Skip to main content
PMC home page
Archives of Disease in Childhood logoLink to Archives of Disease in Childhood
. 2005 Jun;90(6):567–573. doi: 10.1136/adc.2004.051714

Timing of routine immunisations and subsequent hay fever risk

S Bremner 1, I Carey 1, S DeWilde 1, N Richards 1, W Maier 1, S Hilton 1, D Strachan 1, D Cook 1
PMCID: PMC1720414  PMID: 15908618

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.

Full Text

The Full Text of this article is available as a PDF (136.0 KB).

Figure 1.

Figure 1

Open in a new tab

 Odds of hay fever by age (in months) at 3rd DTP. Estimated odds ratios with 95% CI. Arrow represents upper confidence limit off scale. Vaccination in month 5 is base group. None represents unvaccinated.

Figure 2.

Figure 2

Open in a new tab

 Odds of hay fever by age (in months) at MMR. Estimated odds ratios with 95% CI. Vaccination in month 14 is base group. None represents unvaccinated.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aaby P., Shaheen S. O., Heyes C. B., Goudiaby A., Hall A. J., Shiell A. W., Jensen H., Marchant A. Early BCG vaccination and reduction in atopy in Guinea-Bissau. Clin Exp Allergy. 2000 May;30(5):644–650. doi: 10.1046/j.1365-2222.2000.00803.x. [DOI] [PubMed] [Google Scholar]
  2. Alm J. S., Lilja G., Pershagen G., Scheynius A. Early BCG vaccination and development of atopy. Lancet. 1997 Aug 9;350(9075):400–403. doi: 10.1016/S0140-6736(97)02207-1. [DOI] [PubMed] [Google Scholar]
  3. Alm J. S., Swartz J., Lilja G., Scheynius A., Pershagen G. Atopy in children of families with an anthroposophic lifestyle. Lancet. 1999 May 1;353(9163):1485–1488. doi: 10.1016/S0140-6736(98)09344-1. [DOI] [PubMed] [Google Scholar]
  4. Anderson H. R., Poloniecki J. D., Strachan D. P., Beasley R., Björkstén B., Asher M. I., ISAAC Phase 1 Study Group Immunization and symptoms of atopic disease in children: results from the International Study of Asthma and Allergies in Childhood. Am J Public Health. 2001 Jul;91(7):1126–1129. doi: 10.2105/ajph.91.7.1126. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Benn Christine Stabell, Melbye Mads, Wohlfahrt Jan, Björkstén Bengt, Aaby Peter. Cohort study of sibling effect, infectious diseases, and risk of atopic dermatitis during first 18 months of life. BMJ. 2004 Apr 30;328(7450):1223–1223. doi: 10.1136/bmj.38069.512245.FE. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Bremner S. A., Carey I. M., DeWilde S., Richards N., Maier W. C., Hilton S. R., Strachan D. P., Cook D. G. Early-life exposure to antibacterials and the subsequent development of hayfever in childhood in the UK: case-control studies using the General Practice Research Database and the Doctors' Independent Network. Clin Exp Allergy. 2003 Nov;33(11):1518–1525. doi: 10.1046/j.1365-2222.2003.01794.x. [DOI] [PubMed] [Google Scholar]
  7. Burney P. The changing prevalence of asthma? Thorax. 2002 Oct;57 (Suppl 2):II36–II39. [PMC free article] [PubMed] [Google Scholar]
  8. DeWilde S., Carey I. M., Bremner S. A., Richards N., Hilton S. R., Cook D. G. Evolution of statin prescribing 1994-2001: a case of agism but not of sexism? Heart. 2003 Apr;89(4):417–421. doi: 10.1136/heart.89.4.417. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Farooqi I. S., Hopkin J. M. Early childhood infection and atopic disorder. Thorax. 1998 Nov;53(11):927–932. doi: 10.1136/thx.53.11.927. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. 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 Dec;12(6):296–311. doi: 10.1034/j.1399-3038.2001.1r046.x. [DOI] [PubMed] [Google Scholar]
