Prenatal origins of allergic disease

Exposure of pregnant mice to an air pollutant aerosol increases asthma susceptibility in offspring

Air pollution contributes to both exacerbation and development of bronchial asthma. Studies showed that coexposure to air pollution directly promotes sensitization to inhaled allergen in neonatal mice. The aim of this study was to investigate whether prenatal exposure to air pollution could also increase susceptibility to development of asthma in early life. Pregnant female BALB/c mice were exposed to aerosolized leachate of residual oil fly ash (ROFA, 50 mg/ml, 30 min) at 5, 3, and 1 d before delivery. Offspring were treated once at 3 d of age with ovalbumin (OVA, 5 mug) and alum (ip), an intentionally suboptimal dose for sensitization, exposed to aerosolized OVA (1%, 10 min) at 12-14 d or 32-35 d of age, and evaluated 2 d after the final exposure. The offspring of ROFA-exposed mothers (ROFA group) revealed increasing airway hyperresponsiveness (higher enhanced pause [Penh] to methacholine challenge) and elevated substantial numbers of eosinophils in the bronchoalveolar lavage flued (BALF). Histopathology revealed prominent inflammation in the lungs of ROFA group and showed increased allergen-specific IgE and IgG1 levels. Their cultured splenocytes showed an enhanced interleukin (IL)-4/interferon (IFN)-gamma cytokine, indicating Th2 skewed immunity. Data indicate that exposure of pregnant female mice to an air pollutant aerosol increased asthma susceptibility in their offspring.

Analysis of the Relationship between Pollinosis and Date of Birth in Switzerland

BACKGROUND

The first months of life may represent a vulnerable period in the development of atopic diseases. The objective of this study was to examine the relationship between the month of birth and the development of birch and grass pollen allergy in the Swiss population.

METHODS

Data from the Swiss Study on Air Pollution and Lung Diseases in Adults(SAPALDIA) as well as the Swiss Study on Childhood Allergy and Respiratory Symptoms with Respect to Air Pollution and Climate (SCARPOL) were used. A logistic regression was calculated with grass and birch pollen sensitisation (positive skin prick test) or allergy (positive skin prick test and allergic symptoms) as outcome variables and the season of birth as predictor variable. The contribution of the season of birth on pollinosis was further adjusted for well-known risk factors and potential confounding variables.

RESULTS

The logistic regression revealed a significant effect of the season of birth on birch pollen sensitisation and an effect of borderline significance on birch pollen allergy, i.e. subjects born in the pollen season (March to April) showed an increased risk of being sensitised/allergic to birch pollen. The results also indicated a tendency towards an increased risk for subjects born in the grass pollen season (May to June) to develop grass pollen allergy.

CONCLUSION

Our results support the hypothesis that the first few months of life constitute a sensitive period, during which inhalative exposure to certain allergens may predispose to the subsequent development of atopic respiratory disease.

Maternal intake of vitamin D during pregnancy and risk of recurrent wheeze in children at 3 y of age

BACKGROUND

Vitamin D deficiency and asthma are common at higher latitudes. Although vitamin D has important immunologic effects, its relation with asthma is unknown.

OBJECTIVE

We hypothesized that a higher maternal intake of vitamin D during pregnancy is associated with a lower risk of recurrent wheeze in children at 3 y of age.

DESIGN

The participants were 1194 mother-child pairs in Project Viva-a prospective prebirth cohort study in Massachusetts. We assessed the maternal intake of vitamin D during pregnancy from a validated food-frequency questionnaire. The primary outcome was recurrent wheeze, ie, a positive asthma predictive index (>or=2 wheezing attacks among children with a personal diagnosis of eczema or a parental history of asthma).

RESULTS

The mean (+/-SD) total vitamin D intake during pregnancy was 548 +/- 167 IU/d. By age 3 y, 186 children (16%) had recurrent wheeze. Compared with mothers in the lowest quartile of daily intake (median: 356 IU), those in the highest quartile (724 IU) had a lower risk of having a child with recurrent wheeze [odds ratio (OR): 0.39; 95% CI: 0.25, 0.62; P for trend < 0.001]. A 100-IU increase in vitamin D intake was associated with lower risk (OR: 0.81; 95% CI: 0.74, 0.89), regardless of whether vitamin D was from the diet (OR: 0.81; 95% CI: 0.69, 0.96) or supplements (OR: 0.82; 95% CI: 0.73, 0.92). Adjustment for 12 potential confounders, including maternal intake of other dietary factors, did not change the results.

