Atopic dermatitis and respiratory symptoms in Russian and northern Norwegian school children: a comparison study in two arctic areas and the impact of environmental factors.

BACKGROUND: The increase in atopic diseases during recent decades has been related to environmental factors such as indoor and outdoor pollution and the ingestion of certain foods. On the other hand, studies from Eastern Europe (with heavy air pollution) have reported a lower prevalence of atopic diseases and sensitization in their schoolchildren than in children living in Western Europe. OBJECTIVES: This study compares the frequency of atopic diseases and respiratory symptoms in two geographically close arctic areas and points to possible risk factors for development of the diseases. METHODS: A total of 1734 schoolchildren (1183 in Nikel and 551 in Sør-Varanger) were studied using identical, four-page, self-administered questionnaires. RESULTS: Atopic diseases were reported in 38.7% of Norwegian and in 24.2% of Russian children (P < 0.001). Atopic dermatitis (AD) (23.6% vs 7.9%; P < 0.001) and allergic rhinoconjunctivitis (AR) (20.6% vs 14.7%; P < 0.001) occurred more frequently in Sør-Varanger, whereas 'self-reported' asthma (12.3% vs 13.1%) was similar in both areas. However, respiratory symptoms such as coughing, wheezing, breathlessness and bronchitis were 3-4 times more frequent in Nikel (P < 0.001). CONCLUSION: This study disproves a previous hypothesis, i.e. that air pollution must be a major risk factor for the development of atopic diseases. Nevertheless, respiratory tract symptoms may be provoked by environmental pollution. Possible explanations for the higher frequency of atopic diseases in Sør-Varanger may be found in socio-economic and lifestyle differences between the two populations.

Atopic diseases among schoolchildren in Nikel, Russia, an Arctic area with heavy air pollution.

The objective of this study was to describe the prevalence rate of atopic diseases among schoolchildren living in the heavily polluted Arctic town of Nikel, Russia. A self-administered questionnaire was distributed to the parents of 1,800 children aged 8-17 years, 1,684 of whom (93.6%) completed and returned the questionnaire. Atopic diseases were reported in 508 (30.2%) of the children and prevalence was similar for both sexes. Atopic dermatitis occurred most frequently (15.5%), followed by allergic rhinoconjunctivitis (13.9%) and asthma (3.9%). The most pronounced influence on atopic diseases in children was having parents with asthma. Indoor dampness was a significant risk factor eliciting atopic diseases, whereas furred pets, passive smoking and carpets did not influence the prevalence of allergy. We conclude that although atopic diseases are a common health problem in Nikel, they are less prevalent than has been reported in recent studies of Northern European countries. Air pollution does not seem to be a major risk factor for the development of atopic diseases.

Atopic diseases among adults in the two geographically related arctic areas Nikel, Russia and Sør-Varanger, Norway: possible effects of indoor and outdoor air pollution.

BACKGROUND: Previous studies have shown lower prevalence of atopic diseases among adults and school-children in Eastern Europe. OBJECTIVES: To compare the prevalence of atopic diseases among adults in two geographically related arctic areas, Nikel, Russia and Sør-Varanger, Norway. Nikel is a heavily polluted town on the Kola Peninsula. METHODS: The prevalence of eczema, asthma and allergic rhinoconjunctivitis (AR) was assessed using two identical questionnaire studies. The study in Sør-Varanger was conducted in the autumn of 1991 and comprised 1102 adults. In the spring of 1994, 3368 adults in Nikel completed the 4-page questionnaire. Results The lifetime prevalence of atopic diseases was significantly higher in Sør-Varanger than in Nikel (25.2% vs. 11.2%; P < 0.001), most pronounced for eczema (15.9% vs. 5.9%; P < 0.001) and AR (10.3% vs. 5.6%; P < 0.001). There was no significant difference in the prevalence of asthma between the two areas (5.6% vs. 4.9%; RR 1.1). Indoor dampness, carpeted floors and outdoor pollution were found to be significantly higher in Nikel than in Sør-Varanger (P < 0.0001). Smoking habits were different in the two areas. CONCLUSION: Atopic diseases in Sør-Varanger were more than twice that found in Nikel. Western lifestyle and new building techniques resulting in poorly ventilated homes may be the main reasons for these differences. Other factors, such as differences in seeking medical help for physical complaints and in the social and political environment, are also suggested.

