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. 2004 Oct;58(10):852–857. doi: 10.1136/jech.2003.019182

Infections, medication use, and the prevalence of symptoms of asthma, rhinitis, and eczema in childhood

C Cohet 1, S Cheng 1, C MacDonald 1, M Baker 1, S Foliaki 1, N Huntington 1, J Douwes 1, N Pearce 1
PMCID: PMC1763349  PMID: 15365112

Abstract

Background: The "hygiene hypothesis" postulates that infections during infancy may protect against asthma and atopy. There is also some evidence that antibiotic and/or paracetamol use may increase the risk of asthma.

Methods: The study measured the association between infections, and medication use early in life and the risk of asthma at age 6–7 years. It involved 1584 children who had been notified to public health services with serious infections at age 0–4 years, and 2539 children sampled from the general population. For both groups, postal questionnaires were completed by parents.

Results: There was little difference in the prevalence of current wheezing between the childhood infections group (prevalence = 23.5%) and the general population group (prevalence = 24.3%). There was also little difference whether the major site of infection was gastrointestinal (prevalence = 24.1%), invasive (prevalence = 24.6%) or respiratory (prevalence = 21.1%). However, in both groups, there were associations with antibiotic (OR = 1.78, 95% CI 1.49 to 2.14) or paracetamol (OR = 1.38, 95% CI 1.04 to 1.83) use in the first year of life or recent paracetamol use (OR = 2.10, 95% CI 1.78 to 2.49) and current wheezing. There was a weak protective effect of childhood infections in children who had not used antibiotics in the first year of life (OR = 0.78, 95% CI 0.55 to 1.10).

Conclusions: These findings are consistent with other evidence that antibiotic use early in life may increase the risk of asthma. They are also consistent with some preliminary evidence associating paracetamol use with an increased risk of asthma. Any protective effect of notifiable childhood infections was weak.

