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Navaratna S, Estcourt MJ, Burgess J, Waidyatillake N, Enoh E, Lowe AJ, Peters R, Koplin J, Dhamage SC, Lodge CJ. Childhood vaccination and allergy: A systematic review and meta-analysis. Allergy 2021; 76:2135-2152. [PMID: 33569761 DOI: 10.1111/all.14771] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 12/04/2020] [Accepted: 12/23/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND OBJECTIVE As the rise in prevalence of allergic diseases worldwide corresponds in time with increasing infant vaccination, it has been hypothesized that childhood vaccination may increase the risk of allergic disease. We aimed to synthesize the literature on the association between childhood vaccination and allergy. DESIGN We searched the electronic databases PubMed and EMBASE (January 1946-January 2018) using vaccination and allergy terms. METHODS Two authors selected papers according to the inclusion criteria. Pooled effects across studies were estimated using random-effects meta-analysis. Due to inadequate number of homogeneous publications on newer and underused vaccines, meta-analysis was limited to allergic outcomes following administration of (Bacillus Calmette-Guérin) BCG, measles or pertussis vaccination. The review was prospectively registered in the PROSPERO systematic review registry (NO: CRD42017071009). RESULTS A total of 35 publications based on cohort studies and 7 publications based on randomized controlled trials (RCTs) met the inclusion criteria. RCTs: From 2 studies, early vaccination with BCG vaccine was associated with a reduced risk of eczema (RR = 0.83; 95% CI = 0.73-0.93; I2 = 0%) but not food allergy or asthma. No association was found between pertussis vaccine and any allergic outcome based on a single RCT. COHORT STUDIES Childhood measles vaccination was associated with a reduced risk of eczema (RR = 0.65; 95% CI = 0.47-0.90, I2 = 0.0%), asthma (RR = 0.78; 95% CI = 0.62-0.98, I2 = 93.9%) and, with a similar, statistically non-significant reduction in sensitization (RR = 0.78; 95% CI = 0.61-1.01, I2 = 19.4%). CONCLUSIONS We found no evidence that childhood vaccination with commonly administered vaccines was associated with increased risk of later allergic disease. Our results from pooled analysis of both RCTs and cohort studies suggest that vaccination with BCG and measles vaccines were associated with a reduced risk of eczema.
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Affiliation(s)
- Samidi Navaratna
- Faculty of Medicine Department of Community Medicine University of Peradeniya Kandy Sri Lanka
| | - Marie J. Estcourt
- Wesfarmers Centre of Vaccines & Infectious Diseases Telethon Kids InstitutePerth Children's Hospital Nedlands Australia
| | - John Burgess
- Allergy and Lung Health Unit Centre for Epidemiology and Biostatistics Melbourne School of Population and Global Health The University of Melbourne Parkville Vic. Australia
| | - Nilakshi Waidyatillake
- Allergy and Lung Health Unit Centre for Epidemiology and Biostatistics Melbourne School of Population and Global Health The University of Melbourne Parkville Vic. Australia
| | - Elizabeth Enoh
- Reproductive Health Programme United Nations Population Fund (UNFPA) Yaounde Cameroon
| | - Adrian J. Lowe
- Allergy and Lung Health Unit Centre for Epidemiology and Biostatistics Melbourne School of Population and Global Health The University of Melbourne Parkville Vic. Australia
- Murdoch Children's Research InstituteRoyal Children’s Hospital Parkville Vic. Australia
| | - Rachel Peters
- Murdoch Children's Research InstituteRoyal Children’s Hospital Parkville Vic. Australia
- Department of Paediatrics The University of Melbourne Parkville Vic. Australia
| | - Jennifer Koplin
- Allergy and Lung Health Unit Centre for Epidemiology and Biostatistics Melbourne School of Population and Global Health The University of Melbourne Parkville Vic. Australia
- Murdoch Children's Research InstituteRoyal Children’s Hospital Parkville Vic. Australia
- Department of Paediatrics The University of Melbourne Parkville Vic. Australia
| | - Shyamali C. Dhamage
- Allergy and Lung Health Unit Centre for Epidemiology and Biostatistics Melbourne School of Population and Global Health The University of Melbourne Parkville Vic. Australia
- Murdoch Children's Research InstituteRoyal Children’s Hospital Parkville Vic. Australia
- Centre for Food and Allergy Research (CFAR) Murdoch Children’s Research Institute Parkville Vic. Australia
| | - Caroline J. Lodge
- Allergy and Lung Health Unit Centre for Epidemiology and Biostatistics Melbourne School of Population and Global Health The University of Melbourne Parkville Vic. Australia
- Murdoch Children's Research InstituteRoyal Children’s Hospital Parkville Vic. Australia
- Centre for Food and Allergy Research (CFAR) Murdoch Children’s Research Institute Parkville Vic. Australia
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Han DH, Ahn JC, Mun SJ, Park SK, Oh SY, Rhee CS. Novel Risk Factors for Allergic Rhinitis in Korean Elementary School Children: ARCO-kids Phase II in a Community. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2015; 7:234-40. [PMID: 25749770 PMCID: PMC4397363 DOI: 10.4168/aair.2015.7.3.234] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 08/17/2014] [Accepted: 10/01/2014] [Indexed: 02/04/2023]
Abstract
Purpose Allergic rhinitis (AR) is a multifactorial disease whose genetic and environmental risk factors have been studied for decades. Many pediatric studies have pointed out the familial history of allergy, hygiene hypothesis, breast-feeding, pet ownership, and diets as risk factors of AR. However, most of factors are still up for debate. This preliminary report aimed to confirm the known risk factors and find the novel risk factors for AR in the Korean pediatric population. Methods A bi-seasonal, winter and summer, study in 2 elementary schools included all students whose parents completed the questionnaire of medical and social histories, quality of life, infant and early-childhood history, and the living styles. Skin prick tests and endoscopic examinations were conducted on all participants. Results Among total 1,020 children, 338 participants had AR. The multivariate logistic regression analysis highlighted 6 factors: male gender (OR, 2.10; 95% CI, 1.32-3.33), older age (1.65; 1.03-2.65), previous history of allergic conjunctivitis (14.25; 4.99-40.74), asthma (2.73; 0.96-7.76) and pneumonia (0.39; 0.19-0.82), and an hour increase in daily playing time (0.90; 0.80-1.00). Conclusions Lack of pneumonia in early childhood and short playing time are newly found risk factors for Korean pediatric AR in this study confirming male gender, older age and previous history of allergic conjunctivitis and asthma as the risk factors.
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Affiliation(s)
- Doo Hee Han
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Cheul Ahn
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Sue Jean Mun
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Sue K Park
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea.; Department of Biomedical Science, Seoul National University Graduate School, Seoul, Korea.; Cancer Research Institute, Seoul National University, Seoul, Korea
| | - Se Young Oh
- Department of Food and Nutrition, Kyung Hee University College of Human Ecology, Seoul, Korea
| | - Chae Seo Rhee
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea.; Graduate School of Immunology, Seoul National University College of Medicine, Seoul, Korea.; Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea.; Sensory Organ Research Institute, Seoul National University Medical Research Center, Seoul, Korea.; Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
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Abstract
The relationship between inter-generational social mobility of sons and daughters between 1958 and 1991 and biosocial variables, i.e. birth order, number of children in family, father's social class, region, educational attainment of child and father, educational and cognitive test scores (reading, mathematics, verbal and non-verbal IQ tests), was studied in a large British cohort study. The data used were collected as part of the British National Child Development Study (NCDS). The extent of social class mobility was determined inter-generationally and was categorized as none (no change in social class between the father's and index child's social class), upwardly mobile (where the index child moved up one or more social classes compared with their father) or downwardly mobile (where the index child moved down one or more social classes compared with their father). All of the biosocial variables were associated with social mobility when analysed separately. Multivariate analyses revealed that the most significant predictor of mobility categories in both sexes was education of the cohort member, followed by social class of the father. In both sexes mathematics score was a significant predicator, while in sons reading and non-verbal IQ scores were also important predictors. In the light of these results, it appears that social mobility in Britain takes place largely on meritocratic principles.
