Early childhood infections and immunisation and the development of allergic disease in particular asthma in a high-risk cohort: A prospective study of allergy-prone children from birth to six years

Abstract

The role of early childhood infections and immunisation in the development of allergic diseases remains controversial. To examine these associations, six hundred and twenty infants with first-degree relatives with allergic diseases were recruited into the Melbourne Atopy Cohort Study. Information on risk factors and outcomes was collected by interviewer administered questionnaire and was based on parental report and/or a physician's diagnosis. Risk factors examined included early childhood infections (including gastroenteritis, otitis media and lower respiratory tract infections) and immunisations in the first 2 yr of life. Outcomes were current asthma, allergic rhinitis and eczema at 6 yr of age. Univariate and multivariate regression analysis were used to estimate relative risk (RR) and assess confounding. By 6 yr, 79% of the original cohort remained in the study. Those with at least three episodes of gastroenteritis showed an increased risk (crude RR 2.36, 95%CI 1.41 3.95; adjusted RR 2.03 95%CI 1.50 2.75) for the later development of asthma at age 6. Of the scheduled immunisations, Sabin immunisation in the second year had a reduced risk of asthma at 6 yr (crude RR 0.60, 95%CI 0.37 0.98; adjusted RR 0.63 95%CI 0.39 1.02). Combined diphtheria and tetanus (CDT) immunisation in the first year had an increased risk of asthma at 6 yr (RR 1.76, 95%CI 1.11 2.78; adjusted RR 1.88 95%CI 1.28 2.77). Recurrent gastroenteritis in early childhood is associated with a later risk of asthma. This may reflect a cause and effect relationship, or exposure to common risk factors. In contrast, Sabin immunisation in the second year is associated with a decreased risk of asthma in later childhood. CDT immunisation in the first year may be a risk factor for asthma, but the need for CDT immunisation may also be a marker of increased risk of asthma in later childhood.

Lower anti‐echovirus antibody responses in children presenting to hospital with asthma exacerbations

“…Cullinan et al [8] reported that the medical records of young adults with asthma showed a history biased to more gastrointestinal and less upper respiratory tract infection. Similarly a study of 6-year-old children found that children reported to have frequent recurrent gastrointestinal infection in the first 2 years of life had twice the risk of developing asthma [7]. Most of the infection at that age would be with rotavirus, an agent that can repeatedly infect children, being very prevalent in the study area.…”

Rhinitis in children less than 6 years of age: current knowledge and challenges

“…Otitis media with effusion is often a co-morbidity of AR and NAR and should be evaluated in all young children with rhinitis. Recent onset otitis media with effusion in children [44] or occurring in the first 2 years of life [45] is associated with rhinitis at 6 years of age.…”

Vaccination and allergy: EAACI position paper, practical aspects

“…32 Lower rates of allergic symptoms and allergic sensitization have been found among children with measles, but no association was found between measles vaccination and allergic symptoms. 33 DT immunization was associated with asthma in one study, 34 …”