Obiettivo
1. Objectives and expected achievements
The proposed study is the nine year follow-up phase of a multicentre, prospective study of more than 10,000 young adults living in Europe. The proposed study has five overall objectives
1. To determine the incidence and prognosis of allergy, allergic disease and low lung function in adults living in Europe.
2. To describe the distribution of exposure to known or suspected environmental risk factors associated with the incidence and prognosis of allergy, allergic disease and low lung function.
3. To determine the risk attributable to chronic exposure to these environmental risk factors for the incidence and prognosis of allergy, allergic disease and low lung function.
4. To identify subgroups within the population based on gender, prior disease status, bronchial responsiveness and genetic risk who may be more susceptible to these environmental risk factors and measure their excess risk.
5. To establish a DNA bank taken from representative samples of the population that can be linked to health and environmental information.
Objective 1
The incidence (or remission) of the following specific health outcomes will be determined using standardised methods of assessment of :
* allergy - sensitisation to environmental allergen as measured by the presence of serum specific IgE to house dust mite, cat, grass, Cladosporium
* allergic disease - respiratory symptoms suggestive of asthma, physician diagnosed asthma, hayfever and nasal allergies as reported within a questionnaire.
Change in the following continuous measures will be described
* allergy - serum total IgE
* lung function - the clinical measures of respiratory function, forced expiratory volume in one second (FEV1) and forced vital capacity (FVC)
* bronchial responsiveness to methacholine (BHR), a health outcome strongly associated with allergy and allergic disease.
In addition to describing the changes that have occurred within the people in the study analyses will in addition specifically examine whether
* incidence rates in areas of Europe which already have a high prevalence of allergy and allergic disease are similar to those observed in areas that have a low prevalence of allergy and allergic disease
* some high risk individuals, in particular those with atopy and asthma, experience a more rapid rate of decline in lung function than subjects who are non-atopic and non-asthmatic respectively.
Objective 2
The prevalence and distribution of exposure to the following environmental risk factors known or suspected to be of importance in the aetiology and prognosis of allergy and allergic disease will be determined and described using standardised methods
* indoor environment - exposure to environmental tobacco smoke, use of gas appliances, the keeping of cats, house dust mite allergen (Der p 1 and Der f 1),
* outdoor environment - current exposure to PM2.5 historical exposure to NO2 and PM10
* occupational environment - with particular attention to occupations (cleaning, nursing, farmers, metal workers) and exposures (disinfectants, soldering fumes)
In addition, the contribution of modifiable household and lifestyle factors that are associated with high exposure to these agents will be assessed (for example, home ventilation, soft furnishings). Some centres will collect additional information on diet.
Objective 3
Following on from the achievement of objective 1 and objective 2, data will be analysed using techniques appropriate for longitudinal analysis, to determine the association between these exposures and the health outcomes. The adverse health effects of the exposures will be quantified by determination of the absolute, relative and attributable risks associated with chronic exposure to these environmental factors for the development of allergy and allergic disease and low lung function. Where associations are observed the exposure-response will be fully described
Objective 4
Sub-groups who may be particularly vulnerable to chronic exposure to these environmental factors will be identified by further analysis. In particular this study will address whether the effects of the environment are greater in
* those who are sensitised to allergens compared to those who are not
* asthmatics compared to non-asthmatics
* those with low lung function compared to those with good/normal lung function
* women compared to men
* asthmatics who receive regular high quality health care, in particular inhaled steroids compared to those asthmatics who do not
Objective 5
Samples of blood from participants will be stored and DNA extracted. We believe that by the end of the study the genetics of allergy and asthma will have advanced sufficiently for studies which can examine the prevalence of candidate genes within different European populations. Substantial variation in the prevalence of these genes may explain some of the variation in incidence and prevalence of disease in Europe.
The study will be conducted in 25 fieldwork centres (2 in Belgium, 2 in France, 1 in Germany, 3 in Italy, 3 in Netherlands, 5 in Spain, 3 in Sweden, 2 in UK) and 3 centres in 3 European Associated States (Norway, Iceland, Switzerland) and in Tartu, Estonia. The study will involve collection of health information from a representative sample of more than 10,000 individuals and information from a further 2000 people with symptoms highly suggestive of asthma in 1992/3. Environmental information will be collected by home visits and past and current exposure to air pollution will be assessed through retrieval of air pollution records and by a programme of air pollution monitoring.
