Food and drug reactions, wheezing, and eczema in preterm infants.

Abstract

Allergic reactions were investigated in 777 preterm infants who were randomly assigned to early diet and followed up to 18 months post term. Wheezing or asthma was common (incidence 23%); it was associated with neonatal ventilation, maternal smoking, and a family history of atopy and was unexpectedly reduced in babies born by caesarean section. Even in non-ventilated infants, the incidence of subsequent wheezing was 18%, rising to an estimated 44% (using logistic regression) when the foregoing risk factors (excluding ventilation) were present. Eczema occurred in 151 infants (19%) and was strongly associated with multiple pregnancy (30% incidence in twins or triplets). Reactions to cows' milk (incidence: 4 4% from detailed history; 0-8% confirmed by challenge), other foods (10%), and drugs (5%) were within the range reported in full term infants. Milk and food reactions were associated with multiple pregnancy (19%) and a family history of atopy. Reactions to drugs were least likely to occur in infants who had been ventilated and were on multiple medications in the neonatal period, suggesting that drug tolerance may have developed. We speculate that preterm infants may be a high rsk group for asthma and eczema, which could imply an association between atopy and prematurity.

Early events in atopy

“…These include: low birth weight (also in children born at term), maternal smoking (as a stimulant of IgE secretion through an IL-4-mediated mechanism), early and severe infection with respiratory syncytial virus (i.e. respiratory syncytial virus bronchiolitis), vaccination against Bordetella pertussis (induces a temporary increase in IgE production), and early contacts with allergens, such as house dust mite [22,26,30,34,40,41]. The latter seems to be extremely important, as it can induce permanent T h2 features leading to allergic reactions which can persist during longer time periods (years).…”

Respiratory illness in families of preterm infants with chronic lung disease.

“…These children had [1][2][3][4][5][6][7][8][9][10][11][12][13][14] 'asthmatic attacks' (median 3) during the past year. Table 2 shows the prevalence of LRI in four subgroups of preterm children: those who developed CLDN with or without prior RDS and those without CLDN with or without RDS.…”

“…The relation between the presence of CLDN and a family history of COPD, asthma, and allergy was evaluated in two respects: (1) From the relation between the presence or absence of CLDN in a study child and the probability of LRI in the corresponding family (as estimated from data on siblings within each family); (2) From the relation between the presence or absence of CLDN in a child and at least one of the parents and/or grandparents with a history of asthma (COPD, allergy).…”

Birthweight and Preterm Birth in Relation to Indicators of Childhood Asthma

“…Both preterm birth and birthweight have been associated with an excess of childhood respiratory morbidity in the form of symptoms (4)(5)(6), reduced lung function (5,(7)(8)(9)(10)(11), airway hyper-responsiveness (12) and diagnosed asthma (5,6,11,13), but the results of studies have not always been consistent. Low birthweight and preterm birth are more common among disadvantaged groups (14), among whom crowding and lower respiratory tract illness are more frequent; also, poor environmental conditions associated with asthma, eg, parental smoking, may be more likely to prevail (15).…”