CONCLUSION

In the northeastern United States, a higher maternal intake of vitamin D during pregnancy may decrease the risk of recurrent wheeze in early childhood.

Clinical sepsis in neonates is responsible for the lower prevalence of developing allergy

BACKGROUND

The hygiene hypothesis proposes an association between the change in exposure to microbes and the increased incidence of atopic disease. The purpose of the present study was to perform a prospective epidemiological study of the effect of perinatal infection on the development of allergy.

METHODS

Eight hundred and ten children were born at Umeda Gynecological Hospital in Yamaguchi prefecture in Japan between April 1997 and March 1998. A questionnaire survey on the development of allergic diseases was sent by mail in 2002. The presence or absence of neonatal infectious disease (clinical sepsis) and maternal complications during the gestational period and delivery, and the incidence of bacterial infection during the perinatal period, were investigated by examining hospital records.

RESULTS

Data were obtained for 410 children (51%). One hundred and forty-eight children (36.1%) developed allergic diseases. Among children whose mothers had allergies, the percentage of children who developed allergic disease(s) was significantly lower in children who had had clinical sepsis in the neonatal period than in those without clinical sepsis (26.1% vs 49.7%, P < 0.03).

CONCLUSIONS

Clinical sepsis in neonates might reduce the risk of developing allergic diseases in early childhood in children whose mothers have allergies.

Maternal diet during pregnancy in relation to eczema and allergic sensitization in the offspring at 2 y of age

BACKGROUND

Maternal diet during pregnancy might be one of the factors that influences fetal immune responses associated with childhood allergy.

OBJECTIVE

We analyzed the association between maternal diet during the last 4 wk of pregnancy and allergic sensitization and eczema in the offspring at 2 y of age.

DESIGN

Data from 2641 children at 2 y of age were analyzed within a German prospective birth cohort study (LISA). Maternal diet during the last 4 wk of pregnancy was assessed with a semiquantitative food-frequency questionnaire, which was administered shortly after childbirth.

RESULTS

High maternal intake of margarine [adjusted odds ratio (aOR): 1. 49; 95% CI: 1.08, 2.04] and vegetable oils (aOR: 1.48; 95% CI: 1.14, 1.91) during the last 4 wk of pregnancy was positively associated and high maternal fish intake (aOR: 0.75; 95% CI: 0.57, 0.98) was inversely associated with eczema during the first 2 y in the offspring. High celery (aOR: 1.85; 95% CI: 1.18, 2.89) and citrus fruit (aOR: 1.73; 95% CI: 1.18, 2.53) intakes increased the risk of sensitization against food allergens. In turn, sensitization against inhalant allergens was positively related to a high maternal intake of deep-frying vegetable fat (aOR: 1.61; 95% CI: 1.02, 2.54), raw sweet pepper (aOR: 2.16; 95% CI: 1.20, 3.90), and citrus fruit (aOR: 1.72; 95% CI: 1.02, 2.92).

CONCLUSIONS

We suggest that the intake of allergenic foods and foods rich in n-6 polyunsaturated fatty acids during pregnancy may increase and foods rich in n-3 polyunsaturated fatty acids may decrease the risk of allergic diseases in the offspring.

Maternal antioxidant intake in pregnancy and wheezing illnesses in children at 2 y of age

BACKGROUND

Low intakes of dietary antioxidants may contribute to increases in asthma and allergy.

OBJECTIVE

We investigated the association of maternal total intakes (foods + supplements) of 10 antioxidant nutrients during pregnancy with wheezing and eczema in 2-y-old children.

DESIGN

Subjects were 1290 mother-child pairs in an ongoing cohort study. Maternal dietary and supplement intakes were assessed by using a validated food-frequency questionnaire administered in the first and second trimesters. Antioxidant nutrient intakes were calculated, and the mean for each nutrient was considered to be the exposure during pregnancy. The outcomes of interest were any wheezing by the child during either the first or second year of life, recurrent wheezing in both years, and eczema in either the first or second year.

