Frequency of infections and risk of asthma, atopy and airway hyperresponsiveness in children

The role of repeated infections early in life in the development of childhood asthma and allergies has not been clarified. The aim of this study was to investigate the effect of repeated episodes of fever and antibiotic treatments during the first years of life on the prevalence of asthma, bronchial hyperresponsiveness (BHR), and atopy at school age in a representative population. Random samples of schoolchildren aged 5-7 yrs (n=7,545) and 9-11 yrs (n=7,498) were studied using the International Study of Asthma and Allergies in Childhood (ISAAC) phase II protocol. To assess the prevalence of disease and early childhood exposures, parental questionnaires were administered (response rates 82.2% and 85.3%, respectively). In addition, children underwent skin prick tests, hypertonic saline challenge and blood sampling for the measurement of serum immunoglobulin (Ig)E. Repeated episodes of fever and antibiotic treatment in early life were strongly associated with the prevalence of asthma (odds ratio (OR)=7.95; 95% confidence interval (CI) 6.02-10.50) and current wheeze at school age. Within asthmatic children the number of fever episodes and antibiotic courses were strongly inversely related to the prevalence of atopy (OR=0.25; 95% CI 0.11-0.54 for skin test reactivity) and BHR (OR=0.31; 95% CI 0.10-0.92). Furthermore, asthmatic children with recurrent early childhood infections were at a lower risk of being symptomatic at school age. When considering atopic and nonatopic asthmatic children separately, the highest risk of asthma with repeated early childhood infections was found for nonatopic asthma (OR=24.29; 95% Cl 11.86-49.76). These findings suggest that a subgroup of children with a triggering or inducing of asthmatic symptoms through repeated early childhood infections exists within the "asthma syndrome" which has a better prognosis and is less related to the atopic phenotype.

This article has been cited by other articles:

				M-J. Martel, E. Rey, M-F. Beauchesne, J-L. Malo, S. Perreault, A. Forget, and L. Blais Control and severity of asthma during pregnancy are associated with asthma incidence in offspring: two-stage case-control study Eur. Respir. J., September 1, 2009; 34(3): 579 - 587. [Abstract] [Full Text] [PDF]

				K M Eastham, D M Hammal, L Parker, and D A Spencer A follow-up study of children hospitalised with community-acquired pneumonia Arch. Dis. Child., September 1, 2008; 93(9): 755 - 759. [Abstract] [Full Text] [PDF]

				A. M. Hughes, S. Crouch, T. Lightfoot, P. Ansell, J. Simpson, and E. Roman Eczema, Birth Order, and Infection Am. J. Epidemiol., May 15, 2008; 167(10): 1182 - 1187. [Abstract] [Full Text] [PDF]

				A. L. Kozyrskyj, P. Ernst, and A. B. Becker Increased Risk of Childhood Asthma From Antibiotic Use in Early Life Chest, June 1, 2007; 131(6): 1753 - 1759. [Abstract] [Full Text] [PDF]

				I. Kummeling, F. F. Stelma, P. C. Dagnelie, B. E. P. Snijders, J. Penders, M. Huber, R. van Ree, P. A. van den Brandt, and C. Thijs Early Life Exposure to Antibiotics and the Subsequent Development of Eczema, Wheeze, and Allergic Sensitization in the First 2 Years of Life: The KOALA Birth Cohort Study Pediatrics, January 1, 2007; 119(1): e225 - e231. [Abstract] [Full Text] [PDF]

				N. P. Ly, S. L. Rifas-Shiman, A. A. Litonjua, A. O. Tzianabos, B. Schaub, B. Ruiz-Perez, K. G. Tantisira, P. W. Finn, M. W. Gillman, S. T. Weiss, et al. Cord Blood Cytokines and Acute Lower Respiratory Illnesses in the First Year of Life Pediatrics, January 1, 2007; 119(1): e171 - e178. [Abstract] [Full Text] [PDF]

				F. Marra, L. Lynd, M. Coombes, K. Richardson, M. Legal, J. M. FitzGerald, and C. A. Marra Does Antibiotic Exposure During Infancy Lead to Development of Asthma?: A Systematic Review and Metaanalysis Chest, March 1, 2006; 129(3): 610 - 618. [Abstract] [Full Text] [PDF]

				P. Nafstad, B. Brunekreef, A. Skrondal, and W. Nystad Early Respiratory Infections, Asthma, and Allergy: 10-Year Follow-up of the Oslo Birth Cohort Pediatrics, August 1, 2005; 116(2): e255 - e262. [Abstract] [Full Text] [PDF]

				K. Eldeirawi and V. W. Persky History of Ear Infections and Prevalence of Asthma in a National Sample of Children Aged 2 to 11 Years: The Third National Health and Nutrition Examination Survey, 1988 to 1994 Chest, May 1, 2004; 125(5): 1685 - 1692. [Abstract] [Full Text] [PDF]

				P Cullinan, J Harris, P Mills, S Moffat, C White, J Figg, A Moon, and A J Newman Taylor Early prescriptions of antibiotics and the risk of allergic disease in adults: a cohort study Thorax, January 1, 2004; 59(1): 11 - 15. [Abstract] [Full Text] [PDF]

