Journal of Family & Community Medicine
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contact us Login 
 

Users Online: 604 Home Print this page Email this page Small font sizeDefault font sizeIncrease font size

 

 Table of Contents 
ORIGINAL ARTICLE
Year : 2014  |  Volume : 21  |  Issue : 3  |  Page : 154-161  

The impact of Vitamin D deficiency on asthma, allergic rhinitis and wheezing in children: An emerging public health problem


1 Department of Medical Statistics and Epidemiology, Hamad Medical Corporation; Department of Public Health, Weill Cornell Medical College, Ar Rayyan, State of Qatar ; Department of Evidence for Population Health Unit, School of Epidemiology and Health Sciences, University of Manchester, Manchester, UK
2 Department of Pediatrics, Section of Pediatric Allergy and Immunology, Hamad Medical Corporation; Department of Paediatrics, Weill Cornell Medical College, Ar Rayyan, State of Qatar
3 Department of Medical Statistics and Epidemiology, Hamad Medical Corporation; Department of Public Health, Weill Cornell Medical College, Ar Rayyan, State of Qatar
4 Strauss Chair in Respiratory Medicine, Meakins-Christie Laboratories, McGill University, Montreal, Canada

Date of Web Publication15-Oct-2014

Correspondence Address:
Abdulbari Bener
Department of Public Health, Weill Cornell Medical College, P.O. Box 3050, Doha, State of Qatar

Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2230-8229.142967

Rights and Permissions
   Abstract 

Background: Vitamin D deficiency has been declared a public health problem for both adults and children worldwide. Asthma and related allergic diseases are the leading causes of morbidity in children. The objective of this study was to investigate the potential role of Vitamin D deficiency in childhood asthma and other allergic diseases such as allergic rhinitis and wheezing. Materials and Methods: This cross-sectional study was conducted in Primary Health Care Centers (PHCs), from March 2012 to October 2013. A total of 2350 Qatari children below the age of 16 were selected from PHCs, and 1833 agreed to participate in this study giving a response rate of (78%). Face-to-face interviews with parents of all the children were based on a questionnaire that included variables such as socio-demographic information, assessment of nondietary covariates, Vitamin D intake, type of feeding, and laboratory investigations. Their health status was assessed by serum Vitamin D (25-hydoxyvitamin D), family history and body mass index. Results: Most of the children who had asthma (38.5%), allergic rhinitis (34.8%) and wheezing (35.7%) were below 5 years. Consanguinity was significantly higher in parents of children with allergic rhinitis (48.6%), followed by those with asthma (46.4%) and wheezing (40.8%) than in healthy children (35.9%) (P < 0.001). The proportion of severe Vitamin D deficiency was significantly higher in children with wheezing (23.4%), allergic rhinitis (18.5%), and asthma (17%) than in healthy children (10.5%). Exposure to the sun was significantly less in Vitamin D deficient children with asthma (60.3%), allergic rhinitis (62.5%) and wheezing (64.4%) than in controls (47.1%) (P = 0.008). It was found that Vitamin D deficiency was a significant correlate for asthma (odds ratio [OR] =2.31; P < 0.001), allergic rhinitis (OR = 1.59; P < 0.001) and wheezing (relative risk = 1.29; P = 0.05). Conclusion: The study findings revealed a high prevalence of Vitamin D deficiency in children with asthma and allergic diseases. Vitamin D deficiency was a strong correlate for asthma, allergic rhinitis and wheezing.

Keywords: Allergic rhinitis, asthma, children, predictors, Qatar, Vitamin D, wheezing


How to cite this article:
Bener A, Ehlayel MS, Bener HZ, Hamid Q. The impact of Vitamin D deficiency on asthma, allergic rhinitis and wheezing in children: An emerging public health problem. J Fam Community Med 2014;21:154-61

How to cite this URL:
Bener A, Ehlayel MS, Bener HZ, Hamid Q. The impact of Vitamin D deficiency on asthma, allergic rhinitis and wheezing in children: An emerging public health problem. J Fam Community Med [serial online] 2014 [cited 2020 Jul 9];21:154-61. Available from: http://www.jfcmonline.com/text.asp?2014/21/3/154/142967


   Introduction Top


Asthma and related allergic diseases form substantial public health problems worldwide. [1] Asthma remains the most common chronic disease in children and is one of the leading causes of morbidity. The prevalence of asthma and allergic diseases has been increasing rapidly in western and industrialized countries, and it was recently proposed that Vitamin D deficiency may explain some part of this pattern. [2] Vitamin D deficiency has occurred despite the fortification of foods in some western countries, and in areas of the world that are considered sun-replete. It was documented that the global rise in asthma, and allergic diseases may be linked to lower serum 25-hydroxyvitamin D (25(OH)D). [3],[4]