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Nagel G, Weinmayr G, Flohr C, Kleiner A, Strachan DP. Association of pertussis and measles infections and immunizations with asthma and allergic sensitization in ISAAC Phase Two. Pediatr Allergy Immunol 2012; 23:737-46. [PMID: 23005697 DOI: 10.1111/pai.12007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/21/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND Pertussis and measles infection as well as vaccination have been suspected as possible mediating factors of allergic disease in childhood. METHODS Between 1995 and 2005 cross-sectional studies were performed in 29 centers in 21 countries. Parental questionnaires were used to collect information on allergic diseases and exposures. We analyzed data from 54,943 randomly selected schoolchildren aged 8-12 yr. A subgroup of 31,759 children was also skin prick tested (SPT) to common environmental allergens. Combined odds ratios were calculated by random effect models for meta-analysis. RESULTS Pertussis and measles vaccination were not significantly associated with any of the allergy outcomes or SPT positivity. However, pertussis infection was associated with wheeze (OR(ad) 1.68; 95% CI 1.44-1.97) and rhinoconjunctivitis (OR(ad) 1.63; 95% 1.33-2.00). Pertussis infection was also significantly associated with a higher prevalence of reported eczema during the past year in non-affluent countries. Measles infection was associated with a higher prevalence of wheeze (OR(ad) 1.26; 95% 1.10-1.43) and reported eczema (OR(ad) 1.22; 95% 1.08-1.39). No association with SPT positivity was found, suggesting that these associations are unlikely to be mediated by an allergic component. CONCLUSIONS Associations of pertussis and measles infection with symptoms of asthma, rhinoconjunctivitis and eczema were found in both affluent and non-affluent countries and are unlikely to be mediated by IgE.
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Affiliation(s)
- Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.
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Shim JY, Kim HB, Lee SY, Yu J, Kim WK, Kang D, Lee CG, Ha M, Kwon HJ, Hong YC, Park KS, Lee HR, Hong SJ. Effects of early measles on later rhinitis and bronchial hyperresponsiveness. Ann Allergy Asthma Immunol 2010; 105:43-9. [PMID: 20642203 DOI: 10.1016/j.anai.2010.04.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND The hygiene hypothesis suggests that infectious diseases in early life reduce the risk of allergic diseases. OBJECTIVE To investigate the association between measles infection during early childhood and the prevalence of allergic diseases, lung function, bronchial hyperresponsiveness (BHR), and sensitization in later childhood. METHODS A survey was conducted 5 years after a nationwide measles outbreak in Korea. From September 1 through November 30, 2006, we obtained information on history of measles and allergic diseases but not of measles vaccination through a questionnaire completed by 1004 schoolchildren aged 6 to 7 years. Furthermore, we measured measles antibody titers and performed skin prick tests, pulmonary function tests, and methacholine challenge tests. Children were divided into groups based on their history of measles infection and antibody titers. RESULTS Prevalence of measles infection was 8.2%. Children with both a positive measles history and a positive antimeasles antibody had significantly higher antimeasles antibody levels than those without a measles history. The prevalence of current rhinitis (adjusted odds ratio [aOR], 1.86; 95% confidence interval [CI], 1.02-3.40), rhinitis ever (aOR, 2.17; 95% CI, 1.19-3.94), and current BHR (aOR, 1.98; 95% CI, 1.04-3.78) was significantly higher in the group with a positive measles history compared with the group with a negative measles antibody. No differences were found among groups in the prevalence of asthma, lung function, provocation concentration that caused a decrease in forced expiratory volume of 1 second of 20%, or sensitization. CONCLUSION Early measles infection was associated with increased prevalence of rhinitis and BHR at the age of 7 years but has no effect on the development of asthma and allergy at the age of 7 years. This study indicates that common childhood infections such as measles in early age do not protect against later development of allergic diseases.
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Affiliation(s)
- Jung Yeon Shim
- Department of Pediatrics, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Korea
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Abstract
BACKGROUND Breast-feeding protects against many infectious diseases and may also influence immunization outcomes. AIM This study investigated if breast-feeding protects against clinical measles and if it modified the effect of immunization. METHODS We used logistic regression with data for 10 207 individuals from the 1970 British Cohort study (BCS70). Breast-feeding data were collected at five years of age, and information on clinical measles infection, as well as socio-economic measures was collected at the age of ten years. Breast feeding was categorized as: breast-fed <1 month (n = 1611), breast-fed for 1-3 months (n = 1016), breast-fed for more than three months (n = 1108), breast-feeding of uncertain duration (n = 21) and never breast-fed (n = 6451). RESULTS Breast-feeding for more than three months was negatively associated with a diagnosis of clinical measles infection after adjustment for crowding, social class, measles vaccination, parity and sex with an odds ratio (95% confidence interval) of 0.69 (0.60-0.81) compared with those who never breast-fed. Measles vaccination was highly associated with low risk for measles with: 0.14 (0.13-0.16). Age at acute measles infection was not associated with breastfeeding. Breast-feeding did not notably alter measles immunization efficacy. CONCLUSION Immunization against measles provides effective protection against the disease. A more modest reduction in the risk of a measles diagnosis is associated with breast-feeding. The associations with a diagnosis of measles for breast-feeding and measles immunization are independent of each other.
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Affiliation(s)
- S A Silfverdal
- Department of Paediatrics, Clinical Research Centre, Orebro University Hospital, Orebro, Sweden
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Rosenlund H, Bergström A, Alm JS, Swartz J, Scheynius A, van Hage M, Johansen K, Brunekreef B, von Mutius E, Ege MJ, Riedler J, Braun-Fahrländer C, Waser M, Pershagen G. Allergic disease and atopic sensitization in children in relation to measles vaccination and measles infection. Pediatrics 2009; 123:771-8. [PMID: 19255001 DOI: 10.1542/peds.2008-0013] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Our aim was to investigate the role of measles vaccination and measles infection in the development of allergic disease and atopic sensitization. METHODS A total of 14 893 children were included from the cross-sectional, multicenter Prevention of Allergy-Risk Factors for Sensitization in Children Related to Farming and Anthroposophic Lifestyle study, conducted in 5 European countries (Austria, Germany, the Netherlands, Sweden, and Switzerland). The children were between 5 and 13 years of age and represented farm children, Steiner-school children, and 2 reference groups. Children attending Steiner schools often have an anthroposophic (holistic) lifestyle in which some immunizations are avoided or postponed. Parental questionnaires provided information on exposure and lifestyle factors as well as symptoms and diagnoses in the children. A sample of the children was invited for additional tests, and 4049 children provided a blood sample for immunoglobulin E analyses. Only children with complete information on measles vaccination and infection were included in the analyses (84%). RESULTS In the whole group of children, atopic sensitization was inversely associated with measles infection, and a similar tendency was seen for measles vaccination. To reduce risks of disease-related modification of exposure, children who reported symptoms of wheezing and/or eczema debuting during first year of life were excluded from some analyses. After this exclusion, inverse associations were observed between measles infection and "any allergic symptom" and "any diagnosis of allergy by a physician." However, no associations were found between measles vaccination and allergic disease. CONCLUSION Our data suggest that measles infection may protect against allergic disease in children.
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Affiliation(s)
- Helen Rosenlund
- Karolinska Institutet, Institute of Environmental Medicine, Department of Environmental Epidemiology, Box 210, SE-171 77 Stockholm, Sweden.
