Vitamin D and childhood asthma: causation and contribution to disease activity

Current Opinion in Allergy and Clinical Immunology - Tập 19 Số 2 - Trang 126-131 - 2019
Augusto A. Litonjua1,2
1Division of Pediatric Pulmonary Medicine, Department of Pediatrics, Golisano Children's Hospital at Strong, University of Rochester Medical Center, Rochester, New York, USA
2e-mail: [email protected]

Tóm tắt

Purpose of review To review the literature of the past 18 months (April 2017 through September, 2018) relating to vitamin D and childhood asthma. Recent findings A combined analysis of two clinical trials of maternal vitamin D supplementation trials showed a significant protective effect of vitamin D supplementation trials in the primary prevention of asthma and recurrent wheeze up to age 3 years. Secondary analyses from these trials have also suggested that initial maternal vitamin D status could affect the response to supplementation during pregnancy, with the biggest protective effect in children born to mothers with initial 25hydroxyvitamin D (25OHD) levels of at least 30 ng/ml. A postnatal, 6-month vitamin D supplementation trial in black, premature babies showed a 34% decreased risk of recurrent wheezing at 1 year among the infants who received supplementation. An individual patient data meta-analysis of published clinical trials concluded that vitamin D supplementation decreased the risk of asthma exacerbations in those with 25OHD levels less than 10 ng/ml. Results of observational analyses on primary prevention of asthma and in prevention of exacerbations remain mixed, with the bulk of the evidence suggesting that there is a protective effect of higher vitamin D levels. Summary Evidence continues to accumulate that vitamin D supplementation helps to prevent the development of asthma and recurrent wheeze in early life, and may also help in the management of asthma. The level(s) of circulating vitamin D that maximizes these effects remains to be identified.

Từ khóa


Tài liệu tham khảo

Binkley, 2017, Toward clarity in clinical vitamin d status assessment: 25 (OH)D assay standardization, Endocrinol Metab Clin North Am, 46, 885, 10.1016/j.ecl.2017.07.012

Carter, 2018, Hydroxyvitamin D assays: an historical perspective from DEQAS, J Steroid Biochem Mol Biol, 177, 30, 10.1016/j.jsbmb.2017.07.018

Bashir, 2018, Observational studies of vitamin D associations with asthma: problems and pitfalls, Pediatr Pulmonol, 53, 1338, 10.1002/ppul.24131

Heaney, 2014, Guidelines for optimizing design and analysis of clinical studies of nutrient effects, Nutr Rev, 72, 48, 10.1111/nure.12090

Hornsby, 2018, Vitamin D supplementation during pregnancy: effect on the neonatal immune system in a randomized controlled trial, J Allergy Clin Immunol, 141, 269.e1, 10.1016/j.jaci.2017.02.039

Pfeffer, 2018, Vitamin D in asthma: mechanisms of action and considerations for clinical trials, Chest, 153, 1229, 10.1016/j.chest.2017.09.005

Boyle, 2017, The relationship between maternal 25-hydroxyvitamin D status in pregnancy and childhood adiposity and allergy: an observational study, Int J Obes (Lond), 41, 1755, 10.1038/ijo.2017.182

Vereen, 2018, The association of maternal prenatal vitamin D levels and child current wheeze, Ann Allergy Asthma Immunol, 120, 98, 10.1016/j.anai.2017.10.005

Parr, 2018, Vitamin A and D intake in pregnancy, infant supplementation, and asthma development: the Norwegian Mother and Child Cohort, Am J Clin Nutr, 107, 789, 10.1093/ajcn/nqy016

Feng, 2017, In utero exposure to 25-hydroxyvitamin D and risk of childhood asthma, wheeze, and respiratory tract infections: a meta-analysis of birth cohort studies, J Allergy Clin Immunol, 139, 1508, 10.1016/j.jaci.2016.06.065

Shen, 2018, Early life vitamin D status and asthma and wheeze: a systematic review and meta-analysis, BMC Pulm Med, 18, 120, 10.1186/s12890-018-0679-4

Nwaru, 2017, Vitamin D intake during the first 4 years and onset of asthma by age 5: a nested case-control study, Pediatr Allergy Immunol, 28, 641, 10.1111/pai.12773

Litonjua, 2016, Effect of prenatal supplementation with vitamin D on asthma or recurrent wheezing in offspring by age 3 years: the VDAART Randomized Clinical Trial, JAMA, 315, 362, 10.1001/jama.2015.18589

