Transient Suppression of Atopy in Early Childhood Is Associated With High Vaccination Coverage

Abstract

Methods. A German atopy risk-enhanced birth cohort of 1314 neonates who were born in 1990 in 5 German cities was studied. A total of 943 children participated in the follow-up visit at 5 years of age. Atopic symptoms and diagnoses (derived from structured interviews), total serum immunoglobulin E, and specific immunoglobulin E against 9 common allergens (CAP Radio-Allergo-Sorbent Test Fluoro-Enzyme Immunoassay) were evaluated. Children were grouped into dose percentiles according to cumulative doses of any vaccine given up to 5 years of age (<10%, 0 -11 doses; 10%-50%, 12-14 doses; 51%-90%, 15-20 doses; >90%, 21-27 doses).Results. The cumulative vaccine dose was inversely related to atopic dermatitis prevalences at 6 months (13.8%, 5.2%, 5.1%, and 4.5%), 2 years (16.9%, 10.9%, 7.4%, and 3.7%), 3 years (27.6%, 16.4%, 13.5%, and 4.5%), and 5 years (28.3%, 16.0%, 9.3%, and 11.9%). Asthma followed a similar pattern at age 3 (22.4%, 8.6%, 6.7%, and 6.3%), age 4 (20.0%, 8.6%, 8.9%, and 8.1%), and age 5 (20.8%, 12.6%, 10.3%, and 5.5%). Allergic sensitization rates were inversely related to the cumulative vaccine dose at age 2 (37.5%, 29.1%, 23.8%, and 12.9%).Conclusion. Children with a higher vaccination coverage seemed to be transiently better protected against development of atopy in the first years of life. Pediatrics 2003;111:e282-e288. URL: http://www.pediatrics.org/cgi/ content/full/111/3/e282; child, preschool, vaccination, asthma, atopic dermatitis, immunoglobulin E.ABBREVIATIONS. IgE, immunoglobulin E; OR, odds ratio; CI, confidence interval.T here has been much recent debate about the possible promotion of allergy by common childhood vaccinations. A substantial proportion of children predisposed to allergy may not be fully vaccinated because of such apprehension. 1 Promotion of allergy may occur directly, by administering potentially proallergic vaccines, or indirectly, by hindering the Th1-promoting effect of infectious agents against which the child is vaccinated. Pertussis toxin, which is included in all pertussis vaccines, is a classic adjuvant for immunoglobulin E (IgE) formation in animal models 2 and has been linked with a shift toward Th2-like cytokines in humans. 3 Indirect evidence for a role of missing infections that were prevented by immunizations comes from epidemiologic studies showing an association of declining rates of infection with rising prevalences of allergic disease. 4,5 In fact, some recent cross-sectional studies suggest a proallergic effect of early childhood vaccinations. 6,7 Retrospective studies indicate a lower prevalence of atopy among children with a lower vaccination coverage. 6,8,9 Some of these studies are hampered by small sample sizes. This study prospectively investigated the association between childhood vaccinations and atopy and prevalences of atopic disease in children from a large observational birth cohort (MAS-90) up to the age of 5 years. METHODS PatientsAt 6 obstetric departments of 5 German cities (Berlin, Dü sseldorf, Freiburg, Mainz, and Munich), cord-blood I...

Acellular Pertussis Vaccine Protects against Exacerbation of Allergic Asthma Due toBordetella pertussisin a Murine Model

“…A study by Gruber et al (12) revealed no evidence for an allergy-promoting effect of common childhood vaccines in a prospectively monitored atopy risk-enhanced birth cohort. Moreover, children with better vaccination coverage seemed to be better protected against the development of atopy in their second and third years of life.…”

“…Moreover, children with better vaccination coverage seemed to be better protected against the development of atopy in their second and third years of life. In particular, immunizations against measles and mumps, pertussis, and diphtheria and against tetanus were associated with a transient reduction of atopy, whereas immunization against polio and Haemophilus influenzae had no effect (12). A conflicting study of the effects of vaccination on allergies among children in the United States has reported that diphtheria-tetanus-pertussis vaccination appeared to increase the risk of allergies and related respiratory symptoms (21).…”

“…The prevalence of asthma and allergic disease has increased in many countries (5,14), and there has been speculation as to the possible causes (4,46,47), including a possible role of immunization in promoting allergic sensitization (12,55). Asthma is a chronic disease of the respiratory tract and is tightly associated with airway hyperresponsiveness, increased mucus production, and infiltration of the bronchial mucosa by CD4 ϩ T cells (59).…”

“…A number of studies have analyzed the prevalence of allergic sensitization and atopic disease in relation to immunization (12,21). Gruber et al (12) found that children with higher levels of immunization coverage seemed to acquire transient protection against the development of atopy in the first years of life.…”

“…A number of studies have analyzed the prevalence of allergic sensitization and atopic disease in relation to immunization (12,21). Gruber et al (12) found that children with higher levels of immunization coverage seemed to acquire transient protection against the development of atopy in the first years of life. In contrast, Hurwitz and Morgenstern (21) suggested that immunization against diphtheria-pertussis-tetanus appeared to be associated with an increased risk of subsequent asthma or other allergies.…”