Some previous studies by Bener et al. [5],[6],[7],[8] revealed that Vitamin D deficiency was more common in Qatari young population, and was a major contributing factor to many diseases like complications in maternity, diabetes, asthma and allergic diseases. Several other studies also found that Vitamin D deficiency may lead to an increase in the frequency of asthma and attacks of wheezing and necessitate more medications. [8],[9] It is clear that Vitamin D protects children against viral infections and the exacerbation of asthma. [9],[10] When taken during pregnancy, Vitamin D is proven to enhance lung development in infants, and has a preservative effect on the development of wheezing and asthma that may occur later. [11],[12] Another recent study conducted in Qatar reported a high maternal Vitamin D deficiency in pregnant women which is significantly associated with elevated risk of adverse pregnancy outcome. [13] Although a previous study [7] was conducted to prove Vitamin D deficiency as a strong predictor of asthma in children, this study is the first to discover the impact of Vitamin D deficiency in childhood asthma, allergic rhinitis and wheezing.

The growing data suggests that Vitamin D plays an important role in the protection against allergic diseases. The greatest burden of asthma and allergic diseases are during childhood, at which time the rapidly rising rates of diseases are most evident in the population. Considering the high prevalence of Vitamin D insufficiency and allergic diseases in the Qatari population, a cross-sectional study was conducted to better understand the significance of Vitamin D and investigate its impact on asthma, allergic rhinitis and wheezing in children. Furthermore, the study assessed the nondietary covariates and feeding practices in the study sample in order to determine the major contributing factors of Vitamin D deficiency in young Qataris with asthma and allergic diseases.


   Materials and methods Top


Study population

This was a cross-sectional study conducted among the Qatari school children below the age of 16 years to investigate the role of Vitamin D deficiency on asthma and other allergic diseases in them. The survey was conducted at Primary Health Care Centers (PHCs) from March 2012 to October 2013. The IRB approval was obtained from the Research Ethics Committee of the Hamad Medical Corporation to conduct this study. An informed consent was obtained from all participants.

The power calculation was actually based on reported prevalence rate of asthma in Qatar [14] as 20%, allowing an error of 2%. With the level of significance at 5%, and with 95% confidence limits, the sample size needed to achieve the objective of the study was computed as 1833 children. A total of 2350 children were recruited for this study, and 1833 (78%) children below 16 years old were eligible for inclusion in the study. Eleven of the 22 PHCs were selected at random. Subjects were selected systematically 1-in-2 using a systematic sampling procedure. Each participant was provided with brief information about the study and was assured of the strict confidentiality of the data. Subjects were excluded if they had diseases of Vitamin D metabolism or were receiving Vitamin D supplementation.

Socio-demographic characteristics

Health professionals and nurses interviewed parents of all children and completed the questionnaires which covered the information such as age, gender, nationality, educational level, occupation, place of residence (urban and semi-urban), type of house, monthly income, and consanguinity. Also, it included assessment of nondietary covariates such as height, weight, color of the skin, family history, physical activity and duration of the exposure to sunlight. Height and weight were measured using standardized methods, and all the participants wore light clothes and no shoes for this part of the examination. Anthropometry is the measurement of certain parameters of the human body. It is frequently used to assess nutritional status in young children and adults. Anthropometry has also been used to study the growth and development of school-aged children and adolescents. Recently, an attempt been made to use anthropometric methods to assess acute under-nutrition in adolescents. [6],[7],[13] Two essential items are required for the use of anthropometry: An anthropometric indicator and a cut-off point. The indicator, often called an anthropometric index, is a measurement or a combination of measurements taken in the field, such as weight and height, or the combination of measurements with additional data, such as age. Different indices reflect different components of nutritional status. The index weight-for-height indicates thinness, and because acutely undernourished persons generally lose body weight but not height and weight-for-height decreases with acute under-nutrition. However, though young children with chronic under-nutrition may not be thinner than normal children, their growth in height may be retarded. Chronic under-nutrition may not be severe enough to cause weight loss, but does interfere with normal linear growth. As a result, height-for-age is decreased, and children become stunted. Weight-for-age reflects both acute and chronic under-nutrition because both thin children and stunted children are underweight.

The body mass index was calculated as the weight in kilograms (with 1 kg subtracted to allow for clothing) divided by height in meters squared. Furthermore, information on dietary intake, Vitamin D intake, type of feeding were collected. A major part of the designed questionnaire was validated in a previous study by Bener et al. [6],[7] This questionnaire was validated on 50 randomly selected children visiting health centers.

