Publications by authors named "Shyamali Chandrika Dharmage"

6 Publications

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Infant Body Mass Index Trajectories, and Asthma & Lung Function.

J Allergy Clin Immunol 2021 Mar 1. Epub 2021 Mar 1.

Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne Australia; Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia. Electronic address:

Background: The impact of early rapid body mass index (BMI) increase on asthma risk and subsequent lung function remains contentious, with limited prospective studies during a critical window for lung growth.

Objective: We investigated the associations between BMI trajectories in the first 2 years of life, and adolescent asthma and lung function.

Methods: Anthropometric data was collected up to 18 times in the first 24 months on 620 infants from the Melbourne Atopy Cohort Study. BMI trajectories were developed using group-based trajectory modelling. Associations between these trajectories and spirometry, fractional exhaled nitric oxide, and current asthma status at 12 and/or 18 years of age were modelled using multiple linear and logistic regression.

Results: Five BMI trajectories were identified. Compared to the "average trajectory", children belonging to the "early low and catch up" and "persistently high" BMI trajectories were at higher risk of asthma at 18 years (OR=2·2; 95%CI 1·0, 4·8 and 2·4; 1·1, 5·3 respectively). These trajectories were also associated with lower FEV1 by FVC, and higher FeNO levels at 18 years. In addition, children belonging to the "persistently low" trajectory had lower FEV1 (β=-183·9 ml; 95%CI -340·9, -26·9) and FVC (β=-207·8 ml; -393·6, -22·0) at 18 years.

Conclusion: In this cohort, "early low & catch up" and "persistently high" trajectories were associated with asthma and obstructive lung function pattern in adolescence. Having a persistently low BMI at an early age was associated with a restrictive pattern. Thus, maintenance of normal growth patterns may lead to improved adolescent respiratory health.
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http://dx.doi.org/10.1016/j.jaci.2021.02.020DOI Listing
March 2021

Transient childhood wheeze is associated with less atopy in adolescence.

Pediatr Allergy Immunol 2020 11 14;31(8):913-919. Epub 2020 Jul 14.

Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia.

Background: The relationships between childhood wheeze phenotypes and subsequent allergic conditions other than asthma, including hay fever, eczema and sensitization, have not been widely reported. We aimed to investigate this relationship up to late adolescence.

Methods: Using five childhood wheeze phenotypes defined from 620 children in a high-atopy risk birth cohort (Melbourne Atopy Cohort Study), we investigated their relationships with sensitization, eczema, hay fever and fractional exhaled nitric oxide (FeNO) at ages 12 and/or 18 years using logistic and linear regression models.

Results: 'Early Persistent wheeze' was associated with the increased risk of eczema (odds ratio: 3.69; 95% CI: 1.23, 11.12) and sensitization (4.52; 1.50, 13.64) at 12 years. 'Intermediate Onset wheeze' was associated with the increased risk of eczema at 12 years (2.57; 1.11, 5.97), hay fever at 12 (2.87; 1.44, 5.74) and 18 years (2.19; 1.20, 4.02), sensitization at 12 (2.25; 1.17, 4.34) and 18 years (2.46; 1.18, 5.12), and raised FeNO at 18 years. 'Late Onset wheeze' was associated with the increased risk of hay fever at 12 (5.18; 1.11, 24.20) and 18 years (4.20; 1.03, 17.11) and sensitization at 12 years (3.27; 0.81, 13.27). In contrast, 'Early Transient wheeze' was associated with the reduced risk of eczema (0.44; 0.20, 0.96), hay fever (0.57; 0.33, 0.99) and sensitization (0.59; 0.35, 0.99) at 18 years and a lower FeNO compared with 'Never/Infrequent wheezers'.

Conclusions: Persistent wheeze phenotypes were associated with allergic outcomes up to 18 years with 'Intermediate Onset wheeze' being the most atopic group. In contrast, 'Early Transient wheezers' had less risk of allergic outcomes at 18 years. This protective effect may reassure parents of wheezy infants and young children.
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http://dx.doi.org/10.1111/pai.13304DOI Listing
November 2020

A step in the right direction: Harmonizing measures for use in asthma patient registries.

J Allergy Clin Immunol 2019 09 17;144(3):663-664. Epub 2019 Jul 17.

Allergy and Lung Health Unit, University of Melbourne, Melbourne, Australia; Murdoch Childrens Research Institute, Melbourne, Australia.

