Tian X, Li Y, Wang Z et al. (2022). Vitamin D Supplementation and Allergic Diseases during Childhood. A Systematic Review and Meta-Analysis. Nutrients. 14(19): 3947. https://doi.org/10.3390/nu14193947; PMid:36235600 PMCid:PMC9571357
Lowe A, Su J, Tang M, Lodge CJ, Matheson M, Allen KJ et al. (2019). Pebbles study protocol: A randomised controlled trial to prevent atopic dermatitis, food allergy and sensitisation in infants with a family history of allergic disease using a skin barrier improvement strategy. BMJ Open. 9: e024594. https://doi.org/10.1136/bmjopen-2018-024594; PMid:30867201 PMCid:PMC6430027
Lowe AJ, Su JC, Allen KJ, Abramson MJ, Cranswick N, Robertson CF et al. (2018). A randomized trial of a barrier lipid replacement strategy for the prevention of atopic dermatitis and allergic sensitization: The pebbles pilot study. Br. J. Dermatol. 178: e19-e21. https://doi.org/10.1111/bjd.15747; PMid:28639306
Miyaji Y, Yang L, Yamamoto-Hanada K, Narita M, Saito H, Ohya Y. (2020). Earlier aggressive treatment to shorten the duration of eczema in infants resulted in fewer food allergies at 2 years of age. J. Allergy Clin. Immunol. Pract. 8(5): 1721-1724.e1726. https://doi.org/10.1016/j.jaip.2019.11.036; PMid:31821918
Niespodziana K, Stenberg-Hammar K, Papadopoulos NG et al. (2021). Microarray technology may reveal the contribution of allergen exposure and rhinovirus infections as possible triggers for acute wheezing attacks in preschool children. Viruses. 13(5). https://doi.org/10.3390/v13050915; PMid:34063445 PMCid:PMC8155838
Pasha MA, Patel G, Hopp R, Yang Q. (2019). Role of innate lymphoid cells in allergic diseases. Allergy Asthma Proc. 40: 138-145. https://doi.org/10.2500/aap.2019.40.4217; PMid:31018888 PMCid:PMC6500789
Rajput C, Han M, Ishikawa T, Lei J, Goldsmith AM, Jazaeri S et al. (2021). Rhinovirus C Infection Induces Type 2 Innate Lymphoid Cell Expansion and Eosinophilic Airway Inflammation. Front Immunol. 12: 649520. https://doi.org/10.3389/fimmu.2021.649520; PMid:33968043 PMCid:PMC8100319
Rosario CS, Cardozo CA, Neto HJC, Filho NAR. (2021). Do gender and puberty influence allergic diseases? Allergol Immunopathol. 49(2): 122-125. https://doi.org/10.15586/aei.v49i2.49; PMid:33641303
Sahiner UM, Layhadi JA, Golebski K et al. (2021). Innate lymphoid cells: the missing part of a puzzle in food allergy. Allergy. 76(7): 2002-2016. https://doi.org/10.1111/all.14776; PMid:33583026
Sicherer SH, Sampson HA. (2018). Food allergy: a review and update on epidemiology, pathogenesis, diagnosis, prevention, and manage-ment. J Allergy Clin Immunol. 141(1): 41-58. https://doi.org/10.1016/j.jaci.2017.11.003; PMid:29157945
Skjerven HO, Rehbinder EM, Vettukattil R, LeBlanc M, Granum B, Haugen G et al. (2020). Skin emollient and early complementary feeding to prevent infant atopic dermatitis (preventadall): A factorial, multicentre, cluster-randomised trial. Lancet. 395: 951-961. https://doi.org/10.1016/S0140-6736(19)32983-6; PMid:32087121
Sun Y, Meng Y, Ou Z, Li Y, Zhang M, Chen Y et al. (2022). Indoor microbiome, air pollutants and asthma, rhinitis and eczema in preschool children - A repeated cross-sectional study. Environ Int. 161: 107137. https://doi.org/10.1016/j.envint.2022.107137; PMid:35168186
Tenero L, Vaia R, Ferrante G, Maule M, Venditto L, Piacentini G et al. (2023). Diagnosis and management of allergic rhinitis in asthmatic children. Journal of asthma and allergy. 16: 45-57. https://doi.org/10.2147/JAA.S281439; PMid:36636703 PMCid:PMC9829985
Tham EH, Leung DY. (2019). Mechanisms by which atopic dermatitis predisposes to food allergy and the atopic march. Allergy Asthma Immunol Res. 11(1): 4-15. https://doi.org/10.4168/aair.2019.11.1.4; PMid:30479073 PMCid:PMC6267189
Togias A, Gergen PJ, Hu JW et al. (2019). Rhinitis in children and adolescents with asthma: ubiquitous, difficult to control, and associated with asthma outcomes. J Allergy Clin Immunol. 143(3): 1003-1011.e1010. https://doi.org/10.1016/j.jaci.2018.07.041; PMid:30213627 PMCid:PMC6408960
Tohidinik HR, Mallah N, Takkouche B. (2019). History of allergic rhinitis and risk of asthma; a systematic review and meta-analysis. World Allergy Organ J. 12(10): 100069. https://doi.org/10.1016/j.waojou.2019.100069; PMid:31660100 PMCid:PMC6807062
Tsuge M, Ikeda M, Matsumoto N, Yorifuji T, Tsukahara H. (2021). Current Insights into Atopic March. Children (Basel). 8(11): 1067. https://doi.org/10.3390/children8111067; PMid:34828780 PMCid:PMC8620020
Umanets TR, Buratynska AA, Tolkach SI, Stepanova LS, Matveeva SYu, Kondratenkova TV et al. (2020). Impact of risk factors in developing asthma combined with gastroesophageal reflux disease in children. Medicni perspektivi. 25(4): 121-127. https://doi.org/10.26641/2307-0404.2020.4.221399
Ministry of Health of Ukraine. (2021). Asthma in children. Unified clinical protocol of primary, secondary (specialized) medical care. Order of the Ministry of Health of Ukraine of December 23, 2021 N0. 2021-2856: 10-11.
Ministry of Health of Ukraine. (2016). Atopic Dermatitis. Unified clinical protocol of primary, secondary (specialized), tertiary (highly specialized) medical care. Order of the Ministry of Health of Ukraine of July 4, 2016 No. 670.
Volosovets О, Beketova G, Berezenko V, Umanets T, Rechkina O, Mitjurjajeva-Korneyko I et al. (2021). Allergic Rhinitis in Children of Ukraine: Transformation of Morbidity and Prevalence over the Past 24 Years. Pediatrics. Eastern Europe. 9; 3. https://doi.org/10.34883/PI.2021.9.3.003
Wollenberg A, Barbarot S, Bieber T, Christen-Zaech S et al. (2018). Consensus-based European guidelines for treatment of atopic eczema (atopic dermatitis) in adults and children: part I. J Eur Acad Dermatol Venereol. 32(5): 657-682. https://doi.org/10.1111/jdv.14891; PMid:29676534
Yang L, Fu J, Zhou Y. (2020). Research progress in atopic march. Front. Immunol. 11: 1907. https://doi.org/10.3389/fimmu.2020.01907; PMid:32973790 PMCid:PMC7482645
Yonezawa K, Haruna M, Matsuzaki M, Shiraishi M, Kojima R. (2018). Effects of moisturizing skincare on skin barrier function and the prevention of skin problems in 3-month-old infants: A randomized controlled trial. J. Dermatol. 45(1). 24-30. https://doi.org/10.1111/1346-8138.14080; PMid:28983938
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