The questions concerning the diagnosis of asthma were "Has the child ever been diagnosed as having asthma by a doctor"? "Has the child ever needed treatment or hospital admission due to asthma? Similar questions were asked on wheezing allergies. The definition for asthma is a common inflammatory disease of the lungs characterized by episodic airway obstruction caused by extensive narrowing of the bronchi and bronchioles. Common symptoms of asthma include wheezing, coughing and shortness of breath. The International Classification of Diseases and Health Related Problems 10 th Revision was used by the Medical Records Section of the HMC for coding the diagnosis, and J 45 was the ICD 10 code for asthma. Wheezing is the high-pitched whistling sound heard as you breathe when air flow is obstructed in the lung. At the beginning of an asthma attack, wheezing usually only occurs while breathing out or exhaling, but may occur while breathing in if the attack worsens. ICD 10 code was R06.2 for wheezing. Allergies are an abnormally high sensitivity to certain substances such as pollens, foods or microorganisms. Common indications of allergy may include sneezing, itching and skin rashes.

Blood collection and serum measurements of Vitamin D

Trained phlebotomist collected venous blood sample, and serum separated and stored at −70°C until analysis. Serum 25(OH)D, Vitamin D metabolite, was measured using a commercially available kit (DiaSorin Corporate Headquarter, Saluggia, Italy). The treated samples were then assayed using competitive binding radioimmunassay technique. Subjects were classified into four: (1) Severe Vitamin D deficiency, 25(OH) D <10 ng/ml; (2) moderate deficiency, 25(OH) D 10-19 ng/ml; (3) mild deficiency, 25(OH) D 20-29 ng/ml; and (4) normal/optimal level is between 30 and 80 ng/m. [7],[8],[13] According to the recommendations of other studies, [15],[16] we categorized Vitamin D levels as deficient if 25(OH) D was <20 ng/ml, insufficient if it was between 20 and 29 ng/ml and sufficient if >=30 ng/ml. Total and allergen-specific IgE (to a panel of common food and environmental allergens) levels were measured from serum.

Statistical analysis

Statistical significance between two continuous variables was determined using Student's t-test, and Mann-Whitney test was used for nonparametric data. Chi-square was performed to test for differences in proportions of categorical variables between two or more groups. Odds ratio (OR) was calculated with 95% confidence interval to identify the predictors for asthma, allergic rhinitis and wheezing in children. P <0.05 was considered as statistically significant.


   Results Top


[Table 1] shows the socio-demographic characteristics of the study population. Most of the children with asthma (38.5%), allergic rhinitis (34.8%) and wheezing (35.7%) were below the age of 5 years. Mother's education (P < 0.001), father's occupation (P = 0.001), mother's occupation (P < 0.001), home (P = 0.026) were significantly different between healthy subjects and allergic children. Consanguinity was significantly higher in parents of children with allergic rhinitis (48.6%) followed by asthma (46.4%) and wheezing (40.8%) than in healthy children (35.9%) (P < 0.001).
Table 1: Sociodemographic characteristics of asthmatic and allergic diseases and control children (n=1833)


Click here to view


[Table 2] shows the prevalence of serum vitamin level in healthy subjects and children with asthma, allergic rhinitis and wheezing. The proportion of severe Vitamin D deficiency was significantly higher in asthmatic children and those with allergic diseases; wheezing (23.4%), allergic rhinitis (18.5%), asthma (17%) than in controls (10.5%) (P < 0.001). Also, moderate deficiency was more frequent in children who wheezed (39.4%), who had asthma (35.9%) and allergic rhinitis (31.2%) with a significant difference to healthy children (24%) (P < 0.001).
Table 2: Serum Vitamin D level in cases and healthy children (n=1833)


Click here to view


[Table 3] assesses the Vitamin D deficiency in healthy, asthmatic and children with an allergic disease in terms of nondietary covariates and feeding practice. A history of Vitamin D deficiency was more common in mothers of children with allergic rhinitis (42.6%), wheezing (35.6%), asthma (31.6%) compared to healthy children (29.9%). The majority of the cases with Vitamin D deficiency had either wheatish or brown/black skin complexion; asthma (72.4%), allergic rhinitis (78.4%) and wheezing (81.3%) compared to controls (66.9%). A significant difference was observed between Vitamin D deficient, healthy and allergic children (P < 0.001) in terms of physical activity. More than half of the vitamin deficient children with asthma (56.9%) and allergic rhinitis (55.1%) participated in less physical activity. Exposure to the sun was less in Vitamin D deficient children with asthma (60.3%) and allergy rhinitis (62.5%) and wheezing (64.4%) than in controls (47.1%) with a significant difference between these groups (P = 0.001). Vitamin D deficient children with asthma (71.3%), allergic rhinitis (68.2%) and wheezing (64.4%) were breast fed for longer than 6 months with a significant difference with controls (P = 0.001).
Table 3: Assessment of the nondietary covariates and feeding practice in cases and healthy children


