El papel de la vitamina d en la respuesta inmune y en las enfermedades alérgicas

El papel de la vitamina d en la respuesta inmune y en las enfermedades alérgicas

Contenido principal del artículo

Catherine Meza Torres
Javier Marrugo Cano

Resumen

Introducción: la vitamina D es una de las moléculas más pleiotrópicas. Juega un papel
importante en el metabolismo del calcio, en la salud pulmonar y en el sistema inmune.
En estudios epidemiológicos se ha relacionado la insuficiencia de esta vitamina con el
asma y la dermatitis atópica. Así mismo, algunos estudios genéticos que incluyen hasta
el rastreo genómico han reportado asociación entre el receptor de la vitamina D (VDR)
y el asma.
Objetivo: identificar el papel de la vitamina D en la respuesta inmune y en las
enfermedades alérgicas.
Metodología: se realizó una búsqueda electrónica en las bases de datos PubMed,
ScienceDirect, Protein data Bank, NCBI, Blackwell Synergy Wiley Online Library.
Resultados: se selecionaron 120 articulos para la revision y se escogieron 76 articulos
completos y dos resúmenes de nuestro grupo.
Conclusión: estudios epidemiológicos y de genética han relacionado a la vitamina D
y su receptor (VDR) con el desarrollo de las enfermedades alérgicas. Esta evidencia es
extensa y en ocasiones contradictoria, la cual se podría explicar por el reclutamiento
diferencial de coactivadores del complejo VD-VDR-RXR. Sin embargo, la mayoría de los
estudios experimentales in vitro e in vivo demuestran que la vitamina D ejerce un efecto
modulador sobre diversos tipos de células del sistema inmune innato y adaptativo, así
como sobre las células involucradas en la respuesta inmune del tipo Th1, Th2, Treg y
Th17. Se concluye que esta vitamina juega un papel fundamental sobre las respuestas
inmunes innatas y adaptativas, así como en el desarrollo de las enfermedades alérgicas.
Rev.cienc.biomed. 2015;6(2):319-332

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Referencias (VER)

Gupta A, Bush A, Hawrylowicz C, Saglani S. Vitamin D and asthma in children. Paediatr Respir Rev [Internet]. Elsevier Ltd; 2012 Dec [cited 2013 Mar 6];13(4):236–43; quiz 243. Available

from: http://www.ncbi.nlm.nih.gov/pubmed/23069123.

Muehleisen B, Gallo RL. Vitamin D in allergic disease: Shedding light on a complex problem. J Allergy Clin Immunol [Internet]. Elsevier Ltd; 2013 Feb [cited 2013 Mar 6];131(2):324–9.

Available from: http://www.ncbi.nlm.nih.gov/pubmed/23374263.

Bäck O, Blomquist HKS, Hernell O, Stenberg B. Does vitamin D intake during infancy promote the development of atopic allergy? Acta Derm Venereol [Internet]. 2009 Jan [cited 2013 Mar 6];89(1):28–32. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19197538.

Maria I, Costa C. Dermatite atópica e vitamina D : fatos e controvérsias. 2013;88(6):945–53.

Samochocki Z, Bogaczewicz J, Jeziorkowska R, Sysa- Jędrzejowska A, Glińska O, Karczmarewicz E, et al. Vitamin D effects in atopic dermatitis. J Am Acad Dermatol [Internet]. 2013

Aug [cited 2014 May 24];69(2):238–44. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23643343.

Hyppönen E, Berry DJ, Wjst M, Power C. Serum 25-hydroxyvitamin D and IgE - a significant but nonlinear relationship. Allergy [Internet]. 2009 Apr [cited 2013 Mar 6];64(4):613–20.

Available from: http://www.ncbi.nlm.nih.gov/pubmed/19154546.

Munoz C, Meza C, Hernandez LDC, Egea E, Marrugo JA. Immunology U of C, Artagena. Influence of vitamin D in IgE levels in rural and urban Colombian African descendent children. Allergy Eur J Allergy Clin Immunol. 2013;68:653–4.

Poon AH, Laprise C, Lemire M, Montpetit A, Sinnett D, Schurr E, et al. Association of vitamin D receptor genetic variants with susceptibility to asthma and atopy. Am J Respir Crit Care Med

[Internet]. 2004 Nov 1 [cited 2014 Jun 4];170(9):967–73. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15282199.