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Matheson MC, Walters EH, Simpson JA, Wharton CL, Ponsonby AL, Johns DP, Jenkins MA, Giles GG, Hopper JL, Abramson MJ, Dharmage SC. Relevance of the hygiene hypothesis to early vs. late onset allergic rhinitis. Clin Exp Allergy 2009; 39:370-8. [DOI: 10.1111/j.1365-2222.2008.03175.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Bremner SA, Carey IM, DeWilde S, Richards N, Maier WC, Hilton SR, Strachan DP, Cook DG. Infections presenting for clinical care in early life and later risk of hay fever in two UK birth cohorts. Allergy 2008; 63:274-83. [PMID: 18269673 DOI: 10.1111/j.1398-9995.2007.01599.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND The 'hygiene hypothesis' proposes that infections in infancy protect against hay fever (HF). We investigated infections during infancy in relation to HF, including rarer ones not previously researched in this context, while examining the role of potential confounding variables. METHODS From birth cohorts derived within the General Practice Research Database (GPRD) and Doctors Independent Network (DIN) database of computerized patient records from UK general practice, we selected 3549 case-control pairs, matched for practice, age, sex and control follow-up to case diagnosis. Conditional logistic regressions were fitted for each of 30 infections; behavioural problems (BP) acted as a control condition unrelated to HF. Odds ratios (OR), adjusted for consultation frequency were pooled across the databases using fixed effect models. We also adjusted for sibship size in GPRD and a socioeconomic marker in DIN. RESULTS Upper respiratory tract infections, diarrhoea and vomiting and acute otitis media in infancy were each related with a moderately increased risk of HF in both databases, as were BP. These associations were lost on adjustment for consultation frequency. Only bronchiolitis was significantly associated with a reduced pooled risk of HF after adjustment for consultations (OR = 0.8). Adjustment for sibship size in GPRD and a socioeconomic marker in DIN had little impact on the OR. CONCLUSIONS Of 30 infectious illnesses investigated, none had strong or consistent associations with HF after adjustment for consultation frequency. Except for bronchiolitis, possibly a chance finding, none of the clinically apparent infections considered appear to have an important role in allergy prevention.
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Affiliation(s)
- S A Bremner
- Division of Community Health Sciences, St George's, University of London, London, UK
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Abstract
The prevalence of atopic diseases has increased abruptly in recent years in most Westernized societies, making the question why this happened the topic of a heated debate. The best paradigm available to date to explain this steep rise, the 'hygiene hypothesis', supports that it is the excess 'cleanliness' of our environments that has led to the decline in the number of infectious stimuli that are necessary for the proper development of our immune system. Recent findings support that it is the combined effect that not only pathogenic, but also non-pathogenic microorganisms, and even their structural components,can exert on the immune system that deters from the development of atopic responses. Adding to these results are intriguing new findings on the effect different gene polymorphisms can have on an individual's predisposition to allergic diseases. The most important linkages produced, to date, include those among the genes for IL-4, IL-13, HLA-DRB, TNF, LTA,FCER1B, IL-4RA, ADAM33, TCR alpha/delta, PHF11, GPRA, TIM, p40, CD14, DPP10, T-bet, GATA-3, and FOXP3 and allergic disorders. The two parallel research efforts, epidemiologic and genetic, are only recently starting to converge,producing fascinating results on the effect particular gene-environment interactions might have in the development of atopy.The most important lesson learned through this tremendous research effort is that not only a small number but thousands and millions of separate risk factors act in concordance in the production of the allergic phenotype.
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Sánchez-Solis M, García-Marcos L. Do vaccines modify the prevalence of asthma and allergies? Expert Rev Vaccines 2007; 5:631-40. [PMID: 17181437 DOI: 10.1586/14760584.5.5.631] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Epidemiological studies suggest the hypothesis that the increase in asthma and allergies in the industrialized world can be explained by a decline in the number of infectious diseases occurring during childhood. In the context of this 'hygiene hypothesis', is immunization in early life a risk factor for promoting allergic diseases? The majority of studies, especially those conducted with more extensive populations, have not found an increased risk, and although 'not finding an increased risk' is not the same as 'the non-existence of any risk at all', it seems that the evidence is tipped in favor of the absence of risk. Conversely, although some surveys have described a protective effect of vaccination, the majority refuted this result. If there is any effect, it is probably a weak one.
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Affiliation(s)
- Manuel Sánchez-Solis
- Institute of Respiratory Health, University of Murcia, Pediatrics Pneumology Unit, Universitary Hospital Virgen de la Arrixaca, Murcia, Spain.
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Juhn YJ, Kita H, Lee LA, Swanson RJ, Smith R, Bagniewski SM, Weaver AL, Pankratz VS, Jacobson RM, Poland GA. Childhood asthma and measles vaccine response. Ann Allergy Asthma Immunol 2006; 97:469-76. [PMID: 17069101 DOI: 10.1016/s1081-1206(10)60937-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Asthmatic patients have a TH2-predominant milieu that is associated with humoral immunity. However, little is known about whether humoral immune responses to viral antigens differ between asthmatic and nonasthmatic children. OBJECTIVE To determine whether humoral immune response differs in asthmatic patients vs nonasthmatic patients. METHODS Measles virus specific IgG antibody levels were determined for the Rochester Family Measles Study cohort (n = 876), a convenience sample of healthy children 5 to 12 years of age in Rochester, MN. We conducted comprehensive medical record reviews of 838 children who were eligible for this study. We determined the child's asthma status at the time of determination of antibody levels by applying predetermined criteria for asthma. Comparisons were made using the 2-sample t test or chi2 test. RESULTS Of the 838 children, 156 (18.6%) had asthma at the time of the determination of antibody levels and were not taking systemic steroids within 14 days of specimen collection. Among those with a nonequivocal antibody reading, the seropositive response rates were similar in asthmatic patients and nonasthmatic patients (89.7% vs 90.3%, respectively; P = .83). However, the equivocal response rates were slightly higher among asthmatic patients than nonasthmatic patients (6.4% vs 4.7%, respectively). CONCLUSION Asthmatic children seem to have similar humoral immune responses to measles vaccine as those without asthma. Although the findings reassure health care practitioners, whether this finding is generalizable to other vaccines and whether asthmatic patients with low antibody levels have normal cell-mediated immunity need to be elucidated in future studies.
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Affiliation(s)
- Young J Juhn
- Division of Pediatric and Adolescent Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
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Nakajima K, Dharmage SC, Carlin JB, Wharton CL, Jenkins MA, Giles GG, Abramson MJ, Haydn Walters E, Hopper JL. Is childhood immunisation associated with atopic disease from age 7 to 32 years? Thorax 2006; 62:270-5. [PMID: 17090571 PMCID: PMC2117158 DOI: 10.1136/thx.2006.062547] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND There is ongoing conjecture over whether childhood immunisation leads to an increased risk of developing atopic diseases. OBJECTIVE To examine associations between childhood immunisation and the risk of atopic disease. METHOD Immunisation histories of 8443 Tasmanian children born in 1961 obtained from school medical records were linked to the Tasmanian Asthma Study. Associations between immunisation status and atopic diseases were examined while adjusting for possible confounders using multiple logistic regression. RESULTS Diphtheria immunisation was weakly associated with an increased risk of asthma by age 7 years (odds ratio (OR) 1.3, 95% confidence interval (CI) 1.1 to 1.7), but there was no evidence of any association for four other vaccinations studied. An increased risk of eczema by age 7 years was associated with immunisation against diphtheria (OR 1.5, 95% CI 1.1 to 2.1), tetanus (OR 1.5, 95% CI, 1.1 to 2.0), pertussis (OR 1.5, 95% CI 1.1 to 1.9) and polio (OR 1.4, 95% CI 1.0 to 1.9) but not small pox. Similar but slightly weaker patterns of association were observed between the risk of food allergies and immunisation against diphtheria (OR 1.5, 95% CI 1.0 to 2.1), pertussis (OR 1.4, 95% CI 1.1 to 1.9), polio (OR 1.4, 95% CI 1.00 to 2.1) and tetanus (OR 1.30 95% CI 0.99 to 1.70), but not with small pox. There was no evidence of associations between immunisation history and hay fever, or incidence of later-onset atopic outcomes. CONCLUSIONS The few effects seen in this study are small and age-dependent, and nearly all our findings support numerous previous studies of no effect of vaccines on asthma. Based on these findings, the fear of their child developing atopic disease should not deter parents from immunising their children, especially when weighed against the benefits.
