Risk Of Atopic Diseases Research Articles

Effects of antibiotic exposure and immune system challenge on the development of allergic asthma

Abstract. In previous studies, experimenters have found that the risk of atopic disease is increased due to less exposure to infection and increased antibiotic use during immune system development. The data have supported this finding in accordance with hay fever, eczema and atopy, but are inconclusive regarding asthma. This study aims to further research the effects of antibiotic use and immune system challenge early in life on the development of allergic asthma. This was done retrospectively by collecting data from labor and delivery records of mothers who delivered vaginally, pediatric records up until age two, and participant completed questionnaires concerning family medical history and home environment information. A total of 206 women and 277 children, of which 18.4% have asthma, were enrolled in the study. Children who were prescribed antibiotics anytime after birth until two years of age were statistically more often diagnosed with asthma than those who were not given antibiotics (OR 2.884, CI 1....

Prevalence and risk factors of atopic diseases in German children and adolescents

Atopic diseases became an important health problem in affluent Western societies. To study the prevalence and factors associated with the risk of atopic diseases in Germany, data from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) were analysed (n = 17,450). Standardized, computer-assisted personal interviews with parents and parent-administered questionnaires provided physician diagnoses of allergic rhinoconjunctivitis, atopic dermatitis and asthma as well as data on demographic characteristics, migration background, birth order, age at the beginning of nursery, atopic diseases of parents, parents' smoking status, parents' occupation, breastfeeding and living environment. The life-time prevalence of atopic dermatitis was 13.2% (95% confidence limit: 12.5-13.9%), 10.7% (10.1-11.3%) for allergic rhinoconjunctivitis and 4.7% (4.3-5.1%) for asthma. At least one atopic disease in parents was the strongest factor associated with atopic diseases in the offspring, with a prevalence ratio of up to 2.6. High and middle socio-economic status (prevalence ratio, 95% confidence limit: 1.28, 1.12-1.46; 1.15, 1.01-1.32) were associated with the risk of atopic dermatitis, whereas a two-sided background of migration reduced the risk (0.76, 0.65-0.88). Factors that reduced the risk of allergic rhinoconjunctivitis were parents working as self-employed farmers (0.48, 0.30-0.76) and older siblings (0.80, 0.71-0.89), whereas the beginning of nursery school at older age was associated with an increased risk in children who were cared for outside the family before school age (1.05, 1.00-1.10). Living in mould-infested rooms (1.64, 1.23-2.19), an urban living environment (1.20, 1.02-1.42) and a smoking mother and/or father (1.20, 1.02-1.40) were associated with the risk of asthma. Our results are in line with the so-called 'hygiene hypothesis', which emphasizes the role of environmental factors in addition to a genetic predisposition in the development of atopic diseases. Research on factors associated with atopic diseases can facilitate decisions on preventive strategies. Further studies are needed to explore trends in prevalence and risk factors for atopic diseases.

Geburtskohortenstudie zu allergischen Erkrankungen bei Kleinkindern in Nordwestdeutschland

In the late 1990s, a birth cohort study was conducted in the cities of Delmenhorst, Wilhelmshaven and Leer, where more than 3,000 newborn children were recruited in five hospitals. The baseline survey in the clinics was followed by three follow-up surveys 6, 12 and 24 months later. The prime concern of the study was to estimate prevalences and to conduct analyses concerning the association between breastfeeding as well as exposure to pets and the occurrence of allergy symptoms. Children living together with a dog in the same household were at higher risk of disease only if a familial predisposition of allergic diseases was present - without such a familial predisposition a dog in the same household seems to reduce the risk for atopic diseases during the first 2 years of life. A protective effect due to long breastfeeding could be observed in our study in particular in case of a paternal history of allergic diseases, whereas an exclusive maternal history of allergic diseases seems to increase the risk. The concept of the study has proved itself. Contacting mothers in obstetrical departments in hospitals as well as in medical offices of self-employed pediatricians has proven to be very practicable. With comparatively little effort a relatively large cohort was recruited, which allowed us to analyze longitudinal data, adequately taking into account several confounders as well as effect-modifying factors.

