Skip to main content
PMC home page
Thorax logoLink to Thorax
. 1999 Aug;54(8):664–669. doi: 10.1136/thx.54.8.664

Relationship between early life respiratory illness, family size over time, and the development of asthma and hay fever: a seven year follow up study

A Ponsonby 1, D Couper 1, T Dwyer 1, A Carmichael 1, A Kemp 1
PMCID: PMC1745551  PMID: 10413716

Abstract

BACKGROUND—The timing and mechanism of the inverse association between increasing sibling number and atopic disease are not yet understood. A study was undertaken to examine how family size at birth predicts early respiratory illness, to report the association between infant respiratory illness and childhood atopic disease, and to determine whether the protective effect of large family size operates during infancy or later childhood.
METHODS—A prospective follow up study was carried out on 863 children (78%) of 1111 participants in the Tasmanian Infant Health Survey performed in 1988. In 1988 household size and history of respiratory illness were obtained by parental interview at home (median age 35 days) and later by telephone (median age 85 days). In 1995asthma, hay fever, and household size were assessed by parental questionnaire in a large cross sectional survey.
RESULTS—In 1988 increasing resident number (per resident) (adjusted odds ratio (AOR) 1.17 (95% CI 1.05 to 1.31)) and resident density (AOR 1.77 (95% CI 1.07 to 2.94)) were related to parental report of an upper respiratory tract infection (URTI) by one month of age. Children with a reported URTI by home interview were more likely to have subsequent asthma (adjusted relative risk (ARR) 1.27 (95% CI 1.05 to 1.53)). The association between lower respiratory tract infection (LRTI) at telephone interview (relative risk (RR) 1.34 (95% CI 1.02 to 1.75) and asthma was reduced after adjustment for family history of asthma (ARR 1.27 (95% CI 0.98 to 1.66)). Antibiotic use by home interview was not associated with subsequent asthma or hay fever. Indicators of family size in 1988 were associated with hay fever but not asthma but, in contrast, resident number in 1995 was inversely associated with asthma (AOR 0.82 (95% CI 0.72 to 0.92) per resident) and hay fever (AOR 0.82 (95% CI 0.71to 0.96) per resident). Children with no siblings were at risk for current asthma, particularly if symptoms began after the age of four (RR 2.81 (95% CI 1.36 to 5.84)).
CONCLUSIONS—The apparent protective effect of large household size and asthma could not be explained by an increase in reported early respiratory illness. The first year of life may not be the most critical time for the protective effect of large household size to be mediated in relation to asthma, but this effect occurred by the seventh year of life.



Full Text

The Full Text of this article is available as a PDF (86.2 KB).

