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  • 1.
    Almqvist, C
    et al.
    Occupational and Environmental Health, Karolinska Hospital, Stockholm.
    Egmar, Ann-Charlotte
    Occupational and Environmental Health, Karolinska Hospital, Stockholm.
    Hedlin, G
    Department of Woman and Child Health, Karolinska Institutet, Astrid Lindgren Children's Hospital, Stockholm.
    Lundqvist, M
    Occupational and Environmental Health, Karolinska Hospital, Stockholm.
    Nordvall, S L
    Institute of Woman and Child Health, Uppsala University, Uppsala.
    Pershagen, G
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm.
    Svartengren, M
    Department of Public Health Sciences, Karolinska Institutet, Stockholm.
    van Hage-Hamsten, M
    Department of Medicine, Unit of Clinical Immunology and Allergy, Karolinska Institutet and Hospital, Stockholm.
    Wickman, M
    Occupational and Environmental Health, Karolinska Hospital, Stockholm.
    Direct and indirect exposure to pets: - risk of sensitization and asthma at 4 years in a birth cohort2003In: Clinical and Experimental Allergy, ISSN 0954-7894, E-ISSN 1365-2222, Vol. 33, no 9, p. 1190-1197Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: There are conflicting data on the association between early exposure to pets and allergic diseases. Bias related to retrospective information on pet ownership has been addressed as a reason for distorted study results.

    OBJECTIVE: To elucidate how early exposure to cat and dog relates to IgE-sensitization and asthma in children at 2 and 4 years of age, in a prospective birth-cohort study.

    METHODS: Four thousand and eighty-nine families with children born 1994-1996 in predefined areas of Stockholm answered questionnaires on environmental factors and symptoms of allergic disease at birth, one, two and four years of age. Dust samples collected from the mothers' beds at birth were analysed for Fel d 1 and Can f 1 in a subgroup of the cohort. Blood samples taken at four years from 2614 children were analysed for allergen-specific IgE to common airborne allergens. Risk associations were calculated with a multiple logistic regression model, with adjustment for potential confounders.

    RESULTS: A correlation was seen between allergen levels and reported exposure to cat and dog. Exposure to cat seemed to increase the risk of cat sensitization, OR (odds ratio) 1.44 (95% confidence interval 1.03-2.01), whereas dog exposure did not have any effect on dog sensitization, OR 1.16 (0.79-1.72). Dog ownership was related to a reduced risk of sensitization to other airborne allergens, OR 0.36 (0.15-0.83), and a similar tendency was seen for cat ownership OR 0.63 (0.37-1.07). Early dog ownership seemed to be associated with a lower risk of asthma, OR 0.50 (0.24-1.03), with no corresponding effect after cat ownership, OR 0.88 (0.56-1.38).

    CONCLUSION: Early exposure to cat seems to increase the risk of sensitization to cat but not of asthma at 4 years of age. Dog ownership, on the other hand, appears to be associated with lowered risk of sensitization to airborne allergens and asthma. Both aetiological relationships and selection effects have to be considered in the interpretation of these findings.

  • 2.
    Almqvist, C
    et al.
    The Department of Environmental Health, Karolinska Hospital, Stockholm.
    Larsson, P H
    National Institute for Working Life, Stockholm.
    Egmar, Ann-Charlotte
    The Department of Environmental Health, Karolinska Hospital, Stockholm.
    Hedrén, M
    National Institute for Working Life, Stockholm.
    Malmberg, P
    National Institute for Working Life, Stockholm.
    Wickman, M
    The Department of Environmental Health, Karolinska Hospital, Stockholm.
    School as a risk environment for children allergic to cats and a site for transfer of cat allergen to homes1999In: Journal of Allergy and Clinical Immunology, ISSN 0091-6749, E-ISSN 1097-6825, Vol. 103, no 6, p. 1012-1017Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Many children are allergic to furred pets and avoid direct pet contact. The school may be a site of indirect exposure to pet allergens, which may induce or maintain symptoms of allergic diseases.

    OBJECTIVE: We sought to investigate airborne levels of cat allergen (Fel d 1) at schools and in homes with or without cats and to study clothes as a route for dissemination of allergens between homes and school.