Il faut interdire les animaux de compagnie chez l’enfant à risque d’atopie : pour

A better definition of phenotypes would result in better targeting of prevention and treatment objectives. Primary prevention aims to prevent the onset of sensitization in healthy children, especially in those at risk for atopic diseases; secondary prevention aims to prevent the onset of asthma and the acquisition of new sensitizations in previously sensitized children. The concept of the effect of a protective pet remains controversial because the findings have not been duplicated in all studies. Moreover, some studies suggest that exposure to pets promotes allergic disease. Such a protective effect may be influenced by multiple factors, including the type of pet, the timing and intensity of exposure, and genetic factors. Nevertheless, the results of studies on allergen avoidance for primary prevention are insufficient to allow us to reach a definitive conclusion.

Effektmodifikation durch familiäre Prädisposition bei der Analyse des Einflusses von Stillen und Haustierhaltung auf die Entwicklung allergischer Erkrankungen bei Kindern

Introduction: In epidemiological studies an effect modification occurs if a statistical association between an exposure and an outcome differs depending on the levels of a third variable, which is not a deficiency of the study. However, if an effect modification is not accounted for in the statistical analysis of data, this can lead to wrong conclusions and delusive interpretations of the results. Regarding the occurrence of allergic diseases in children, socio-economic status and familial predisposition are often discussed as potential effect modifiers. Methods: Using the data of a birth cohort study we demonstrate the role of familial predisposition as an effect modifier when analyzing the relationship between pet keeping as well as breastfeeding and the occurrence of allergic diseases in two years old children. A few days after delivery 3,132 mothers of German nationality were asked about education, keeping of domestic animals and family history of allergic diseases. Within the first two years of their children's life more than half of these mothers were interviewed for three more times. Important parts of these follow-up interviews were concerned with the mothers' breastfeeding behaviour as well as with symptoms of allergic diseases of the children. Results: Using stratified logistic regression models it could be shown that children living together with a dog in the same household were at higher risk of disease only if a familial predisposition of allergic diseases was present - without such a familial predisposition a dog in the same household seems to reduce the risk for atopic diseases during the first 2 years of life. A protective effect due to long breastfeeding could be observed in our study in particular in case of a paternal history of allergic diseases, whereas an exclusive maternal history of allergic diseases seems to increase the risk. Conclusion: The results of our analyses show that the influence of pet keeping and breastfeeding on the development of allergic diseases in children should only be assessed by simultaneously accounting for different patterns of family history of these diseases.

Preterm Birth Reduces the Incidence of Atopy in Adults

M Siltanen, K Wehlkalampi, P Hovi. J Allergy Clin Immunol. 2011;127(4):935–942 There is evidence that the risk for atopic disease is influenced during fetal development and by early life events. This study evaluated the association between preterm birth, very low birth weight (VLBW), and atopy in young adulthood. Subjects from the Helsinki Study of VLBW Adults were compared to matched controls born at ≥37 weeks' gestation. Of 255 VLBW adults (birth weight: 1120 ± 221 g; weeks of gestation: 29.2 ± 2.2) and 314 controls (birth weight: 3593 ± 471 g; weeks of gestation: 40.1 ± 1.1) invited, 166 (65.1%) and 172 (54.8%), respectively, chose to participate. The mean age …

Childhood immunization and atopic disease into middle-age - a prospective cohort study

The association between childhood immunizations and risk of atopic diseases is unclear. No study has examined possible associations between childhood immunizations and such diseases in middle age. The Tasmanian Longitudinal Health Study (TAHS) is a population based cohort study of respiratory disease. The TAHS participants were followed from 7 to 44 yrs of age. Immunizations during childhood were examined for any association with asthma and atopic disease at age 44 yrs. Multivariable regression models were used to estimate relative risks while adjusting for confounders. Cox regression was used to estimate the association between childhood immunizations and asthma developing after the age of 7 yrs. We found no association between any childhood immunization (Diphtheria, Tetanus, Pertussis, Polio, Smallpox) and asthma (ORs ranged from 0.87 to 1.17 p > 0.05), eczema (ORs ranged from 0.99 to 1.07 p > 0.05), food allergy (ORs ranged from 0.97 to 1.11 p > 0.05), or hay fever (ORs ranged from 1.02 to 1.05 p > 0.05) at age 44. Nor did we find any association between childhood immunizations and an increased risk of incident asthma after the age of 7 yrs (Diphtheria HR = 1.06, 95% CI 0.82, 1.36; Tetanus HR = 1.13, 95% CI 0.88, 1.44; Pertussis HR = 1.03, 95% CI 0.81, 1.30; Polio HR = 1.15, 95% CI 0.86, 1.54; Smallpox HR = 1.21, 95% CI 0.99, 1.48; DTP HR = 1.05, 95% CI 0.85, 1.30). Our analysis does not support any association between common childhood immunizations and risk of asthma and atopic disease in middle-age. Our findings should provide reassurance that in terms of life time risk of asthma and atopic disease, childhood immunization is safe.

