Tobacco smoke exposure and allergic sensitization in children: A propensity score analysis

Department of Public Health Sciences Division of Allergy and Clinical Immunology, Henry Ford Hospital, Detroit, Michigan Department of Pediatrics, Georgia Health Sciences University, Augusta, Georgia, USA.
Respirology (Impact Factor: 3.35). 05/2012; 17(7):1068-72. DOI: 10.1111/j.1440-1843.2012.02201.x
Source: PubMed


Background and objective: There is conflicting evidence of the effect of environmental tobacco smoke (ETS) on the development of allergic diseases in children. Studies have shown that this relationship differs depending on maternal history of the disease. We employed the rigour of propensity score methods to assess this relationship using data from a birth cohort.
Methods: Using n = 662 children from the Wayne County Health, Environment, Allergy and Asthma Longitudinal Study, we assessed the relationship between early-life ETS and subsequent allergic sensitization via a positive skin prick test (SPT+) or at least one specific immunoglobulin E (IgE) ≥ 0.35 (sIgE+) in children aged 2–3 years. Propensity score estimation followed by full and nearest neighbour matching was compared with standard multivariable regression models.
Results: Among children without a maternal history of allergic disease, ETS was positively associated with allergic sensitization in children with an adjusted odds ratio (aOR) for SPT+ of 2.32 (95% confidence interval (CI): 1.28–4.22) and the aOR for sIgE+ was 2.53 (95% CI: 1.43–4.48). Contrarily, for children with a positive maternal history, the aOR for SPT+ and sIgE+ was 0.56 (95% CI: 0.24–1.32) and 0.43 (95% CI: 0.20–0.91), respectively.
Conclusions: Using propensity score methods to rigorously control for confounding factors, ETS exposure was found to reduce the risk of allergic sensitization in children with a positive maternal history. There is a strong association between early-life ETS and the development of allergic sensitization for children aged 2–3 years without maternal history.

Download full-text


Available from: Jerel Ezell, Jun 24, 2015
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Despite the well publicised health effects of passive smoking, many young children are still exposed to cigarette smoke in the home. Exposure to environmental tobacco smoke (ETS) often begins in-utero, due to maternal smoking, and continues during childhood if parents or regular visitors smoke. Worldwide, the prevalence of smoking during pregnancy varies between less than 10% to over 30%, and although smoking amongst pregnant women and women of child bearing age are decreasing in some countries, they are increasing in others © 2012 The Authors. Respirology © 2012 Asian Pacific Society of Respirology.
    Respirology 08/2012; 17(7):1029-30. DOI:10.1111/j.1440-1843.2012.02241.x · 3.35 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Purpose of review: There is increasing evidence that the prenatal window represents a critical period in which the developing immune system may be primed toward an allergic phenotype. Studies have investigated the role of a number of maternal environmental exposures on subsequent allergic disorders in the offspring. We summarize findings from recent studies on prenatal environmental factors influencing IgE levels, atopy, and early asthma. Recent findings: A building literature supports the influence of maternal exposure to environmental pollutants, such as allergens, traffic-related air pollution, tobacco smoke, and organochlorine compounds and social factors on allergic outcomes. More novel associations have been investigated, such as the effect of prenatal exposures to phthalates, bisphenol A, and magnetic fields. There is also rising interest in epigenetics as a pathway of action by which maternal exposure affect immune health. Summary: Emerging research highlights the challenges of investigating in-utero exposures and of relating exposures to such a heterogeneous and complex outcome as allergic disease. Further research is needed on the mechanisms by which prenatal exposure influences allergic response in childhood and how postnatal, familial and social factors, and sex can modify disease outcomes. Epigenetics is a promising new frontier, and likely one of several explanatory factors.
    Current Opinion in Allergy and Clinical Immunology 02/2013; 13(2). DOI:10.1097/ACI.0b013e32835e82d3 · 3.57 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Asthma and COPD continue to have considerable impact on disease burden and mortality world-wide. Early diagnosis still remains a challenge, with low uptake of spirometry in many countries. Implementing best practice management for airways disease is a critical goal for health care systems - the management now includes pharmacological and non-pharmacological approaches to the lung disease, as well as recognition and treatment of comorbidities. Finally the pathogenesis of airways disease continues to be fertile field of investigation, in order to better prevent disease, slow progression, and identify relevant biomarkers. A large number of studies published in Respirology in 2012 have addressed all of these important clinical and scientific issues, and made major contributions to advance this field and hopefully improve outcomes for patients with asthma and COPD.
    Respirology 04/2013; 18(3). DOI:10.1111/resp.12049 · 3.35 Impact Factor
Show more