The primary prevention of asthma in children study: Design of a multifaceted prevention program

Abstract

The PREVASC study addresses the primary prevention of asthma in infants and small children. The objective of this study is to investigate whether a multifaceted prenatally started intervention strategy in high-risk infants leads to a decrease in the occurrence of (severe) asthma and whether a refinement of the prevention strategy leads to an increase in the adherence to the prevention program. The primary prevention program includes house dust mite impermeable bed coverings, education on breast feeding, hypoallergenic feeding, timing of introduction of solid food and smoking cessation. A total of 888 infants were prenatally included. By the time of inclusion the mothers were 3-7 months pregnant. About 27 infants were excluded from the study and 18 dropped out. Of the remaining 843 infants 535 had a first-degree familial predisposition of asthma (high-risk group), whereas a reference group of 308 (162 boys) infants was not predisposed for asthma in the first-degree (low-risk group). To evaluate the (cost-)effectiveness of the preventive intervention, 222 (118 boys) infants of the high-risk group allocated to the intervention group and 221 (112 boys) allocated to a control group are followed up. The low-risk infants served as controls to evaluate the predictive value of high risk (first-degree familial predisposition of asthma). The infants are followed from the prenatal stage until they reach the age of 6 yr. The remaining 92 high-risk infants were included in an optimized randomized-clinical adherence trial (RCAT). Of these 92 infants, 45 (20 boys) were allocated to an intervention group and 47 (24 boys) to a control group. Until now all infants have been followed for at least 1 yr.

Interleukin 13, CD14, pet and tobacco smoke influence atopy in three Dutch cohorts: the allergenic study

“…In addition, a geneenvironment interaction of CD14 haplotype tagging SNPs with pet exposure was shown to be present with respect to total and FIGURE 2. Association of IL13 39UTR genotypes with logarithmised total serum immunoglobulin (Ig)E levels (mean and 95% confidence intervals) at ages 1, 2, 4 and 8 yrs in a) the pooled data, and b) the Prevention and Incidence of Asthma and Mite Allergy (PIAMA) [15], c) the Prevention of Asthma in Children (PREVASC) [16,17] specific IgE at ages 4 and 8 yrs, but absent at ages 1 and 2 yrs. Highly significant and consistent associations of IL13 and CD14 polymorphisms with IgE levels and sensitisation in childhood were found by pooling data from three birth cohorts.…”

“…The present study includes three prospective Dutch birth cohorts of similar design: Prevention and Incidence of Asthma and Mite Allergy (PIAMA) [15]; Prevention of Asthma in Children (PREVASC) [16,17]; and Child, Parent, Health, Focus on Lifestyle and Predisposition (KOALA) [18]. The three cohorts recruited children during pregnancy.…”

“…n FIGURE 1. Interaction of CD14 -550C/T genotypes in the presence (+) and absence (-) of dog exposure at home in the first year of life on total serum immunoglobulin (Ig)E levels (mean and 95% confidence intervals) at age 4 and 8 yrs in: a) pooled data; b) the Prevention and Incidence of Asthma and Mite Allergy (PIAMA) study [15]; and c) the Prevention of Asthma in Children (PREVASC) [16,17] studies. IgE measurements were not available at age 4 yrs in the Child, Parent, Health, Focus on Lifestyle and Predisposition (KOALA) study [18] …”

Prevention of allergic sensitization by environmental control

“…The Prevention of Asthma in Children Study is based in the Netherlands and recruited women during pregnancy from 1997 to 2002 [22]. The study is made up of an observational cohort with a nested intervention study of 476 high-risk infants (with a fi rst-degree relative with asthma).…”

Interaction of T-cell and antigen presenting cell co-stimulatory genes in childhood IgE

“…PIAMA (Prevention and Incidence Asthma and Mite Allergy) [10], PREVASC (Prevention of Asthma in Children) [11,12] and KOALA (Child, parents and health: lifestyle and genetic constitution) [13]. Genetic studies were approved by local medical ethics committees of participating institutes.…”