    METHODS: Airborne cat allergen was collected with personal samplers from (1) children attending classes with many (>25%) or few (<10%) cat owners and (2) homes with or without cats. A recently developed amplified ELISA assay, which detects low levels of airborne cat allergen in pet-free environments, was used. Dust samples were collected from clothes and mattresses.

    RESULTS: There was a 5-fold difference in the median levels of airborne cat allergen between classes with many and few cat owners (2.94 vs 0.59 ng/m3; P <.001). The median airborne cat allergen concentration in classes with many cat owners was significantly higher than that found in the homes of non-cat owners (P <.001) but lower than that found in homes with cats (P <.001). Allergen levels in non-cat owners' clothes increased after a school day (P <.001). Non-cat owners in classes with many cat owners had higher levels of mattress-bound cat allergen (P =.01).

    CONCLUSION: The results indicate significant exposure to cat allergen at school. Allergen is spread through clothing from homes with cats to classrooms. There the allergen is dispersed in air and contaminates the clothes of children without cats. The allergen levels in non-cat owners' homes correlate with exposure to cat allergen at school.

  • 3.
    Almqvist, Catarina
    et al.
    The Department of Occupational and Environmental Health, Karolinska Hospital, Stockholm.
    Egmar, Ann-Charlotte
    The Department of Occupational and Environmental Health, Karolinska Hospital, Stockholm.
    van Hage-Hamsten, Marianne
    The Department of Medicine, Unit of Clinical Immunology and Allergy, Karolinska Institutet, Stockholm.
    Berglind, Niklas
    The Department of Occupational and Environmental Health, Karolinska Hospital, Stockholm.
    Pershagen, Göran
    The Institute of Environmental Medicine, Karolinska Institutet.
    Nordvall, S Lennart
    The Institute of Woman and Child Health, Uppsala University, Uppsala.
    Svartengren, Magnus
    The Department of Public Health Sciences, Karolinska Institutet.
    Hedlin, Gunilla
    The Department of Woman and Child Health, Karolinska Institutet, Astrid Lindgren Children's Hospital, Stockholm.
    Wickman, Magnus
    The Department of Occupational and Environmental Health, Karolinska Hospital, Stockholm.
    Heredity, pet ownership, and confounding control in a population-based birth cohort2003In: Journal of Allergy and Clinical Immunology, ISSN 0091-6749, E-ISSN 1097-6825, Vol. 111, no 4, p. 800-806Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The association between pet ownership in childhood and subsequent allergic disease is controversial. Bias related to selection of pet exposure has been suggested as a reason for contradictory study results.

    OBJECTIVE: The purpose of this investigation was to elucidate how pet exposure depends on family history of allergic disease, smoking, and socioeconomic factors in a prospective birth cohort.

    METHODS: Parents of 4089 two-month-old children answered a questionnaire that included detailed questions about family history of asthma (maternal, paternal, and sibling), rhinoconjunctivitis, atopic eczema/dermatitis syndrome, pollen and pet allergy, smoking habits, parental occupation, and family pet ownership (cat and dog). Dust samples collected from the mothers' beds were analyzed for Fel d 1 and Can f 1 in a subgroup of the cohort.

    RESULTS: Cats were less frequently kept in families with parental asthma, rhinoconjunctivitis, or pet or pollen allergy (3.5% to 5.8%) than in families without parental allergic disease (10.8% to 11.8%). Dogs were less common in families with (3.3%) than in families without (5.9%) parental atopic eczema/dermatitis syndrome. Families with smoking mothers and those with low socioeconomic index kept cats and dogs more frequently. Cat allergen levels were lower in homes with than in homes without maternal pet allergy, and this tended to hold true even for homes without a cat. Cat ownership decreased from birth to 2 years of age, especially in families with parental history of allergic diseases.

    CONCLUSION: There seems to be a selection of pet exposure based on parental history of allergy, maternal smoking, and socioeconomic factors. This has to be taken into consideration in evaluations of risk associations between pet exposure and allergic disease in childhood.