RESULTS

No association was observed between maternal total intake of any antioxidant nutrient and eczema. In multivariate logistic regression models, the highest quartile compared with the lowest quartile of maternal total intakes of vitamin E [odds ratio (OR): 0.70; 95% CI: 0.48, 1.03] and zinc (OR: 0.59; 95% CI: 0.41, 0.88) was inversely associated with any wheezing at 2 y of age (P for trend = 0.06 and 0.01 over quartiles of intake for vitamin E and zinc, respectively). Similar results were obtained for recurrent wheezing at 2 y of age with vitamin E (OR: 0.49; 95% CI: 0.27, 0.90) and zinc (OR: 0.49; 95% CI: 0.27, 0.87) (P for trend = 0.05 and 0.06 over quartiles of intake for vitamin E and zinc, respectively).

CONCLUSION

Our results suggest that higher maternal total intakes of antioxidants during pregnancy may decrease the risks for wheezing illnesses in early childhood.

Low maternal vitamin E intake during pregnancy is associated with asthma in 5-year-old children

RATIONALE

We have previously reported an association between reduced maternal vitamin E intake during pregnancy and wheezing in 2-yr-old children.

OBJECTIVES

To assess whether maternal nutrient intake during pregnancy is associated with asthma-related outcomes in children aged 5 yr.

METHODS

A longitudinal cohort study of 1,861 children born to women recruited during pregnancy and followed up at 5 yr.

MEASUREMENTS

Maternal nutrient status was assessed by a food frequency questionnaire and plasma levels. Respiratory and food frequency questionnaires were completed at 5 yr and children were invited for measurement of spirometry and skin-prick testing.

MAIN RESULTS

Symptom and food frequency questionnaire data were available for 1,253 and 1,120 children, respectively; 700 children were skin prick tested, and FEV(1) was measured in 478 and exhaled nitric oxide in 167 children. In 5-yr-old children, maternal vitamin E intake during pregnancy was negatively associated with wheeze in previous year (odds ratio per intake quintile, 0.82; 95% confidence interval, 0.71-0.95), asthma ever (0.84, 0.72-0.98), asthma and wheeze in previous year (0.79, 0.65-0.95), and persistent wheezing (0.77, 0.63-0.93). Maternal plasma alpha-tocopherol during pregnancy was positively associated with post-bronchodilator FEV(1) at 5 yr, with a 7-ml (95% confidence interval, 0-14; p = 0.04) increase in FEV(1) per microg/ml alpha-tocopherol. Maternal zinc intake during pregnancy was negatively associated with asthma ever (0.83, 0.71-0.78) and active asthma (0.72, 0.59-0.89). There were no associations between children's nutrient intake and respiratory outcomes.

CONCLUSION

Maternal intake of foods containing vitamin E and zinc during pregnancy is associated with differences in the risks of developing childhood wheeze and asthma.

Wheezing, asthma, hay fever, and atopic eczema in relation to maternal occupations in pregnancy

OBJECTIVES

To examine whether prenatal occupational exposures, especially to organic solvents, are associated with atopic diseases in childhood.

METHODS

The study comprised children born in Odense or Aalborg, Denmark between 1984 and 1987. Occupational job titles were derived from questionnaires filled out by the mothers when attending midwife centres. Assessment of organic solvent exposures was based on job titles selected by occupational specialists. A follow up questionnaire to the parents provided data on medical diagnoses as well as wheezing symptoms for 7844 children aged 14-18. Multivariate logistic regression analyses were performed to estimate the cumulative risk for wheezing (early wheezing not diagnosed as asthma), asthma, hay fever, and atopic eczema during childhood by means of odds ratios (OR) and 95% confidence intervals (CI).

RESULTS

Explorative analyses by maternal job titles in pregnancy showed elevated odds ratios concerning different atopic diseases for occupational groups such as "bakers, pastry cooks, and confectionary makers", "dental assistants", "electrical and electronic assemblers", "sewers and embroiders", and "bookbinders and related workers". An excess risk ratio for hay fever (OR 2.8, CI 1.1 to 7.5) was found following maternal gestational exposure to organic solvents. Furthermore, a slightly raised odds ratio for asthma was observed in children of shift workers (OR 1.2, CI 1.0 to 1.5).

CONCLUSION

The data suggest links between certain maternal occupations during pregnancy and atopic diseases, which merits further scrutiny. However, no consistent pattern was seen across the different atopic diseases.

Association between indoor renovation activities and eczema in early childhood

BACKGROUND

Other factors besides a genetic disposition seem to play a role in the development of allergic disorders. Exposure to risk factors such as indoor air pollution is becoming increasingly interesting, especially during early childhood.