Raby B, Lazarus R, Silverman EK, Lake S, Lange C, Wjst M, et al. Association of vitamin D receptor gene polymorphisms with childhood and adult asthma. Am J Respir Crit Care Med

[Internet]. 2004 Nov 15 [cited 2014 Jun 4];170(10):1057–65. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15282200.

Ismail MF, Elnady HG, Fouda EM. Genetic variants in vitamin D pathway in Egyptian asthmatic children: a pilot study. Hum Immunol [Internet]. American Society for Histocompatibility and

Immunogenetics; 2013 Dec [cited 2014 Jun 18];74(12):1659–64. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24007655.

Wjst M, Altmüller J, Braig C, Bahnweg M, André E. A genome-wide linkage scan for 25-OH-D(3) and 1,25-(OH)2-D3 serum levels in asthma families. J Steroid Biochem Mol Biol [Internet].

Mar [cited 2014 Jun 18];103(3-5):799–802. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17236760.

Study TI, Committee S. Worldwide variation in prevalence of symptoms of asthma , allergic rhinoconjunctivitis , and atopic eczema : ISAAC. 1998;351:1225–32.

Asher MI, Montefort S, Björkstén B, Lai CKW, Strachan DP, Weiland SK, et al. Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in

childhood: ISAAC Phases One and Three repeat multicountry cross-sectional surveys. Lancet [Internet]. 2006 Aug 26;368(9537):733–43. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16935684.

Marrugo J, Hernández L, Villalba V. Prevalence of self-reported food allergy in Cartagena ( Colombia) population. 2008;36(6):320–4.

Dennis RJ, Caraballo L, García E, Rojas MX, Rondon M a, Pérez A, et al. Prevalence of asthma and other allergic conditions in Colombia 2009-2010: a cross-sectional study. BMC Pulm Med [Internet]. BioMed Central Ltd; 2012 Jan [cited 2014 Jun 15];12(1):17. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3488963&tool=pmcentrez&rendertype=abstract

Yepes-Nuñez JJ, Gómez-García C, Espinosa-Herrera Y, Cardona-Villa R. Health-related quality of life in children and adults with respiratory allergy in Colombia: prospective study. Allergol Immunopathol (Madr) [Internet]. 2012 [cited 2014 Jun 15];40(6):379–84. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22316550.

Small M, Piercy J, Demoly P, Marsden H. Burden of illness and quality of life in patients being treated for seasonal allergic rhinitis: a cohort survey. Clin Transl Allergy [Internet]. 2013

Jan;3(1):33. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3852

&tool=pmcentrez&rendertype=abstract.

Law AW, Reed SD, Sundy JS, Schulman K a. Direct costs of allergic rhinitis in the united states: Estimates from the 1996 medical expenditure panel survey. J Allergy Clin Immunol [Internet]. 2003 Feb [cited 2014 Jun 15];111(2):296–300. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0091674902913308.

Strachan DP. household size. Br Med J. 1989;299(November):1259–60.

Hooper R, Calvert J, Thompson RL, Deetlefs ME, Burney P. Urban/rural differences in diet and atopy in South Africa. Allergy [Internet]. 2008 Apr [cited 2011 Oct 29];63(4):425–31. Available

from: http://www.ncbi.nlm.nih.gov/pubmed/18315730.

Marrugo J, Urrego J, Fang L, Hernandez L LL. Influence of rural and urban dietary and lifestyle patterns in atopic diseases in a Colombian African-descent population. J Allergy Clin Immunol.

;8334.

Devereux G, Seaton A. Diet as a risk factor for atopy and asthma. J Allergy Clin Immunol [Internet]. 2005 Jun [cited 2011 Aug 14];115(6):1109–17; quiz 1118. Available from: http://www.

ncbi.nlm.nih.gov/pubmed/15940119.

Allan K, Devereux G. Diet and asthma: nutrition implications from prevention to treatment. J Am Diet Assoc [Internet]. Elsevier Inc.; 2011 Feb [cited 2011 Jul 25];111(2):258–68. Available

from: http://www.ncbi.nlm.nih.gov/pubmed/21272700.

Villanueva D, Marrugo J. De la dieta y sus metabolitos. RevMedicaSanitas. 2014;17(4):212–30.

Villanueva D. Influencia de los ácidos grasos poliinsaturados omega-3 y omega-6 de la dieta y de sus metabolitos en la respuesta inmune de tipo alérgico. Rev Fac Med. 2015;63(2):301–13.

Torres-Borrego J, Moreno-Solís G, Molina-Terán AB. Diet for the prevention of asthma and allergies in early childhood: much ado about something? Allergol Immunopathol (Madr) [Internet].