Atopic disease among adults in Northern Russia, an area with heavy air pollution.

The cumulative incidence of atopic disease among adults was assessed in the heavily polluted Russian town Nikel on the Kola peninsula. The study was conducted in spring 1994 using a self-administered questionnaire. A total of 3,368 (93.6%) of the 3,600 subjects returned a completed questionnaire. Information about atopic diseases, smoking habits and living conditions in the family was also obtained. A cumulative incidence of atopic diseases of 11% was reported in 377 adults. This was significantly more frequent in women (12.7%) than in men (9.7%). Smoking habits differed from other western countries, as 53% of males and only 10% of females smoked. Indoor damp was reported by 13% and the keeping of dogs and cats by 52%. Our study indicates that atopic diseases is less frequent among adults in a heavily polluted Arctic Russian town than in western industrialized countries.

Atopic diseases among adults in Sør-Varanger community, northern Norway. An epidemiological study in an arctic area influenced by Russian industrial pollution.

BACKGROUND: Atopic diseases are common in western industrialized countries and their prevalence appears to be increasing. The prevalence seems to be higher in the cold, northerly regions of Europe. AIM: The aim of the study was to assess the prevalence of atopic diseases among adults in Sør-Varanger community, northern Norway, an arctic area at 70 degrees latitude north influenced by industrial pollution from smelting plants on the Kola peninsula. PATIENTS AND METHODS: The parents of all 575 schoolchildren aged 7-12 years in Sør-Varanger community (northern Norway) received a four page questionnaire concerning home environment and symptoms of allergy. A total of 1102 adults filled in and returned the questionnaire. RESULTS: 25.2% of the adults reported past and/or present symptoms (prevalence) of atopic diseases, whereas 38.7% of the children reported atopic symptoms. The prevalence of eczema occurred in 15.9%, followed by allergic rhinoconjunctivitis (10.3%) and asthma (5.6%), however, a significant difference between sexes was only found for eczema (p < 0.0005). Women smoked more frequently (45.6%) than men (39.0%). Keeping of furred pets occurred in 54.3% and dampness in 3.6% of the homes. CONCLUSION: This study indicates that the frequency of atopic diseases among adults is only two thirds of that reported in schoolchildren. Thus, the increased prevalence of atopic diseases over one generation could point towards factors associated with western lifestyle and living conditions (allergens and adjuvant factors).

Allergen content in dust from homes and schools in northern Norway in relation to sensitization and allergy symptoms in schoolchildren.

BACKGROUND: Previous studies have shown a high prevalence of atopic diseases among school children in the community of Sør-Varanger. Moreover, animal dander followed by pollen and house dust mite, were the most common allergens in skin prick tests. OBJECTIVE: To assess the allergen content in homes (living-rooms and mattresses) and classrooms of children living in an arctic area at 70 degrees. The presence of allergens in homes and schools and their relationship to atopy was of particular interest. METHODS: Dust samples from 38 homes and seven schools in northern Norway were collected by vacuum cleaning. The presence of allergens of dog, birch, timothy, Cladosporium herbarum, codfish and hen egg-white was investigated by radio-allergosorbent test (RAST) inhibition and the presence of major allergens of cat Felis domesticus (Fel d I) and house dust mites (HDM) Dermatophagoides pteronyssinus (Der p I) and Dermatophagoides farinae (Der f I) by enzyme-linked immunosorbent assay (ELISA). RESULTS: Mattresses contained significantly more dust per unit area than living-rooms and classrooms. No statistically significant differences in allergen content for dog, birch, timothy. Cladosporium, codfish and hen egg-white were seen between HDM-sensitized and non-atopic children. Most dust samples contained dog allergens with the highest allergenic activity found in living-rooms of those keeping dogs. An increased level of Fel d I was detected in only one of 38 samples from living-rooms (this family kept a cat) and in 25 of 38 samples from mattresses with ranges from 24 to 84 ng/m2. The highest concentrations were found in mattresses of children keeping cats. Increased levels (> or = 25 ng/m2) of Der p I were found only in homes and virtually only in mattresses of HDM-sensitized children. An increased level of Der f I was found in only one case, i.e. in the mattress of an HDM-sensitized child where additionally Der p I and HDMs were demonstrated microscopically. When relating Der p I to HDM-sensitization an odds ratio of more than 16 (95% CI: 1.6-394.3) was found. All extracts from living-rooms included codfish allergens. Low RAST inhibition values were detected for hen egg-white. Cladosporium, birch and timothy pollen in most samples. Furthermore, the study demonstrated that dust from schools was relatively free of allergens. CONCLUSION: Previous findings indicating that the main allergen exposure problem in this geographical area is that of pet allergens were confirmed.