METHODS

Within an epidemiological study (LISS: Leipzig infection, allergy and airway diseases study among school starters, involving 2536 children, birth cohort 1991/92, carried out in 1997/98) the effect of indoor exposure on physician-confirmed eczema and allergic symptoms has been investigated. The exposure situation has been characterized on hand of the redecoration activities (painting, floor covering and new furniture) before birth and in the first years of life.

RESULTS

Highly exposed children showed a significant effect on allergic disorders. The lifetime prevalences without any vs. all three redecoration activities were for allergic symptoms 9.3% vs. 17.2% and for eczema 11.5% vs. 20.4%. Adjusted for confounders, the redecoration associated burden led to odds ratios of 1.8 (95% CI: 1.3-2.6) for allergic symptoms and 1.9 (95% CI: 1.4-2.7) for eczema.

CONCLUSION

Exposure emissions due to redecoration activities seem to be associated with the risk of eczema and allergic symptoms. Thus, prevention of allergic disorders should include the avoidance of such activities around birth and in the first year of life.

A comparison of virus-associated and multi-trigger wheeze in school children

To examine differences between virus-associated wheeze and wheeze associated with other triggers (multi-trigger wheeze) in elementary school children, we performed a cross-sectional school-based questionnaire study of 5,998 children mainly 7 to 12 years of age, with outliers 6 and 13 years of age. Using parent-completed questionnaires, we identified 522 children who wheezed only during upper respiratory tract infections (virus-associated wheeze), 1,186 children who wheezed on other occasions (multi-trigger wheeze), and 4,290 children with no wheeze. In comparison with children who had multi-trigger wheeze, children with virus-associated wheeze were more likely to be male, to be younger, and to have less frequent wheezy episodes. They were less likely to have night cough, shortness of breath or chest tightness, to have a personal or parental history of atopic disorders, to have a diagnosis of asthma, or to be receiving asthma treatment. Both types of wheeze were associated with social deprivation, a relationship that persisted after controlling for family smoking. Virus-associated wheeze is a common but diminishing problem in this age group, and the differences between virus-associated wheeze and multi-trigger wheeze already noted in pre-school children persist in this older age group.

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

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.

Exclusive breastfeeding and risk of atopic dermatitis in some 8300 infants

Earlier studies on breastfeeding and atopy in infants have yielded contradictory results. We examined the relationship between exclusive breastfeeding and atopic dermatitis (AD) in a cohort of infants born between 1 October 1997 and 1 October 1999 in south-east Sweden. We evaluated the risk of AD 'at least once' or 'at least three times' during the first year of life in relation to duration of exclusive breastfeeding: <4 months (short exclusive breastfeeding; SEBF) vs. > or = 4 months. All data were obtained through questionnaires. Of 8346 infants with breastfeeding data, 1943 (23.3%) had suffered from AD during the first year of life. Duration of exclusive breastfeeding was not associated with lower risk of AD (p = 0.868). SEBF did not influence the risk of any AD (OR = 1.03; 95% CI OR = 0.91-1.17; p = 0.614) or AD at least three times (OR = 0.97; 95% CI OR = 0.81-1.16; p = 0.755) during the first year of life. Adjustment for confounders did not change these point estimates. Neither was there any link between SEBF and risk of AD among infants with a family history of atopy [adjusted odds ratio (AOR) = 1.16; 95% CI AOR = 0.90-1.48; p = 0.254]. Furred pets at home were linked to a lower risk of AD both among infants with a family history of atopy (AOR = 0.76; 95% CI AOR = 0.60-0.96; p = 0.021) and among infants with no such history (AOR = 0.79; 95% CI AOR = 0.69-0.90; p < 0.001). Infants with no family history of atopy were less prone to develop AD if parents smoked (AOR = 0.76; 95% CI AOR = 0.61-0.95; p = 0.016). This study indicates that exclusive breastfeeding does not influence the risk of AD during the first year of life, while presence of furred pets at home seems to be negatively associated with AD.

[Interleukin levels in umbilical cord blood: relationship with a family history of allergic disease]

BACKGROUND

The development of allergic pathology takes place as result of an alteration of the immunity and alteration of the corporal mechanism of protection, giving rise to an erroneous answer or exaggerated forehead to innocuous antigens, that it generates clinical symptoms with cutaneous, digestive or respiratory manifestations. The frequency and distribution of this process have undergone an increase from the 1970, which causes that a greater interest in the knowledge of the mechanisms exists that produce this clinic. The answer by immunoglobulin E is regulated by the answer of lymphocytes T-helper-1 represented by interleukin 2 and gamma-interferon that inhibits their production, and the answer of lymphocytes T-helper-2 formed by interleukin 4, interleukin 10 and interleukin 13 that stimulate the production of immunoglobulin E.