  • 4.
    Bergfors, Sofi
    et al.
    Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm; Stockholm County Council, Health Care Services, Stockholm.
    Åström, Mimmi
    Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm; Stockholm County Council, Health Care Services, Stockholm.
    Burström, Kristina
    Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm; Stockholm County Council, Health Care Services, Stockholm; Department of Public Health Sciences, Equity and Health Policy Research Group, Karolinska Institutet, Stockholm.
    Egmar, Ann-Charlotte
    The Swedish Red Cross University College. Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm.
    Measuring health-related quality of life with the EQ-5D-Y instrument in children and adolescents with asthma2015In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 104, no 2, p. 167-173Article in journal (Refereed)
    Abstract [en]

    AIM: Asthma is one of the most common chronic paediatric diseases worldwide and affects different dimensions of health-related quality of life. This study tested the feasibility and convergent validity of using the EQ-5D-Y instrument on children and adolescents with asthma.

    METHODS: A cross-sectional design was chosen, and children with asthma, aged from 8 to 16 years, were recruited from clinics in Stockholm, Sweden. To test convergent validity, the EQ-5D-Y instrument was combined with the Paediatric Quality of Life Questionnaire.

    RESULTS: The EQ-5D-Y proved feasible as nearly 96% of the 94 respondents completed all items on the questionnaire. High and moderate correlations between the two instruments were found for the dimensions of 'doing usual activities' and 'activity limitations' and for 'having pain or discomfort' and 'symptoms'. The visual analogue scale of the ED-5D-Y correlated with the Paediatric Quality of Life Questionnaire total score and the self-rated health question. The dimensions on the EQ-5D-Y with most reported problems were 'usual activities', 'pain or discomfort' and 'worried, sad or unhappy'.

    CONCLUSION: The EQ-5D-Y instrument seemed to provide feasibility and convergent validity for measuring health-related quality of life in children and adolescents with asthma.

  • 5.
    Egmar, Ann-Charlotte
    et al.
    Department of Environmental Health, Stockholm County Council, Stockholm.
    Almqvist, C
    Department of Environmental Health, Stockholm County Council, Stockholm.
    Emenius, G
    Department of Environmental Health, Stockholm County Council, Stockholm.
    Lilja, G
    Department of Environmental Health, Stockholm County Council, Stockholm.
    Wickman, M
    Department of Environmental Health, Stockholm County Council, Stockholm.
    Deposition of cat (Fel d 1), dog (Can f 1), and horse allergen over time in public environments--a model of dispersion1998In: Allergy. European Journal of Allergy and Clinical Immunology, ISSN 0105-4538, E-ISSN 1398-9995, Vol. 53, no 10, p. 957-961Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The occurrence and accumulation over time in public environments of cat, dog, and horse allergens was evaluated.

    METHODS: Concentrations of animal danders were analyzed by ELISA and countercurrent immunoelectrophoresis (CCIE).

    RESULTS: Among factory-new mattresses, 15/17 contained detectable levels of cat and/or dog allergen, whereas no horse allergen was found although six of the mattresses were stuffed with horsehair. Dust from 15 used mattresses contained significantly higher concentrations of Fe1 d 1 and Can f 1 than the factory-new ones (P < 0.001). Allergen concentrations and titers correlated to the period of time that the mattresses had been tried by customers; rs = 0.52-0.77, P = 0.04-0.001 (cat), rs = 0.38-0.48, P = 0.15-0.08 (dog), and rs = 0.64-0.74, P = 0.008-0.003 (horse). The increase over time occurred rapidly in highly frequented stores and after 3 weeks reached concentrations that have been found in homes where furred pets had formerly been kept or even the lower allergen scale of homes where pets were currently kept.

    CONCLUSIONS: The dispersion of allergens from furred animals to pet-free public places is likely to occur by deposition from people who have been in direct or indirect contact with pets, and high levels of such allergens seem to accumulate in a short period of time.