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Affiliation(s)
- Kazunori Nakajima
- Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, School of Population Health, The University of Melbourne, Level 2, 723 Swanston Street, Carlton, VIC 3053 Australia
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Bloomfield SF, Stanwell-Smith R, Crevel RWR, Pickup J. Too clean, or not too clean: the hygiene hypothesis and home hygiene. Clin Exp Allergy 2006; 36:402-25. [PMID: 16630145 PMCID: PMC1448690 DOI: 10.1111/j.1365-2222.2006.02463.x] [Citation(s) in RCA: 136] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The 'hygiene hypothesis' as originally formulated by Strachan, proposes that a cause of the recent rapid rise in atopic disorders could be a lower incidence of infection in early childhood, transmitted by unhygienic contact with older siblings. Use of the term 'hygiene hypothesis' has led to several interpretations, some of which are not supported by a broader survey of the evidence. The increase in allergic disorders does not correlate with the decrease in infection with pathogenic organisms, nor can it be explained by changes in domestic hygiene. A consensus is beginning to develop round the view that more fundamental changes in lifestyle have led to decreased exposure to certain microbial or other species, such as helminths, that are important for the development of immunoregulatory mechanisms. Although this review concludes that the relationship of the hypothesis to hygiene practice is not proven, it lends strong support to initiatives seeking to improve hygiene practice. It would however be helpful if the hypothesis were renamed, e.g. as the 'microbial exposure' hypothesis, or 'microbial deprivation' hypothesis, as proposed for instance by Bjorksten. Avoiding the term 'hygiene' would help focus attention on determining the true impact of microbes on atopic diseases, while minimizing risks of discouraging good hygiene practice.
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Affiliation(s)
- S F Bloomfield
- London School of Hygiene and Tropical Medicine, London, UK.
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Abstract
The hygiene hypothesis was developed in response to data suggesting that the increase in allergic diseases as well as asthma was secondary to a reduced exposure to infectious stimuli. Indeed, the epidemiologic changes, resulting in an increase in atopic disease, have been impressive and intriguing. Furthermore, although there clearly is a genetic component to atopic diseases, genetics cannot account for a marked increase in the incidence and prevalence of allergic manifestations within a few generations. Thus, environmental factors have been suggested as responsible for the changing prevalence. There are two--not mutually exclusive--possibilities, namely, that substances that promote atopy have been added to the environment or that factors that provided protection from allergic disease were lost from the environment. Both outdoor and indoor pollution, along with a long list of other environmental factors, have been proposed. It is of interest that in many developed countries, certain types of pollution have decreased, whereas the prevalence of atopic disease has increased. In this review, we have explored a detailed analysis of a large number of studies that have focused on this issue and suggest that, although the hygiene hypothesis has merit, the stimuli responsible for the new epidemiology remain enigmatic.
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Affiliation(s)
- Andrea T Borchers
- Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis School of Medicine, TB 192, Davis, CA 95616, USA
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Adler UC. The influence of childhood infections and vaccination on the development of atopy: A systematic review of the direct epidemiological evidence. HOMEOPATHY 2005; 94:182-95. [PMID: 16060204 DOI: 10.1016/j.homp.2005.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND The 'hygiene hypothesis' has been used to justify a belief common among homeopaths, that the suppression of childhood infections and immunisation may lead to the development of chronic atopic diseases. OBJECTIVES To analyse the influence of childhood infections and immunisation on the development of atopy. METHODS Qualitative systematic review of direct epidemiological evidence (Medline 1993-2004) concerning the influence of childhood infections and immunisation on the development of atopy and discussion based on homeopathy. CONCLUSIONS (1) Childhood infections do not protect against atopy; on the contrary, they increase the risk of allergic diseases, in agreement to Hahnemann's observations, which included epidemic diseases among the factors capable of stimulating the development of chronic diseases. (2) Vaccination is not a risk factor for atopy, notwithstanding the allergenic effect of some vaccines.
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Affiliation(s)
- U C Adler
- Al. dos Jurupis, 284, São Paulo-SP 04088-00, Brazil.
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Bremner SA, Carey IM, DeWilde S, Richards N, Maier WC, Hilton SR, Strachan DP, Cook DG. Timing of routine immunisations and subsequent hay fever risk. Arch Dis Child 2005; 90:567-73. [PMID: 15908618 PMCID: PMC1720414 DOI: 10.1136/adc.2004.051714] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Suggestions that immunisation influences allergic disease risk, either positively (pertussis) or negatively (BCG) are of concern for vaccination policy. AIMS To determine whether DTP, MMR, and BCG vaccination in infancy influenced hay fever risk. METHODS Case-control study of 7098 hay fever cases and controls, within two primary care databases. One control per case was matched for practice, age, and sex. Odds ratios (OR) were derived using conditional logistic regression. RESULTS Compared to those completing in month 5 (base group) (39.3%), DTP unvaccinated children (4.3%) had a similar risk of hay fever (OR = 0.94, 95% CI 0.73 to 1.23). However, those completing after 12 months (4.2%) had a reduced risk (OR = 0.60, 95% CI 0.45 to 0.76) compared to the base group. Compared to those vaccinated in month 14 (base group) (29.5%), MMR unvaccinated children (2.3%) had an OR of 0.79 (95% CI 0.58 to 1.08). Completion of MMR after two years was associated with reduced hay fever risk (OR = 0.62, 95% CI 0.48 to 0.80) compared to the base group. The effects of late immunisation with DTP and MMR were independent. Those vaccinated with BCG by age 2 (2.4%) had an odds ratio of 1.28 (95% CI 0.96 to 1.70). Adjustment for consulting behaviour, social factors, or sibship size did not alter these associations. CONCLUSIONS Immunisation against DTP or MMR does not increase the risk of hay fever. The lower confidence limit for BCG vaccination contradicts the hypothesised protective effect. The reduced risk of hay fever among children immunised late may be explained by a third factor causing both postponement and reduced risk such as intercurrent febrile illnesses.
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Affiliation(s)
- S A Bremner
- Department of Community Health Sciences, St George's Hospital Medical School, Cranmer Terrace, London SW17 0RE, UK
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19
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Abstract
The ability to produce allergic responses begins early in fetal life along with the development of other elements of the immune system. Among the most interesting questions related to the development of allergic disease are whether the fetus in utero commonly is exposed to sufficient allergen to induce IgE production and how much the mother's immune responses affect the developing fetal immune system. After birth, it seems that many factors, including the frequency and severity of infections and the timing and intensity of allergen and animal exposures, continue to influence immune development.
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Affiliation(s)
- Christina M Abraham
- Section of Allergy-Immunology, Medical College of Georgia, 1120 15th Street, BG 1009, Augusta, GA 30912, USA
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20
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Bresciani M, Parisi C, Menghi G, Manghi G, Bonini S. The hygiene hypothesis: does it function worldwide? Curr Opin Allergy Clin Immunol 2005; 5:147-51. [PMID: 15764905 DOI: 10.1097/01.all.0000162307.89857.88] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE OF REVIEW This article intends to be a systematic review of papers published during 2003-2004 quoted in a Medline search for 'hygiene hypothesis'. The worldwide perspective of the article does not refer just to a geographical concept, but tries also to address the question of whether the consensus on the hypothesis is global or whether it applies to all types of allergic or immunologic disease, to any age sample or infectious agent. Furthermore, the article outlines those clinical and experimental studies which, in the authors' opinion, may represent significant contributions to a better understanding of the hygiene hypothesis and may guide further investigations on the subject. RECENT FINDINGS The association between a reduced exposure to infectious agents (as a part of a changed lifestyle) and a higher prevalence of atopy seems now to be confirmed by consistent evidence. Mechanisms underlying this association, however, are not yet completely clear (immune deviation or immune regulation). SUMMARY Further experimental and clinical studies are needed, with special reference to the time, duration and intensity of exposure to any specific infectious agent which is related to well-defined allergy outcomes. The background information for using microbial products in allergy prevention and treatment is still limited.