METHODS AND RESULTS

A study of cases and controls with a sample of 70 appears new born considering antecedent relatives of first degree of allergic disease (47 no, 23 yes). Values in umbilical cord blood were moderate of interleukins 4, 10, 13 and gamma-interferon (kit CLB, and method ELISA). Values for interleukin 4 and interleukin 13 have not been obtained. One has been greater values of interleukin 10 in children of mother or brother affection (mother affects IL 10 = 48.7 pg/ml, in front of mother does not affect IL 10 = 31.62 pg/ml, p = 0.081, no signification), (brother affection IL 10 = 72.8 pg/ml, in front of brother no affection IL 10 = 32.31 pg/ml, p = 0.0062, is significant). Difference for gamma-interferon was not obtained.

CONCLUSIONS

As it has already been shown in other studies, interleukin 10 increases in cord blood in children whose mother is the one who presents the disease. It emphasizes the increase of interleukin 10 in blood of umbilical cord of children with brother affection of allergic disease. Still it is left much to do and by means of later pursuit it is hoped to obtain interest results.

Prenatal factors associated with the development of eczema in the first year of life

Prenatal factors have been implicated in childhood eczema, but the relationship between maternal cytokine production during pregnancy and infant eczema is unknown. Non-selected women in their third trimester were enrolled in the Tucson Infant Immune Study. Data from three sources were used to define MD-eczema: parent-completed illness questionnaires at age 2, 3, 4, 6 and 9 months regarding physician-seen eczema, parent-completed questionnaires at 12 months regarding physician-diagnosed eczema, and medical record reviews. Blood samples were taken from mothers during their third trimester and from the umbilical cord at birth. Maternal peripheral blood mononuclear cells and cord blood mononuclear cells were stimulated with ConA/PMA, and supernatants were assayed for IFN-gamma and IL-4, -5, -10, and -13. Of 364 children, 28% were seen by a physician for eczema by 1 yr of age. After adjustment for potential confounders using logistic regression, the odds for development of eczema in infancy were significantly higher when mothers had active eczema in pregnancy (OR, 2.46, CI 1.0-5.8, p <0.042) and when mothers were in the highest tertile of serum IgE production (OR 2.28, CI 1.2-4.4, p <0.013). Colds in the third trimester were associated with lower odds of eczema (OR 0.32, CI 0.16-0.63, p <0.001). Our findings from this cohort study suggest that in utero factors, including maternal IgE, colds, and eczema, may influence the risk of infant eczema.

Risk of physician-diagnosed asthma in the first 6 years of life

OBJECTIVE

The objective of this cohort study was to determine if complications of pregnancy and labor, characteristics at birth, and exposure to infections influence the incidence of asthma in the first 6 years of life.

DESIGN

We identified all children born between 1980 and 1990 in the Province of Manitoba, Canada. We used records of physician contacts (inpatient and outpatient) and services of the universal provincial health insurance plan to follow up 170,960 children from birth to the age of 6 years to identify the first diagnosis of asthma. Information on mothers and siblings was also obtained to determine family history of disease and exposure to infections.

RESULTS

During the study period, a diagnosis of asthma was made in 14.1% of children by the age of 6 years. The incidence was higher in boys than in girls, in those with family history of allergic diseases. It was higher in urban than in rural areas, and lowest in those born in winter. Asthma was more likely in those with low birth weight and premature birth. Certain congenital abnormalities and complications of pregnancy and labor also increased the risk of asthma. The risk of asthma increased with maternal age. Both upper and lower respiratory infections increased the risk of subsequent asthma, and this effect was more important than exposure to familial respiratory infections, which also tended to increase asthma risk. The risk of asthma decreased with the number of siblings when siblings had a history of allergic disorders.

CONCLUSIONS

In addition to genetic influences, intrauterine and labor conditions are determinants of asthma. Exposure to both upper and lower respiratory tract infections increases the risk; these infections do not explain the protective effect associated with the increasing number of siblings.