Scientific approach
The proposed study is the nine year follow-up phase of a multi-centre, prospective study of more than 10,000 young adults living in Europe.
In 1992/3 a multi-centre study was conducted in which young adults aged between 20 and 44 years were selected at random from available population based registers to take part in a survey of respiratory disease. More than thirty centres across Europe each recruited about 300 men and 300 women for a detailed assessment of symptoms (respiratory symptoms, nasal symptoms, asthma), factors known or hypothesised to be of importance for allergy and allergic disease (family size, family history of disease, occupation, childhood and current exposure to pets, exposure to tobacco smoke, dampness, ventilation, use of soft furnishings, use of gas appliances) and use of health services and treatment (including use of inhaled steroids) for respiratory disease. During a clinical examination blood was taken for measurement of specific IgE to house dust mite, cat, grass and Cladosporium and total IgE. Forced expiratory volume in one second (FEV1), forced vital capacity (FVC) and bronchial reactivity to methacholine were measured. In addition each centre also surveyed in the same manner a sample of about 150 adults with symptoms highly suggestive of asthma.
These young adults are now aged between 27 and 51 years and they will be recontacted by mail or phone and will complete a short questionnaire asking about respiratory symptoms (this short questionnaire will be the same as one administered in 1992/3). Many of the participants may have moved but the following strategies will be adopted to increase the response rate
* in 1992/3 many participants provided the name and address of a relative or friend who was unlikely to move. In the event that we cannot trace participants these 'named contacts' will be asked the whereabouts of the participants
* names will be checked against electoral rolls, patient registers, telephone directories
Assessment of health status at the fieldwork centre (funds are not being requested for this part of the study)
All participants who are contacted will be invited to a local fieldwork centre. All fieldwork centres are within either an outpatient or lung function laboratory in a local hospital or research centre. In the fieldwork centre the following procedures will be performed
* detailed administered questionnaire
* self completion of the SF-36 a validated and widely used quality of life questionnaire that can be used to assess quality of life in those with and without allergic disease
* venesection - blood will be taken for measurement of specific IgE to house dust mite, grass, cat and Cladosporium
* total IgE
* samples for DNA
* measurement of lung function
* bronchial challenge testing
* assessment of diet by food frequency questionnaire in a limited number of fieldwork centres
People who have moved out of the study area will be asked to provide as much health information as feasible (for example, health questionnaires by phone)
In order to maximise the standardisation and comparability of the health information and to maximise the potential to examine associations between changes in health status and environment, additional funding is requested for
* Central analysis of blood samples for total and specific IgE (including transport of samples to the laboratory)
* Collection of dust samples from some individuals taking part in the study (including personnel time, travel from fieldwork centres to homes)
* Central analysis of dust samples for house dust mite allergens (including transport of samples to laboratory)
* Monitoring of PM2.5 in all centres (including personnel and equipment)
* Transport of samples to Germany for establishment of a DNA bank
Funding from Switzerland (dependent on the success of this application) will provide a programme of assessment of outdoor pollution through collection of records and by analysis of the PM2.5 filters.
Campo scientifico (EuroSciVoc)
CORDIS classifica i progetti con EuroSciVoc, una tassonomia multilingue dei campi scientifici, attraverso un processo semi-automatico basato su tecniche NLP. Cfr.: Il Vocabolario Scientifico Europeo.
CORDIS classifica i progetti con EuroSciVoc, una tassonomia multilingue dei campi scientifici, attraverso un processo semi-automatico basato su tecniche NLP. Cfr.: Il Vocabolario Scientifico Europeo.
- scienze mediche e della salute scienze della salute infermieristica
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- scienze mediche e della salute scienze della salute nutrizione
- scienze mediche e della salute medicina clinica allergologia
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Coordinatore
WC2R 2LS LONDON
Regno Unito
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