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Mommers M, Swaen GMH, Weishoff-Houben M, Creemers H, Freund H, Dott W, van Schayck CP. Childhood infections and risk of wheezing and allergic sensitisation at age 7-8 years. Eur J Epidemiol 2005; 19:945-51. [PMID: 15575353 DOI: 10.1007/s10654-004-6016-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Childhood atopic disease has been associated with exposure to infections early in life. There is however considerable controversy on this issue, since evidence exists for both protective and adverse effects of infections. Aim of this study was to investigate the association between childhood infections and the occurrence of wheeze and allergic sensitisation in 7-8-year-old Dutch and German children. METHODS A nested case-control study was conducted among German and Dutch children participating in a large longitudinal study on respiratory health. Parents of 510 7-8-year-old children with respiratory complaints and an equal number of children without respiratory complaints were asked to complete a questionnaire. Blood samples were collected for specific serum Immunoglobulin E (IgE) analysis. Data on childhood infections were collected through records of the participating Municipal Health Services. RESULTS No association was found between recent wheeze and any of the childhood infections investigated. For scarlet fever infection an increased risk of allergic sensitisation (OR: 2.82; 95% CI: 1.40-5.72) and sensitisation against grasses (OR: 3.00; 95% CI: 1.35-6.69) at the age of 7-8 years was found. Varicella infection tended towards increased risk of sensitisation against grasses (OR: 1.88; 95% CI: 0.99-3.58). For allergic sensitisation and sensitisation against grasses the odds ratios increased with increasing number of infections. CONCLUSIONS The results do not lend support to the suggestion that childhood infection protects against wheezing or allergic sensitisation at age 7-8 years. Scarlet fever or varicella infection presented an increased risk of allergic sensitisation.
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Affiliation(s)
- Monique Mommers
- Institute for Hygiene and Environmental Medicine, R WTH Aachen, Germany.
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Resch A, Schlipköter U, Crispin A, Behrendt H, Heinrich J, Wichmann HE, Ring J, Schäfer T. Atopic disease and its determinants -- a focus on the potential role of childhood infection. Clin Exp Allergy 2004; 34:1184-91. [PMID: 15298557 DOI: 10.1111/j.1365-2222.2004.02016.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Atopic diseases develop on a genetic background and are modulated by environmental factors among which some infectious diseases are thought to have a protective influence. OBJECTIVE The aim of this study was to determine the influence of infectious diseases in younger ages, bacterial and viral, on atopic diseases and sensitization to aero- and food-allergens in adults. METHODS A population-based sample of 4262 subjects aged 25-74 years were interviewed concerning their history of infectious disease within the first 18 years of life. Information about allergic disease, including atopic eczema, allergic rhinitis (AR), and asthma was obtained. A blood sample was drawn and analysed for allergen-specific IgE antibodies against food- and aero-allergens. RESULTS Multiple logistic regression analyses identified viral infection to be associated with AR (adjusted odds ratio (OR) = 1.39; 95% confidence interval (95% CI): 1.13-1.72) and sensitization to aeroallergens (OR = 1.21; 95% CI: 1.05-1.41). Bacterial disease was a negative predictor for atopy development in the subgroup of patients sensitized to nutritional allergens with concomitant atopic eczema (OR = 0.34; 95% CI: 0.11-0.99), AR (OR = 0.67; 95% CI: 0.42-1.07), or asthma (OR = 0.41; 95% CI: 0.19-0.87). Influences of viral and bacterial infection on AR differed with regard to family history of atopic disease. CONCLUSION In our study population, history of viral infection was consistently positively associated with AR. Our data suggests that bacterial infections might be preventive for specific subgroups of atopy.
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Affiliation(s)
- A Resch
- Department of Medical Informatics, Biometry, and Epidemiology, Ludwig-Maximilians-University, Munich, Germany.
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23
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Roost HP, Gassner M, Grize L, Wüthrich B, Sennhauser FH, Varonier HS, Zimmermann H, Braun-Fahrländer C. Influence of MMR-vaccinations and diseases on atopic sensitization and allergic symptoms in Swiss schoolchildren. Pediatr Allergy Immunol 2004; 15:401-7. [PMID: 15482514 DOI: 10.1111/j.1399-3038.2004.00192.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The prevalence of asthma and allergic disease has increased in many countries. It has been proposed that vaccinations may contribute to the development of allergic disease by reducing clinical infections in infancy or through the direct IgE-inducing effects of the vaccines. Evidence for a potential role of immunizations in the development of allergic disease is scarce. Therefore the objective was to study the associations between vaccinations against measles, mumps and rubella (MMR), natural infections of these diseases and atopic sensitization to indoor and outdoor allergens and allergic symptoms in schoolchildren. The cross-sectional study including 1537 8(th) grade school children aged 13-15 years living in 10 communities across Switzerland was organized in the framework of an environmental health surveillance program within the School Health Services (Swiss Surveillance Program of Childhood Asthma and Allergies with respect to Air Pollution and Climate, SCARPOL). Main outcome measures were asthma and sneezing during pollen season assessed by parental questionnaires and atopic sensitization determined by IgE concentrations to various allergens. It was found that parents' reported history of measles or mumps was associated with a stronger immune response than two or more vaccinations against the respective infection (measles: geometric mean IgG titers (GMT) lU/ml (95% Cl) 2.8 (2.0-3.9) vs. 1.2 (1.0-1.4), mumps: GMT PE/ml (95% Cl) 16.3 (13.9-19.1) vs. 8.5 (6.1-11.7). With respect to atopic sensitization similar associations for exposure by natural MMR-infections or MMR-vaccinations were found: measles: OR (95% Cl) 1.02 (0.53-1.96) vs. 1.22 (0.69-2.16), mumps: 0.59 (0.38-0.93) vs. 0.79 (0.49-1.27), rubella: 0.93 (0.61-1.43) vs. 0.95 (0.66-1.37), respectively. Inverse relationships were found between the risk of asthma and a positive disease history or vaccination of measles 0.36 (0.14-0.91) vs. 0.45 (0.21-0.98) or a positive serum titer against measles 0.65 (0.35-1.20). From the present study can be concluded that exposure by MMR-vaccinations or natural MMR-infections in childhood does not increase the risk of sensitization to common allergens as well as to allergic respiratory diseases. MMR-vaccinations or natural MMR-infections are therefore an unlikely factor contributing to the increase in atopic disease in developed countries.
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Affiliation(s)
- H-P Roost
- Swiss Federal Office of Public Health, Division of Epidemiology and Infectious Diseases, CH-3003 Bern, Switzerland.
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24
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Mommers M, Weishoff-Houben M, Swaen GMH, Creemers H, Freund H, Dott W, van Schayck CP. Infant immunization and the occurrence of atopic disease in Dutch and German children: a nested case-control study. Pediatr Pulmonol 2004; 38:329-34. [PMID: 15334511 DOI: 10.1002/ppul.20089] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Our goal was to assess the role of early childhood vaccination in the occurrence of respiratory symptoms and allergic sensitization in 7-8-year-old Dutch and German children. A nested case-control study was conducted among children participating in a large longitudinal study on respiratory health, to study the relationship between vaccination (bacille Calmette-Guérin (BCG), pertussis, measles/mumps, rubella, and Haemophilus influenza type b (Hib)) and respiratory symptoms and allergic sensitization. Parents of 510 7-8-year-old children with respiratory complaints and an equal number of randomly selected children without respiratory complaints were asked to complete a questionnaire. Blood samples were collected for specific serum IgE analysis. Vaccination status was assessed through the records of the participating Municipal Health Services. No association between vaccination against pertussis, measles, rubella, or Hib and respiratory symptoms or allergic sensitization was found. For sensitization against house dust mite, BCG vaccination resulted in an increased risk (OR, 2.28; 95% CI, 1.05-4.96). Birth order was inversely associated with allergic sensitization, but was not related to respiratory symptoms. We found an association between BCG vaccination and the subsequent risk for sensitization against house dust mite. No evidence was found for an association between vaccination and respiratory symptoms. Earlier reports of an association of birth order with atopic disease were supported by the results of the present study.
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Affiliation(s)
- M Mommers
- Institute for Hygiene and Environmental Medicine, RWTH Aachen, Aachen, Germany.