[cited 2013 Mar 6];40(4):244–52. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22425606.

Harik-Khan RI. Serum Vitamin Levels and the risk of asthma in children. Am J Epidemiol [Internet]. 2004 Feb 15 [cited 2013 Mar 6];159(4):351–7. Available from: http://aje.oupjournals.org/cgi/doi/10.1093/aje/kwh053.

Pillai SG, Chiano MN, White NJ, Speer M, Barnes KC, Carlsen K, et al. A genome-wide search for linkage to asthma phenotypes in the genetics of asthma international network families:

evidence for a major susceptibility locus on chromosome 2p. Eur J Hum Genet [Internet]. 2006 Mar [cited 2014 Jun 18];14(3):307–16. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16391567.

Taher Y, Van Esch M, Hofman G, Henricks J, van Oosterhout JM. 1,25-Dihydroxyvitamin D3 potentiates the beneficial effects of allergen immunotherapy in a mouse model of allergic asthma:

role for IL-10 and TGF- J Immunol [Internet]. 2008;180(8):5211–21. Available from: http://www.jimmunol.org/cgi/doi/10.4049/jimmunol.180.8.5211.

White P, Cooke N. The multifunctional properties and characteristics of vitamin D-binding protein. Trends Endocrinol Metab [Internet]. 2000 Oct;11(8):320–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/10996527.

Baeke F, Takiishi T, Korf H, Gysemans C, Mathieu C. Vitamin D : modulator of the immune system. Curr Opin Pharmacol [Internet]. Elsevier Ltd; 2010;10(4):482–96. Available from: http://dx.doi.org/10.1016/j.coph.2010.04.001.

Kasiske BL. K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. [Internet]. Kasiske BL, editor. American Journal of kidney diseases : the official journal of the National Kidney Foundation. Minneapolis,MN55404: AJKD; 2003. S1-201 p. Available

from: http://www.ncbi.nlm.nih.gov/pubmed/14520607.

Holick MF. Vitamin D deficiency. N Engl J Med [Internet]. 2007 Jul 19;357(3):266–81. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17634462.

Pludowski P, Holick MF, Pilz S, Wagner CL, Hollis BW, Grant WB, et al. Vitamin D effects on musculoskeletal health, immunity, autoimmunity, cardiovascular disease, cancer, fertility, pregnancy,

dementia and mortality-a review of recent evidence. Autoimmun Rev [Internet]. Elsevier B.V.; 2013 Aug [cited 2014 May 23];12(10):976–89. Available from: http://www.ncbi.nlm.nih.gov/

pubmed/23542507.

Quack M, Carlberg C. Ligand-triggered stabilization of vitamin D receptor/retinoid X receptor heterodimer conformations on DR4-type response elements. J Mol Biol [Internet]. 2000 Feb

[cited 2014 Jun 18];296(3):743–56. Available from: http://www.ncbi.nlm.nih.gov/pubmed/10677278.

Bikle DD, Teichert A, Arnold LA, Uchida Y, Elias PM, Oda Y. Differential regulation of epidermal function by VDR coactivators. J Steroid Biochem Mol Biol. 2010;121(1-2):308–13.

Carvallo L, Henriquez B, Olate J, van Wijnen AJ, Lian JB, Stein GS, et al. The 1alpha,25-dihydroxy Vitamin D3 receptor preferentially recruits the coactivator SRC-1 during up-regulation of the osteocalcin gene. J Steroid Biochem Mol Biol [Internet]. 2007 Mar [cited 2014 Jun 18];103(3-5):420–4. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3118563&tool=pmcentrez&rendertype=abstract.

Bikle DD, Teichert a, Arnold L a, Uchida Y, Elias PM, Oda Y. Differential regulation of epidermal function by VDR coactivators. J Steroid Biochem Mol Biol [Internet]. Elsevier Ltd; 2010 Jul [cited

Jun 18];121(1-2):308–13. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2906691&tool=pmcentrez&rendertype=abstract.

Rachez C, Freedman LP. Mechanisms of gene regulation by vitamin D(3) receptor: a network of coactivator interactions. Gene [Internet]. 2000 Apr 4;246(1-2):9–21. Available from: http://

www.ncbi.nlm.nih.gov/pubmed/10767523.

