Abstract
Background: For many years it has been assumed that the risk of childhood respiratory allergies is related to allergen exposures in early life. There are, however, few prospective data in support. We aimed to examine this relationship in a representative cohort of children born in Ashford, Kent (UK).
Methods: 625 children (94% of those eligible) were followed from birth to the age of 5.5 years at which time 552 underwent skin prick testing to extracts of house dust mite and cat fur allergens. Maternal reports of wheeze in the last year were collected by interview. These outcomes were related to individual domestic concentrations of Der p 1 and Fel d I allergens estimated from dust collection at the age of 8 weeks.
Results: 10% of children were sensitised to house dust mite or cat at age 5.5 years; 7% had atopic wheeze. No significant relationships between allergen exposure and either sensitisation or wheeze were found but, on examination, the exposure-response relationships for both allergens and for each outcome rose steeply at low levels of exposure and were attenuated at high levels of exposure. These patterns were modified by paternal atopy and by birth order.
Conclusions: There are no linear relationships between early allergen exposure and the induction of childhood respiratory allergy; rather, the risks of IgE sensitisation and asthma rise at very low levels of exposure and are attenuated thereafter. These patterns are influenced by parental atopy and birth order. These findings suggest important gene-environment interactions in the development of atopy and asthma and imply that reductions in domestic allergen exposure alone are unlikely to have a major impact in decreasing the incidence of these diseases in childhood.
Full Text
The Full Text of this article is available as a PDF (132.0 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Atkinson W., Harris J., Mills P., Moffat S., White C., Lynch O., Jones M., Cullinan P., Newman Taylor A. J. Domestic aeroallergen exposures among infants in an English town. Eur Respir J. 1999 Mar;13(3):583–589. doi: 10.1183/09031936.99.13358599. [DOI] [PubMed] [Google Scholar]
- Cullinan P., Cook A., Gordon S., Nieuwenhuijsen M. J., Tee R. D., Venables K. M., McDonald J. C., Taylor A. J. Allergen exposure, atopy and smoking as determinants of allergy to rats in a cohort of laboratory employees. Eur Respir J. 1999 May;13(5):1139–1143. doi: 10.1034/j.1399-3003.1999.13e33.x. [DOI] [PubMed] [Google Scholar]
- Heinrich Joachim, Hölscher Bernd, Douwes Jeroen, Richter Kai, Koch Andrea, Bischof Wolfgang, Fahlbusch Bärbel, Kinne Raimund W., Wichmann H-Erich, INGA Study Group Reproducibility of allergen, endotoxin and fungi measurements in the indoor environment. J Expo Anal Environ Epidemiol. 2003 Mar;13(2):152–160. doi: 10.1038/sj.jea.7500267. [DOI] [PubMed] [Google Scholar]
- Kalra S., Crank P., Hepworth J., Pickering C. A., Woodcock A. A. Absence of seasonal variation in concentrations of the house dust mite allergen Der p1 in south Manchester homes. Thorax. 1992 Nov;47(11):928–931. doi: 10.1136/thx.47.11.928. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Kuehr J., Frischer T., Karmaus W., Meinert R., Barth R., Schraub S., Daschner A., Urbanek R., Forster J. Natural variation in mite antigen density in house dust and relationship to residential factors. Clin Exp Allergy. 1994 Mar;24(3):229–237. doi: 10.1111/j.1365-2222.1994.tb00224.x. [DOI] [PubMed] [Google Scholar]
- Kuehr J., Frischer T., Meinert R., Barth R., Forster J., Schraub S., Urbanek R., Karmaus W. Mite allergen exposure is a risk for the incidence of specific sensitization. J Allergy Clin Immunol. 1994 Jul;94(1):44–52. doi: 10.1016/0091-6749(94)90070-1. [DOI] [PubMed] [Google Scholar]
- 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]
- Pearce N., Douwes J., Beasley R. Is allergen exposure the major primary cause of asthma? Thorax. 2000 May;55(5):424–431. doi: 10.1136/thorax.55.5.424. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Platts-Mills T., Vaughan J., Squillace S., Woodfolk J., Sporik R. Sensitisation, asthma, and a modified Th2 response in children exposed to cat allergen: a population-based cross-sectional study. Lancet. 2001 Mar 10;357(9258):752–756. doi: 10.1016/S0140-6736(00)04168-4. [DOI] [PubMed] [Google Scholar]
- 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]
- Stayner Leslie, Steenland Kyle, Dosemeci Mustafa, Hertz-Picciotto Irva. Attenuation of exposure-response curves in occupational cohort studies at high exposure levels. Scand J Work Environ Health. 2003 Aug;29(4):317–324. doi: 10.5271/sjweh.737. [DOI] [PubMed] [Google Scholar]
- Sunyer J., Antó J. M., Harris J., Torrent M., Vall O., Cullinan P., Newman-Taylor A., AMICS study. Asthma Multi-centre Infants Cohort Study Maternal atopy and parity. Clin Exp Allergy. 2001 Sep;31(9):1352–1355. doi: 10.1046/j.1365-2222.2001.01187.x. [DOI] [PubMed] [Google Scholar]
- Svanes C., Jarvis D., Chinn S., Burney P. Childhood environment and adult atopy: results from the European Community Respiratory Health Survey. J Allergy Clin Immunol. 1999 Mar;103(3 Pt 1):415–420. doi: 10.1016/s0091-6749(99)70465-3. [DOI] [PubMed] [Google Scholar]
- Wahn U., Lau S., Bergmann R., Kulig M., Forster J., Bergmann K., Bauer C. P., Guggenmoos-Holzmann I. Indoor allergen exposure is a risk factor for sensitization during the first three years of life. J Allergy Clin Immunol. 1997 Jun;99(6 Pt 1):763–769. doi: 10.1016/s0091-6749(97)80009-7. [DOI] [PubMed] [Google Scholar]