  • 6.
    Egmar, Ann-Charlotte
    et al.
    Department of Environmental Health, Stockholm County Council, St Goran's Children's Hospital, Karolinska Institute, Stockholm.
    Emenius, G
    Department of Environmental Health, Stockholm County Council, St Goran's Children's Hospital, Karolinska Institute, Stockholm.
    Almqvist, C
    Department of Environmental Health, Stockholm County Council, St Goran's Children's Hospital, Karolinska Institute, Stockholm.
    Wickman, M
    Department of Environmental Health, Stockholm County Council, St Goran's Children's Hospital, Karolinska Institute, Stockholm.
    Cat and dog allergen in mattresses and textile covered floors of homes which do or do not have pets, either in the past or currently1998In: Pediatric Allergy and Immunology, ISSN 0905-6157, E-ISSN 1399-3038, Vol. 9, no 1, p. 31-35Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to measure the levels of cat and dog allergen in homes of families that had either never kept pets or kept or had kept cats or dogs. From a small residential area outside Stockholm consisting of 250 houses with similar exteriors 70 homes were included. Dust samples were collected from mattresses and textile-covered floors. The levels of cat and dog allergen were analysed by ELISA. Fel d1 was found in mattress dust in all 70 homes, median 0.5 micrograms/g [0.24-8.89 micrograms/g (quartiles)] and textile-covered floors 0.7 micrograms/g (0.20-2.52 micrograms/g). Can f1, was found in 98% of the collected samples, mattress dust 1.89 micrograms/g (0.70-9.20 micrograms/g) and textile-covered floor dust 2.5 micrograms/g (1.04-2.72 micrograms/g). There was a positive correlation (p < 0.001) between allergen levels in dust from mattresses and textile-covered floors for both Fel d1 (r = 0.68) and Can f1 (r = 0.78). The highest levels of cat and dog allergen were found in homes with furred pets (p < 0.001). A significant (p < 0.001) difference was seen in the levels of Fel d1 and Can f1 between the homes of former pet-owners and homes without pets. In summary; cat and dog allergens are present in homes regardless of whether such animals live in the house or not. Mattresses seem to be an underestimated reservoir for pet allergens even in homes without pets. It is important to note that the homes of former pet owners have much lower levels of allergen than current pet owners.

  • 7.
    Jonsson, M.
    et al.
    Department of Womans and Childrens Health, Karolinska Institutet / Centre of Occupational and Environmental Medicine, Stockholm County Counsil.
    Bergström, A.
    Karolinska Institutet, Institute of Environmental Medicine.
    Egmar, Ann-Charlotte
    Red Cross University College of Nursing. Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet.
    Wickman, M.
    Karolinska Institutet, Institute of Environmental Medicine / Sachs’ Children's Hospital, Södersjukhuset.
    Lind, T.
    Centre of Occupational and Environmental Medicine, Stockholm County Counsil / Karolinska Institutet, Institute of Environmental Medicine.
    Kull, I
    Karolinska Institutet, Institute of Environmental Medicine / Sachs’ Children's Hospital, Södersjukhuset / Department of Clinical Science and Education, Stockholm South General Hospital, Karolinska Institutet.
    Health related quality of life among adolescents with asthma2014In: Allergy. European Journal of Allergy and Clinical Immunology, ISSN 0105-4538, E-ISSN 1398-9995, Vol. 69, no Suppl. 99: SI, p. 328-328Article in journal (Other academic)
  • 8.
    Jonsson, Marina
    et al.
    Centre of Occupational and Environmental Medicine, Stockholm County Council; Department of Women's and Children's Health, Karolinska Institutet.
    Bergström, Anna
    Institute of Environmental Medicine, Karolinska Institutet.
    Egmar, Ann-Charlotte
    The Swedish Red Cross University College, Department of Public Health and Medicine.
    Hedlin, Gunilla
    Department of Women's and Children's Health, Karolinska Institutet; Centre for Allergy Research, Karolinska Institutet; Astrid Lindgren Children's Hospital, Karolinska University Hospital.
    Lind, Tomas
    Centre of Occupational and Environmental Medicine, Stockholm County Council; Institute of Environmental Medicine, Karolinska Institutet.
    Kull, Inger
    Institute of Environmental Medicine, Karolinska Institutet; Sachs' Children's Hospital, Södersjukhuset; Department of Clinical Science and Education, Stockholm South General Hospital, Karolinska Institutet.
    Asthma during adolescence impairs health-related quality of life2016In: Journal of Allergy and Clinical Immunology: In Practice, ISSN 2213-2198, E-ISSN 2213-2201, Vol. 4, no 1, p. 144-146Article in journal (Refereed)
    Abstract [en]

    Clinical Implications

    Asthma during adolescence impairs health-related quality of life, especially if the asthma is uncontrolled. To use questions about health-related quality of life (HRQoL) and markers associated with asthma control in the clinic can identify adolescents with an increased risk for impaired HRQoL.