Song Y, Hong J, Liu D, Lin Q, Lai G. 1,25-dihydroxyvitamin D3 inhibits nuclear factor kappa B activation by stabilizing inhibitor IκBα via mRNA stability and reduced phosphorylation in passively

sensitized human airway smooth muscle cells. Scand J Immunol [Internet]. 2013 Feb [cited 2014 Jun 18];77(2):109–16. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23126502.

Helming L, Böse J, Ehrchen J, Schiebe S, Frahm T, Geffers R, et al. 1alpha,25-Dihydroxyvitamin D3 is a potent suppressor of interferon gamma-mediated macrophage activation. Blood [Internet]. 2005 Dec 15 [cited 2014 Jun 3];106(13):4351–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16118315.

Calton EK, Keane KN, Newsholme P, Soares MJ. The impact of Vitamin D levels on inflammatory status: A systematic review of immune cell studies. PLoS One. 2015;10(11):1–12.

Lagishetty V, Liu NQ, Hewison M. Vitamin D metabolism and innate immunity. Mol Cell Endocrinol [Internet]. Elsevier Ireland Ltd; 2011 Dec 5 [cited 2014 May 25];347(1-2):97–105. Available

from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3200473&tool=pmcentrez&rendertype=abstract.

Riek AE, Oh J, Bernal-Mizrachi C. 1,25(OH)2 vitamin D suppresses macrophage migration and reverses atherogenic cholesterol metabolism in type 2 diabetic patients. J Steroid Biochem Mol Biol [Internet]. Elsevier Ltd; 2013 Jul [cited 2014 Jun 4];136:309–12. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23333932.

Penna G, Adorini L. 1 ,25-Dihydroxyvitamin D3 Inhibits Differentiation, Maturation, Activation, and Survival of Dendritic Cells Leading to Impaired Alloreactive T Cell Activation. J Immunol [Internet]. 2000 Mar 1 [cited 2014 Jun 18];164(5):2405–11. Available from: http://www.jimmunol.org/cgi/doi/10.4049/jimmunol.164.5.2405.

Adorini L, Penna G. Dendritic cell tolerogenicity: a key mechanism in immunomodulation by vitamin D receptor agonists. Hum Immunol [Internet]. American Society for Histocompatibility

and Immunogenetics; 2009 May [cited 2013 Mar 6];70(5):345–52. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0198885909000214.

Froicu M, Weaver V, Wynn T a, McDowell MA, Welsh JE, Cantorna MT. A crucial role for the vitamin D receptor in experimental inflammatory bowel diseases. Mol Endocrinol [Internet]. 2003 Dec [cited 2014 Jun 18];17(12):2386–92. Available from: http://www.ncbi.nlm.nih.gov/pubmed/14500760.

Boonstra a, Barrat FJ, Crain C, Heath VL, Savelkoul HF, O’Garra a. 1alpha,25-Dihydroxyvitamin d3 has a direct effect on naive CD4(+) T cells to enhance the development of Th2 cells. J Immunol

[Internet]. 2001 Nov 1;167(9):4974–80. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11673504.

Thoma-Uszynski S. Induction of direct antimicrobial activity through mammalian toll-Like receptors. Science (80- ) [Internet]. 2001;291(5508):1544–7. Available from: http://www.science-mag.org/cgi/doi/10.1126/science.291.5508.1544.

Liu PT, Stenger S, Li H, Wenzel L, Tan BH, Krutzik SR, et al. Toll-like receptor triggering of a vitamin D-mediated human antimicrobial response. Science [Internet]. 2006 Mar 24 [cited 2014 May 26];311(5768):1770–3. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16497887.

Chun RF, Lauridsen AL, Suon L, Zella L a, Pike JW, Modlin RL, et al. Vitamin D-binding protein directs monocyte responses to 25-hydroxy- and 1,25-dihydroxyvitamin D. J Clin Endocrinol

Metab [Internet]. 2010 Jul [cited 2014 Jun 18];95(7):3368–76. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2928899&tool=pmcentrez&rendertype=abstract.

Tissa R. Hata, Kotol P, Jackson M, Nguyen M, Paik A, Udall D, et al. Administration of oral vitamin D induces cathelicidin production in atopic individuals. J Allergy Clin Immunol.

;122(4):828–9.

Wang T-T, Nestel FP, Bourdeau V, Nagai Y, Wang Q, Liao J, et al. Cutting Edge: 1,25-Dihydroxyvitamin D3 is a direct inducer of antimicrobial peptide gene expression. J Immunol [Internet].