Dermatitis herpetiformis and celiac disease are both primarily associated with the HLA-DQ (alpha 1*0501, beta 1*02) or the HLA-DQ (alpha 1*03, beta 1*0302) heterodimers.

HLA-DRB1,-DQA1, and -DQB1 genomic typing of 50 patients with dermatitis herpetiformis and of 290 healthy blood donors was performed. Genes encoding the DQ (alpha 1*0501, beta 1*02) heterodimer were carried by 43 (86%) of the patients and 72 (25%) of the controls. Of the remaining seven patients six (12% of all the patients) carried genes encoding the DQ (alpha 1*03, beta 1*0302) heterodimer. These HLA associations are very similar to those observed in patients with celiac disease. We thus conclude that dermatitis herpetiformis and celiac disease are associated to the very same HLA-DQ alpha beta heterodimers.

Serum alpha 2-macroglobulin levels in psoriatic patients treated with UVB and PUVA.

BACKGROUND: Abnormalities in proteinase metabolisms have been found in psoriasis and higher concentrations of neutral proteinases in psoriatic skin lesions than in unaffected skin of psoriatic patients have been observed. AIM: The aim of the study was to determine whether repeated whole body UV-(UVB and PUVA) irradiation is associated with changes in proteinase inhibitor alpha 2-macroglobulin (alpha 2-M) in patients with active plaque psoriasis. PATIENTS AND METHODS: In this study, the sera alpha 2-M levels were evaluated in cases of active plaque psoriasis before UV-, four weeks UVB (15 patients) and PUVA (11 patients) irradiation, and two weeks after completed treatment. RESULTS: Both UVB and PUVA treatment had no significant influence on alpha 2-M levels in psoriatic sera, it was, however, sufficient to treat most of the skin lesions. DISCUSSION: The beneficial effect of phototherapy in psoriasis seems not to be mediated through increased binding of proteinases by proteinases inhibitor alpha 2-M from serum.

Viable fungi in indoor air in homes and schools in the Sør-Varanger community during winter.

The present study investigated the content of fungal aerospores in homes and schools of house-dust-mite (HDM)-sensitized and control children in a subarctic area. During winter, airborne microfungi were collected from the homes and schools of 19 HDM-sensitized children and 19 nonatopic controls, all living in the community of Sør-Varanger, northern Norway. The samples were cultivated and microfungal growth was identified microscopically. Indoor humidity, temperature, and carbon dioxide (CO2) concentrations were measured. Housing conditions and sociodemographic and symptom data were obtained by a questionnaire. Penicillium was the most common microfungus in both homes and schools, followed by various yeasts, Aspergillus, Cladosporium, and Mucor. The number of infected homes was equal in the HDM-sensitized group and the control group, but aerospore counts were higher in the HDM-sensitized group than in the control group. The lowest aerospore counts were found in the schools. High aerospore counts also appeared to be related to high indoor humidity. The keeping of pets and damp indoor conditions were more frequent in homes of HDM-sensitized children than in the control group, whereas parental smoking and carpeting occurred with equal frequency in both groups. This indicates that no allergy sanitation measures had been undertaken, especially in the homes of the HDM-sensitized children.

House-dust mite content in mattresses in relation to residential characteristics and symptoms in atopic and nonatopic children living in northern Norway.

