Skip to main content
PMC home page
Thorax logoLink to Thorax
. 2003 Jun;58(6):489–493. doi: 10.1136/thorax.58.6.489

Primary prevention of asthma and atopy during childhood by allergen avoidance in infancy: a randomised controlled study

S Arshad 1, B Bateman 1, S Matthews 1
PMCID: PMC1746711  PMID: 12775858

Abstract

Background: Recent increases in the prevalence of asthma and atopy emphasise the need for devising effective methods for primary prevention in children at high risk of atopy.

Method: A birth cohort of genetically at risk infants was recruited in 1990 to a randomised controlled study. Allergen avoidance measures were instituted from birth in the prophylactic group (n=58). Infants were either breast fed with mother on a low allergen diet or given an extensively hydrolysed formula. Exposure to house dust mite was reduced by the use of an acaricide and mattress covers. The control group (n=62) followed standard advice as normally given by the health visitors. At age 8, all 120 children completed a questionnaire and 110 (92%) had all assessments (skin prick test, spirometry, and bronchial challenges).

Results: In the prophylactic group eight children (13.8%) had current wheeze compared with 17 (27.4%) in the control group (p=0.08). Respective figures were eight (13.8%) and 20 (32.3%) for nocturnal cough (p=0.02) and 11 of 55 (20.0%) and 29 of 62 (46.8%) for atopy (p=0.003). After adjusting for confounding variables, the prophylactic group was found to be at a significantly reduced risk for current wheeze (odds ratio (OR) 0.26 (95% confidence interval (CI) 0.07 to 0.96)), nocturnal cough (OR 0.22 (95% CI 0.06 to 0.83)), asthma as defined by wheeze and bronchial hyperresponsiveness (OR 0.11 (95% CI 0.01 to 1.02)), and atopy (OR 0.21 (95% CI 0.07 to 0.62)).

Conclusion: Strict allergen avoidance in infancy in high risk children reduces the development of allergic sensitisation to house dust mite. Our results suggest that this may prevent some cases of childhood asthma.

Full Text

The Full Text of this article is available as a PDF (99.9 KB).