Antibiotic Use in the First Year of Life and Risk of Atopic Disease in Early Childhood

Kusel MMH, de Klerk N, Holt PG, Sly PD. Clin Exp Allergy. 2008;38(12):1921–1928 PURPOSE OF THE STUDY. To investigate an association with antibiotic use in the first year of life and subsequent development of atopic disease in the first 5 years of life. STUDY POPULATION. A prospective birth cohort of 198 children considered to be at high atopic risk was recruited prenatally and monitored for 5 years. Risk was based on ≥1 parent with a doctor's diagnosis of asthma, hay fever, or eczema. METHODS. Parents kept a daily …

Correlation between early neonatal diet and atopic symptoms up to 5‐7 years of age in very low birth weight infants: follow‐up of randomized, double‐blind study

The influence of early feeding on the risk of atopic diseases has been studied in full-term newborns, not in very low birth weight infants (VLBW). The study evaluated effect of early feeding of VLBW infants with either cow's milk-based formula (CMF) or extensively hydrolyzed milk formula (HF) on incidence of atopic diseases and markers of atopy at 5-7 years of age. This was a follow-up of the randomized, double-blind study evaluating the influence of different enteral feeding protocols on the early morbidity of VLBW infants. In the original study 80 children were randomly allocated into 2 groups receiving during first month of life HF (experimental group) or CMF (control group). At the age of 5-7 years, 62 children among 74 available (84%) with mean birthweight 1124g were evaluated according to standardized ISAAC (International Study of Asthma and Allergies in Childhood) protocol. Total IgE level, specific IgE, lymphocyte CD4+CCR4+/CD4+CXCR3+ ratio and skin prick tests (SPT) were done. Prevalence of obvious allergic diseases was not significantly different between the studied groups (HF: 12/33; CMF: 6/29; RR [relative risk] HF vs CMF: 1.76; 95%CI [confidence interval]: 0.76-4.09). Comparison of atopic status across groups revealed similar rate of positive markers of atopy: IgE (RR: 2.57 95%CI: 0.91-8,08), SPT (RR: 5.13; 95%CI: 0.93-31.6), lymphocyte CD4+CCR4+/CD4+CXCR3+ ratio (OR: 2.32; 95%CI: 0.78-7.53) in the both studied groups. Based on the carried out follow-up study we were unable to confirm the usefulness of hydrolyzed formula in prevention of allergy in an unselected cohort of very low birth weight infants.

Antibiotic use in the first year of life and risk of atopic disease in early childhood

Reduced post-natal microbial stimulation resulting from improvements in public health measures, smaller family size, and through increased antibiotic use has been postulated to account for the increasing prevalence of atopic diseases seen predominantly in developed countries. To investigate use of antibiotics in the first year of life and subsequent development of atopic disease in early childhood. A prospective birth cohort of 198 children at high atopic risk was recruited prenatally and followed for 5 years. Illnesses and antibiotic use were ascertained through daily diaries, and diagnoses of asthma and hayfever were collected by questionnaire interviews. The children were examined regularly for eczema, and atopic status was defined by skin prick tests and serum total IgE. The effect of antibiotic use on subsequent atopic disease was examined using logistic regression with propensity score adjustment. 54.0% (107/198) of children received at least one course of antibiotics, mainly for acute respiratory illnesses (ARI). Thirty-three percent (329/984) of the ARI involved the lower respiratory tract (LRI). Twenty-three percent (222/984) of ARI were treated with antibiotics, with LRI significantly more likely to receive antibiotics. Antibiotic use was associated with asthma (unadjusted odds ratio 2.3; 95% confidence interval 1.2-4.5; P=0.01) but this association was reduced after propensity score adjustment. No associations were found between antibiotic use and eczema, current wheeze, current asthma, atopic asthma, allergic rhinoconjunctivitis or atopy. Although this was a small study, systematic and careful monitoring of ARI, antibiotic use, and asthma and atopic diseases did not indicate that receipt of antibiotics early in life led to subsequent asthma or atopy at 5 years.

