A prospective birth cohort study of different risk factors for development of allergic diseases in offspring of non-atopic parents

Abstract

Background: Allergic diseases are thought to be inherited. Prevalence of allergic diseases has, however, increased dramatically in last decades, suggesting environmental causes for the development of allergic diseases.Objective: We studied risk factors associated with the development of atopic dermatitis (AD), allergic rhinitis (AR) and asthma (AS) in children of non-atopic parents in a subtropical country.Methods: In a birth cohort of 1,497 newborns, parents were prenatally enrolled and validated for allergic diseases by questionnaire, physician-verified and total or specific Immunoglobulin E (IgE) levels; 1,236 and 756 children, respectively, completed their 3-year and 6-year follow-up. Clinical examination, questionnaire, and blood samples for total and specific IgE of the children were collected at each follow-up visit.Results: Prevalence of AD, AR and AS was, respectively, 8.2%, 30.8% and 12.4% in children of non-atopic parents. Prevalence of AR (p<.001) and AS (p=.018) was significantly higher in children of parents who were both atopic. A combination of Cesarean section (C/S) and breastfeeding for more than 1 month showed the highest risk for AD (OR=3.111, p=.006). Infants living in homes with curtains and no air filters had the highest risk for AR (OR=2.647, p<.001), and male infants of non-atopic parents living in homes without air filters had the highest risk for AS (OR=1.930, p=.039).Conclusions: Breastfeeding and C/S affect development of AD. Gender, use of curtains and/or air filters affect AR and AS, suggesting that control of the perinatal environment is necessary for the prevention of atopic diseases in children of non-atopic parents.

Prevalence of infant sneezing without colds and prediction of childhood allergy diseases in a prospective cohort study

“…The prevalence of children with allergic rhinitis (AR) at 6 years of age while defined by symptoms of easy sneezing and/or itching eyes for longer than 2 weeks in the past six months and had been diagnosed with AR by a physician was 55.6, 67.5 and 76.0%, respectively, in infants with no sneezing, occasional sneezing and frequent sneezing at 18 months of age. The prevalence is higher than those (30.8-50.7%) defined by physician-diagnosed rhinitis with detection of specific aeroallergen IgE in our previous study [ 12 ]. We did not use the latter definition in this study because we measured specific IgE only in 2 common aeroallergens (house dust mite and cockroach).…”

“…Atopic disease in a mother increases the risk of atopic eczema in her child but is a poor predictor of atopic eczema [ 8 ]. Breastfeeding, Cesarean section, use of curtains and/or air filters affect development of atopic dermatitis (AD), allergic rhinitis (AR) and asthma (AS) in offspring of non-atopic parents [ 12 ]. These results suggest that perinatal factors in addition to parental inheritance have an impact on the development of childhood allergic diseases and that it is important to identify an early infant predictor to facilitate the prediction and prevention of childhood allergy diseases.…”

Epidemiology of allergic rhinitis and associated risk factors in Asia

“… Significant parameter ➢ Fungi Norbäck et al , 2016 (1) [ 41 ] Malaysia, Johor Bahru 462 students from 8 random schools Cross-sectional questionnaire based study, building inspections 18.8% for students from junior high schools N.A. Significant parameters ➢ Atopy ➢ Family history of allergic disease ➢ Fungi ➢ House dust mite ➢ Race Insignificant parameters ➢ Gender ➢ Smoking Norbäck et al , 2016 (2) [ 35 ] China, Shanghai 13,335 children, aged 4-6 years Cross-sectional questionnaire based study 12.6% Answer yes for “Has your child ever had a problem with sneezing, or a runny, or blocked nose when he/she did not have a cold or the flu in the past years” Significant parameters ➢ Breastfeeding ➢ Gruel introduction Huang et al , 2017 [ 34 ] Taiwan 1497 newborns Birth cohort follow-up, questionnaire survey, physician-verified and serological testing Non-atopic parents & one atopic parent & atopic parents : 30.8% vs 39.9% vs 54.7% Doctor diagnosis Significant parameters ➢ Age of gestation ➢ Gender ➢ Residency Lee et al , 2017 [ 42 ] Kuwait 1154 students, aged 18-26 years attending Kuwait University Cross-sectional questionnaire based study 20.4% (95% Cl- 18.1-22.9) Current rhinitis: “ever doctor-diagnosed rhinitis” plus “having problems with sneezing, runny, or blocked nose in the absence of cold or flu in the last 12 months” Significant parameters ➢ Age ➢ Family history of allergic diseases ➢ Pet Insignificant parameters ➢ Birth order ➢ Gender ➢ Mode of delivery ➢ Smoking Ziyab, 2017 [ 8 ] …”

Human Milk and Allergic Diseases: An Unsolved Puzzle

“…At the beginning of the last century, Grulee and Sanford suspected a link between HM substitute feeding and a higher incidence of eczema [ 35 ]. Since then many prospective and retrospective observational studies have tested breastfeeding associations with the onset of allergic disease, providing mixed results for eczema [ 19 , 20 , 21 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 ] sensitisation [ 21 , 37 , 42 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 ] and asthma [ 19 , 20 , 21 , 36 , 42 , 47 , 48 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 ]. Messages culminating from these studies range from a protective...…”