				P. Cullinan, J.M. Harris, A.J. Newman Taylor, M. Jones, P. Taylor, J.R. Dave, P. Mills, S.A. Moffat, C.W. White, J.K. Figg, et al. Can early infection explain the sibling effect in adult atopy? Eur. Respir. J., December 1, 2003; 22(6): 956 - 961. [Abstract] [Full Text] [PDF]

				F Nja, W Nystad, O Hetlevik, K C Lodrup Carlsen, and K-H Carlsen Airway infections in infancy and the presence of allergy and asthma in school age children Arch. Dis. Child., July 1, 2003; 88(7): 566 - 569. [Abstract] [Full Text] [PDF]

				C. Cole Johnson, D. R. Ownby, E. M. Zoratti, S. Hensley Alford, L. K. Williams, and C. L. M. Joseph Environmental Epidemiology of Pediatric Asthma and Allergy Epidemiol. Rev., December 1, 2002; 24(2): 154 - 175. [Full Text] [PDF]

				C Svanes, D Jarvis, S Chinn, E Omenaas, A Gulsvik, and P Burney Early exposure to children in family and day care as related to adult asthma and hay fever: results from the European Community Respiratory Health Survey Thorax, November 1, 2002; 57(11): 945 - 950. [Abstract] [Full Text] [PDF]

				T. M. McKeever, S. A. Lewis, C. Smith, and R. Hubbard 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., September 15, 2002; 166(6): 827 - 832. [Abstract] [Full Text]

				M. Calvani Jr, C. Alessandri, and E. Bonci Fever episodes in early life and the development of atopy in children with asthma Eur. Respir. J., August 1, 2002; 20(2): 391 - 396. [Abstract] [Full Text] [PDF]

				M. N. Hylkema, W. Timens, M. Luinge, N. van der Werf, and M. O. Hoekstra The Effect of Bacillus Calmette-Guerin Immunization Depends on the Genetic Predisposition to Th2-Type Responsiveness Am. J. Respir. Cell Mol. Biol., August 1, 2002; 27(2): 244 - 249. [Abstract] [Full Text] [PDF]

				J. C. Celedon, A. A. Litonjua, L. Ryan, S. T. Weiss, and D. R. Gold 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., July 1, 2002; 166(1): 72 - 75. [Abstract] [Full Text] [PDF]

				W.H. Oddy, N.H. de Klerk, P.D. Sly, and P.G. Holt The effects of respiratory infections, atopy, and breastfeeding on childhood asthma Eur. Respir. J., May 1, 2002; 19(5): 899 - 905. [Abstract] [Full Text] [PDF]

				M H de Jong, V T M Scharp-Van Der Linden, R Aalberse, H S A Heymans, and B Brunekreef The effect of brief neonatal exposure to cows' milk on atopic symptoms up to age 5 Arch. Dis. Child., May 1, 2002; 86(5): 365 - 369. [Abstract] [Full Text] [PDF]

				A. E. Varner The Increase in Allergic Respiratory Diseases : Survival of the Fittest? Chest, April 1, 2002; 121(4): 1308 - 1316. [Abstract] [Full Text] [PDF]

				W Karmaus and C Botezan Does a higher number of siblings protect against the development of allergy and asthma? A review J Epidemiol Community Health, March 1, 2002; 56(3): 209 - 217. [Abstract] [Full Text] [PDF]

				H. Renz and U. Herz The bidirectional capacity of bacterial antigens to modulate allergy and asthma Eur. Respir. J., January 1, 2002; 19(1): 158 - 171. [Abstract] [Full Text] [PDF]

				E. Rönmark, E. Jönsson, T. Platts-Mills, and B. Lundbäck Incidence and Remission of Asthma in Schoolchildren: Report From the Obstructive Lung Disease in Northern Sweden Studies Pediatrics, March 1, 2001; 107(3): 37e - 37. [Abstract] [Full Text]

				E von Mutius Paediatric origins of adult lung disease {bullet} 6: Paediatric origins of adult lung disease Thorax, February 1, 2001; 56(2): 153 - 157. [Full Text]

				S H Downs, G B Marks, R Sporik, E G Belosouva, N G Car, and J K Peat Continued increase in the prevalence of asthma and atopy Arch. Dis. Child., January 1, 2001; 84(1): 20 - 23. [Abstract] [Full Text]

				P. Nafstad, P. Magnus, and J. J. K. Jaakkola Early Respiratory Infections and Childhood Asthma Pediatrics, September 1, 2000; 106(3): 38e - 38. [Abstract] [Full Text]

				E. VON MUTIUS Statistical/Design Methods Am. J. Respir. Crit. Care Med., August 1, 2000; 162(2): S34 - 35. [Full Text] [PDF]

				S. Stick Paediatric origins of adult lung disease bullet 1: The contribution of airway development to paediatric and adult lung disease Thorax, July 1, 2000; 55(7): 587 - 594. [Full Text]

				C Bodner, W J Anderson, T S Reid, and D J Godden Childhood exposure to infection and risk of adult onset wheeze and atopy Thorax, May 1, 2000; 55(5): 383 - 387. [Abstract] [Full Text]

				P. M Matricardi, F. Rosmini, S. Riondino, M. Fortini, L. Ferrigno, M. Rapicetta, and S. Bonini Exposure to foodborne and orofecal microbes versus airborne viruses in relation to atopy and allergic asthma: epidemiological study BMJ, February 12, 2000; 320(7232): 412 - 417. [Abstract] [Full Text]