  11. Grüber Christoph, Illi Sabina, Lau Susanne, Nickel Renate, Forster Johannes, Kamin Wolfgang, Bauer Carl-Peter, Wahn Volker, Wahn Ulrich, MAS-90 Study Group Transient suppression of atopy in early childhood is associated with high vaccination coverage. Pediatrics. 2003 Mar;111(3):e282–e288. doi: 10.1542/peds.111.3.e282. [DOI] [PubMed] [Google Scholar]
  12. Grüber Christoph, Meinlschmidt Gerhard, Bergmann Renate, Wahn Ulrich, Stark Klaus. Is early BCG vaccination associated with less atopic disease? An epidemiological study in German preschool children with different ethnic backgrounds. Pediatr Allergy Immunol. 2002 Jun;13(3):177–181. doi: 10.1034/j.1399-3038.2002.01006.x. [DOI] [PubMed] [Google Scholar]
  13. Hopkin J. M. The rise of atopy and links to infection. Allergy. 2002;57 (Suppl 72):5–9. doi: 10.1034/j.1398-9995.57.s72.8.x. [DOI] [PubMed] [Google Scholar]
  14. Hurwitz E. L., Morgenstern H. Effects of diphtheria-tetanus-pertussis or tetanus vaccination on allergies and allergy-related respiratory symptoms among children and adolescents in the United States. J Manipulative Physiol Ther. 2000 Feb;23(2):81–90. [PubMed] [Google Scholar]
  15. Jansen V. A. A., Stollenwerk N., Jensen H. J., Ramsay M. E., Edmunds W. J., Rhodes C. J. Measles outbreaks in a population with declining vaccine uptake. Science. 2003 Aug 8;301(5634):804–804. doi: 10.1126/science.1086726. [DOI] [PubMed] [Google Scholar]
  16. Kemp T., Pearce N., Fitzharris P., Crane J., Fergusson D., St George I., Wickens K., Beasley R. Is infant immunization a risk factor for childhood asthma or allergy? Epidemiology. 1997 Nov;8(6):678–680. doi: 10.1097/00001648-199710000-00011. [DOI] [PubMed] [Google Scholar]
  17. Krause Tyra G., Hviid Anders, Koch Anders, Friborg Jeppe, Hjuler Thomas, Wohlfahrt Jan, Olsen Ove Rosing, Kristensen Bjarne, Melbye Mads. BCG vaccination and risk of atopy. JAMA. 2003 Feb 26;289(8):1012–1015. doi: 10.1001/jama.289.8.1012. [DOI] [PubMed] [Google Scholar]
  18. Lewis S. A., Britton J. R. Measles infection, measles vaccination and the effect of birth order in the aetiology of hay fever. Clin Exp Allergy. 1998 Dec;28(12):1493–1500. doi: 10.1046/j.1365-2222.1998.00436.x. [DOI] [PubMed] [Google Scholar]
  19. Maitra Anirban, Sherriff Andrea, Griffiths Mansel, Henderson John, Avon Longitudinal Study of Parents and Children Study Team Pertussis vaccination in infancy and asthma or allergy in later childhood: birth cohort study. BMJ. 2004 Mar 19;328(7445):925–926. doi: 10.1136/bmj.38045.858889.EB. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Matricardi P. M., Ronchetti R. Are infections protecting from atopy? Curr Opin Allergy Clin Immunol. 2001 Oct;1(5):413–419. doi: 10.1097/01.all.0000011054.18314.67. [DOI] [PubMed] [Google Scholar]
  21. Matricardi Paolo Maria, Rosmini Francesco, Panetta Valentina, Ferrigno Luigina, Bonini Sergio. Hay fever and asthma in relation to markers of infection in the United States. J Allergy Clin Immunol. 2002 Sep;110(3):381–387. doi: 10.1067/mai.2002.126658. [DOI] [PubMed] [Google Scholar]