Maternal pollen allergy may be more important than birch pollen exposure during pregnancy for atopic airway disease in the child

In 1993 extremely high levels of birch pollen were recorded in Stockholm, Sweden. We investigated the effects of this exposure on sensitization and development of atopic airway disease in children. The aim of this study was to assess the influence of maternal birch sensitization and symptoms of pollen allergy, as well as exposure to birch pollen during pregnancy, on sensitization and development of atopic airway disease in children. A total of 387 children with atopic heredity (70% had atopic mothers) and born in Stockholm 1993 or 1994 were investigated at age 4.5-5 yr. The children were examined and skin prick tested with inhalant and food allergens. IgE-antibodies against birch pollen and recombinant birch pollen allergen were analyzed in serum. The same tests were performed on the mothers. Children of mothers with symptoms of pollen allergy more often showed symptoms of rhinoconjunctivitis at age 4.5-5, after both high dose [Odds ratio (OR) 5.3; 95% confidence interval (CI): 2.0-13.7] and low dose (OR 4.0; 95% CI: 1.5-10.9) exposure to birch pollen during pregnancy. Similar tendencies were noted for children of mothers sensitized to birch, where stronger effects were suggested in boys (OR 3.8; 95% CI: 1.3-11.5) than in girls (OR 1.2; 95% CI: 0.2-5.5) in the high-dose exposed group. For asthma symptoms and sensitization to birch in the children the results were less consistent. It may be concluded that, maternal pollen allergy seems to have a stronger influence on the development of rhinoconjunctivitis in children with a family history of atopy than the degree of allergen exposure during pregnancy.

Antioxidant intake in pregnancy in relation to wheeze and eczema in the first two years of life

Two thousand women were recruited for a prospective investigation of the influence of maternal antioxidant intake in pregnancy on the development of asthma and eczema in children. A food frequency questionnaire was used to characterize diet during pregnancy and blood antioxidant levels were measured. Postal questionnaires were used to follow up the 1,924 singleton children born to the cohort at 6, 12, and 24 months of age. There were no associations between maternal antioxidant intake and wheezing symptoms and eczema in the children's first year. In the children's second year, maternal vitamin E intake during pregnancy was negatively associated with wheeze in the absence of a "cold" (p for trend 0.010) and, in children whose mothers were atopic, there was a negative association between maternal vitamin E intake and childhood eczema (p for trend 0.024). Maternal vitamin C intake during pregnancy was positively associated with "ever wheeze" and eczema during the children's second year. This study suggests that maternal dietary antioxidant intakes during pregnancy may modify the risks of developing wheeze and eczema during early childhood. Further follow up of the cohort will determine whether maternal diet during pregnancy is associated with asthma and atopic disease in later childhood.

The relation of markers of fetal growth with asthma, allergies and serum immunoglobulin E levels in children at age 5-7 years

BACKGROUND

It has been suggested that fetal growth and maturation have an impact on the development of allergic diseases later in life.

OBJECTIVE

To examine the association between measures of fetal growth and allergic disease in children at age 5-7 years.

METHODS

As part of the German International Study of Asthma and Allergies in Childhood phase II surveys, a random sample of school beginners (n=1138) was examined in 1995. Data on anthropometric measures at birth and gestational age were obtained from maternal copies of birth records. Data on symptoms and doctor-diagnosed asthma, atopic dermatitis and hayfever were gathered by parental questionnaires. Atopic sensitization was assessed by serum IgE and skin prick tests to common aeroallergens. Children (741) had complete data for the explanatory variables of interest and were thus eligible for this analysis. Confounder-adjusted prevalence odds ratios (PORs) and means ratios with 95% confidence intervals (CI) were calculated using multiple logistic and linear regression.

RESULTS

Birth weight and gestational age were positively associated with atopic sensitization (Ptrend=0.025 and 0.035, respectively). Children with a low birth weight relative to head circumference had a decreased risk of sensitization (POR 0.44, 95% CI 0.21-0.91; Ptrend=0.020). Moreover, total serum IgE increased with increasing birth weight (Ptrend=0.042). No consistent relationship was observed between markers of fetal growth and wheezing, doctor-diagnosed asthma, atopic dermatitis and hayfever.

CONCLUSION

These data suggest that fetal growth and maturity are associated with atopic sensitization and total serum IgE levels in childhood.

Primary dietary prevention of food allergy

OBJECTIVE

To present research and clinical evidence on the use of primary dietary prevention in food allergy management.