Selected References

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

  1. Aberg N., Hesselmar B., Aberg B., Eriksson B. Increase of asthma, allergic rhinitis and eczema in Swedish schoolchildren between 1979 and 1991. Clin Exp Allergy. 1995 Sep;25(9):815–819. doi: 10.1111/j.1365-2222.1995.tb00023.x. [DOI] [PubMed] [Google Scholar]
  2. Arshad S. H., Matthews S., Gant C., Hide D. W. Effect of allergen avoidance on development of allergic disorders in infancy. Lancet. 1992 Jun 20;339(8808):1493–1497. doi: 10.1016/0140-6736(92)91260-f. [DOI] [PubMed] [Google Scholar]
  3. Chai H., Farr R. S., Froehlich L. A., Mathison D. A., McLean J. A., Rosenthal R. R., Sheffer A. L., Spector S. L., Townley R. G. Standardization of bronchial inhalation challenge procedures. J Allergy Clin Immunol. 1975 Oct;56(4):323–327. doi: 10.1016/0091-6749(75)90107-4. [DOI] [PubMed] [Google Scholar]
  4. Chan-Yeung M., Manfreda J., Dimich-Ward H., Ferguson A., Watson W., Becker A. A randomized controlled study on the effectiveness of a multifaceted intervention program in the primary prevention of asthma in high-risk infants. Arch Pediatr Adolesc Med. 2000 Jul;154(7):657–663. doi: 10.1001/archpedi.154.7.657. [DOI] [PubMed] [Google Scholar]
  5. Custovic A., Simpson B. M., Simpson A., Kissen P., Woodcock A., NAC Manchester Asthma and Allergy Study Group Effect of environmental manipulation in pregnancy and early life on respiratory symptoms and atopy during first year of life: a randomised trial. Lancet. 2001 Jul 21;358(9277):188–193. doi: 10.1016/S0140-6736(01)05406-X. [DOI] [PubMed] [Google Scholar]
  6. Dold S., Wjst M., von Mutius E., Reitmeir P., Stiepel E. Genetic risk for asthma, allergic rhinitis, and atopic dermatitis. Arch Dis Child. 1992 Aug;67(8):1018–1022. doi: 10.1136/adc.67.8.1018. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Hide D. W., Arshad S. H., Twiselton R., Stevens M. Cord serum IgE: an insensitive method for prediction of atopy. Clin Exp Allergy. 1991 Nov;21(6):739–743. doi: 10.1111/j.1365-2222.1991.tb03204.x. [DOI] [PubMed] [Google Scholar]
  8. Hide D. W., Matthews S., Matthews L., Stevens M., Ridout S., Twiselton R., Gant C., Arshad S. H. Effect of allergen avoidance in infancy on allergic manifestations at age two years. J Allergy Clin Immunol. 1994 May;93(5):842–846. doi: 10.1016/0091-6749(94)90375-1. [DOI] [PubMed] [Google Scholar]
  9. Hide D. W., Matthews S., Tariq S., Arshad S. H. Allergen avoidance in infancy and allergy at 4 years of age. Allergy. 1996 Feb;51(2):89–93. [PubMed] [Google Scholar]
  10. Høst A., Husby S., Osterballe O. A prospective study of cow's milk allergy in exclusively breast-fed infants. Incidence, pathogenetic role of early inadvertent exposure to cow's milk formula, and characterization of bovine milk protein in human milk. Acta Paediatr Scand. 1988 Sep;77(5):663–670. doi: 10.1111/j.1651-2227.1988.tb10727.x. [DOI] [PubMed] [Google Scholar]
  11. Kjellman N. I. Prediction and prevention of atopic allergy. Allergy. 1998;53(45 Suppl):67–71. doi: 10.1111/j.1398-9995.1998.tb04943.x. [DOI] [PubMed] [Google Scholar]
  12. Lau S., Illi S., Sommerfeld C., Niggemann B., Bergmann R., von Mutius E., Wahn U. Early exposure to house-dust mite and cat allergens and development of childhood asthma: a cohort study. Multicentre Allergy Study Group. Lancet. 2000 Oct 21;356(9239):1392–1397. doi: 10.1016/s0140-6736(00)02842-7. [DOI] [PubMed] [Google Scholar]
  13. O'Connor G., Sparrow D., Taylor D., Segal M., Weiss S. Analysis of dose-response curves to methacholine. An approach suitable for population studies. Am Rev Respir Dis. 1987 Dec;136(6):1412–1417. doi: 10.1164/ajrccm/136.6.1412. [DOI] [PubMed] [Google Scholar]
  14. Pearce N., Pekkanen J., Beasley R. How much asthma is really attributable to atopy? Thorax. 1999 Mar;54(3):268–272. doi: 10.1136/thx.54.3.268. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Peat J. K., Li J. Reversing the trend: reducing the prevalence of asthma. J Allergy Clin Immunol. 1999 Jan;103(1 Pt 1):1–10. doi: 10.1016/s0091-6749(99)70517-8. [DOI] [PubMed] [Google Scholar]
  16. Peat J. K., Toelle B. G., Gray E. J., Haby M. M., Belousova E., Mellis C. M., Woolcock A. J. Prevalence and severity of childhood asthma and allergic sensitisation in seven climatic regions of New South Wales. Med J Aust. 1995 Jul 3;163(1):22–26. doi: 10.5694/j.1326-5377.1995.tb126083.x. [DOI] [PubMed] [Google Scholar]
  17. Ridout S., Twiselton R., Matthews S., Stevens M., Matthews L., Arshad S. H., Hide D. W. Acarosan and the Acarex test in the control of house dust mite allergens in the home. Br J Clin Pract. 1993 May-Jun;47(3):141–144. [PubMed] [Google Scholar]
  18. Saarinen U. M., Kajosaari M. Breastfeeding as prophylaxis against atopic disease: prospective follow-up study until 17 years old. Lancet. 1995 Oct 21;346(8982):1065–1069. doi: 10.1016/s0140-6736(95)91742-x. [DOI] [PubMed] [Google Scholar]
  19. Sears M. R., Burrows B., Flannery E. M., Herbison G. P., Holdaway M. D. Atopy in childhood. I. Gender and allergen related risks for development of hay fever and asthma. Clin Exp Allergy. 1993 Nov;23(11):941–948. doi: 10.1111/j.1365-2222.1993.tb00279.x. [DOI] [PubMed] [Google Scholar]
  20. Sporik R., Holgate S. T., Platts-Mills T. A., Cogswell J. J. Exposure to house-dust mite allergen (Der p I) and the development of asthma in childhood. A prospective study. N Engl J Med. 1990 Aug 23;323(8):502–507. doi: 10.1056/NEJM199008233230802. [DOI] [PubMed] [Google Scholar]
  21. Wahn U., von Mutius E. Childhood risk factors for atopy and the importance of early intervention. J Allergy Clin Immunol. 2001 Apr;107(4):567–574. doi: 10.1067/mai.2001.112943. [DOI] [PubMed] [Google Scholar]
  22. Zeiger R. S., Heller S., Mellon M. H., Forsythe A. B., O'Connor R. D., Hamburger R. N., Schatz M. Effect of combined maternal and infant food-allergen avoidance on development of atopy in early infancy: a randomized study. J Allergy Clin Immunol. 1989 Jul;84(1):72–89. doi: 10.1016/0091-6749(89)90181-4. [DOI] [PubMed] [Google Scholar]

Articles from Thorax are provided here courtesy of BMJ Publishing Group

RESOURCES