Hollams, 2017, Vitamin D over the first decade and susceptibility to childhood allergy and asthma, J Allergy Clin Immunol, 139, 472.e9, 10.1016/j.jaci.2016.07.032

Wolsk, 2017, Vitamin D supplementation in pregnancy, prenatal 25 (OH)D levels, race, and subsequent asthma or recurrent wheeze in offspring: secondary analyses from the Vitamin D Antenatal Asthma Reduction Trial, J Allergy Clin Immunol, 140, 1423.e5, 10.1016/j.jaci.2017.01.013

Wolsk, 2017, Prenatal vitamin D supplementation reduces risk of asthma/recurrent wheeze in early childhood: a combined analysis of two randomized controlled trials, PLoS One, 12, e0186657, 10.1371/journal.pone.0186657

Hibbs, 2018, Effect of vitamin D supplementation on recurrent wheezing in black infants who were born preterm: the D-Wheeze Randomized Clinical Trial, JAMA, 319, 2086, 10.1001/jama.2018.5729

Brehm, 2009, Serum vitamin D levels and markers of severity of childhood asthma in Costa Rica, Am J Respir Crit Care Med, 179, 765, 10.1164/rccm.200808-1361OC

Brehm, 2010, Serum vitamin D levels and severe asthma exacerbations in the Childhood Asthma Management Program study, J Allergy Clin Immunol, 126, 52.e5, 10.1016/j.jaci.2010.03.043

Xystrakis, 2006, Reversing the defective induction of IL-10-secreting regulatory T cells in glucocorticoid-resistant asthma patients, J Clin Invest, 116, 146, 10.1172/JCI21759

Chambers, 2015, Distinct endotypes of steroid-resistant asthma characterized by IL-17A (high) and IFN-gamma (high) immunophenotypes: potential benefits of calcitriol, J Allergy Clin Immun, 136, 628, 10.1016/j.jaci.2015.01.026

Lan, 2014, 25-hydroxyvitamin D3-deficiency enhances oxidative stress and corticosteroid resistance in severe asthma exacerbation, PLoS One, 9, e111599, 10.1371/journal.pone.0111599

Gupta, 2011, Relationship between serum vitamin D, disease severity, and airway remodeling in children with asthma, Am J Respir Crit Care Med, 184, 1342, 10.1164/rccm.201107-1239OC

Han, 2017, Vitamin D insufficiency and asthma in a US nationwide study, J Allergy Clin Immunol Pract, 5, 790.e1, 10.1016/j.jaip.2016.10.013

Szentpetery, 2018, Vitamin D insufficiency, plasma cytokines, and severe asthma exacerbations in school-aged children, J Allergy Clin Immunol Pract, 6, 289.e2, 10.1016/j.jaip.2017.07.019

Havan, 2017, Effects of 25 hydroxy vitamin D levels on the severity and asthma control in school age asthma patients, Arch Argent Pediatr, 115, 336

Omand, 2018, 25-hydroxyvitamin D and health service utilization for asthma in early childhood, Pediatr Pulmonol, 53, 1018, 10.1002/ppul.24067

Reinehr, 2018, 25-Hydroxvitamin D concentrations are not lower in children with bronchial asthma, atopic dermatitis, obesity, or attention-deficient/hyperactivity disorder than in healthy children, Nutr Res, 52, 39, 10.1016/j.nutres.2018.01.002

Tromp, 2018, 25-Hydroxyvitamin D concentrations, asthma and eczema in childhood: the generation R study, Clin Nutr, 37, 169, 10.1016/j.clnu.2016.11.019

Pfeffer, 2018, Effects of vitamin D on inflammatory and oxidative stress responses of human bronchial epithelial cells exposed to particulate matter, PLoS One, 13, e0200040, 10.1371/journal.pone.0200040

Han, 2018, Exposure to polycyclic aromatic hydrocarbons, vitamin D, and lung function in children with asthma, Pediatr Pulmonol, 53, 1362, 10.1002/ppul.24084

Alansari, 2017, Rapid vs maintenance vitamin d supplementation in deficient children with asthma to prevent exacerbations, Chest, 152, 527, 10.1016/j.chest.2017.06.021

Martineau, 2016, Vitamin D for the management of asthma, Cochrane Database Syst Rev, 9, CD011511

Jolliffe, 2017, Vitamin D supplementation to prevent asthma exacerbations: a systematic review and meta-analysis of individual participant data, Lancet Respir Med, 5, 881, 10.1016/S2213-2600(17)30306-5