;173:2909–12. Available from: http://www.jimmunol.org/content/173/5/2909nhttp://www.jimmunol.org/content/173/10/6490.4.full.pdfnhttp://www.jimmunol.org/.

Karlsson J, Carlsson G, Larne O, Andersson M, Pütsep K. Vitamin D3 induces pro-LL-37 expression in myeloid precursors from patients with severe congenital neutropenia. J Leukoc

Biol [Internet]. 2008 Nov [cited 2014 Jun 18];84(5):1279–86. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18703682.

Veldman CM, Cantorna MT, Deluca HF. Expression of 1,25-Dihydroxyvitamin D 3 Receptor in the Immune System 1. 2000;374(2):334–8.

Mahon BD, Wittke A, Weaver V, Cantorna MT. The targets of vitamin D depend on the differentiation and activation status of CD4 positive T cells. J Cell Biochem [Internet]. 2003

Aug 1 [cited 2014 Jun 18];89(5):922–32. Available from: http://www.ncbi.nlm.nih.gov/pubmed/12874827.

Baeke F, Korf H, Overbergh L, van Etten E, Verstuyf A, Gysemans C, et al. Human T lymphocytes are direct targets of 1,25-dihydroxyvitamin D3 in the immune system. J Steroid

Biochem Mol Biol [Internet]. Elsevier Ltd; 2010 Jul [cited 2014 Jun 18];121(1-2):221–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20302932.

Rigby WF, Stacy T, Fanger MW. Inhibition of T lymphocyte mitogenesis by 1,25-dihydroxyvitamin D3 (calcitriol). J Clin Invest [Internet]. 1984 Oct;74(4):1451–5. Available from:

http://www.pubmedcentral.nih.gov/articlerender.fcgi? artid=425314&tool=pmcentrez&rendertype=abstract.

Staeva-Vieira TP, Freedman LP. 1,25-Dihydroxyvitamin D3 Inhibits IFN- and IL-4 Levels During In Vitro Polarization of Primary Murine CD4+ T Cells. J Immunol [Internet]. 2002 Feb 1 [cited 2014 Jun 18];168(3):1181–9. Available from: http://www.jimmunol.org/cgi/doi/10.4049/jimmunol.168.3.1181.

Jeffery LE, Burke F, Mura M, Zheng Y, Qureshi OS, Hewison M, et al. 1,25-Dihydroxyvitamin D3 and IL-2 combine to inhibit T cell production of inflammatory cytokines and promote development

of regulatory T cells expressing CTLA-4 and FoxP3. J Immunol [Internet]. 2009 Nov 1 [cited 2014 May 27];183(9):5458–67. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2810518&tool=pmcentrez&rendertype=abstract.

Nanzer AM, Chambers ES, Ryanna K, Richards DF, Black C, Timms PM, et al. Enhanced production of IL-17A in patients with severe asthma is inhibited by 1α,25-dihydroxyvitamin D3 in a glucocorticoid-independent fashion. J Allergy Clin Immunol [Internet]. Elsevier Ltd; 2013 Aug [cited 2014 Jun 18];132(2):297–304.e3. Available from: http://www.ncbi.nlm.

nih.gov/pubmed/23683514.

Joshi S, Pantalena L-C, Liu XK, Gaffen SL, Liu H, Rohowsky-Kochan C, et al. 1,25-dihydroxyvitamin D(3) ameliorates Th17 autoimmunity via transcriptional modulation of interleukin-

A. Mol Cell Biol [Internet]. 2011 Sep [cited 2014 May 23];31(17):3653–69. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3165548&tool=pmcentrez&rendertype=abstract.

Anolik JH, Aringer M. New treatments for SLE: cell-depleting and anti-cytokine therapies. Best Pract Res Clin Rheumatol [Internet]. 2005 Oct [cited 2014 Jun 18];19(5):859–78. Available

from: http://www.ncbi.nlm.nih.gov/pubmed/16150407.

Heine G, Anton K, Henz BM, Worm M. 1alpha,25-dihydroxyvitamin D3 inhibits anti-CD40 plus IL-4-mediated IgE production in vitro. Eur J Immunol [Internet]. 2002 Dec;32(12):3395–404. Available from: http://www.ncbi.nlm.nih.gov/pubmed/12432570.

Devereux G, Litonjua A a, Turner SW, Craig LC a, McNeill G, Martindale S, et al. Maternal vitamin D intake during pregnancy and early childhood wheezing. Am J Clin Nutr [Internet].

Mar;85(3):853–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17344509.