Click here to view


[Table 4] identified the predictors of the development of asthma, allergic rhinitis and wheezing in children. Vitamin D deficiency (OR = 2.31; P < 0.001), breast feeding >6 months (OR = 2.14; P < 0.001) and parental consanguinity (OR = 1.90; P = 0.034) were the major predictors of asthma in Qatari children. For allergic rhinitis, breast feeding >6 months (OR = 2.10; P < 0.001), short outdoor time (OR = 1.73; P = 0.003), and Vitamin D deficiency (OR = 1.59; P < 0.001) were the strong predictors. For wheezing, breast feeding <6 months (OR = 1.67; P = 0.044) and Vitamin D deficiency (OR = 1.29; P = 0.046) were the significant contributing risk factors.
Table 4: Predictors for asthma, allergic rhinitis and wheezing in children (n=1833)


Click here to view


[Figure 1] reveals Vitamin D status in cases and controls. Vitamin D deficient group was higher in asthma, allergic rhinitis and wheezing children, whereas Vitamin D insufficient group was higher in healthy children P < 0.001.
Figure 1: Vitamin D status in the studied children with asthma and allergic diseases and healthy children P < 0.001

Click here to view



   Discussion Top


The epidemic rise in asthma and related allergic disease is a major public health problem worldwide. [1] Several studies have reported that Vitamin D deficiency is associated with an increased incidence of asthma and allergy symptoms. [17],[18] In the current study sample, there was a high prevalence of Vitamin D deficiency in Qatari children with asthma and allergic diseases than in healthy children. The prevalence of severe Vitamin D deficiency was significantly higher in Qatari children with asthma (17%), allergic rhinitis (18.5%), wheezing (23.4%) than in healthy children (10.5%), which is in agreement with the studies conducted among African-American [19] and Iranian [20] children. A few epidemiological studies have reported a similar finding that Vitamin D deficiency is associated with an increased incidence of asthma and allergy symptoms. [2],[20],[21] However, some studies [22],[23] failed to confirm these results. An Australian multicenter study [23] reported that there was no association between any of the Vitamin D related measures and childhood asthma and allergic disorders.

In the study sample of Qatari children, nearly half of the healthy children also had mild Vitamin D deficiency (48.6%) and 10.5% had severe deficiency. This shows that the incidence of Vitamin D insufficiency is surprisingly high in the general population. It was reported [24] that Vitamin D deficiency is highly prevalent even in sun-replete areas of the world and that Vitamin D supplementation and fortification of foods were inadequate to prevent deficiency. This shows that Vitamin D deficiency was very common in the general population as is the prevalence of asthma and allergies and it confirms that Vitamin D levels may affect the risk for the development of asthma and allergies.

The present study assessed the nondietary covariates and breast feeding practice in cases and controls. A history of Vitamin D deficiency was more prevalent in mothers of children with allergic rhinitis (42.6%), wheezing (35.6%), asthma (31.6%) than in healthy children (29.9%). Camargo et al. [25] reported that high Vitamin D levels during maternity decreased childhood wheezing by nearly 50% compared with low maternal 25(OH)D. This suggests that a lower Vitamin D level was associated with an increased risk of recurrence of allergic diseases in young children. The developing foetus depends entirely on its mother for the supply of 25(OH)D and poor maternal Vitamin D status is reflected in the infant's health at birth. Another study in the UK [22] also found that higher Vitamin D consumption by the pregnant mother was significantly associated with a decreased risk of allergies in children aged 5 years. Also, Vitamin D supplement during breastfeeding was very poor in the study sample. More than half of the healthy (55.6%), asthma (55.2%), allergic rhinitis (55.7%) and wheezing (50.8%) children did not have Vitamin D supplement. Vitamin D deficient allergic children were breastfed for longer than 6 months; asthma (71.3%), allergic rhinitis (68.2%) and wheezing (64.4%). Hence, maternal Vitamin D deficiency could be one of the reasons for the high prevalence of Vitamin D deficiency in Qatari children that led to the risk for asthma and allergic diseases in children.