  22. McKeever Tricia M., Lewis Sarah A., Smith Chris, Collins Juliet, Heatlie Heath, Frischer Martin, Hubbard Richard. 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 Jan;109(1):43–50. doi: 10.1067/mai.2002.121016. [DOI] [PubMed] [Google Scholar]
  23. Nilsson Lennart, Kjellman N-I Max, Bjorksten Bengt. Allergic disease at the age of 7 years after pertussis vaccination in infancy: results from the follow-up of a randomized controlled trial of 3 vaccines. Arch Pediatr Adolesc Med. 2003 Dec;157(12):1184–1189. doi: 10.1001/archpedi.157.12.1184. [DOI] [PubMed] [Google Scholar]
  24. Offit Paul A., Hackett Charles J. Addressing parents' concerns: do vaccines cause allergic or autoimmune diseases? Pediatrics. 2003 Mar;111(3):653–659. doi: 10.1542/peds.111.3.653. [DOI] [PubMed] [Google Scholar]
  25. Paunio M., Heinonen O. P., Virtanen M., Leinikki P., Patja A., Peltola H. Measles history and atopic diseases: a population-based cross-sectional study. JAMA. 2000 Jan 19;283(3):343–346. doi: 10.1001/jama.283.3.343. [DOI] [PubMed] [Google Scholar]
  26. Pershagen G. Can immunization affect the development of allergy? Pediatr Allergy Immunol. 2000;11 (Suppl 13):26–28. doi: 10.1034/j.1399-3038.2000.00507.x. [DOI] [PubMed] [Google Scholar]
  27. Shaheen S. O., Aaby P., Hall A. J., Barker D. J., Heyes C. B., Shiell A. W., Goudiaby A. Measles and atopy in Guinea-Bissau. Lancet. 1996 Jun 29;347(9018):1792–1796. doi: 10.1016/s0140-6736(96)91617-7. [DOI] [PubMed] [Google Scholar]
  28. Shirakawa T., Enomoto T., Shimazu S., Hopkin J. M. The inverse association between tuberculin responses and atopic disorder. Science. 1997 Jan 3;275(5296):77–79. doi: 10.1126/science.275.5296.77. [DOI] [PubMed] [Google Scholar]
  29. Strachan D. P. Family size, infection and atopy: the first decade of the "hygiene hypothesis". Thorax. 2000 Aug;55 (Suppl 1):S2–10. doi: 10.1136/thorax.55.suppl_1.s2. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Strachan D. P. Hay fever, hygiene, and household size. BMJ. 1989 Nov 18;299(6710):1259–1260. doi: 10.1136/bmj.299.6710.1259. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Strannegård I. L., Larsson L. O., Wennergren G., Strannegård O. Prevalence of allergy in children in relation to prior BCG vaccination and infection with atypical mycobacteria. Allergy. 1998 Mar;53(3):249–254. doi: 10.1111/j.1398-9995.1998.tb03884.x. [DOI] [PubMed] [Google Scholar]
  32. Upton M. N., McConnachie A., McSharry C., Hart C. L., Smith G. D., Gillis C. R., Watt G. C. Intergenerational 20 year trends in the prevalence of asthma and hay fever in adults: the Midspan family study surveys of parents and offspring. BMJ. 2000 Jul 8;321(7253):88–92. doi: 10.1136/bmj.321.7253.88. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Wjst M., Dold S., Reitmeir P., Fritzsch C., von Mutius E., Thiemann H. H. Pertussis infection and allergic sensitization. Ann Allergy. 1994 Nov;73(5):450–454. [PubMed] [Google Scholar]
  34. Wong G. W., Hui D. S., Tam C. M., Chan H. H., Fok T. F., Chan-Yeung M., Lai C. K. Asthma, atopy and tuberculin responses in Chinese schoolchildren in Hong Kong. Thorax. 2001 Oct;56(10):770–773. doi: 10.1136/thorax.56.10.770. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Archives of Disease in Childhood are provided here courtesy of BMJ Publishing Group

RESOURCES