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25
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von Hertzen LC, Haahtela T. Immunization and atopy: possible implications of ethnicity. J Allergy Clin Immunol 2004; 113:401-6. [PMID: 15007336 DOI: 10.1016/j.jaci.2003.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The possible effects of immunization on subsequent development of asthma and atopy remains a matter of controversy. Although some studies have suggested that immunization might increase the risk for atopic disease, a number of studies have found no association or have even reported a protective effect for immunization against atopy. Recent studies have provided evidence that ethnicity might affect the susceptibility to the immunomodulatory effects of vaccination. In this review the association between immunization and atopy and the effect of ethnicity on this association are briefly outlined. The focus will be particularly on BCG vaccination.
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Kuyucu S, Saraçlar Y, Tuncer A, Saçkesen C, Adalioglu G, Sümbüloglu V, Sekerel BE. Determinants of atopic sensitization in Turkish school children: effects of pre- and post-natal events and maternal atopy. Pediatr Allergy Immunol 2004; 15:62-71. [PMID: 14998384 DOI: 10.1046/j.0905-6157.2003.00115.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Emergence of new environmental risk factors, and/or loss of protective factors of a traditional lifestyle may explain the increase, or variations in prevalence of allergic diseases. The aim of this study was to delineate the prevalence and spectrum of, and to reveal the causal and/or protective factors for atopic sensitization among a heterogeneous cohort of Turkish children, for the first time in our country. The study design adhered to International Study of Asthma and Allergies in Childhood (ISAAC) phase II protocol. A self-administered parental questionnaire about demographic characteristics and detailed risk factors, and skin-prick test with 13 allergens were employed in a clustered random sample of 8-11-yr-old Turkish school children. Atopy was defined as the presence of at least one positive skin reaction to any allergen tested. The association between a total of 78 risk factors and different aspects of atopy were analyzed in 1144 children with multivariate logistic regression analysis. The overall prevalence of atopy was 20.6%. Most common sensitizations were to grass pollens, Dermatophagoides pteronyssinus and Blatella germanica. Day care attendance, high paternal education level, male gender and maternal asthma were significant risk factors for atopy. Breastfeeding more than 6 months (compared with 0-6 months), maternal smoking during pregnancy and a birth weight under 2500 g were inversely related to (or protective factors for) atopic sensitization. Maternal atopic disease had significant effects on risk factors pattern. In children with a maternal atopy history a low birth weight, day care attendance and maternal smoking during the first year of life independently increased the risk of atopic sensitization. Gender, breastfeeding and paternal education did not show any association with atopy in this group of children. A history of measles and low gestational age were significant protective factors for mite sensitization. This study showed that children of atopic mothers showed a different profile of risk factors associated with atopic sensitization, when compared with other children. Prenatal and early childhood events had important associations with atopic sensitization.
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Affiliation(s)
- Semanur Kuyucu
- Pediatric Allergy and Asthma Unit, Faculty of Medicine, Hacettepe University, 06880 Cankaya, Ankara, Turkey
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27
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Abstract
OBJECTIVES There is an urgent need to identify the environmental changes responsible for the increasing burden of allergic disease. A reduction in the diversity and magnitude of "microbial burden" in early life has been implicated in this growing propensity for allergy sensitization. The "hygiene hypothesis" proposes that deficient bacteria-derived maturation signals during early immune development increases the susceptibility to allergic responses. This article reviews the current evidence for this relationship in the context of improved public health and living conditions. DATA SOURCES Evidence derived from a wide range of epidemiologic and intervention studies in humans and experimental animal models is reviewed. RESULTS There is extensive epidemiologic evidence linking allergic disease with a number of lifestyle factors that may reflect reduced microbial burden. These studies cannot exclude other possible causal pathways because most parameters (such as family size) are only indirect measures of early childhood infection. However, direct evidence that bacteria can inhibit allergic immune responses provides a plausible mechanistic basis for the hygiene hypothesis. In both animals and humans, microbial antigens can promote nonallergic (type 1) responses and inhibit allergic (type 2) immune responses. These pro-type 1 effects have been used in allergen immunotherapy and other treatments for allergic disease with some success. Although the potential benefits of bacterial exposure appear most relevant in early life when immune responses develop, the role in disease prevention remains controversial. Furthermore, there is currently no evidence that existing childhood vaccine programs to prevent serious infectious disease are responsible for the increase in allergic disease. CONCLUSIONS Although microbial antigens can inhibit allergic immune responses, these effects appear to depend on the timing of exposure, the genetic susceptibility of the individual, the nature of the organism, and other poorly defined factors in prevailing environment. Although there is indirect support for the hygiene hypothesis, there is currently no definitive proof that reduced microbial burden is the cause of the current "allergy epidemic."
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Affiliation(s)
- Susan L Prescott
- Department of Paediatrics, University of Western Australia, Perth, Western Australia, Australia.
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Grüber C, Illi S, Lau S, Nickel R, Forster J, Kamin W, Bauer CP, Wahn V, Wahn U. Transient suppression of atopy in early childhood is associated with high vaccination coverage. Pediatrics 2003; 111:e282-8. [PMID: 12612285 DOI: 10.1542/peds.111.3.e282] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To analyze prevalences of allergic sensitization and atopic disease in relation to vaccination coverage. 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.
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Affiliation(s)
- Christoph Grüber
- Department of Pediatric Pneumology and Immunology, Charité-Humboldt University, Berlin, Germany.
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Koppelman GH, Jansen DF, Schouten JP, van der Heide S, Bleecker ER, Meyers DA, Postma DS. Sibling effect on atopy in children of patients with asthma. Clin Exp Allergy 2003; 33:170-5. [PMID: 12580908 DOI: 10.1046/j.1365-2222.2003.01591.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Multiple population studies have shown the presence of a sibling effect on atopic disease. However, it is unclear if the sibling effect is also of importance in subjects who are genetically at high risk for the development of atopy. OBJECTIVE To study the presence of a sibling effect on markers of atopy (serum total IgE, specific IgE, skin tests) and asthma (bronchial hyper-responsiveness to histamine) in families ascertained through a parent with asthma. METHODS First-degree offspring in 200 asthma families were studied (n = 541). Mixed effects regression models were used to account for the dependence of the observations within a family, and to adjust for possible confounding variables. RESULTS Multiple regression analysis showed that having older siblings was inversely related to atopy, defined as >/= 2, >/= 3, >/= 4, or >/= 5 skin tests (P = 0.07-0.009). In addition, family size (number of siblings) had a significant protective effect on the presence of specific IgE to common aeroallergens (P = 0.03). Exposure to cigarette smoke in the first 3 years of life significantly increased the risk of having specific IgE to common aeroallergens (P = 0.04). No sibling effect was detected for serum total IgE or bronchial hyper-responsiveness to histamine. CONCLUSIONS This study shows a protective sibling effect on the presence and severity of atopy but not on bronchial hyper-responsiveness in children who are genetically at risk. The identification of the sibling effect in high-risk families stresses the need to understand the basis of this effect, in order to design future prevention programmes.
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Affiliation(s)
- G H Koppelman
- Department of Pulmonary Rehabilitation, Beatrixoord, Haren, The Netherlands
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30
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Abstract
The equity heuristic is a decision rule specifying that parents should attempt to subdivide resources more or less equally among their children. This investment rule coincides with the prescription from optimality models in economics and biology in cases in which expected future return for each offspring is equal. In this article, the authors present a counterintuitive implication of the equity heuristic: Whereas an equity motive produces a fair distribution at any given point in time, it yields a cumulative distribution of investments that is unequal. The authors test this analytical observation against evidence reported in studies exploring parental investment and show how the equity heuristic can provide an explanation of why the literature reports a diversity of birth order effects with respect to parental resource allocation.