The rise in allergic diseases is unequivocally linked to environmental and lifestyle factors associated with industrialization and progressive westernization. Webb [26] reported that the determinants of Vitamin D status include exposure to the sun and time spent outdoors, diet and supplement use, latitude, season, age, skin color and skin coverage. It was quite evident in the study sample that exposure to sunlight and physical activity were less in Qatari children. More than half of the children with asthma (60.3%), allergic rhinitis (62.5%) and wheezing (64.4%) had significantly less exposure to sunlight than the healthy children (47.1%). Also, a significant difference was observed between healthy and allergic children in terms of physical activity. A majority of the Qatari children had either whitish or brown skin complexion; asthma (72.4%), allergic rhinitis (78.4%) and wheezing (81.3%). A study by Bose et al. [27] reported that a combination of limitations in sunlight exposure and darker pigmentation may amplify the risk of Vitamin D deficiency contributing to greater asthma morbidity than their white counterparts. Vitamin D has received tremendous amount of attention recently due to the ever-increasing reports of its association with a wide range of conditions, from cancer to fertility to longevity. [28] The fascination of the association of disease with Vitamin D deficiency comes from the relatively easy solution to overcoming such a risk factor, that is, either by an increase in sun exposure and/or diet supplementation. Many reviews have been written on a protective role of Vitamin D in asthma and related morbidities. [5],[6],[7],[8],[9],[10],[11],[12],[13],[15],[16],[28] In Qatar, although there is sufficient ultraviolet B intensity for cutaneous synthesis of 25(OH)D throughout the year, the cutaneous Vitamin D synthesis is limited by the lifestyle factors of Qatari community such as limitations to outdoor activities, pattern of clothing and the extreme climate throughout the year. The state of Qatar is a rapidly developing country with influences of a western life style which is changing the lifestyle of the people, from life outdoors to more time spent indoors. The study findings reveal that the lifestyle patterns and environment in Qatar do not promote Vitamin D synthesis in children which might have increased the risk for asthma and other allergies.

It was identified that Vitamin D level was a significant major predictor for asthma (OR = 2.31, P < 0.001), allergic rhinitis (OR = 1.59; P < 0.001) and wheezing (OR = 1.29; P = 0.05). The current study suggests that adequate or higher concentrations of 25(OH) D in childhood generally give protection from allergic diseases, although a few studies have shown an adverse effect of Vitamin D on asthma and allergies. Variations in Vitamin D status and intake have been implicated in the development of allergies and are considered one of a number of explanations for epidemiological and immunological associations. Hence, it may be useful to measure the levels of Vitamin D of infants with asthma and allergic diseases and give them Vitamin D supplementation in order to prevent asthma and allergic diseases.


   Conclusions Top


The present study investigated the role of Vitamin D in childhood asthma and allergies. The data showed lower serum 25(OH) D levels in children with asthma, allergic rhinitis and wheezing than healthy children. Vitamin D insufficiency was common in the study sample whereas severe Vitamin D deficiency was significantly higher in children with asthma and allergic diseases than in healthy children. In the study sample, the determinants of Vitamin D deficiency in asthma and allergies included less exposure to sun, less time spent outdoors, breast feeding for longer than 6 months, maternal Vitamin D deficiency and parental consanguinity. Increased exposure to the sun could also be associated with decreased likelihood of asthma.


   Acknowledgment Top


This work was generously supported and funded by the Qatar Foundation Grant No. NPRP08-760-3-153. The authors would like to thank all parents and children who participated in this study as well as the Hamad Medical Corporation for their support and ethical approval (HMC-MRC RP# 12034/12-RC/70813/13).

 
   References Top

1.Masoli M, Fabian D, Holt S, Beasley R, Global Initiative for Asthma (GINA) Program. The global burden of asthma: Executive summary of the GINA Dissemination Committee report. Allergy 2004;59:469-78.  Back to cited text no. 1
    
2.Litonjua AA, Weiss ST. Is Vitamin D deficiency to blame for the asthma epidemic? J Allergy Clin Immunol 2007;120:1031-5.  Back to cited text no. 2
    
3.Sandhu MS, Casale TB. The role of Vitamin D in asthma. Ann Allergy Asthma Immunol 2010;105:191-9.  Back to cited text no. 3
    
4.Weiss ST, Litonjua AA. Maternal diet vs lack of exposure to sunlight as the cause of the epidemic of asthma, allergies and other autoimmune diseases. Thorax 2007;62:746-8.  Back to cited text no. 4
    
5.Bener A, Ehlayel MS, Alsowaidi S, Sabbah A. Role of breast feeding in primary prevention of asthma and allergic diseases in a traditional society. Eur Ann Allergy Clin Immunol 2007;39:337-43.  Back to cited text no. 5
    
6.Bener A, Al-Ali M, Hoffmann GF. Vitamin D deficiency in healthy children in a sunny country: Associated factors. Int J Food Sci Nutr 2009;60 Suppl 5:60-70.  Back to cited text no. 6
    
7.Bener A, Ehlayel MS, Tulic MK, Hamid Q. Vitamin D deficiency as a strong predictor of asthma in children. Int Arch Allergy Immunol 2012;157:168-75.  Back to cited text no. 7
    