DATA SOURCES

We conducted MEDLINE searches for pertinent articles published between January 1986 and October 2001 with use of the following keywords or phrases: prevention and diet and allergy, food allergy and prevention, and dietary prevention and food allergy or allergens. Also included are information and commentary reflecting the authors' cumulative clinical experience in an allergy unit of a city hospital.

RESULTS

We define as "proactive" those strategies centered on "success factors," such as the early postnatal environment, prolonged breast-feeding, and use of formula and probiotic supplementation, in contrast to earlier "prohibitionist" approaches to prevention of food allergy. These two approaches are not antagonistic and may even be synergistic. We introduce this distinction in light of epidemiologic evidence and out of concern about compliance and the quality of life for patients.

CONCLUSIONS

Inasmuch as nutritional and immune maturation are implicated, the prohibitionist measures that are most effective in primary prevention of food allergy are exclusive breast-feeding for at least 6 months (for lifelong immunity and other benefits), delayed (after the sixth month) introduction of solid foods, and on-indication use of "hypoallergenic" formulas. Whether proactive strategies can be contemplated remains a debatable issue. Evidence for and against the scientific use of probiotics as well as microbiologic, epidemiologic, and clinical data are discussed. Review of published epidemiologic studies and randomized clinical trials is essential before planning dietary intervention or prevention.

Molecular aspects of allergy

Atopic diseases such as asthma, rhinitis, eczema and food allergies have increased in most industrialised countries of the world during the last 20 years. The reasons for this increase are not known and different hypotheses have been assessed including increased exposure to sensitising allergens or decreased stimulation of the immune system during critical periods of development. In allergic diseases there is a polarisation of the Th2 response and an increase in the production of type 2 cytokines which are involved in the production of immunoglobulin E and the development of mast cells, basophils and eosinophils leading to inflammation and disease. The effector phase of atopy is initiated by interaction with Fc epsilon RI expressed on effector cells such as mast cells and basophils but also found on an ever increasing list of cells. Binding of a polyvalent allergen to the variable part of IgE leads to a cross-link of the receptor that triggers the cell to release histamine and pharmacological mediators of the symptomatic allergic response. Cross-linking of Fc epsilon RI by autoantibodies against the alpha-chain of the Fc epsilon RI, causing subsequent histamine release is thought to be involved in the pathogenesis of other diseases such as chronic idiopathic urticaria (CIU). To date, most therapeutic strategies are aimed at inhibiting and controlling components of the inflammatory response. Recently, new treatment strategies have emerged that focus on the development of preventive and even curative treatments. The most promising therapeutic approaches are aimed at inhibiting the IgE-Fc epsilon RI interaction with the use of non-anaphylactogenic anti-IgE or anti-Fc epsilon RIalpha autoantibodies. Clinical trials in humans using an humanised anti-IgE antibody showed that this antibody was well tolerated and reduced both symptoms and use of medication in asthma and allergic rhinitis. Thus interruption of the atopic cascade at the level of the IgE-Fc epsilon RI interaction with the use of non-anaphylactogenic antibodies is effective and represents an attractive therapy for the treatment of atopic disease.

Paracetamol use in pregnancy and wheezing in early childhood

BACKGROUND

We recently reported links between frequent paracetamol (acetaminophen) use and wheezing and asthma in adults and children, but data are lacking on possible effects of prenatal exposure on wheezing in early childhood.

METHODS

In the population based Avon Longitudinal Study of Parents and Children (ALSPAC) women were asked twice during pregnancy (at 18-20 weeks and 32 weeks) about their usage of paracetamol and aspirin. Six months after birth, and at yearly intervals thereafter, mothers were asked about wheezing and eczema symptoms in their child. The effects of paracetamol and aspirin use in pregnancy on the risk in the offspring of wheezing at 30-42 months (n=9,400) and eczema at 18-30 months (n=10,216) and on their risk of different wheezing patterns (defined by presence or absence of wheezing at <6 months and at 30-42 months) were examined.

RESULTS

Paracetamol was taken frequently (most days/daily) by only 1% of women. After controlling for potential confounders, frequent paracetamol use in late pregnancy (20-32 weeks), but not in early pregnancy (<18-20 weeks), was associated with an increased risk of wheezing in the offspring at 30-42 months (adjusted odds ratio (OR) compared with no use 2.10 (95% CI 1.30 to 3.41); p=0.003), particularly if wheezing started before 6 months (OR 2.34 (95% CI 1.24 to 4.40); p=0.008). Assuming a causal relation, only about 1% of wheezing at 30-42 months was attributable to this exposure. Frequent paracetamol use in pregnancy was not associated with an increased risk of eczema. Frequent aspirin use in pregnancy was associated with an increased risk of wheezing only at <6 months.

