This study does not find evidence supporting a delayed introduction of solids beyond the sixth month of life for the prevention of AD and atopic sensitization. We cannot rule out that delaying the introduction of solids for the first 4 months of life might offer some protection. Measures to avoid reverse causality have to be considered in the conduction, analysis, and interpretation of cohort studies on the topic.

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on behalf of the LISA study group Allergens and endotoxin on mothers9 mattresses and total immunoglobulin E in cord blood of neonates. J. Heinrich, G. Bolte, B.Hölscher, J. Douwes, I. Lehmann, B. Fahlbusch, W. Bischof, M. Weiss, M. Borte, H-E. Wichmann, on behalf of the LISA study group. #ERS Journals Ltd 2002. ABSTRACT: The current authors examined whether mite and cat allergen and bacterial endotoxin levels in dust of the mothers9 mattresses were associated with cord blood immunoglobulin (Ig)E (CB-IgE) levels in newborns.Data from 1,332 term and normal weight neonates, from an ongoing birth cohort study, Influences of life-style related factors on the immune system and the development of allergies in childhood (LISA), with complete information on exposure to biocontaminants in mattress dust and CB-IgE were analysed. (4th quartile) were chosen as cut-offs. Nonparametric smoothing (generalised additive models) showed statistically significant confounder-adjusted associations between elevated CB-IgE levels (o0.45 kU?L -1 ) and log-transformed exposures to cat (linear), mite (inverse u-shaped), and endotoxin (u-shaped).After adjustment for covariables, elevated CB-IgE levels (logistic regression using the 1st-4th quartiles of exposure) were positively associated with high cat-allergen exposure and medium exposure to mite allergen, but were inversely associated with exposure to endotoxin. The associations were similar, but somewhat weaker, when 0.35 kU?L -1 was used as cut-off. These results, showing an association between prenatal allergen and endotoxin exposures and immunoglobulin E production, suggest that the development of foetal immune responses may be affected.

It has been hypothesized that cesarean delivery might have an impact on the development of atopic diseases because of its gut flora modulating properties. In the present study, we analysed the association between cesarean delivery and atopic diseases using data of 2500 infants enrolled in the LISA-Study, a German prospective multicenter birth cohort study. Data on symptoms and physician-diagnosed atopic diseases were gathered by questionnaires shortly after birth and at infant's age 6, 12, 18, and 24 months. In addition, sensitization to common food and inhalant allergens was assessed by measuring specific immunoglobulin E (IgE) using the CAP-RAST FEIA method at the age of 2 yr. Confounder-adjusted odds ratios (aOR) with 95% confidence intervals (CI) were calculated by multiple logistic regression. We found a positive association between cesarean delivery and occurrence of at least one episode of wheezing [aOR 1.31 (95% CI 1.02-1.68)] and of recurrent wheezing [1.41 (1.02-1.96)] during the first 2 yr of life. Furthermore, effect estimates for allergic sensitization defined as at least one specific IgE >/=0.70 kU/l against any allergen [1.48 (0.98-2.24)], against food allergens [1.64 (1.03-2.63)], and against inhalant allergens [1.75 (0.98-3.12)] were increased. Symptoms of atopic dermatitis [1.21 (0.92-1.59)], physician-diagnosed atopic dermatitis [1.04 (0.79-1.39)], and symptoms of allergic rhinoconjunctivitis [1.40 (0.80-2.44)] were only marginally increased in children delivered by cesarean section. In conclusion, our results suggest that cesarean delivery may be an additional risk factor for wheezing and allergic sensitization at least to food allergens up to the age of 2 yr. This should be considered when cesarean section is done for other than medical reasons.

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