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Bager P, Westergaard T, Rostgaard K, Hjalgrim H, Melbye M. Age at childhood infections and risk of atopy. Thorax 2002; 57:379-82. [PMID: 11978910 PMCID: PMC1746340 DOI: 10.1136/thorax.57.5.379] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND It has been proposed that early age at exposure to common childhood infections is associated with a decreased risk of allergy. Previous studies on the possible association between allergy and infection with measles, mumps, rubella, and varicella have not been conclusive as most did not include information on exact age at exposure. The objective of our study was to investigate whether early age at exposure to these infections was associated with a decreased risk of atopy using information on exact age at infection. METHODS The study population consisted of 889 pregnant women who participated in a national birth cohort study in Denmark and for whom detailed information on history of measles, rubella, varicella, and mumps before school entry (age 7 years) was available from school health records from Copenhagen. Atopic status was assessed serologically by a specific response to 11 common inhalant allergens using serum samples obtained from the women during pregnancy. RESULTS Measles in the first year of life was associated with a higher risk of atopy than no measles before age 7 years (OR 3.36, 95% CI 1.47 to 7.68). There was no association between atopy and mumps, rubella, or varicella in the first 7 years of life or with measles acquired after the first year of life. The risk of atopy increased significantly with increasing number of childhood infections in the first 2 years of life (p(trend)=0.01). CONCLUSIONS These findings do not support the suggestion that childhood exposure to measles, rubella, varicella, or mumps protects against atopy, even if acquired very early in life.
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Affiliation(s)
- P Bager
- Department of Epidemiology Research, Danish Epidemiology Science Centre, Statens Serum Institut, 5 Artillerivej, DK-2300 Copenhagen S, Denmark
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Karmaus W, Botezan C. Does a higher number of siblings protect against the development of allergy and asthma? A review. J Epidemiol Community Health 2002; 56:209-17. [PMID: 11854343 PMCID: PMC1732088 DOI: 10.1136/jech.56.3.209] [Citation(s) in RCA: 218] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
STUDY OBJECTIVE To review the "protective" effects of having a higher number of siblings for the risk of atopic eczema, asthma wheezing, hay fever, and allergic sensitisation. METHOD Review of the literature (Medline since 1965 and references). MAIN RESULTS 53 different studies were identified. For eczema, 9 of 11 studies reported an inverse relation with number of siblings; for asthma and wheezing, 21 of 31 reported the inverse association; for hay fever, all 17 studies showed the effect; for allergic sensitisation or immunoglobulin E reactivity 14 of 16 studies supported the "protective" effect of a higher number of siblings. The studies emphasise a "theory" that is based exclusively on epidemiological associations. CONCLUSIONS Research has not yet answered the question of which causal factors explain the sibling effect. Causal factors must meet two criteria; they must vary with sibship size and they must protect against atopic manifestations. The prevailing "hygiene hypothesis" failed to explain the findings adequately. Alternative explanations include in utero programming or endocrine explanatory models. The epidemiology research into siblings and atopic disorders has entered an intellectually challenging phase. Possessing sufficient knowledge about the causal factors might prevent at least 30% of all cases of asthma, eczema, and hay fever.
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Affiliation(s)
- W Karmaus
- Department of Epidemiology, Michigan State University 48823, USA.
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33
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Affiliation(s)
- R Michael Sly
- Section of Allergy and Immunology, Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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34
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McKeever TM, Lewis SA, Smith C, Collins J, Heatlie H, Frischer M, Hubbard R. Early exposure to infections and antibiotics and the incidence of allergic disease: a birth cohort study with the West Midlands General Practice Research Database. J Allergy Clin Immunol 2002; 109:43-50. [PMID: 11799364 DOI: 10.1067/mai.2002.121016] [Citation(s) in RCA: 189] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND It has been suggested that the rise in prevalence of allergic disease in westernized countries is due in part to a decrease in exposure to infections and an increase in the use of antibiotics early in life. OBJECTIVE The purpose of this investigation was to quantify the relationships between (1) exposure to personal infections, infections in siblings, and use of antibiotics in early life and (2) the incidence of allergic disease. METHODS Using the West Midlands section of the UK General Practice Research Database, we established a historical birth cohort of children (N = 29,238). For each child, we identified all personal infections and infections in siblings and determined the use of antibiotics in early life; we also noted incident diagnoses of asthma, eczema, and hay fever. The data were analyzed through use of Cox regression. RESULTS There was no clear protective effect of exposure to either personal infections or infections in siblings with respect to the incidence of allergic disease. Antibiotic exposure was associated with an increased risk of developing allergic disease in a dose-related manner: having 4 or more courses of antibiotics in the first year of life was associated with an increased incidence of asthma (hazard ratio [HR], 3.13; 95% CI, 2.75-3.57), eczema (HR, 1.48; 95% CI, 1.31-1.68), and hay fever (HR, 2.12; 95% CI, 1.68-2.66). However, adjusting for consulting behavior reduced these effects (adjusted HR [95% CI]: asthma, 1.99 [1.72-2.31]; eczema, 1.01 [0.88-1.17]; hay fever, 1.14 [0.88-1.47]). CONCLUSIONS We found no evidence that exposure to infections reduced the incidence of allergic disease, and infections did not explain the previous findings of a strong birth order effect in this cohort. The use of antibiotics might be associated with early diagnoses of allergic disease.
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Affiliation(s)
- Tricia M McKeever
- Division of Respiratory Medicine, University of Nottingham, United Kingdom
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Bilenki L, Wang S, Fan Y, Yang J, Han X, Yang X. Chlamydia trachomatis infection inhibits airway eosinophilic inflammation induced by ragweed. Clin Immunol 2002; 102:28-36. [PMID: 11781065 DOI: 10.1006/clim.2001.5144] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
While much progress has been achieved in controlling infectious diseases, there is a startling increase in the prevalence of allergic disorders in developed countries. Previous studies using experimental murine models of asthma have demonstrated that mycobacterial infections are capable of suppressing asthma-like reactions induced by ovalbumin (OVA). Using a different intracellular bacterium, Chlamydia trachomatis mouse pneumonitis (MoPn), we examined the effect of infection on the development of allergic responses to a common natural airborne allergen, ragweed (RW). The data showed that airway eosinophilia induced by ragweed sensitization/challenge was significantly reduced in MoPn-infected mice. MoPn-infected mice also exhibited significantly lower levels of allergen-driven Th2 cytokine production, namely IL-4, IL-5, IL-10, and IL-13, following ragweed exposure in comparison with those treated with ragweed only. Additionally, the production of eotaxin, a C-C chemokine for eosinophil chemoattraction following RW exposure, was significantly reduced in the lungs of MoPn-infected mice. However, MoPn infection did not reduce the levels of RW-specific IgE and IgG1 production in the sera, nor did it diminish the level of total serum IgE. These data provide evidence that the suppression of the allergic airway inflammation induced by a common environmental allergen is attainable through intracellular bacterial infection.
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Affiliation(s)
- Laura Bilenki
- Immune Regulation of Allergy Research Group, University of Manitoba, Winnipeg, Manitoba R3E 0W3, Canada
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Mullooly JP, Pearson J, Drew L, Schuler R, Maher J, Gargiullo P, DeStefano F, Chen R. Wheezing lower respiratory disease and vaccination of full-term infants. Pharmacoepidemiol Drug Saf 2002; 11:21-30. [PMID: 11998547 DOI: 10.1002/pds.678] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
PURPOSE There have been speculations that increases in vaccinations have caused recent increases in wheezing lower respiratory disease during infancy. We assess possible associations between vaccines and incidence of wheezing in full-term infants. METHODS We conducted a matched case-control study of full-term infants born into the Kaiser Permanente Northwest health plan during 1991-1994 and continuously enrolled for at least 12 months (n = 1366 case-control pairs). Potential cases of wheeze were ascertained from medical care databases and verified by chart review. Vaccinations, demographic factors, and wheeze risk factors were abstracted from charts. Adjusted relative risks of first onset of wheeze during post-vaccination exposure windows were estimated by conditional logistic regression. We also conducted case-series analyses of wheeze onsets. RESULTS We found no evidence that risk of wheeze during infancy is associated with recency of vaccination with whole-cell pertussis (DTP), hepatitis b (HBV), Haemophilus influenzae type b (HIB), oral polio (OPV), or measles, mumps and rubella (MMR) vaccines. We also found no evidence that risk of first wheeze is associated with exposure to HBV or MMR. CONCLUSIONS Recent increases in wheezing during infancy do not appear to be related to increases in vaccinations of full-term infants.
