Background
Infant predictors of early childhood allergic rhinitis (AR) are poorly understood.
Objective
Identify environmental exposures and host factors during infancy that predicts AR at age three.
Methods
High risk children from Greater Cincinnati were followed annually from ages one to three. Allergic rhinitis (AR) was defined as sneezing, runny or blocked nose in the prior 12 months and positive skin prick test (SPT) to one or more aeroallergens. Environmental and standardized medical questionnaires determined exposures and clinical outcomes. Primary activity area dust samples were analyzed for house dust endotoxin (HDE) and (1-3)-β-D-glucan. Fine particulate matter (PM2.5) sampled at 27 monitoring stations was used to estimate personal elemental carbon attributable to traffic (ECAT) exposure by land use regression model.
Results
Of 361 children in this analysis, 116 had AR and 245 were non-atopic, non-symptomatic. Prolonged breastfeeding in African-American children (aOR 0.8; 95% CI 0.6–0.9) and multiple children in the home during infancy was protective of AR (aOR 0.4; 95% CI 0.2–0.8). Food SPT positivity and tree SPT positivity in infancy increased the risk of AR at age three (aOR 4.4; 95% CI 2.1–9.2) and (aOR 6.8; 95% CI 2.5–18.7), respectively. HDE exposure was associated with AR; the effect was dependent on exposure level. ECAT and ETS exposure showed no effect on AR.
Conclusion
Prolonged breastfeeding in African-Americans and multiple children in the home during infancy reduced the risk of AR at age three. SPT positivity to food and tree allergens enhanced risk. The HDE effect on AR was related to exposure.
Penicillin skin testing is feasible in the ED setting. A substantial number of patients who self-report a penicillin allergy do not exhibit immunoglobulin E-mediated sensitization to penicillin major and minor determinants. Penicillin testing in the ED may allow the use of more appropriate antibiotics for patients presenting with a history of penicillin allergy.
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