CONCLUSIONS

Frequent use of paracetamol in late pregnancy may increase the risk of wheezing in the offspring, although such an effect could explain only about 1% of the population prevalence of wheezing in early childhood.

[Anaphylactic shock associated with ceftriaxone therapy in a newborn]

CASE REPORT

During an hospitalization, a ten-day-old newborn infant was treated with ceftriaxone (Rocephine i.v., 390 mg/day) for an infection secondary to the presence of an umbilical catheter. A few minutes after the end of the fifth injection, the infant presented with cyanosis, initially localized at the perfusion site, then generalized, a tachycardia followed by acute circulatory failure with arterial hypotension and finally a multiple organe failure with coagulation, kidney and liver dysfunction. The infant received classical resuscitation treatment and recovered without short term sequelae. The time of onset was in favour of drug-induced accident. A postnatal sensitization during previous injections might have occurred, although the latency of immediate hypersensitivity reactions after a first sensitizing contact is usually longer. A sensitization in utero or via breast feeding was ruled out due to the absence of maternal exposure to ceftriaxone. The absence of urticaria and bronchospasm, and the initial localization of cyanosis were not in favour of a classic allergic disease. An other cause, toxic or infectious cannot be ruled out.

Living with asthma: the experiences of young people at home and at school

This study is concerned with how young people with moderate to severe asthma live with and explain the disorder and manage the resulting symptoms. Based on in-depth interviews with 55 young people aged 11-16 living in West London, it shows that asthma restricted their lives at school and recreationally but that they were actively involved with their condition and its management. The study reveals that while prescribed medicines in the form of inhalers were used as the primary means of coping with asthma episodes, the young people were concerned about being dependent on such medicines, in line with more general ambivalence in late modern cultures about the long term use of prescribed medicines. It also demonstrates how social relations in particular contexts help to determine the extent to which asthma episodes can be managed.

Allergen-specific T cell reactivity in cord blood: the influence of maternal cytokine production

BACKGROUND

Successful pregnancy is dependent upon T helper (Th)2-type-dominated immunological responsiveness in gestation-associated compartments.

OBJECTIVE

In our study we observed the influence of the maternal Th2-associated cytokine pattern on the naive fetal T cell phenotype and asked if circulating Th2 cytokines of atopic mothers affects the Th1/Th2 differentiation of the fetus.

METHODS

Cord blood mononuclear cells (CBMC) and peripheral blood mononuclear cells (PBMC) of the corresponding mothers were isolated. The proliferative response of CBMC and PBMC to Betalactoglobulin (BLG) was assessed by liquid scintillation counting. The cytokines interferon (IFN)-gamma, and interleukin (IL)-5, IL-10 and IL-13 in the cell culture supernatants were measured using the ELISA technique. We then defined two subgroups based on maternal levels of specific IgE against aeroallergens: sensitized mothers (MA(+)) and their neonates (NMA(+)) (n = 18) and non-sensitized mothers (MA(-)) and their neonates (NMA(-)) (n = 29).

RESULTS

Nearly all mothers (98%) and neonates (92%) had a positive proliferation response after stimulation with BLG (mean stimulation index (10-90 percentile): neonates: 7 (2-15); mothers 14 (5-29)). In supernatants of BLG-stimulated cell cultures, sensitized mothers showed a significantly lower IFN-gamma concentration in comparison to non-sensitized mothers (MA(+) = 25; MA(-) = 123 IU/L; P < 0,05), whereas the neonates did not differ significantly (NMA(+) = 306; NMA(-) = 224 IU/L; n. s.). Nor was any difference found in the IL-13 concentration between the two groups of sensitized and non-sensitized mothers (MA(+) = 48; MA(-) = 125 pg/mL; n. s.). CBMC of neonates with a sensitized mother showed significantly higher IL-13 concentrations in response to BLG than neonates of non-sensitized mothers (NMA(+) = 1442, NMA(-) 738 pg/mL; P < 0.05). The IL-5 and IL-10 concentrations did not differ significantly within the neonatal and the maternal subgroups.

CONCLUSIONS

Our data suggests that maternal sensitization to allergens is associated with the reduced maternal production of the Th2 antagonist IFN-gamma and elevated production of the Th2 cytokine IL-13 in the offspring.