Woodcock A, Lowe LA, Murray CS, et al. Early life environmental control: effect on symptoms, sensitization, and lung function at age 3 years

North West Lung Centre, Wythenshawe Hospital, Manchester M23 9LT, UK.
American Journal of Respiratory and Critical Care Medicine (Impact Factor: 13). 09/2004; 170(4):433-9. DOI: 10.1164/rccm.200401-083OC
Source: PubMed


We investigated whether environmental control during pregnancy and early life affects sensitization and lung function at the age of 3 years. High-risk children (n = 251) were prenatally randomized to stringent environmental control (active) or no intervention (control). Questionnaires, skin testing, IgE, and specific airway resistance (sRaw) measurement were completed at the age of 3 years. Children in the active group were significantly more frequently sensitized compared with control subjects (at least one allergen by skin tests: risk ratio, 1.61; 95% confidence interval [CI], 1.02-2.55; p = 0.04; mite by IgE: risk ratio, 2.85; 95% CI, 1.02-7.97; p = 0.05). However, sRaw was significantly better in the active group (kiloPascal/second, geometric mean [95% CI]: 1.05 [1.01-1.10] vs. 1.19 [1.13-1.25], p < 0.0001, active vs. control). Maximal flow at functional residual capacity was measured using rapid thoracic compression at the age of 4 weeks in a subgroup. Prospective lung function data (at infancy and 3 years) were obtained in 32 children (14 active and 18 control). There was no difference in infant lung function between the groups, but at 3 years, sRaw was significantly lower in the active compared with control children (p = 0.003). Stringent environmental control was associated with increased risk of mite sensitization but better results for some measurements of lung function in high-risk children at the age of 3 years.

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    • "Our reported adverse association between silt and wheeze would be consistent with an endotoxin mediated mechanism suggested by Braun-Fahrlander et al. (2002). Our reported association with silt provides an alternative explanation for the observation that stringent antenatal and early life dust mite eradication measures that reduce the level of house dust, whilst having minimal, if any effect on allergic sensitisation, has been reported to improve lung function (specific airway conductance) at age 3 years (Woodcock et al., 2004). Our findings raise the possibility that the beneficial effects of early life dust mite eradication may be a consequence of reductions in household silt. "
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    ABSTRACT: The increase in asthma and allergies has been attributed to declining exposure to environmental microorganisms. The main source of these is soil, the composition of which varies geographically and which is a major component (40-45%) of household dust. Our hypothesis-generating study aimed to investigate associations between soil components, respiratory health and allergy in a Scottish birth cohort. The cohort was recruited in utero in 1997/8, and followed up at one, two and five years for the development of wheezing, asthma and eczema. Lung function, exhaled nitric oxide and allergic sensitization were measured at age five in a subset. The Scottish Soils Database held at The James Hutton Institute was linked to the birth cohort data by the residential postcode at birth and five years. The soil database contained information on size separates, organic matter concentration, pH and a range of inorganic elements. Soil and clinical outcome data were available for 869, 790 and 727 children at one, two and five years. Three hundred and fifty nine (35%) of children had the same address at birth and five years. No associations were found between childhood outcomes and soil content in the residential area at age five. The soil silt content (2-20μm particle size) of the residential area at birth was associated with childhood wheeze (adjusted OR 1.20, 95% CI [1.05; 1.37]), wheeze without a cold (1.41 [1.18; 1.69]), doctor-diagnosed asthma (1.54 [1.04; 2.28]), lung function (FEV1: beta -0.025 [-0.047;-0.001]) and airway inflammation (FENO: beta 0.15 [0.03; 0.27]) at age five, but not with allergic status or eczema. Whilst residual confounding is the most likely explanation for the associations reported, the results of this study lead us to hypothesise that early life exposure to residential soil silt may adversely influence childhood respiratory health, possibly because of the organic components of silt.
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    • "Thus, organisms exposed to immunotoxicants in utero exhibit heightened immune and inflammatory activation, often expressed as autoimmune diseases (Holladay, 1999). Children born from mothers exposed to allergens during pregnancy exhibit greater allergic responses, but also improved respiratory function (Woodcock et al., 2004). Potentiated responses to environmental stimuli could add a significant advantage in organisms for survival in the adverse environmental conditions by enabling early detection of threats, and escape from them. "
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    Full-text · Article · Apr 2013 · Journal of Physiology-Paris
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    • "The role of allergen exposure in pregnancy and early life as a risk factor for subsequent allergic disease has been the subject of much debate. While observational studies suggest that high levels of exposure to house dust mite (HDM) allergen increase risk of allergic disease [1,2], intervention studies that reduce HDM allergen levels have failed to show any reduction in asthma or allergic disease outcomes [3-5]. Similarly, there is insufficient evidence to either recommend pet keeping, or removal, for prevention of allergic disease [6,7]. "
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