8.Ehlayel MS, Bener A, Sabbah A. Is high prevalence of Vitamin D deficiency evidence for asthma and allergy risks? Eur Ann Allergy Clin Immunol 2011;43:81-8.  Back to cited text no. 8
    
9.Tolppanen AM, Sayers A, Granell R, Fraser WD, Henderson J, Lawlor DA. Prospective association of 25-hydroxyvitamin d3 and d2 with childhood lung function, asthma, wheezing, and flexural dermatitis. Epidemiology 2013;24:310-9.  Back to cited text no. 9
    
10.Barday L. Vitamin D insufficiency linked to asthma severity. Am J Respir Crit Care Med 2009;179:739-42.  Back to cited text no. 10
    
11.Camargo CA Jr, Rifas-Shiman SL, Litonjua AA, Rich-Edwards JW, Weiss ST, Gold DR, et al. Maternal intake of Vitamin D during pregnancy and risk of recurrent wheeze in children at 3 y of age. Am J Clin Nutr 2007;85:788-95.  Back to cited text no. 11
    
12.Miyake Y, Sasaki S, Tanaka K, Hirota Y. Dairy food, calcium and Vitamin D intake in pregnancy, and wheeze and eczema in infants. Eur Respir J 2010;35:1228-34.  Back to cited text no. 12
    
13.Bener A, Al-Hamaq AO, Saleh NM. Association between Vitamin D insufficiency and adverse pregnancy outcome: Global comparisons. Int J Womens Health 2013;5:523-31.  Back to cited text no. 13
    
14.Bener A, Janahi IA, Sabbah A. Genetics and environmental risk factors associated with asthma in schoolchildren. Eur Ann Allergy Clin Immunol 2005;37:163-8.  Back to cited text no. 14
    
15.Brehm JM, Acosta-Pérez E, Klei L, Roeder K, Barmada M, Boutaoui N, et al. Vitamin D insufficiency and severe asthma exacerbations in Puerto Rican children. Am J Respir Crit Care Med 2012;186:140-6.  Back to cited text no. 15
    
16.Brehm JM, Schuemann B, Fuhlbrigge AL, Hollis BW, Strunk RC, Zeiger RS, et al. Serum Vitamin D levels and severe asthma exacerbations in the Childhood Asthma Management Program study. J Allergy Clin Immunol 2010;126:52-8.  Back to cited text no. 16
    
17.Majak P, Olszowiec-Chlebna M, Smejda K, Stelmach I. Vitamin D supplementation in children may prevent asthma exacerbation triggered by acute respiratory infection. J Allergy Clin Immunol 2011;127:1294-6.  Back to cited text no. 17
    
18.Weiss ST, Litonjua AA. Childhood asthma is a fat-soluble Vitamin deficiency disease. Clin Exp Allergy 2008;38:385-7.  Back to cited text no. 18
    
19.Freishtat RJ, Iqbal SF, Pillai DK, Klein CJ, Ryan LM, Benton AS, et al. High prevalence of Vitamin D deficiency among inner-city African American youth with asthma in Washington, DC. J Pediatr 2010;156:948-52.  Back to cited text no. 19
    
20.Alyasin S, Momen T, Kashef S, Alipour A, Amin R. The relationship between serum 25 hydroxyvitamin D levels and asthma in children. Allergy Asthma Immunol Res 2011;3:251-5.  Back to cited text no. 20
    
21.Litonjua AA. Childhood asthma may be a consequence of Vitamin D deficiency. Curr Opin Allergy Clin Immunol 2009;9:202-7.  Back to cited text no. 21
    
22.Devereux G, Litonjua AA, Turner SW, Craig LC, McNeill G, Martindale S, et al. Maternal Vitamin D intake during pregnancy and early childhood wheezing. Am J Clin Nutr 2007;85:853-9.  Back to cited text no. 22
    
23.Hughes AM, Lucas RM, Ponsonby AL, Chapman C, Coulthard A, Dear K, et al. The role of latitude, ultraviolet radiation exposure and Vitamin D in childhood asthma and hayfever: An Australian multicenter study. Pediatr Allergy Immunol 2011;22:327-33.  Back to cited text no. 23
    
24.Binkley N, Novotny R, Krueger D, Kawahara T, Daida YG, Lensmeyer G, et al. Low Vitamin D status despite abundant sun exposure. J Clin Endocrinol Metab 2007;92:2130-5.  Back to cited text no. 24
    
25.Camargo CA Jr, Clark S, Kaplan MS, Lieberman P, Wood RA. Regional differences in EpiPen prescriptions in the United States: The potential role of Vitamin D. J Allergy Clin Immunol 2007;120:131-6.  Back to cited text no. 25
    
