Birth by cesarean section, allergic rhinitis, and allergic sensitization among children with a parental history of atopy. J Allergy Clin Immunol

Division of Immunology, Children's Hospital Boston, Boston, Mass, USA.
The Journal of allergy and clinical immunology (Impact Factor: 11.48). 07/2008; 122(2):274-9. DOI: 10.1016/j.jaci.2008.05.007
Source: PubMed


Cesarean delivery can alter neonatal immune responses and increase the risk of atopy. Studies of the relation between cesarean delivery and allergic diseases in children not selected on the basis of a family history of atopy have yielded inconsistent findings.
We sought to examine the relation between birth by cesarean delivery and atopy and allergic diseases in children at risk for atopy.
We examined the relation between mode of delivery and the development of atopy and allergic diseases among 432 children with a parental history of atopy followed from birth to age 9 years. Asthma was defined as physician-diagnosed asthma and wheeze in the previous year, and allergic rhinitis was defined as physician-diagnosed allergic rhinitis and naso-ocular symptoms apart from colds in the previous year. Atopy was considered present at school age if there was 1 or more positive skin test response or specific IgE to common allergens. Stepwise logistic regression was used to study the relation between cesarean delivery and the outcomes of interest.
After adjustment for other covariates, children born by cesarean section had 2-fold higher odds of atopy than those born by vaginal delivery (odds ratio, 2.1; 95% CI, 1.1-3.9). In multivariate analyses birth by cesarean section was significantly associated with increased odds of allergic rhinitis (odds ratio, 1.8; 95% CI, 1.0-3.1) but not with asthma.
Our findings suggest that cesarean delivery is associated with allergic rhinitis and atopy among children with a parental history of asthma or allergies. This could be explained by lack of contact with the maternal vaginal/fecal flora or reduced/absent labor during cesarean delivery.

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Available from: Elaine Borland Hoffman, PhD, Oct 01, 2015
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    • "Some studies have shown an increased risk for atopy in children born by Caesarean section (Maitra et al., 2004; Renz-Polster et al., 2005; Salam et al., 2006; Pistiner et al., 2008; Kolokotroni et al., 2012), leaving them at an increased risk for hypersensitivity (Pistiner et al., 2008; Kolokotroni et al., 2012) but the relationship is not straightforward. Kolokotroni et al. found an increased risk of atopy in children born by caesarean section only for families with a history of allergic disease (Kolokotroni et al., 2012). "
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    ABSTRACT: Preterm birth occurs in 11% of live births globally and accounts for 35% of all newborn deaths. Preterm newborns have immature immune systems, with reduced innate and adaptive immunity; their immune systems may be further compromised by various factors associated with preterm birth. The immune systems of preterm infants have a smaller pool of monocytes and neutrophils, impaired ability of these cells to kill pathogens, and lower production of cytokines which limits T cell activation and reduces the ability to fight bacteria and detect viruses in cells, compared to term infants. Intrauterine inflammation is a major contributor to preterm birth, and causes premature immune activation and cytokine production. This can induce immune tolerance leading to reduced newborn immune function. Intrauterine inflammation is associated with an increased risk of early-onset sepsis and likely has long-term adverse immune consequences. Requisite medical interventions further impact on immune development and function. Antenatal corticosteroid treatment to prevent newborn respiratory disease is routine but may be immunosuppressive, and has been associated with febrile responses, reductions in lymphocyte proliferation and cytokine production, and increased risk of infection. Invasive medical procedures result in an increased risk of late-onset sepsis. Respiratory support can cause chronic inflammatory lung disease associated with increased risk of long-term morbidity. Colonization of the infant by microorganisms at birth is a significant contributor to the establishment of the microbiome. Caesarean section affects infant colonization, potentially contributing to lifelong immune function and well-being. Several factors associated with preterm birth alter immune function. A better understanding of perinatal modification of the preterm immune system will allow for the refinement of care to minimize lifelong adverse immune consequences.
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    • "It is possible that this association may be different in the atopic and non-atopic asthma phenotypes since research evidence suggests that risk factors associated with asthma might be different for each asthma phenotype. Indeed, the results of a more recent longitudinal study [22], showed that C/S delivery was positively associated with allergic rhinitis and atopy, but not asthma, among 432 children aged 9 years with a parental history of atopic diseases,. Interestingly, another prospective study from the Netherlands followed 2917 children from birth to 8 years of age and showed that the association of C/S delivery with asthma was stronger in children of two atopic parents than in children of non-allergic parents whilst in contrast to the previous study, no association was shown with atopy [23]. "
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    ABSTRACT: Background Studies on the association of birth by caesarean section (C/S) and allergies have produced conflicting findings. Furthermore, evidence on whether this association may differ in those at risk of atopy is limited. This study aims to investigate the association of mode of delivery with asthma and atopic sensitization and the extent to which any effect is modified by family history of allergies. Methods Asthma outcomes were assessed cross-sectionally in 2216 children at age 8 on the basis of parents’ responses to the ISAAC questionnaire whilst skin prick tests to eleven aeroallergens were also performed in a subgroup of 746 children. Adjusted odds ratios of asthma and atopy by mode of delivery were estimated in multivariable logistic models while evidence of effect modification was examined by introducing interaction terms in the models. Results After adjusting for potential confounders, children born by C/S appeared significantly more likely than those born vaginally to report ever wheezing (OR 1.36, 95% CI 1.07-1.71), asthma diagnosis (OR 1.41, 95% CI 1.09-1.83) and be atopic (OR 1.67, 95% CI 1.08-2.60). There was modest evidence that family history of allergies may modify the effect of C/S delivery on atopy (p for effect modification=0.06) but this was not the case for the asthma outcomes. Specifically, while more than a two-fold increase in the odds of being a topic was observed in children with a family history of allergies if born by C/S (OR 2.62, 95% CI 1.38-5.00), no association was observed in children without a family history of allergies (OR 1.16, 95% CI 0.64-2.11). Conclusions Birth by C/S is associated with asthma and atopic sensitization in childhood. The association of C/S and atopy appears more pronounced in children with family history of allergies.
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    • "Modern sanitation and water treatment practices, the widespread use of antibiotics, modern practices in obstetrics (e.g., delivery by caesarian section and the use of antiseptics), and the use of substitutes for mother's milk, have all profoundly affected the microbiome. These changes almost certainly contribute to hyperimmune-associated disease [24] [25], but it is profound changes in colonization of the gut by helminths rather than changes in colonization of the gut by microorganisms that has been identified as the single most important factor impacting epidemics of hyperimmune-associated disease [26] [27] [28] [29]. Helminths interact in a complex manner with the immune system of the host as well as with the microorganisms of the human biome, forming a key component of the highly interdependent network normally associated with the human biome (Fig. 1). "
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