Doctor of Philosophy, The Ohio State University, 1970, Graduate School

Committee: Not Provided (Other) Subjects: Health Sciences

MS, University of Cincinnati, 2014, Medicine: Clinical and Translational Research

Background: The association between allergic disease and behavioral symptoms in childhood is not well established. Objective: To longitudinally examine the relationship of allergic diseases and atopy at age four with validated measures of internalizing, anxiety, and depressive symptoms at age 7 years. Methods: Children enrolled in the Cincinnati Childhood Allergy and Air Pollution Study (CCAAPS), a birth cohort study, completed skin prick testing (SPT) and clinical examinations at 1, 2, 3, 4, and 7 years of age. At age seven, parents completed the Behavior Assessment System for Children, Second Edition (BASC-2), a validated psychological assessment of internalizing disorders composite scale including subscales anxiety and depression. The associations between rhinitis, persistent wheezing, eczema, and allergic sensitization at age four and internalizing disorders at age seven are examined by logistic and linear regression adjusting for maternal education, gender, parental asthma, BMI, and sleep disturbance. Results: In a cohort of 546 children with complete information on allergic disease and behavioral symptoms, the prevalence of internalizing disorders was 13.4%, anxiety disorders 15.2%, and depression was 10.8%. Allergic rhinitis at age 4 years was significantly associated with having elevated BASC-2 scores in the clinically `at risk' range for internalizing disorders, (aOR=3.2 [1.8-5.8]), anxiety disorders (aOR=2.0 [1.2-3.6]), and depressive disorders (aOR=3.2 [1.7-6.5]). Atopic persistent wheeze at age 4 years was significantly associated with BASC-2 `at risk' score for internalizing disorders (aOR=2.7 [1.2-6.3]). Aeroallergen sensitization and food sensitization alone were not associated with BASC-2 `at risk' score for internalizing, anxiety, or depressive disorders. Presence of more than one allergic disease (rhinitis, persistent wheeze, or eczema) was significantly associated with BASC-2 `at risk' score for internalizing disorders (aOR=4.0 [2.0- (open full item for complete abstract)

Committee: Erin Nicole Haynes Ph.D. (Committee Chair); Amal Halim Assa'ad M.D. (Committee Member); Linda Levin Ph.D. (Committee Member); Patrick Ryan Ph.D. (Committee Member) Subjects: Surgery

MS, University of Cincinnati, 2004, Medicine : Epidemiology (Environmental Health)

This study examined infants' risk for developing upper respiratory symptoms (URS) in relation to their exposure to environmental tobacco smoke (ETS) and mold. Eligible infants (n=633) were identified by birth records and had one parent that was atopic by positive skin prick test (SPT). Exposure information was collected at the time of parent SPT, and the average age of the infants was seven months. Parents were asked to complete monthly diaries related to their infants' URS. Our analysis included two models, one using parental report of mold/mildew and a sub-analysis (n=342) using in-home assessor report of none, low or high mold exposure. When controlling for race, gender and socioeconomic status, multivariate logistic regression showed an increased risk of sinus infection with parental report of mold/mildew (OR 1.91; 95%CI 1.14-3.23) and exposure to >20 cigarettes/day (2.38; 1.26-4.49); in the in-home assessor report, high mold was even more significant (6.7; 2.27-19.79). Ear infection was also associated with assessor report of mold, in both the low (1.77; 1.17-2.67) and high (3.07; 1.32-7.12) categories. Rhinitis was significantly associated with parental report of mold/mildew (1.32; 1.31-1.47) and exposure to >20 cigarettes/day (1.74; 1.14-2.65). Although significant associations were not observed with allergic rhinitis, elevated odds ratios were observed with both parent and assessor report of mold. This analysis suggests that mold is a risk factor of sinus infection, ear infection and rhinitis, while ETS is a risk factor of sinus infections and rhinitis. This analysis suggests that mold exposure and not ETS is associated with ear infections in infants. The sub-analysis findings also may suggest that mold exposure is a stronger risk factor than ETS for sinus infection, while ETS may be more closely associated with rhinitis.

Committee: Dr. Grace LeMasters (Advisor) Subjects: Environmental Sciences

PhD, University of Cincinnati, 2012, Medicine: Epidemiology (Environmental Health)

Allergic rhinitis (AR) is an IgE-mediated disease of the upper respiratory tract characterized by symptoms of rhinorrhea, nasal obstruction, itching, and sneezing in response to allergen exposure. Allergic rhinitis is common in childhood, affecting 42% of six year old children, and is associated with an increased risk of asthma. Thus, determining early childhood risk factors may be important for not only AR, but also asthma. The study hypothesis is that size of the specific aeroallergen wheal area in ages one through three is significantly associated with AR at age four. Two specific aims were completed to test this hypothesis. The first specific aim of this study was to determine the size of the skin prick test (SPT) wheal area from 15 individual aeroallergens during early childhood (age one through three) and its association with AR at age four. The second aim was to determine if any individual age-specific aeroallergen wheal area association persisted in a multivariate logistic regression model after controlling for covariates and multiple testing. The analysis was extended further to address a more specific phenotype, allergic eosinophilic rhinitis (AER), defined as AR with nasal eosinophilia. We examined if the individual aeroallergen wheal areas were associated with AER in univariate and multivariate analysis. This study was part of the Cincinnati Childhood Asthma and Air Pollution Study where allergen skin prick tests (SPT) were performed at ages one through four at annual clinical visits. SPT wheal circumferences were traced, recorded on transpore tape, and digitized which allowed accurate estimates of wheal areas by planimetry. Timothy and Alternaria wheal areas at age two were significantly associated to AR at age four (aOR 1.06; 95% CI, 1.02 - 1.11; p = 0.01) and (aOR 1.07; 95% CI 1.0-1.15; p = 0.04), respectively. Fescue, dog, and Penicillium wheal areas at age three were significantly associated with AR at age four (aOR 1.08; 95% CI, 1.02 - 1.15; p = 0. (open full item for complete abstract)

Committee: Grace Lemasters PhD (Committee Chair); David Bernstein MD (Committee Member); Linda Levin PhD (Committee Member); Michell Lierl MD (Committee Member) Subjects: Epidemiology