26.Webb AR. Who, what, where and when-influences on cutaneous Vitamin D synthesis. Prog Biophys Mol Biol 2006;92:17-25.  Back to cited text no. 26
    
27.Bose S, Breysse PN, McCormack MC, Hansel NN, Rusher RR, Matsui E, et al. Outdoor exposure and Vitamin D levels in urban children with asthma. Nutr J 2013;12:81.  Back to cited text no. 27
    
28.Poon AH, Mahboub B, Hamid Q. Vitamin D deficiency and severe asthma. Pharmacol Ther 2013;140:148-55.  Back to cited text no. 28
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]


This article has been cited by
1 Therapeutic effect of vitamin D supplementation on allergic rhinitis
Mehdi Bakhshaee,Mohammadreza Sharifian,Freshteh Esmatinia,Bashir Rasoulian,Masoud Mohebbi
European Archives of Oto-Rhino-Laryngology. 2019;
[Pubmed] | [DOI]
2 Vitamin D Status Modifies the Response to Indoor Particulate Matter in Obese Urban Children with Asthma
Sonali Bose,Gregory B. Diette,Han Woo,Kirsten Koehler,Karina Romero,Ana M. Rule,Barbara Detrick,Emily Brigham,Meredith C. McCormack,Nadia N. Hansel
The Journal of Allergy and Clinical Immunology: In Practice. 2019;
[Pubmed] | [DOI]
3 The association between vitamin deficiency and otolaryngologic diseases: A therapeutic target
Yu Huang,Aiguo Liu,Li Liu,Binru Wang,Gengtian Liang
Medical Hypotheses. 2019; : 109448
[Pubmed] | [DOI]
4 Vitamin D: A Modulator of Allergic Rhinitis
Sunita Agarwal,Shashank Nath Singh,Rohtash Kumar,Ritu Sehra
Indian Journal of Otolaryngology and Head & Neck Surgery. 2019;
[Pubmed] | [DOI]
5 Meta-analysis of vitamin D and lung function in patients with asthma
Jian Liu,Yong-Quan Dong,Jie Yin,Jian Yao,Jie Shen,Guo-Jie Sheng,Kun Li,Hai-Feng Lv,Xing Fang,Wei-Fang Wu
Respiratory Research. 2019; 20(1)
[Pubmed] | [DOI]
6 Relationship of serum vitamin D and interleukin-31 levels to allergic or nonallergic rhinitis in children
Seong Jun Park,Ji Eun Soh,Moon Soo Park,Hye Lim Jung,Jae Won Shim,Deok Soo Kim,Jung Yeon Shim
Allergy, Asthma & Respiratory Disease. 2018; 6(1): 41
[Pubmed] | [DOI]
7 ALLERGIC RHINITIS IN PRE-SCHOOL CHILDREN LIVING IN URBAN SETTINGS OF THE ALTAI REGION: A POPULATION-BASED CROSS-SECTIONAL STUDY
Natalia V. Shakhova,Elena M. Kamaltynova,Yuriy Ph. Lobanov,Tatyana S. Ardatova
Current pediatrics. 2018; 17(3): 236
[Pubmed] | [DOI]
8 The association of serum 25-OH vitamin D with asthma in Saudi adults
Nasser M. Al-Daghri,Omar S. Al-Attas,Sobhy M. Yakout,Abdullah M. Alnaami,Kaiser Wani,Majed S. Alokail
Medicine. 2018; 97(36): e12286
[Pubmed] | [DOI]
9 The Effect of Vitamin D Supplementation on Children with Allergic Rhinitis
Piyush Upadhyay,Rakhi Jain
Pediatric Oncall. 2017; 14(3)
[Pubmed] | [DOI]
10 Let Them Breathe
Marilyn Clifford
NASN School Nurse. 2017; 32(2): 91
[Pubmed] | [DOI]
11 The role of vitamin D in allergic rhinitis
Hui-Qin Tian,Lei Cheng
Asia Pacific Allergy. 2017; 7(2): 65
[Pubmed] | [DOI]
12 Inhalant Allergy Evaluation in ENT Patients
Kathleen Masella,Osaretin C. Aimuyo,Monica O. Patadia
Current Otorhinolaryngology Reports. 2017; 5(4): 212
[Pubmed] | [DOI]
13 Serum 25-hydroxyvitamin D inversely associated with blood eosinophils in patients with persistent allergic rhinitis
Hai-Yan Wu,Jin-Xiang Chen,Hui-Qin Tian,Xiu-Ling Zhang,Hai-Yan Bian,Lei Cheng
Asia Pacific Allergy. 2017; 7(4): 213
[Pubmed] | [DOI]
14 Vitamin D Status and Recurrent Wheezing in Infancy: Is There a Link?
Joseph L. Mathew