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Selected References

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  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. Asher M. I., Barry D., Clayton T., Crane J., D'Souza W., Ellwood P., Ford R. P., Mackay R., Mitchell E. A., Moyes C. The burden of symptoms of asthma, allergic rhinoconjunctivitis and atopic eczema in children and adolescents in six New Zealand centres: ISAAC Phase One. N Z Med J. 2001 Mar 23;114(1128):114–120. [PubMed] [Google Scholar]
  5. 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]
  6. Baker M. G., Martin D. R., Kieft C. E., Lennon D. A 10-year serogroup B meningococcal disease epidemic in New Zealand: descriptive epidemiology, 1991-2000. J Paediatr Child Health. 2001 Oct;37(5):S13–S19. doi: 10.1046/j.1440-1754.2001.00722.x. [DOI] [PubMed] [Google Scholar]
  7. Ball T. M., Castro-Rodriguez J. A., Griffith K. A., Holberg C. J., Martinez F. D., Wright A. L. Siblings, day-care attendance, and the risk of asthma and wheezing during childhood. N Engl J Med. 2000 Aug 24;343(8):538–543. doi: 10.1056/NEJM200008243430803. [DOI] [PubMed] [Google Scholar]
  8. Balzer B. Paracetamol and asthma. Thorax. 2000 Oct;55(10):882–884. [PubMed] [Google Scholar]
  9. Celedon Juan C., Wright Rosalind J., Litonjua Augusto A., Sredl Diane, Ryan Louise, Weiss Scott T., Gold Diane R. Day care attendance in early life, maternal history of asthma, and asthma at the age of 6 years. Am J Respir Crit Care Med. 2002 Nov 21;167(9):1239–1243. doi: 10.1164/rccm.200209-1063OC. [DOI] [PubMed] [Google Scholar]
  10. Celedón Juan C., Litonjua Augusto A., Ryan Louise, Weiss Scott T., Gold Diane R. Day care attendance, respiratory tract illnesses, wheezing, asthma, and total serum IgE level in early childhood. Arch Pediatr Adolesc Med. 2002 Mar;156(3):241–245. doi: 10.1001/archpedi.156.3.241. [DOI] [PubMed] [Google Scholar]
  11. Celedón Juan C., Litonjua Augusto A., Ryan Louise, Weiss Scott T., Gold Diane R. Lack of association between antibiotic use in the first year of life and asthma, allergic rhinitis, or eczema at age 5 years. Am J Respir Crit Care Med. 2002 Jul 1;166(1):72–75. doi: 10.1164/rccm.2109074. [DOI] [PubMed] [Google Scholar]
  12. Cooper P. J. Can intestinal helminth infections (geohelminths) affect the development and expression of asthma and allergic disease? Clin Exp Immunol. 2002 Jun;128(3):398–404. doi: 10.1046/j.1365-2249.2002.01908.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Cooper Philip J., Chico Martha E., Bland Martin, Griffin George E., Nutman Thomas B. Allergic symptoms, atopy, and geohelminth infections in a rural area of Ecuador. Am J Respir Crit Care Med. 2003 Apr 24;168(3):313–317. doi: 10.1164/rccm.200211-1320OC. [DOI] [PubMed] [Google Scholar]
  14. Douwes Jeroen, Pearce Neil. Asthma and the westernization 'package'. Int J Epidemiol. 2002 Dec;31(6):1098–1102. doi: 10.1093/ije/31.6.1098. [DOI] [PubMed] [Google Scholar]
  15. Droste J. H., Wieringa M. H., Weyler J. J., Nelen V. J., Vermeire P. A., Van Bever H. P. Does the use of antibiotics in early childhood increase the risk of asthma and allergic disease? Clin Exp Allergy. 2000 Nov;30(11):1547–1553. doi: 10.1046/j.1365-2222.2000.00939.x. [DOI] [PubMed] [Google Scholar]
  16. 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]
  17. Flynn M. G. Respiratory symptoms, bronchial responsiveness, and atopy in Fijian and Indian children. Am J Respir Crit Care Med. 1994 Aug;150(2):415–420. doi: 10.1164/ajrccm.150.2.8049824. [DOI] [PubMed] [Google Scholar]
  18. Grüber C., Kulig M., Bergmann R., Guggenmoos-Holzmann I., Wahn U., MAS-90 Study Group Delayed hypersensitivity to tuberculin, total immunoglobulin E, specific sensitization, and atopic manifestation in longitudinally followed early Bacille Calmette-Guérin-vaccinated and nonvaccinated children. Pediatrics. 2001 Mar;107(3):E36–E36. doi: 10.1542/peds.107.3.e36. [DOI] [PubMed] [Google Scholar]
  19. Holt P. G., Sly P. D., Björkstén B. Atopic versus infectious diseases in childhood: a question of balance? Pediatr Allergy Immunol. 1997 May;8(2):53–58. doi: 10.1111/j.1399-3038.1997.tb00145.x. [DOI] [PubMed] [Google Scholar]
  20. Illi S., von Mutius E., Lau S., Bergmann R., Niggemann B., Sommerfeld C., Wahn U., MAS Group Early childhood infectious diseases and the development of asthma up to school age: a birth cohort study. BMJ. 2001 Feb 17;322(7283):390–395. doi: 10.1136/bmj.322.7283.390. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. MANTEL N., HAENSZEL W. Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst. 1959 Apr;22(4):719–748. [PubMed] [Google Scholar]
  22. Martinez F. D., Holt P. G. Role of microbial burden in aetiology of allergy and asthma. Lancet. 1999 Sep;354 (Suppl 2):SII12–SII15. doi: 10.1016/s0140-6736(99)90437-3. [DOI] [PubMed] [Google Scholar]
  23. 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]
  24. Martinez Fernando D. Respiratory syncytial virus bronchiolitis and the pathogenesis of childhood asthma. Pediatr Infect Dis J. 2003 Feb;22(2 Suppl):S76–S82. doi: 10.1097/01.inf.0000053889.39392.a7. [DOI] [PubMed] [Google Scholar]