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Affiliation(s)
- John P Mullooly
- Center for Health Research, 3800 N. Interstate Ave., Portland, OR 97227, USA.
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Grüber C, Nilsson L, Björkstén B. Do early childhood immunizations influence the development of atopy and do they cause allergic reactions? Pediatr Allergy Immunol 2001; 12:296-311. [PMID: 11846867 DOI: 10.1034/j.1399-3038.2001.1r046.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Concerns about allergic side-effects of vaccines and about a possible promotion of allergic diseases contribute to incomplete vaccination rates in childhood. This article reviews the current understanding of these issues. There is evidence that pertussis and diphtheria/tetanus antigens elicit immunoglobulin E (IgE) antibody formation as part of the immune response. In murine models, pertussis toxin is an effective adjuvant for IgE formation against simultaneously administered antigens. In children, however, sensitization to unrelated antigens or development of allergic diseases do not seem to be augmented. In contrast, bacille Calmette-Guérin (BCG) and measles vaccination have been proposed as suppressors of allergy because of their T helper 1 (Th1)-fostering properties. In the murine system, BCG inhibits allergic sensitization and airway hyper-reactivity. Some epidemiological studies in humans suggest an inhibitory effect of tuberculosis on allergy. BCG vaccination in children, however, has no or merely a marginal suppressive effect on atopy. Other vaccine components such as egg proteins, gelatin, and antibiotics are a potential hazard to children with severe clinical reactions to these allergens. These rare children should be vaccinated under special precautions. In conclusion, vaccination programs do not explain the increasing prevalence of allergic diseases, but individual children may uncommonly develop an allergic reaction to a vaccine. The risks of not vaccinating children, however, far outweigh the risk for allergy. Therefore, childhood vaccination remains an essential part of child health programs and should not be withheld, even from children predisposed for allergy.
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Affiliation(s)
- C Grüber
- Department of Pediatric Pneumology and Immunology, Charité - Humboldt University, Berlin, Germany.
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Bousquet J, Van Cauwenberge P, Khaltaev N. Allergic rhinitis and its impact on asthma. J Allergy Clin Immunol 2001; 108:S147-334. [PMID: 11707753 DOI: 10.1067/mai.2001.118891] [Citation(s) in RCA: 2094] [Impact Index Per Article: 91.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- J Bousquet
- Department of Allergy and Respiratory Diseases, University Hospital and INSERM, Montpellier, France
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Wills-Karp M, Santeliz J, Karp CL. The germless theory of allergic disease: revisiting the hygiene hypothesis. Nat Rev Immunol 2001; 1:69-75. [PMID: 11905816 DOI: 10.1038/35095579] [Citation(s) in RCA: 593] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Rising rates of allergic disease accompany the healthier benefits of a contemporary westernized lifestyle, such as low infant mortality. It is likely that these twinned phenomena are causally related. The hygiene hypothesis states that allergy and increased longevity are both consequences of reducing infectious stressors during early childhood for millennia. Mechanistic explanations for the hygiene hypothesis have typically invoked the T-helper-type 1/2 (T(H)1/T(H)2) model. Here, we discuss why we favour a broader 'counter-regulatory' model--one that might also explain the increasing incidence of autoimmune disease in westernized countries.
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Affiliation(s)
- M Wills-Karp
- Division of Immunobiology, Children's Hospital Research Foundation, Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA.
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Imani F, Kehoe KE. Infection of human B lymphocytes with MMR vaccine induces IgE class switching. Clin Immunol 2001; 100:355-61. [PMID: 11513549 DOI: 10.1006/clim.2001.5073] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Circulating immunoglobulin E (IgE) is one of the characteristics of human allergic diseases including allergic asthma. We recently showed that infection of human B cells with rhinovirus or measles virus could lead to the initial steps of IgE class switching. Since many viral vaccines are live viruses, we speculated that live virus vaccines may also induce IgE class switching in human B cells. To examine this possibility, we selected the commonly used live attenuated measles mumps rubella (MMR) vaccine. Here, we show that infection of a human IgM(+) B cell line with MMR resulted in the expression of germline epsilon transcript. In addition, infection of freshly prepared human PBLs with this vaccine resulted in the expression of mature IgE mRNA transcript. Our data suggest that a potential side effect of vaccination with live attenuated viruses may be an increase in the expression of IgE.
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Affiliation(s)
- F Imani
- Division of Clinical Immunology, Department of Medicine, The Johns Hopkins University School of Medicine, Asthma and Allergy Center, 5501 Hopkins Bayview Circle, Baltimore, Maryland 21224, USA.
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Anderson HR, Poloniecki JD, Strachan DP, Beasley R, Björkstén B, Asher MI. Immunization and symptoms of atopic disease in children: results from the International Study of Asthma and Allergies in Childhood. Am J Public Health 2001; 91:1126-9. [PMID: 11441744 PMCID: PMC1446713 DOI: 10.2105/ajph.91.7.1126] [Citation(s) in RCA: 89] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This study tested the hypothesis that immunization is related to the prevalence of atopic disease in childhood. METHODS We used data from the International Study of Asthma and Allergies in Childhood to perform an ecologic analysis of national and local immunization rates for tuberculosis, diphtheria and tetanus toxoids and pertussis (DTP), and measles and prevalence of atopic disease symptoms (asthma, allergic rhinoconjunctivitis, and atopic eczema). RESULTS In 13- to 14-year-old children, there were significant negative associations with local birth-year immunization rates for DTP and measles but none with rates for tuberculosis. No associations were found in 6- to 7-year-old children. No associations with national immunization rates were found. CONCLUSIONS International variations in childhood atopic diseases are unlikely to be explained by variations in immunization.
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Affiliation(s)
- H R Anderson
- Department of Public Health Sciences, St. George's Hospital Medical School, Cranmer Terrace, London SW17 0RE UK.
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Baudoin P, van der Horst-Bruinsma IE, Dekker-Saeys AJ, Weinreich S, Bezemer PD, Dijkmans BA. Increased risk of developing ankylosing spondylitis among first-born children. ARTHRITIS AND RHEUMATISM 2000; 43:2818-22. [PMID: 11145041 DOI: 10.1002/1529-0131(200012)43:12<2818::aid-anr23>3.0.co;2-f] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Studies in mice have demonstrated an increased risk of ankylosing enthesopathy in earlier litters compared with later-born offspring. In humans, birth order and maternal age as risk factors for ankylosing spondylitis (AS) have not been investigated previously. This study was undertaken to investigate whether first-born children have a higher risk of AS than later-born children and whether maternal age at delivery is another risk factor. METHODS The birth order of 162 AS patients was compared with that of their healthy siblings, both for the total group and with stratification for maternal age at first delivery. Maternal age at the time of delivery of AS patients who were first-born children was compared with the mean maternal age at first delivery in the Dutch population. RESULTS The number of first-born children with AS was significantly higher than would be expected in case of an equal risk between first-born and later-born children (26 versus 20 for families with 2 children [P = 0.029] and 63 versus 47.6 for all families [P = 0.004]). Also, the mean maternal age at first delivery was lower in mothers of AS patients (24.8 years) compared with mothers of healthy controls (26.1 years). CONCLUSION Low birth order is a risk factor for AS in humans.
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Affiliation(s)
- P Baudoin
- University Hospital, Vrije Universiteit, Amsterdam, The Netherlands
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Abstract
Viral infections have become increasingly recognized as a significant cause of asthma exacerbations, mainly because of improved viral detection techniques. Unfortunately, the ability to specifically treat viral infections and to limit the asthma morbidity associated with these agents has not kept pace with diagnostic technology. This article focuses on current concepts of the epidemiology of viruses in asthma exacerbations, investigations studying the physiologic and immunologic consequences of viral infection, and potential therapies to minimize virally-induced airway hyperresponsiveness. To impact this significant health problem, researchers must definitively ascertain the mechanisms by which viruses induce airway reactivity and must develop rational, safe approaches to prevent the consequences of viral infection in the patient with asthma.
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Affiliation(s)
- R S Peebles
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232-2650, USA
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