The Indian Journal of Pediatrics. 2016; 83(12-13): 1363
[Pubmed] | [DOI]
15 Vitamin D levels in allergic rhinitis: a systematic review and meta-analysis
Yoon Hee Kim,Kyung Won Kim,Min Jung Kim,In Suk Sol,Seo Hee Yoon,Hyeong Sik Ahn,Hyun Jung Kim,Myung Hyun Sohn,Kyu-Earn Kim
Pediatric Allergy and Immunology. 2016; 27(6): 580
[Pubmed] | [DOI]
16 Vitamin D Status in Infants with Two Different Wheezing Phenotypes
Ali Ozdemir,Dilek Dogruel,Ozlem Yilmaz
The Indian Journal of Pediatrics. 2016;
[Pubmed] | [DOI]
17 Prevalence of Vitamin D Deficiency and Insufficiency in Korean Children and Adolescents and Associated Factors
Anna Lee,Se Hwi Kim,Chung Mo Nam,Young-Jin Kim,Soo-Ho Joo,Kyoung-Ryul Lee
Laboratory Medicine Online. 2016; 6(2): 70
[Pubmed] | [DOI]
18 Increased serum VDBP as a risk predictor for steroid resistance in asthma patients
Hongjuan Jiang,Xiangyu Chi,Xuan Zhang,Jing Wang
Respiratory Medicine. 2016;
[Pubmed] | [DOI]
19 Associations of maternal and fetal 25-hydroxyvitamin D levels with childhood lung function and asthma: the Generation R Study
T. Gazibara,H. T. den Dekker,J. C. de Jongste,J. J. McGrath,D. W. Eyles,T. H. Burne,I. K. Reiss,O. H. Franco,H. Tiemeier,V. W. V. Jaddoe,L. Duijts
Clinical & Experimental Allergy. 2016; 46(2): 337
[Pubmed] | [DOI]
20 Serum 25-hydroxyvitamin D3 levels in children with allergic or nonallergic rhinitis
Mahmut Dogru,Ayse Suleyman
International Journal of Pediatric Otorhinolaryngology. 2016; 80: 39
[Pubmed] | [DOI]
21 Vitamin D exposure during pregnancy, but not early childhood, is associated with risk of childhood wheezing
L. N. Anderson,Y. Chen,J. A. Omand,C. S. Birken,P. C. Parkin,T. To,J. L. Maguire
Journal of Developmental Origins of Health and Disease. 2015; 6(04): 308
[Pubmed] | [DOI]
22 Vitamin D Deficiency and Allergic Rhinitis in Children: A Narrative Review
Javad Ghaffari,Alireza Ranjbar,Annegret Quade
Journal of Pediatrics Review. 2015; 3(2)
[Pubmed] | [DOI]
23 Cow’s milk-based beverage consumption in 1- to 4-year-olds and allergic manifestations: an RCT
M. V. Pontes,T. C. M. Ribeiro,H. Ribeiro,A. P. de Mattos,I. R. Almeida,V. M. Leal,G. N. Cabral,S. Stolz,W. Zhuang,D. M. F. Scalabrin
Nutrition Journal. 2015; 15(1)
[Pubmed] | [DOI]
24 Association of VDR and CYP2R1 Polymorphisms with Mite-Sensitized Persistent Allergic Rhinitis in a Chinese Population
Hui-Qin Tian,Xin-Yuan Chen,Ying Lu,Wen-Min Lu,Mei-Lin Wang,Hai-Long Zhao,Mei-Ping Lu,Han Zhou,Ruo-Xi Chen,Zheng-Dong Zhang,Chong Shen,Lei Cheng,Qing-Yi Wei
PLOS ONE. 2015; 10(7): e0133162
[Pubmed] | [DOI]
25 Vitamin D Status: A Different Story in the Very Young versus the Very Old Romanian Patients
Adela Chirita-Emandi,Demetra Socolov,Carmen Haivas,Anca Calapi?,Cristina Gheorghiu,Maria Puiu,Dengshun Miao
PLOS ONE. 2015; 10(5): e0128010
[Pubmed] | [DOI]



 

Top
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
   Introduction
    Materials and me...
   Results
   Discussion
   Conclusions
   Acknowledgment
    References
    Article Figures
    Article Tables

 Article Access Statistics
    Viewed4799    
    Printed112    
    Emailed1    
    PDF Downloaded2906    
    Comments [Add]    
    Cited by others 25    

Recommend this journal

Advertise | Sitemap | What's New | Feedback | Disclaimer
© Journal of Family and Community Medicine | Published by Wolters Kluwer - Medknow
Online since 05th September, 2010