Prospective study of breast-feeding in relation to wheeze, atopy, and bronchial hyperresponsiveness in the Avon Longitudinal Study of Parents and Children (ALSPAC)

Breast-feeding clearly protects against early wheezing, but recent data suggest that it might increase later risk of atopic disease and asthma. We sought to examine the relationship between breast-feeding and later asthma and allergy outcomes by using data from the Avon Longitudinal Study of Parents and Children, a large birth cohort in the United Kingdom. We used adjusted logistic regression models to evaluate the association between breast-feeding and atopy at age 7 years, bronchial responsiveness to methacholine at age 8 years, and wheeze at ages 3 and 7 1/2 years. Bayesian methods were used to assess the possibility of bias caused by an influence of early wheezing on the duration of breast-feeding, as well as selection bias. Breast-feeding was protective for wheeze in the first 3 years of life (odds ratio [OR] of 0.80 [95% CI, 0.70-0.90] for > or = 6 months relative to never) but not wheeze (OR, 0.98; 95% CI, 0.79-1.22), atopy (OR, 1.12; 95% CI, 0.92-1.35), or bronchial hyperresponsiveness (OR, 1.07; 95% CI, 0.82-1.40) at ages 7 to 8 years. Bayesian models adjusting for the longer duration of breast-feeding among children with wheezing in early infancy produced virtually identical results. We did not find consistent evidence for either a deleterious effect or a protective effect of breast-feeding on later risk of allergic disease in a large prospective birth cohort of children with objective outcome measures and extensive data on potential confounders and effect modifiers. Neither reverse causation nor loss to follow-up appears to have materially biased our results.

Consumption of organic foods and risk of atopic disease during the first 2 years of life in the Netherlands

We prospectively investigated whether organic food consumption by infants was associated with developing atopic manifestations in the first 2 years of life. The KOALA Birth Cohort Study in the Netherlands (n 2764) measured organic food consumption, eczema and wheeze in infants until age 2 years using repeated questionnaires. Diet was defined as conventional ( 90 % organic). Venous blood samples taken from 815 infants at 2 years of age were analysed for total and specific IgE. Multivariate logistic regression models were fitted to control for potential confounding factors. Eczema was present in 32 % of infants, recurrent wheeze in 11 % and prolonged wheezing in 5 %. At 2 years of age, 27 % of children were sensitised against at least one allergen. Of all the children, 10 % had consumed a moderately organic diet and 6 % a strictly organic diet. Consumption of organic dairy products was associated with lower eczema risk (OR 0.64 (95 % CI 0.44, 0.93)), but there was no association of organic meat, fruit, vegetables or eggs, or the proportion of organic products within the total diet with the development of eczema, wheeze or atopic sensitisation. Further studies to substantiate these results are warranted.