Selected References

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

  1. Asher M. I., Keil U., Anderson H. R., Beasley R., Crane J., Martinez F., Mitchell E. A., Pearce N., Sibbald B., Stewart A. W. International Study of Asthma and Allergies in Childhood (ISAAC): rationale and methods. Eur Respir J. 1995 Mar;8(3):483–491. doi: 10.1183/09031936.95.08030483. [DOI] [PubMed] [Google Scholar]
  2. Backman A., Björkstén F., Ilmonen S., Juntunen K., Suoniemi I. Do infections in infancy affect sensitization to airborne allergens and development of atopic disease? A retrospective study of seven-year-old children. Allergy. 1984 May;39(4):309–315. doi: 10.1111/j.1398-9995.1984.tb00867.x. [DOI] [PubMed] [Google Scholar]
  3. Bodner C., Godden D., Seaton A. Family size, childhood infections and atopic diseases. The Aberdeen WHEASE Group. Thorax. 1998 Jan;53(1):28–32. doi: 10.1136/thx.53.1.28. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Campbell D. E., Kemp A. S. Measles and atopy in African children. Lancet. 1996 Sep 21;348(9030):825–825. doi: 10.1016/s0140-6736(05)65244-0. [DOI] [PubMed] [Google Scholar]
  5. Campbell D. E., Kemp A. S. Proliferation and production of interferon-gamma (IFN-gamma) and IL-4 in response to Staphylococcus aureus and staphylococcal superantigen in childhood atopic dermatitis. Clin Exp Immunol. 1997 Feb;107(2):392–397. doi: 10.1111/j.1365-2249.1997.278-ce1172.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Forastiere F., Agabiti N., Corbo G. M., Dell'Orco V., Porta D., Pistelli R., Levenstein S., Perucci C. A. Socioeconomic status, number of siblings, and respiratory infections in early life as determinants of atopy in children. Epidemiology. 1997 Sep;8(5):566–570. doi: 10.1097/00001648-199709000-00015. [DOI] [PubMed] [Google Scholar]
  7. Gibson H. B., Silverstone H., Gandevia B., Hall G. J. Respiratory disorders in seven-year-old children in Tasmania. Aims, methods and administration of the survey. Med J Aust. 1969 Jul 26;2(4):201–205. [PubMed] [Google Scholar]
  8. Holt P. G. A potential vaccine strategy for asthma and allied atopic diseases during early childhood. Lancet. 1994 Aug 13;344(8920):456–458. doi: 10.1016/s0140-6736(94)91776-0. [DOI] [PubMed] [Google Scholar]
  9. Jarvis D., Chinn S., Luczynska C., Burney P. The association of family size with atopy and atopic disease. Clin Exp Allergy. 1997 Mar;27(3):240–245. [PubMed] [Google Scholar]
  10. Leeder S. R., Corkhill R., Irwig L. M., Holland W. W., Colley J. R. Influence of family factors on the incidence of lower respiratory illness during the first year of life. Br J Prev Soc Med. 1976 Dec;30(4):203–212. doi: 10.1136/jech.30.4.203. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Martinez F. D., Stern D. A., Wright A. L., Taussig L. M., Halonen M. Association of non-wheezing lower respiratory tract illnesses in early life with persistently diminished serum IgE levels. Group Health Medical Associates. Thorax. 1995 Oct;50(10):1067–1072. doi: 10.1136/thx.50.10.1067. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Matricardi P. M., Franzinelli F., Franco A., Caprio G., Murru F., Cioffi D., Ferrigno L., Palermo A., Ciccarelli N., Rosmini F. Sibship size, birth order, and atopy in 11,371 Italian young men. J Allergy Clin Immunol. 1998 Apr;101(4 Pt 1):439–444. doi: 10.1016/s0091-6749(98)70350-1. [DOI] [PubMed] [Google Scholar]
  13. Matricardi P. M., Rosmini F., Ferrigno L., Nisini R., Rapicetta M., Chionne P., Stroffolini T., Pasquini P., D'Amelio R. Cross sectional retrospective study of prevalence of atopy among Italian military students with antibodies against hepatitis A virus. BMJ. 1997 Apr 5;314(7086):999–1003. doi: 10.1136/bmj.314.7086.999. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Peat J. K., Britton W. J., Salome C. M., Woolcock A. J. Bronchial hyperresponsiveness in two populations of Australian schoolchildren. II. Relative importance of associated factors. Clin Allergy. 1987 Jul;17(4):283–290. doi: 10.1111/j.1365-2222.1987.tb02016.x. [DOI] [PubMed] [Google Scholar]
  15. Ponsonby A. L., Couper D., Dwyer T., Carmichael A. Cross sectional study of the relation between sibling number and asthma, hay fever, and eczema. Arch Dis Child. 1998 Oct;79(4):328–333. doi: 10.1136/adc.79.4.328. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Ponsonby A. L., Couper D., Dwyer T., Carmichael A., Wood-Baker R. Exercise-induced bronchial hyperresponsiveness and parental ISAAC questionnaire responses. Eur Respir J. 1996 Jul;9(7):1356–1362. doi: 10.1183/09031936.96.09071356. [DOI] [PubMed] [Google Scholar]
  17. Rona R. J., Duran-Tauleria E., Chinn S. Family size, atopic disorders in parents, asthma in children, and ethnicity. J Allergy Clin Immunol. 1997 Apr;99(4):454–460. doi: 10.1016/s0091-6749(97)70070-8. [DOI] [PubMed] [Google Scholar]
  18. Räsänen M., Laitinen T., Kaprio J., Koskenvuo M., Laitinen L. A. Hay fever, asthma and number of older siblings--a twin study. Clin Exp Allergy. 1997 May;27(5):515–518. [PubMed] [Google Scholar]
  19. Sears M. R., Holdaway M. D., Flannery E. M., Herbison G. P., Silva P. A. Parental and neonatal risk factors for atopy, airway hyper-responsiveness, and asthma. Arch Dis Child. 1996 Nov;75(5):392–398. doi: 10.1136/adc.75.5.392. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. 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]
  21. Shaw R., Woodman K., Ayson M., Dibdin S., Winkelmann R., Crane J., Beasley R., Pearce N. Measuring the prevalence of bronchial hyper-responsiveness in children. Int J Epidemiol. 1995 Jun;24(3):597–602. doi: 10.1093/ije/24.3.597. [DOI] [PubMed] [Google Scholar]
  22. 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]
  23. Sigurs N., Bjarnason R., Sigurbergsson F., Kjellman B., Björkstén B. Asthma and immunoglobulin E antibodies after respiratory syncytial virus bronchiolitis: a prospective cohort study with matched controls. Pediatrics. 1995 Apr;95(4):500–505. [PubMed] [Google Scholar]
  24. Strachan D. P., Harkins L. S., Johnston I. D., Anderson H. R. Childhood antecedents of allergic sensitization in young British adults. J Allergy Clin Immunol. 1997 Jan;99(1 Pt 1):6–12. doi: 10.1016/s0091-6749(97)70294-x. [DOI] [PubMed] [Google Scholar]
  25. 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]
  26. Strachan D. P., Taylor E. M., Carpenter R. G. Family structure, neonatal infection, and hay fever in adolescence. Arch Dis Child. 1996 May;74(5):422–426. doi: 10.1136/adc.74.5.422. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. d'Espaignet E. T., Dwyer T., Newman N. M., Ponsonby A. L., Candy S. G. The development of a model for predicting infants at high risk of sudden infant death syndrome in Tasmania. Paediatr Perinat Epidemiol. 1990 Oct;4(4):422–435. doi: 10.1111/j.1365-3016.1990.tb00670.x. [DOI] [PubMed] [Google Scholar]
  28. von Mutius E., Martinez F. D., Fritzsch C., Nicolai T., Reitmeir P., Thiemann H. H. Skin test reactivity and number of siblings. BMJ. 1994 Mar 12;308(6930):692–695. doi: 10.1136/bmj.308.6930.692. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Thorax are provided here courtesy of BMJ Publishing Group

RESOURCES