Exposure to birch pollen in infancy and development of atopic disease in childhood

doi:10.1067/mai.2002.125829

Journal of Allergy and Clinical Immunology

Volume 110, Issue 1, July 2002, Pages 78-84

https://doi.org/10.1067/mai.2002.125829 Get rights and content

Abstract

Background: The relationship between early allergen exposure, sensitization, and development of atopic disease remains controversial. In 1993, extremely high levels of birch pollen were recorded in Stockholm, Sweden, creating the unique opportunity to study children with different exposures during infancy. Objective: We sought to assess the influence of early high-dose exposure to an inhalant allergen (birch pollen) on sensitization and development of atopic disease in children. Methods: A total of 583 children with atopic heredity born in Stockholm in February through April 1992, 1993, or 1994 were investigated at age 4.5 to 5 years. The children were examined and underwent skin prick testing with inhalant and food allergens. IgE antibodies (RAST) against birch pollen and recombinant birch pollen allergen (rBet v 1) were analyzed in serum. Results: The children born in 1993 (high-dose exposure at 0-3 months) were more often sensitized (ie, positive skin prick test response) to birch pollen than the children born in 1994 (low-dose exposure; 17.8% and 8.8%, respectively; odds ratio [OR], 2.4; 95% CI, 1.2-4.6). A tendency in the same direction was seen for children born in 1992 (high-dose exposure at 12-15 months; OR, 1.7; 95% CI, 0.9-3.2). The results were supported by the RAST analyses. The prevalence of bronchial asthma, allergic rhinoconjunctivitis, and atopic dermatitis did not differ between the birth-year groups. However, the prevalence of pollen- and animal dander-induced allergic asthma was increased in the children born in 1993 (OR, 2.6; 95% CI, 1.2-5.6). An interaction between early high-dose exposure to birch pollen and cat in the household was suggested for sensitization to cat (P = .06). Conclusion: Exposure to high levels of birch pollen in infancy increases the risk of sensitization to the same allergen, as well as the risk of allergic asthma. (J Allergy Clin Immunol 2002;110:78-84.)

Section snippets

Study population

Children living in southwestern Stockholm (Brännkyrka, Skärholmen, Hägersten, Huddinge, and Botkyrka municipalities) and born in Stockholm County between February and April 1992, 1993, or 1994 were investigated (Table I).

. Selection of children for the study

Empty Cell	High-dose exposure to birch at 1 y of age in children born in 1992	High-dose exposure to birch at 0-3 mo in children born in 1993	Low-dose exposure to birch at 0-3 mo in children born in 1994
Screening stage
Selected for screening	735	781	721

Results

The total pollen counts for the 3 spring seasons reported in Stockholm were as follows: 1992, 2194; 1993, 26,805; and 1994, 435 counts/m³ air (Fig 1).

. Total pollen counts for the 3 spring seasons: 1992, 2194; 1993, 26,805; and 1994, 435 counts/m³ air.

The 583 children participating in the study included 283 boys and 300 girls. The mean age at examination was 4.9 years (range, 4.7-5.2 years). Demographic data are presented in Table II.

. Demographic data and risk factors for atopic disease in

Discussion

This study demonstrated a dose-dependent relationship between exposure to airborne birch pollen during infancy and sensitization to the same allergen in children, assessed by the prevalence of positive SPT responses. The RAST analysis against birch pollen and rBet v 1 supported these results. The cumulative incidence of allergic asthma (ie, asthma caused by exposure to pollen, animal dander, or both) was increased in high-dose compared with low-dose exposed children. Thus in this specific group

Acknowledgements

We thank Kerstin Sundell-Celicel and Monica Nordlund for excellent assistance, The Swedish Museum of Natural History, Palynological Laboratory, for supporting the pollen records and Pharmacia Diagnostic AB for supply of reagents. Anne Kihlström, Gunilla Hedlin, Gunnar Lilja, and Göran Pershagen were all involved in planning the study, data analysis, and manuscript preparation. Anne Kihlström did the clinical part of the study. Anne Kihlström, Gunilla Hedlin, and Gunnar Lilja did pediatric

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^☆: Supported by the Swedish Foundation for Health Care Sciences and Allergy Research, the Swedish Asthma and Allergy Association, the Consul Th C Berg's Foundation, the Swedish Order of Freemasons, and the Samariten Foundation.

^☆☆: Reprint requests: Anne Kihlström, MD, Department of Paediatrics B57, Huddinge University Hospital, S-14186 Stockholm, Sweden.

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Asthma, Rhinitis, Other Respiratory DiseasesExposure to birch pollen in infancy and development of atopic disease in childhood☆,☆☆

Abstract

Section snippets

Study population

Results

Discussion

Acknowledgements

Lancet

Lancet

J Allergy Clin Immunol

J Allergy Clin Immunol

Lancet

Lancet

Respir Med

Worldwide variation in prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and atopic eczema: ISAAC. The International Study of Asthma and Allergies in Childhood (ISAAC) Steering Committee

Lancet

Increase of asthma, allergic rhinitis and eczema in Swedish schoolchildren between 1979 and 1991 [see comments]

Clin Exp Allergy

Atopic sensitization and respiratory symptoms among Polish and Swedish school children

Clin Exp Allergy

Prevalence of respiratory and atopic disorders among children in the East and West of Germany five years after unification

Eur Respir J

Exposure to endotoxin or other bacterial components might protect against the development of atopy

Clin Exp Allergy

Prevalence of allergy in children in relation to prior BCG vaccination and infection with atypical mycobacteria

Allergy

Prevalence of hay fever and allergic sensitization in farmer's children and their peers living in the same rural community. SCARPOL team. Swiss Study on Childhood Allergy and Respiratory Symptoms with Respect to Air Pollution

Clin Exp Allergy

Indoor environmental risk factors in young asthmatics: a case-control study

Arch Dis Child

Does early exposure to cat or dog protect against later allergy development?

Clin Exp Allergy

Dependence of immediate hypersensitivity on the month of birth

Clin Allergy

Asthma, Rhinitis, Other Respiratory Diseases
Exposure to birch pollen in infancy and development of atopic disease in childhood☆,☆☆