BCG vaccination and risk of atopic diseases in a twin cohort

BCG vaccination and risk of atopic diseases in a twin cohort

Season of Birth and Risk of Atopic Disease among Children and Adolescents

Background. Season of birth (SOB) has been regarded as a risk factor for atopy. The aim of this study was to explore the relationship between season of birth (SOB) and later development of atopic disease in children and adolescents. Methods. A total of 1,007 randomly selected subjects, 7 to 17 years of age, who were living in urban Copenhagen, Denmark were studied. All participants were interviewed about respiratory symptoms and possible risk factors for atopic disease. Skin test reactivity, serum total immunoglobulin E (IgE), and airway responsiveness were measured using standard techniques. Results. The overall risk of atopy, as judged by skin test reactivity and serum total IgE, was the same regardless of SOB. On the contrary, asthma was more common in subjects born in the autumn compared with subjects born during the remaining part of the year (12.4% vs. 5.6%), OR = 2.40, 95% CI (1.56–3.94), p < 0.001. This was observed both for atopic asthma OR = 2.41, 95% CI (1.25–4.64), p = 0.007, non-atopic asthma, OR = 2.35, 95% CI (1.14–4.83), p = 0.02, and house dust mite (HDM) sensitive airway hyperresponsiveness, OR = 3.00, 95% CI (1.44–6.24), p = 0.002. Rhinitis and pollen allergy were not significantly related to SOB. Conclusions. Atopy itself is independent of season of birth, whereas asthma is more prevalent among subjects born during the autumn. Regarding asthma, these results suggest that the first months of life enclose a period of particular vulnerability towards environmental risk factors, especially exposure to aeroallergens like HDM.

Atopic eczema in children: another harmful sequel of divorce

Different lifestyle factors seem to be associated with the risk for atopic diseases and some studies suggest that stress increases the risk of allergic sensitization, asthma and atopic eczema. Only few studies have investigated the association of early stressful life events and atopic eczema (AE) in children. Parents of participants of the ongoing LISA birth cohort study were asked to give information on life events, such as severe disease or death of a family member, unemployment, or divorce of the parents. Lifetime prevalence of AE and incidence after the assessment period for life events were compared. Prevalence of AE until the age of 4 years was 21.4%. Reported life events within the first 2 years were: severe disease (17.5%) or death (8.4%) of a family member, divorce/separation (3.4%), and unemployment (2.7%). Divorce/separation was associated with a significantly [odds ratio (OR) 3.59, 95% confidence interval (CI) 1.69-7.66] increased and disease with a significantly (OR 0.29, 95% CI 0.13-0.68) decreased incidence of AE for the subsequent 2 years of life. No effect was seen for unemployment. Divorce/separation of the parents and severe disease of a family member influence the risk of developing AE.

Hospital admission with neonatal sepsis and development of atopic disease: Is there a link?

The role of suspected or confirmed neonatal sepsis in modifying the risk of atopic disease during childhood was assessed. Children with early-onset neonatal sepsis were identified from a cohort of neonates, hospitalized between 1990 and 1995. Of 196 individuals, 140 were recruited (71.4%). Pre- and postnatal history was ascertained from neonatal medical records. Based on clinical symptoms and a positive blood culture or at least three of initially defined laboratory or bacteriological criteria, they were stratified in either confirmed neonatal sepsis (CS) or suspected sepsis (SS) group. A control group (C) comprised children who were never hospitalized during infancy (n = 696). Primary end-point was the development of atopic dermatitis, bronchial asthma or allergic rhinitis during childhood (mean age 8.4 yr, range 5.7-12.4). CS and SS children had a higher prevalence of atopic dermatitis (CS 15.7%, SS 21.4%) compared with controls (C 5.2%, p < 0.001). Similarly, children with SS (7.1%), but not with CS (4.3%) had significantly more often a doctor's diagnosis of bronchial asthma compared to controls (1.9%, p = 0.02). No difference in the prevalence of allergic rhinitis was observed (CS 4.3%, SS 10%, C 8.3%). After adjusting for parental history of atopic disease and demographic factors, no significant difference for the risk to develop atopic dermatitis, asthma or allergic rhinitis among the groups was calculated in children with normal birth weight (>2500 g). Our data failed to show a possible link between hospital admission with SS and development of atopic disease.

Probiotics That Modify Disease Risk

Probiotics are defined as live bacterial preparations with clinically documented health effects in humans. Probiotics have specific properties and targets in the human intestinal tract and intestinal microbiota. Each probiotic strain, independent of its genus and species is unique and, thus, the properties and the human health effects of each strain have to be assessed in a case-by-case manner. Understanding the mechanisms by which probiotics influence the normal intestinal microbiota and counteract aberrancies in microbiota would facilitate the use of probiotics for both dietary management and reduction in risk of specific diseases. Development of intestinal microbiota is an important factor affecting the health of the newborn. Recent studies suggest that specific bacterial components, especially the bifidobacteria, have a key impact on development of a healthy balanced infant microbiota. The composition of infant and child intestinal microbiota may become aberrant and thus influence the development of diarrheal, inflammatory, and allergic diseases. Based on this understanding, positive health effects of probiotics have been reported in the management of diarrheal, inflammatory, and allergic diseases in infants. Most recently, a reduction in risk of atopic diseases followed early administration of specific probiotics.

