Risk Factors for Infantile Recurrent Otitis Media: Atopy but Not Type of Feeding

Abstract

ABSTRACT. We followed 183 infants from birth to 2.3 yr of age. Of these infants 28 had recurrent otitis media (ROM), defined as five or more separate episodes of otitis media (OM) during the first 2 yr of life or four such episodes during their 2nd yr. The O M presented during their 1st yr (early-onset ROM) in 12 infants and during their 2nd yr (2nd yr ROM) in 16. Eighty infants had no O M and served as a comparison group. Regarding type of feeding, the infants with early-onset ROM did not differ from their age-matched pairs in the comparison group either 1 month before the first O M or at the time of first episode of OM. Exclusive breast-feeding did not prevent O M and early weaning was not a risk factor for ROM. Atopy was associated with ROM with a relative risk of 1.9 (95% confidence limits 1.2-3.2). It was particularly prevalent among the infants with early-onset ROM, in 67 versus in 25% in the comparison group ( p < 0.01). During , the 2nd yr daily contact with five or more children was associated with ROM with a relative risk of 2.1 (1.3-3.3). The infants with 2nd-yr ROM were in daily contact with more children than the comparison group (mean 11 versus 5; p < 0.001). Parental smoking was more frequent among the infants with ROM than in the comparison group (54 versus 33%; p < 0.05). In the infants with early-onset ROM plasma concentration of IgM antibodies to cow's milk was highest at the age of 9 months, and the concentration of IgE was highest at the ages of 9 and 12 months. In conclusion atopy, not the type of feeding, is a risk factor for early-onset ROM, and daycare outside the home for ROM during the 2nd yr. (Pediatr Res 23: 509-512,1988) Abbreviations OM, otitis media ROM, recurrent otitis media CM, cow's milk CMA, cow's milk allergy OM may occur in early infancy, but its incidence increases rapidly after the age of 6 months (1, 2). In a Finnish follow-up study 5% of infants had OM during the first 6 months of life, 36% during their 1st yr, and 59% during their 2nd and 3rd yr (3). Several risk factors have been identified: daycare outside the home (4), enlarged adenoids (5), feeding in the horizontal position (6), smoking at home (7), and atopy (8,9), particularly food allergy (9). Some studies suggest a protective effect of breast- feeding (3, 10, I I) but others detect none (2, 13). Any study of the impact of feeding on morbidity is beset with numerous methodologic limitations (14).In this prospective study we followed 198 infants throughout the 1st yr of life, carefully recording their feeding regimen, illnesses, and environment. For 183 of the infants similar data were obtained from the parents regarding the 2nd yr by a detailed questionnaire. From these data we analyzed the risk factors for ROM. MATERIALS AND METHODSWe followed 198 healthy newborns from birth; they were seen at clinic visits at 2, 4, 6, 9, and 12 months of age, and whenever they had any problems regarding feeding, nursing, or illness. At a mean age of 2.3 yr 60 of the infants were examined by one of us (V-M.T.), and a questi...

Th2 cytokine expression in atopic children with otitis media with effusion

“…A study by Lecks et al found that 88 % of OME patients had positive skin scratch tests 30. Using the skin prick technique, Caffarel1i et al found no difference in the prevalence of a1lergen reactivity between OME patients (27 %) and controls (31 %) 26. The relatively high number of OME patients who were found to he positive for atopy in earlier compared to later studies, may he partiy explained by the use of the skin scratch test, which has a high false positive rate compared to the prick test.…”

Risk Factors for Recurrent Acute Otitis Media and Chronic Otitis Media with Effusion in Childhood

“…Mandel et al [83] followed up 148 children, aged 1.0-8.6 years, and showed that the lack of breastfeeding was one of the significant predictors of otitis media with effusion (OME) and AOM incidence. However, there are some studies that have not found a protective effect of breast-feeding in the risk of otitis media [84,85].…”

Fatores de risco para otite média aguda recorrente: onde podemos intervir? - uma revisão sistemática da literatura

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