RESUMO
BACKGROUND: Little is known about differential effects of antibiotic use on allergic diseases in rural versus urban environments. OBJECTIVE: To examine whether area of residence in the first year of life modifies the relation between antibiotic use in early life and allergic diseases during childhood. METHODS: Cross-sectional study of allergic diseases in 1517 children (ages 6-7 years) attending 101 schools in urban and rural areas of San Francisco (Córdoba, Argentina). Current asthma, wheeze, and allergic rhinoconjunctivitis were defined on the basis of responses to a validated questionnaire from the International Study of Asthma and Allergies in Childhood. Multivariate logistic regression was used for the analysis of antibiotic use and allergic diseases. RESULTS: After adjustment for paracetamol use, bronchiolitis, and other covariates, antibiotic use in the first year of life was associated with increased odds of current wheeze (odds ratio [OR], 1.8; 95% CI, 1.3-2.6) and allergic rhinoconjunctivitis (OR, 1.9; 95% CI, 1.3-2.7). After stratification by area of residence, antibiotic use was associated with current wheeze (OR, 2.4; 95% CI, 1.5-4.0) and allergic rhinoconjunctivitis (OR, 2.1; 95% CI, 1.3-3.4) among children who lived in an urban area in their first year of life, but not among those who lived in a rural area in their first year of life. CONCLUSIONS: Early-life antibiotic use is associated with current wheeze and allergic rhinoconjunctivitis in Argentinean children who lived in urban areas during their first year of life. Exposure to a rural environment early in life may protect against the adverse effects of antibiotics on atopic diseases in children.
Assuntos
Antibacterianos/uso terapêutico , Conjuntivite/epidemiologia , Sons Respiratórios , Rinite Alérgica/epidemiologia , Argentina/epidemiologia , Asma/epidemiologia , Criança , Feminino , Humanos , Masculino , Razão de Chances , População Rural , População UrbanaRESUMO
RATIONALE: Little is known about residence in a rural or farming environment and allergic diseases in Latin America. METHODS: Cross-sectional study of rural residence and current wheeze, current asthma and current symptoms of allergic rhino-conjunctivitis in 1,804 adolescents (ages 13-14 years) attending 31 schools in urban and rural areas of San Francisco (Córdoba, Argentina). Rural residence was classified as never, previous, and current. Duration of rural residence was categorized as 0, >0 but ≤5 years, and >5 years. Current wheeze, current asthma, and current allergic rhino-conjunctivitis were defined on the basis of responses to an extensively validated questionnaire from the International Study of Asthma and Allergies in Childhood. Logistic regression was used for the multivariable analysis of rural residence and the outcomes of interest. RESULTS: After adjustment for current smoking and other covariates, current rural residence (odds ratio [OR] = 0.15, 95% confidence interval [CI] = 0.03-0.81) and rural residence for >5 years (OR = 0.32, 95%CI = 0.12-0.84) were significantly associated with reduced odds of current wheeze. In a multivariable analysis, current residence in a rural area (OR = 0.52, 95%CI = 0.32-0.86) and rural residence for >5 years (OR = 0.44, 95%CI = 0.26-0.73) were significantly associated with reduced odds of allergic rhino-conjunctivitis. This association was no longer significant after additional adjustment for current residence in a dairy farm, which was significantly associated with reduced odds of allergic rhino-conjunctivitis. Similarly, current regular contact with farm animals was significantly associated with reduced odds of allergic rhino-conjunctivitis. CONCLUSIONS: Among Argentinean adolescents, current rural residence and rural residence for >5 years were associated with reduced odds of current wheeze and allergic rhino-conjunctivitis. These potential protective effects may be explained by a dairy farm environment, including regular contact with farm animals. Pediatr Pulmonol. 2017;52:21-28. © 2016 Wiley Periodicals, Inc.
Assuntos
Agricultura , Asma/epidemiologia , Conjuntivite Alérgica/epidemiologia , Meio Ambiente , Sons Respiratórios , População Rural , Adolescente , Argentina/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Prevalência , Fatores de Risco , Inquéritos e QuestionáriosRESUMO
Childhood asthma is a widespread health problem because of its epidemic prevalence, as asthma affects more than 300 million people worldwide. Results from cross-sectional and cohort studies show that asthma starts in childhood in a large proportion of cases. A proper diagnosis is easier to make in adults and school-age children, as permanent changes in lung development, the strong impact of environmental factors on the airways, the immunologic maturity process, and the use of some diagnostic tools make asthma more difficult to diagnose in preschool children. This period of a child's life is an interesting challenge for pediatricians and specialists. The aim of the present review is to analyze the current knowledge regarding making an early and accurate asthma diagnosis and therefore deciding on the correct treatment to gain control over asthma symptoms and minimize health risks.