Relationship between early exposure to egg yolk and atopic dermatitis in 18 months old children

Background: Atopic eczema/dermatitis syndrome (AEDS) is the most frequent inflammatory disease of the skin in the childhood. A cause-effect link between food allergy and atopic dermatitis (AD) has been established and sensitization to hen’s egg is considered a strong predictor for AD. Egg yolk is usually introduced into the child’s diet in the first year. The purpose of this study was to assess the influence of early introduction of egg yolk into the diet on AD prevalence in 18 month old children. Methods: 269 infants with birth weight at least 3000 g and with a positive history of parental allergy confirmed by allergy testing were included. They were divided in three groups according their age at the introduction of boiled egg into the child’s diet: group A – children eating egg yolk from 6 month; group B – children eating egg yolk from 9 month; group C – children eating egg yolk from 12 month. Children from all groups were exclusively breast fed for at least 6 month while their mothers were on a diet without eggs. The diagnosis of AD was made according to the criteria of Hanifin and Rajka. At 18 months of age sensitization to egg yolk was evaluated with specific IgE testing and skin-prick test (SPT). Statistical analysis was performed with SPSS 10.0 using the MantelHaenszel chi-square test. Results: In group A 57.1%, group B 31.7% and in group C 21.3% of children developed AEDS (p < 0.0001). Elevated serum total IgE had 58.9% of children from group A, 34.1% from group B and 18.7% from group C (p < 0.0001). Elevated specific IgE antibodies to egg yolk had 25.0% of children from group A, 12.2% from B and 6.7% from C (p = 0.001). Positive SPT with egg yolk had in group A 37.5%, B 23.1% and C 18.7% of children with AD (p = 0.099). Conclusions: We demonstrated a negative influence of early introduction of egg yolk into the diet on AD and AEDS prevalence in a group of newborns at risk for atopic diseases.

Probiotics—Immunomodulatory Potential Against Allergic Disease

ABSTRACT: Interactions between microbes and host have recently prompted active research subsequent to the demonstration that the generation of immunophysiological regulation in the gastrointestinal tract depends on the establishment of indigenous microbiota. The gut microflora provides maturational signals for the gut‐associated lymphoid tissue, particularly for the IgA plasma cells, conferring the first line of host immunological defense. The probiotic effects in allergic disease have been attributed to restoration to normal of increased intestinal permeability and unbalanced gut microecology, improvement of the intestine's immunological barrier functions, alleviation of the intestinal inflammatory response, and reduced generation of proinflammatory cytokines characteristic of local and systemic allergic inflammation. Moreover, the potential of specific strains of the gut microbiota to contribute to the generation of TH1‐ and TH3‐type immune responses counter‐regulating the TH2‐type immune responses in atopic disease may create optimal conditions to redirect the polarized immunological memory of the newborn to a healthy balance and thereby reduce the risk of atopic disease. The objective of probiotic intervention in allergy is to control the allergic inflammatory response before the TH2‐type immune responsiveness to environmental antigens is consolidated.

Developmental factors associated with risk for atopic disease: implications for vaccine strategies in early childhood

There is growing interest in the potential interactions between infant vaccination and risk for development of atopic disease. The aspect of this issue which has dominated this debate concerns suggestions that infant vaccination may stimulate allergic sensitisation. These suggestions derive from retrospective epidemiological analyses and will remain speculative unless they can be confirmed in prospective studies, particularly as conflicting findings have been reported. However, there is a potentially more important issue surfacing in this debate, which entails the converse situation, i.e. that genetic risk for atopy influences capacity to respond to vaccination during infancy. Support for the latter possibility comes from recent studies on the role of developmental factors which determine immune competence during infancy, and attendant risk for inflammatory and infectious diseases. The relevant findings are reviewed briefly below.