The occurrence of house-dust mites (HDMs) was investigated in the mattresses of 19 children previously found to be skin prick test (SPT) positive to HDM and in 19 nonatopic children derived from an extensive survey of 424 schoolchildren, all living in northern Norway. Domestic mites were counted and identified microscopically. Mite counts ranging from 10 to 1800 mites per gram mattress dust were found in 10 of the 19 HDM-sensitized children compared to none in the control group, corresponding to an odds ratio of more than 20. Of the 540 domestic mites found, 70 were identified by species. Dermatophagoides pteronyssinus (Dpt) was the only HDM species identified (64 mites), while five were storage mites and one was a Tarsonemus species. Positive radioallergosorbent tests (RAST) to Dpt were demonstrated in 9/10 children with and in 5/9 without mite infestation compared to none in the control group. Elevated IgE levels were also found more frequently in children with mite-infested mattresses than in those without. IgE levels were within normal levels in all 19 children in the control group. Latent atopy was found in four children, three with and one without mite infestation. There was no correlation between the concentration of mites and the degree of sensitization. Poor ventilation, increased humidity, and water leak(s) were associated with the presence of domestic mites in mattresses. As HDM growth is highly dependent on humidity and microhabitat, it should be possible to avoid HDM exposure and allergy in this region.

Contact allergy in relation to hand eczema and atopic diseases in north Norwegian schoolchildren.

Patch testing was carried out in 424 schoolchildren (223M, 201F), aged 7-12 years, in northern Norway. In 99 (23.3%) of these children, one or more allergic patch test reactions were demonstrated; 30 children reacted to two and 6 to three or more substances; 53 irritant reactions were recorded in 33 (7.8%) of those tested. From a total of 144 positive tests, the most common allergen was nickel (14.9%), followed by cobalt (5.7%), kathon CG (5.2%), lanolin (1.7%) and neomycin (1.4%). Both allergic and irritant reactions were found twice as frequently in girls as in boys. Positive patch tests were significantly more frequent in atopic (28.8%) than in non-atopic (17.9%) children, being most pronounced in atopic girls (37.4%). Hand eczema was reported to have occurred or to be present in 6.5% of cases. Twenty-nine of 36 children reporting hand eczema participated in the clinical examination. Altogether 15 (3.5%) children had hand eczema at the time of the clinical examination but 12 of these children had no previous history of hand eczema. In 14 of these 15 subjects, the eczema was localized to the back of the hands, with 13 having atopic dermatitis. In 4 of these 15 children, an allergic patch test reaction was found; however, in only 2 of these 4 was the test considered to be clinically relevant for the diagnosis allergic hand eczema. In conclusion, irritant hand eczema may occur in early childhood and is most prevalent in children with atopic dermatitis.

Irradiances and health risks associated with the use of UV lamps and sunbeds.

UV spectra of old sun lamps have been measured and found to contain significant amounts of UVC in addition to UVB and UVA irradiances. Their spectra are compared with that of a modern sunbed, a solar spectrum obtained with a solar elevation of 29.3 degrees and the extraterrestrial UV spectrum. The effects of UVC on human skin is rarely studied, but we know that UVB can be harmful. Old UVR lamps for cosmetic tanning irradiate significant amounts of UVB and UVC, and are therefore not recommendable. However, several action spectra indicate small health risks with limited UVA exposure, but a drastic increase in the UVA doses may be one reason for the increasing skin malignancies observed in western countries. Further research to clarify these observations has to be carried out.

Prevalence and some clinical aspects of atopic dermatitis in the community of Sør-Varanger.

A study of the prevalence of atopic dermatitis among 7-12-year-old children was carried out in a rural community in Northern Norway close to the Russian border. Of the 424 children investigated, 37% had a past and/or present history of atopic dermatitis (cumulative incidence), whereas 23% were classified as having atopic dermatitis by clinical examination (point prevalence). A history of atopic dermatitis during the past year was reported by 26% of the children. Flexural lichenified dermatitis was present in 88%, and 12% of the children had facial and extensor involvement with or without hand dermatitis. Two thirds of the children showed mild and one third moderate symptoms; only 3 children had severe symptoms confirmed by clinical examination. The ratio of girls with atopic dermatitis to boys with atopic dermatitis was about 1.3:1. Onset of atopic dermatitis within the first 2 years of life occurred in 64% of cases, with no sex differences. Remission of atopic dermatitis occurred in 1 of 8 before the age of 5, with earlier cessation in boys. Mucous membrane atopy alone was reported by 13% of them and in combination with atopic dermatitis also in 13%. Parental history of atopic diseases was reported by 37% of all children, more frequently in mothers than in fathers. In families with no parental history of atopic diseases, 41% of the children appeared to develop some kind of atopic disease; this increased to 63% with a single and to 75% with a double parental history.(ABSTRACT TRUNCATED AT 250 WORDS)

Metal allergy in north Norwegian schoolchildren and its relationship with ear piercing and atopy.