Sharief S, Jariwala S, Kumar J, Muntner P, Melamed ML. Vitamin D levels and food and environmental allergies in the United States: results from the National Health and Nutrition Examination Survey 2005-2006. J Allergy Clin Immunol [Internet]. Elsevier Ltd; 2011 May [cited 2014 May 30];127(5):1195–202. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3085636&tool=pmcentrez&rendertype=abstract.

Eyal Oren, Banerji A, Camargo CA. Vitamin D and atopic disorders in an obese population screened for vitamin D deficiency. J Allergy Clin Immunol [Internet]. 2008 Feb [cited 2014 May 27];121(2):531–3. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18155280

Osborne NJ, Ukoumunne OC, Wake M, Allen KJ. Prevalence of eczema and food allergy is associated with latitude in Australia. J Allergy Clin Immunol. 2012;129(3):865–7.

Baïz N, Dargent-Molina P, Wark JD, Souberbielle J-C, Annesi-Maesano I. Cord serum 25-hydroxyvitamin D and risk of early childhood transient wheezing and atopic dermatitis. J

Allergy Clin Immunol [Internet]. 2014 Jan [cited 2014 Jun 3];133(1):147–53. Available

from: http://www.ncbi.nlm.nih.gov/pubmed/23810764.

Initiative G. Global strategy for asthma management and prevention. 2010;

Tolppanen A, Sayers A, Granell R, Fraser WD, Henderson J, Lawlor D a. Prospective Association of 25-Hydroxyvitamin D3 and D2 with Childhood Lung Function, Asthma, Wheezing, and Flexural Dermatitis. Epidemiology [Internet]. 2013;24(2):25–33. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23377091.

Kolokotroni O, Papadopoulou A, Middleton N, Kouta C, Raftopoulos V, Nicolaidou P, et al. Vitamin D levels and status amongst asthmatic and non-asthmatic adolescents

in Cyprus: a comparative cross-sectional study. BMC Public Health [Internet]. 2015;15(1):48. Available from: http://www.scopus.com/inward/record.url?eid=2-s2.0-84924232771&partnerID=tZOtx3y1.

Erkkola M, Kaila M, Nwaru BI, Kronberg-Kippilä C, Ahonen S, Nevalainen J, et al. Maternal vitamin D intake during pregnancy is inversely associated with asthma and allergic rhinitis in 5-year-old children. Clin Exp Allergy [Internet]. 2009 Jun [cited 2014 May

;39(6):875–82. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19522996.

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 [Internet]. Mosby, Inc.; 2010;156(6):948–52. Available from: http://dx.doi.org/10.1016/j.jpeds.2009.12.033.

Brehm JM, Celedón JC, Soto-Quiros ME, Avila L, Hunninghake GM, Forno E, et al. Serum vitamin D levels and markers of severity of childhood asthma in Costa Rica. Am J Respir Crit Care Med [Internet]. 2009 May 1 [cited 2013 Mar 6];179(9):765–71. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2675563&tool=pmcentrez&rendertype=abstract.

Elias PM, Hatano Y, Williams ML. Basis for the barrier abnormality in atopic dermatitis: outside-inside-outside pathogenic mechanisms. J Allergy Clin Immunol [Internet]. 2008

Jun [cited 2014 Jun 16];121(6):1337–43. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2706021&tool=pmcentrez&rendertype=abstract.

O’Regan GM, Sandilands A, McLean WHI, Irvine AD. Filaggrin in atopic dermatitis. J Allergy Clin Immunol [Internet]. 2008 Oct [cited 2014 May 23];122(4):689–93. Available from:

http://www.ncbi.nlm.nih.gov/pubmed/18774165.

Gale CR, Robinson SM, Harvey NC, Javaid MK, Jiang B, Martyn CN, et al. Maternal vitamin D status during pregnancy and child outcomes. Eur J Clin Nutr [Internet]. 2008 Jan [cited

Jun 10];62(1):68–77. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2629513&tool=pmcentrez&rendertype=abstract.

Cheng HM, Kim S, Park G-H, Chang SE, Bang S, Won CH, et al. Low vitamin D levels are associated with atopic dermatitis, but not allergic rhinitis, asthma, or IgE sensitization, in the adult Korean population. J Allergy Clin Immunol [Internet]. Elsevier Ltd; 2014 Apr [cited 2014 Jun 14];133(4):1048–55. Available from: http://www.ncbi.nlm.nih.gov/pubmed/