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http://dx.doi.org/10.1016/j.jaci.2019.07.005DOI Listing
September 2019

Do hydrolysed infant formulas reduce the risk of allergic disease?

BMJ 2016 Mar 8;352:i1143. Epub 2016 Mar 8.

Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Vic 3010, Australia.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4783515PMC
http://dx.doi.org/10.1136/bmj.i1143DOI Listing
March 2016

Early-life risk factors and incidence of rhinitis: results from the European Community Respiratory Health Study--an international population-based cohort study.

J Allergy Clin Immunol 2011 Oct 12;128(4):816-823.e5. Epub 2011 Jul 12.

MEGA Epidemiology, University of Melbourne, Melbourne, Australia.

Background: Rhinitis is an increasingly common condition with a heavy health care burden, but relatively little is known about its risk factors.

Objective: To examine the association between early-life factors and the development of rhinitis in the European Community Respiratory Health Study (ECRHS).

Methods: In 1992-1994, community-based samples of 20-44-year-old people were recruited from 48 centers in 22 countries. On average, 8.9 years later, 28 centers reinvestigated their samples. Onset of rhinitis was reported by 8486 participants in interviewer-led questionnaires. Cox regression was used to assess independent predictors of rhinitis at ages ≤5, 6-10, 11-20, and ≥21 years.

Results: The crude lifelong incidence of rhinitis was 7.00/1000/year (men) and 7.95/1000/year (women) (P = .002). Women developed less rhinitis in later childhood (hazard ratios [HR], 0.63; 95% CI, 0.47-0.85) and more rhinitis in adulthood (HR, 1.36; 95% CI, 1.11-1.66) than did men. In atopic subjects, siblings were associated with lower risk of rhinitis throughout life (pooled HR, 0.94; 95% CI, 0.91-0.98 per 1 sibling). Early contact with children in the family or day care was associated with less incidence of rhinitis, predominantly before age 5 years (HR, 0.84; 95% CI, 0.72-0.99). Early childhood pets or growing up on a farm was associated with less incidence of rhinitis in adolescence (HR, 0.50; 95% CI, 0.37-0.68). Combining these factors showed evidence of a dose-response relationship (trend P = .0001).

Conclusions: Gender is a strong risk factor for rhinitis, with age patterns varying according to atopic status. Protective effects of early contact with children and animals were suggested for incident rhinitis, with risk patterns varying by age window and atopic status.
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http://dx.doi.org/10.1016/j.jaci.2011.05.039DOI Listing
October 2011

Breast-feeding and atopic disease: a cohort study from childhood to middle age.

J Allergy Clin Immunol 2007 Nov 31;120(5):1051-7. Epub 2007 Aug 31.

Center for Molecular, Environmental, Genetic & Analytic Epidemiology, School of Population Health, University of Melbourne, Melbourne, Australia.

Background: The literature regarding the association between breast-feeding and atopic diseases has been contradictory.

Objective: We have assessed the relationship between breast-feeding and atopic disorders in a cohort followed into middle age.

Methods: The Tasmanian Asthma Study is a population-based prospective cohort study that has followed participants from the age of 7 to 44 years. Exclusive breast-feeding in the first 3 months of life was examined as a risk factor for atopic diseases by using multiple logistic regression and generalized estimating equation analyses.

Results: At age 7 years, exclusively breast-fed children with a maternal history of atopy had a marginally lesser risk of current asthma than those not exclusively breast-fed (odds ratio [OR], 0.8; 95% CI, 0.6-1.0). However, after age 7 years, the risk reversed, and exclusively breast-fed children had an increased risk of current asthma at 14 (OR, 1.46; 95% CI, 1.02-2.07), 32 (OR, 1.84; 95% CI, 1.06-3.3), and 44 (OR, 1.57; 95% CI, 1.15-2.14) years. Exclusively breast-fed children also had a reduced risk of food allergy at age 7 years but an increased risk of food allergy (OR, 1.26; 95% CI, 1.1-1.5) and allergic rhinitis (OR, 1.2; 95% CI, 1.0-1.3) at 44 years.

Conclusion: Exclusively breast-fed babies with a maternal history of atopy were less likely to develop asthma before the age of 7 years, but more likely to develop asthma after the age of 7 years.

Clinical Implications: The current recommendation to breast-feed high-risk infants for protection against early wheezing illness can be confirmed. However, the recommendation should be reconsidered for protection against allergic asthma and atopy in the longer term.
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http://dx.doi.org/10.1016/j.jaci.2007.06.030DOI Listing
November 2007