Mechanisms of asthma and allergic inflammation
Respiratory illnesses in early life and asthma and atopy in childhood

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Background

The relation between respiratory illnesses in early life and the development of asthma and atopy in childhood is incompletely understood.

Objective

We sought to examine the relationship between respiratory illnesses in early life and atopic diseases at school age.

Methods

We performed a prospective birth cohort study of the relationship between respiratory illnesses in the first year of life and asthma, atopy (sensitization to ≥1 allergen), and allergic rhinitis at school age in 440 children with a parental history of atopy. Logistic regression was used to examine the relationship between respiratory illnesses and asthma, atopy, and allergic rhinitis. The relationship between respiratory illnesses in early life and repeated measures of wheezing between the ages of 1 and 7 years was investigated by using a proportional hazards models.

Results

Physician-diagnosed croup (adjusted odds ratio [OR], 0.30; 95% CI, 0.12-0.72) and having 2 or more physician-diagnosed ear infections (adjusted OR, 0.58; 95% CI, 0.35-0.98) in the first year of life were inversely associated with atopy at school age. Physician-diagnosed bronchiolitis before age 1 year was significantly associated with asthma at age 7 years (adjusted OR, 2.77; 95% CI, 1.23-6.22). Recurrent nasal catarrh (≥3 episodes of a runny nose) in the first year of life was associated with allergic rhinitis at age 7 years (adjusted OR, 2.99; 95% CI, 1.03-8.67).

Conclusion

The relationship between early-life respiratory illnesses and asthma and atopy is complex and likely dependent on the type of infection and immune response it initiates.

Clinical implications

Certain respiratory illnesses in early life modify the risk of atopy and asthma at school age.

Section snippets

Study cohort

Five hundred five infants with a history of asthma or allergies in at least one parent were recruited between September 1994 and August 1996. Details of the screening process and eligibility criteria have been described in detail previously.19 Briefly, eligibility criteria included living within the limits of route 128, which surrounds the city of Boston; maternal age of 18 years or older; and history of allergies, asthma, or hay fever in either parent. Children were excluded if they were

Results

The characteristics of the 498 study subjects have been described in detail elsewhere.22 Of the 498 study participants, 440 (88.4%) were followed up to the age of 7 years, and 271 (54.4%) had an assessment of allergic sensitization at school age. Children who dropped out of the study before age 7 years were more likely to be of nonwhite ethnicity and to be from a family with an average household income of less than $30,000 per year (Table I). There were no significant differences in the

Discussion

Among children at risk for asthma and atopy, we found an inverse association between 2 physician-diagnosed illnesses (croup and recurrent ear infections) and atopy at school age.

Most studies of the relation between ear infections (eg, otitis media) and atopy have been cross-sectional.30, 31, 32 Tainio et al33 found a positive association between recurrent otitis media (≥5 episodes) in the first year of life and atopy at age 2 years; however, atopy was a combined end point consisting of asthma,

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  • Cited by (0)

    The Epidemiology of Home Allergens and Asthma Study is supported by National Institutes of Health (NIH) grant AIEHS35786 to Dr Gold. Dr Celedón is supported by NIH grants HL04370 and HL073373. Dr Ramsey is supported by the Department of Medicine of the University of Manitoba, a Canada sponsorship award, and NIH/National Heart, Lung, and Blood Institute Training grant 5 T32 HL07427.

    Disclosure of potential conflict of interest: The authors have declared that they have no conflict of interest.

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