In 424 schoolchildren (223 boys and 201 girls) aged 7-12 years undergoing routine patch tests, 21.0% (89 children), 38.8% (78/201) of girls and 4.9% (11/223) of boys, had had their ears pierced. 18.6% (79 children, 55 girls and 24 boys) gave a history of cutaneous reactions to metallic jewelry, and in 17.2% (73 children, 49 girls and 24 boys), sensitivity to one or more metals was confirmed. Metal allergy was confirmed by patch testing in only 34.2% of the children with a history of metal dermatitis, and 13.3% of those without a history of metal reactions had, in fact, positive patch tests to 1 or more metals. The low sensitivity (37.0%) and low positive predictive value (34.2%), together with high specificity (85.2%) and high negative predictive value (86.7%), seem to justify dermatological examination of individuals with a positive symptom-based diagnosis only. Nickel sensitivity was found in 14.9% (63 children, 44 girls and 19 boys). There is clearly a relationship between ear piercing and induction of nickel allergy in girls, as nickel sensitivity in girls with pierced ears was 2x (30.8%) that found in those without (16.3%) pierced ears. In boys, nickel sensitivity was much less frequent and few cases were related to ear piercing. Atopy appeared to influence the propensity for developing metal sensitivity in girls, as atopic girls showed positive metal tests 2x as frequently (30.8%) as non-atopic (17.0%).(ABSTRACT TRUNCATED AT 250 WORDS)

An immunohistochemical study of lysozyme in the skin of psoriatic patients.

The distribution of lysozyme was investigated in psoriatic skin lesions, perilesional skin and in skin from healthy controls, using the immunoperoxidase techniques avidin-biotin complex and alkaline phosphatase-anti alkaline phosphatase. Lysozyme was identified in polymorphonuclear leukocytes present in the Munro microabscesses and also occasionally in other parts of the skin, as shown by very strong cytoplasmic staining. Stratum corneum, stratum granulosum and stratum spinosum were weakly stained. In some cases positive staining along the dermal collagen bundles was demonstrated and is most likely to be related to the number of inflammatory cells in the papillary dermis. Psoriatic skin lesions stained significantly stronger for lysozyme than did perilesional skin (p < 0.0001), whereas skin from healthy controls stained weakly positive or was lysozyme negative. Lysozyme may be of some importance in the psoriatic disease process. By comparison the alkaline phosphatase-anti-alkaline phosphatase was found to be the most specific of the two techniques.

Dietary supplementation with very long-chain n-3 fatty acids in patients with atopic dermatitis. A double-blind, multicentre study.

The purpose of this study was to investigate whether fish oil and/or corn oil had a beneficial effect on the clinical state of atopic dermatitis, and to evaluate the dietary intake of nutrients in this group of patients. In a double-blind, multicentre study lasting 4 months, during wintertime, 145 patients with moderate to severe atopic dermatitis were randomly assigned to receive either 6 g/day of concentrated n-3 fatty acids, or an isoenergetic amount of corn oil. As local treatment, only an emollient cream or hydrocortisone cream was allowed. The fatty acid pattern in serum phospholipids, and the dietary intake of nutrients were monitored in a subgroup of patients, and the results were compared with a group of patients with psoriasis. The overall clinical score, as evaluated by the physicians, improved during the trial by 30% in the fish oil (P < 0.001) and 24% in the corn oil group (P < 0.001). This was also consistent with the results from a selected skin area, and it was further confirmed by the total subjective clinical score reported by the patients. There were no significant differences in the clinical scores between the two groups at baseline, and at the end of the study. In the fish oil group, the amount of n-3 fatty acids in serum phospholipids was significantly increased at the end of the trial, compared with pretreatment values (P < 0.001), whereas the level of n-6 fatty acids was decreased (P < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

A survey of atopic diseases among school children in Sør-Varanger community. Possible effects of subarctic climate and industrial pollution from Russia.