  • 9.
    Leander, Mai
    et al.
    Uppsala universitet, Arbets- och miljömedicin.
    Cronqvist, Agneta
    Institutionen för vårdvetenskap, Ersta Sköndal högskola.
    Janson, Christer
    Uppsala universitet, Lungmedicin och allergologi.
    Uddenfeldt, Monica
    Uppsala universitet, Arbets- och miljömedicin.
    Rask-Andersen, Anna
    Uppsala universitet, Arbets- och miljömedicin.
    Health-related quality of life predicts onset of asthma in a longitudinal population study2009In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 103, no 2, p. 194-200Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Health-related quality of life (HRQL) has been increasingly used as an outcome measure in asthma, but less is known about the prognostic implication of low health-related quality of life. The purpose of this study was to investigate if a set of quality of life measures could predict onset of asthma. METHODS: In the baseline study 391 subjects without asthma answered a respiratory questionnaire and the Gothenburg Quality of Life (GQL) instrument in 1990. The GQL questionnaire included two parts: (1) the prevalence of HRQL-related symptoms and (2) well-being scores for physical, mental and social dimensions. The participants were also investigated with spirometry and allergy testing. In 2003, the same respiratory questionnaire that had been used in 1990 was sent. There were 290 responders, of whom 22 subjects had developed asthma. RESULTS: Participants who had developed asthma by the follow-up had a higher prevalence of sleep disturbances (30% vs. 10%), problems with chest pain (16% vs. 2%), depression (40% vs. 20%) difficulty relaxing (40% vs. 13%) and constipation (25% vs. 2%) at baseline than participants who did not develop asthma (p<0.05). Subjects who developed asthma also scored significantly lower on well-being variables as sleep, energy, mood, patience, memory, appetite, fitness and sense of appreciation outside home. These differences remained after adjusting for age, sex, smoking habits, asthma heredity, socioeconomic groups and building dampness. CONCLUSION: Participants with low health-related quality of life at baseline were more likely to report having developed asthma 12 years later.

  • 10.
    Leander, Mai
    et al.
    Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University; Department of Medical Sciences, Respiratory Medicine and Allergology, Uppsala University.
    Lampa, Erik
    Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University.
    Rask-Andersen, Anna
    Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University.
    Franklin, Karl
    Surgical and Perioperative sciences, Department of Surgery, Umeå University.
    Gislason, Thorarinn
    Department of Respiratory Medicine and Sleep, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland; Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland.
    Oudin, Anna
    Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University.
    Svanes, Cecilie
    Bergen Respiratory Research Group, Institute of Medicine, University of Bergen and Department of Occupational Medicine, Haukeland University Hospital Bergen, Bergen, Norway.
    Torén, Kjell
    Section of Occupational and Environmental Medicine University of Gothenburg .
    Janson, Christer
    Department of Medical Sciences, Respiratory Medicine and Allergology, Uppsala University.
    Impact of anxiety and depression on respiratory symptoms2014In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 198, no 11, p. 1594-1600Article in journal (Refereed)
    Abstract [en]

    Psychological factors such as anxiety and depression are prevalent in patients with asthma. The purpose of this study was to investigate the relationship between respiratory symptoms and psychological status and to estimate the importance of psychological status in comparison with other factors that are known to be associated with respiratory symptoms.

    This study included 2270 subjects aged 20–44 (52% female) from Sweden, Iceland, and Norway. Each participant underwent a clinical interview including questions on respiratory symptoms. Spirometry and methacholine challenge were performed. Symptoms of depression and anxiety were measured using the Hospital Anxiety and Depression Scale (HADS).

    Eighty-two percent of the subjects reported no anxiety or depression whatsoever, 11% reported anxiety, 2.5% depression and 4% reported both anxiety and depression. All respiratory symptoms, such as wheezing, breathlessness and nightly symptoms, were more common, at a statistically significant level, in participants who had depression and anxiety, even after adjusting for confounders (ORs 1.33 – 1.94). The HADS score was the most important determinant for nightly symptoms and attacks of breathlessness when at rest whereas bronchial responsiveness was the most important determinant for wheezing, and breathlessness when wheezing. The probability of respiratory symptoms related to HADS score increased with increasing HADS score for all respiratory symptoms.

    In conclusion, there is a strong association between respiratory symptoms and psychological status. There is therefore a need for interventional studies designed to improve depression and anxiety in patients with respiratory symptoms.

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