  25. 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]
  26. Matricardi P. M., Rosmini F., Riondino S., Fortini M., Ferrigno L., Rapicetta M., Bonini S. Exposure to foodborne and orofecal microbes versus airborne viruses in relation to atopy and allergic asthma: epidemiological study. BMJ. 2000 Feb 12;320(7232):412–417. doi: 10.1136/bmj.320.7232.412. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. 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]
  28. 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]
  29. McKeever Tricia M., Lewis Sarah A., Smith Chris, Hubbard Richard. The importance of prenatal exposures on the development of allergic disease: a birth cohort study using the West Midlands General Practice Database. Am J Respir Crit Care Med. 2002 Sep 15;166(6):827–832. doi: 10.1164/rccm.200202-158OC. [DOI] [PubMed] [Google Scholar]
  30. Mendall M. A., Kumar D. Antibiotic use, childhood affluence and irritable bowel syndrome (IBS). Eur J Gastroenterol Hepatol. 1998 Jan;10(1):59–62. doi: 10.1097/00042737-199801000-00011. [DOI] [PubMed] [Google Scholar]
  31. Nafstad P., Magnus P., Jaakkola J. J. Early respiratory infections and childhood asthma. Pediatrics. 2000 Sep;106(3):E38–E38. doi: 10.1542/peds.106.3.e38. [DOI] [PubMed] [Google Scholar]
  32. Newson R. B., Shaheen S. O., Chinn S., Burney P. G. Paracetamol sales and atopic disease in children and adults: an ecological analysis. Eur Respir J. 2000 Nov;16(5):817–823. doi: 10.1183/09031936.00.16581700. [DOI] [PubMed] [Google Scholar]
  33. Palmer Lyle J., Celedón Juan C., Weiss Scott T., Wang Binyan, Fang Zhian, Xu Xiping. Ascaris lumbricoides infection is associated with increased risk of childhood asthma and atopy in rural China. Am J Respir Crit Care Med. 2002 Jun 1;165(11):1489–1493. doi: 10.1164/rccm.2107020. [DOI] [PubMed] [Google Scholar]
  34. Pearce N., Douwes J., Beasley R. The rise and rise of asthma: a new paradigm for the new millennium? J Epidemiol Biostat. 2000;5(1):5–16. [PubMed] [Google Scholar]
  35. Scrivener S., Yemaneberhan H., Zebenigus M., Tilahun D., Girma S., Ali S., McElroy P., Custovic A., Woodcock A., Pritchard D. Independent effects of intestinal parasite infection and domestic allergen exposure on risk of wheeze in Ethiopia: a nested case-control study. Lancet. 2001 Nov 3;358(9292):1493–1499. doi: 10.1016/S0140-6736(01)06579-5. [DOI] [PubMed] [Google Scholar]
  36. 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]
  37. Shaheen S. O., Newson R. B., Sherriff A., Henderson A. J., Heron J. E., Burney P. G. J., Golding J., ALSPAC Study Team Paracetamol use in pregnancy and wheezing in early childhood. Thorax. 2002 Nov;57(11):958–963. doi: 10.1136/thorax.57.11.958. [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Shaheen S. O., Sterne J. A., Songhurst C. E., Burney P. G. Frequent paracetamol use and asthma in adults. Thorax. 2000 Apr;55(4):266–270. doi: 10.1136/thorax.55.4.266. [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. 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]
  40. Sigurs N., Bjarnason R., Sigurbergsson F., Kjellman B. Respiratory syncytial virus bronchiolitis in infancy is an important risk factor for asthma and allergy at age 7. Am J Respir Crit Care Med. 2000 May;161(5):1501–1507. doi: 10.1164/ajrccm.161.5.9906076. [DOI] [PubMed] [Google Scholar]
  41. 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]
  42. Strachan D., Sibbald B., Weiland S., Aït-Khaled N., Anabwani G., Anderson H. R., Asher M. I., Beasley R., Björkstén B., Burr M. Worldwide variations in prevalence of symptoms of allergic rhinoconjunctivitis in children: the International Study of Asthma and Allergies in Childhood (ISAAC). Pediatr Allergy Immunol. 1997 Nov;8(4):161–176. doi: 10.1111/j.1399-3038.1997.tb00156.x. [DOI] [PubMed] [Google Scholar]
  43. Wickens K., Pearce N., Crane J., Beasley R. Antibiotic use in early childhood and the development of asthma. Clin Exp Allergy. 1999 Jun;29(6):766–771. doi: 10.1046/j.1365-2222.1999.00536.x. [DOI] [PubMed] [Google Scholar]
  44. Williams H., Robertson C., Stewart A., Aït-Khaled N., Anabwani G., Anderson R., Asher I., Beasley R., Björkstén B., Burr M. Worldwide variations in the prevalence of symptoms of atopic eczema in the International Study of Asthma and Allergies in Childhood. J Allergy Clin Immunol. 1999 Jan;103(1 Pt 1):125–138. doi: 10.1016/s0091-6749(99)70536-1. [DOI] [PubMed] [Google Scholar]
  45. Wjst M., Hoelscher B., Frye C., Wichmann H. E., Dold S., Heinrich J. Early antibiotic treatment and later asthma. Eur J Med Res. 2001 Jun 28;6(6):263–271. [PubMed] [Google Scholar]
  46. Xu B., Pekkanen J., Järvelin M. R., Olsen P., Hartikainen A. L. Maternal infections in pregnancy and the development of asthma among offspring. Int J Epidemiol. 1999 Aug;28(4):723–727. doi: 10.1093/ije/28.4.723. [DOI] [PubMed] [Google Scholar]

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