The occurrence of atopic diseases in school children in the community of Sør-Varanger was studied on the basis of a questionnaire sent to the parents of all the 575 children aged 7-12 years. 551 children (95.8%), 266 girls and 285 boys, completed the questionnaire. Atopic diseases were reported to be present or to have occurred in 249 (45.2%) of the 551 children, more frequently in girls (50.4%) than in boys (40.4%) (p < 0.02). Asthma occurred in 68 cases (12.3%), with almost the same frequency in girls (13.2%) and boys (11.2%). Allergic rhinoconjunctivitis was detected in 113 children (20.6%); it was slightly more frequent in boys (21.8%) than in girls (18.9%) but did not reach statistical significance. Urticaria occurred in 72 cases (13.1%), more frequently in girls (17.7%) than in boys (8.8%) (p < 0.002), while atopic dermatitis occurred in 130 cases (23.6%), again more frequently in girls (27.6%) than in boys (19.6%) (p < 0.03). Ninety-four (37.8%) of the children experienced more than one atopic symptom. In 75% of the children with dermatitis the age at onset was under 5 and more than 50% of the children with asthma had experienced symptoms before the age of 3. Parental history of atopic diseases was reported by 35.6% of all children, more frequently in mothers (30.2%) than in fathers (20.1%). On the other hand, 30.6% of children with no parental history of atopic diseases appeared to develop some kind of atopic disease; this increased to 48.0% with a single and to 56.1% with a double parental history.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of dietary supplementation with very-long-chain n-3 fatty acids in patients with psoriasis.

BACKGROUND: In several studies dietary fish oil has been found to have beneficial effect on psoriasis, but the results are contradictory and based mainly on open studies or studies of small numbers of patients. METHODS: In a four-month double-blind, multicenter trial, we randomly assigned 145 patients with moderate-to-severe psoriasis to receive in their diet either highly purified ethyl esters of n-3 fatty acids ("fish oil"; 6 g of oil per day, containing 5 g of eicosapentaenoic and docosahexaenoic acid) or an isoenergetic amount of corn oil containing mainly n-6 fatty acids. All the patients were advised to reduce their intake of saturated fatty acids. A 48-hour dietary recall was performed, and the fatty-acid pattern in the serum phospholipids was monitored in a subgroup of patients. RESULTS: In the fish-oil group, n-3 fatty acids were increased in serum phospholipids (P < 0.001), the ratio of arachidonic acid to eicosapentaenoic acid decreased (P < 0.001), and the level of n-6 fatty acids decreased (P < 0.001). In the corn-oil group, only docosahexaenoic acid increased significantly (P < 0.05). The ratio of polyunsaturated to saturated fatty acids increased in both groups. Plasma concentrations of triacylglycerol decreased from base line in the fish-oil group (P < 0.05). The score on the Psoriasis Area and Severity Index, as evaluated by the physicians, did not change significantly during the trial in either group. This was also true of a total subjective score reported by the patients, but a selected area of skin in the corn-oil group showed a significant reduction in the clinical signs (P < 0.05). Scaling was reduced from base line in both groups (P < 0.01). The fish-oil group had less cellular infiltration (P < 0.01), and the corn-oil group had improvement in desquamation and redness (P < 0.05). There was no significant difference in clinical manifestations between the groups. Among the patients in the fish-oil group, an increase in the concentration of n-3 fatty acids in serum phospholipids was not accompanied by clinical improvement, whereas in the corn-oil group there was a significant correlation between clinical improvement and an increase in eicosapentaenoic acid and total n-3 fatty acids. CONCLUSIONS: Dietary supplementation with very-long-chain n-3 fatty acids was no better than corn-oil supplementation in treating psoriasis. Clinical improvement was not correlated with an increase in the concentration of n-3 fatty acids in serum phospholipids among the patients in the fish-oil group, whereas there was a significant correlation between clinical improvement and an increase in eicosapentaenoic acid and total n-3 fatty acids in the corn-oil group.