The prevalence of and risk factors for atopy in early childhood: A whole population birth cohort study,☆☆,,★★

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Abstract

Objectives: A birth cohort was followed-up to age 4 years to record the development of allergic disorders and to study the influence of genetic and environmental factors. Methods: Information on family history and environmental factors was obtained at birth, and serum cord IgE was measured. At age 4 years, 1218 children were reviewed. Results: By age 4 years, 27% of the children had symptoms of allergic disease. Period prevalence of asthma increased from 8.7% in infancy to 14.9% at 4 years. Family history of atopy was the single most important risk factor for atopy in children. Sibling atopy was a stronger predictor of clinical disease than maternal or paternal atopy, whereas paternal atopy, male sex, and high cord IgE were significant for the development of allergen sensitization. Children of asthmatic mothers were three times more likely to have asthma (odds ratio [OR]: 3.0, 95% confidence interval [CI]: 1.6-5.8) and rhinitis (OR: 2.9, CI: 1.1-7.4). Formula feeding before 3 months of age predisposed to asthma at age 4 years (OR: 1.8, CI: 1.2-2.6). The effect of maternal smoking on childhood wheeze seen at 1 and 2 years was lost by age 4, except for a subgroup with negative skin test responses (nonatopic asthma). Less than half (46%) of the infantile wheezers were still wheezing at 4 years of age. Conclusion: Family history of atopy remains the most important risk factor for atopy in children, but other markers can be identified with a potential for intervention at an early age.

Section snippets

Study population

Fifteen hundred thirty six children born consecutively on the Isle of Wight between January 1989 and February 1990 were included prenatally in a prospective cohort study. After excluding perinatal deaths, adoptions, and refusals, 1456 babies were available for follow-up. The findings at age 1 and 2 years have been reported.4, 18, 19 At birth, cord serum total IgE was measured in a majority by using an enzyme immunoassay (EIA ULTRA; Pharmacia Diagnostics AB, Uppsala, Sweden).4 At age 4 years,

Results

Twelve hundred eighteen children (83.6% of the original cohort) were seen after their fourth birthday, and 981 (80.5%) underwent skin prick tests. There was no selective loss from follow-up because the prevalence of atopy in 169 children seen at age 2 but not at 4 years was similar to the prevalence for the whole cohort at 2 years (23% vs 23.4%). Fig. 1 gives the period prevalence of atopic disorders at 1, 2, and 4 years and the cumulative prevalence for those assessed at all three follow-up

DISCUSSION

Studies recording the evolution of disease from birth over a prolonged period are often marred by a gradual loss of subjects.5, 7, 22 Over 80% of the Isle of Wight cohort was reviewed at the age of 4 years, and a majority underwent skin prick tests. Ambiguities over the definition of asthma, especially during infancy and early childhood, make the estimates of prevalence unreliable and render comparisons between studies difficult. In this study the cumulative prevalence of asthma by the age of 4

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    From the David Hide Asthma & Allergy Research Centre, St. Mary's Hospital, Newport, Isle of Wight.

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    Supported by the Isle of Wight Health Authority Trust Fund.

    Reprint requests: Syed Hasan Arshad, DM, MRCP, The David Hide Asthma & Allergy Research Centre, St. Mary's Hospital, Newport, Isle of Wight PO30 5TG, United Kingdom.

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