Farm environment in childhood prevents the development of allergies.
BACKGROUND
A protective effect of infections in early life might explain the firmly reported finding of an inverse association between atopic disorders and large sibships.


OBJECTIVE
To study the effect of childhood farm, rural non-farm and urban environment, as well as family size and other factors on the occurrence of asthma, wheezing and atopic disorders up to young adulthood.


METHODS
Data on lifetime prevalence of physician-diagnosed asthma, allergic rhinitis and/or allergic conjunctivitis, atopic dermatitis, as well as self-reported episodic wheezing from 10 667 Finnish first-year university students aged 18-24 years were collected by a postal questionnaire. Associations of lifetime prevalence of the diseases with living on a farm, in a rural non-farm and urban environment during childhood were estimated by logistic regression analysis. Adjustment was made for potential confounding by gender, parental atopy, parental education, number of older siblings, day care outside the home and passive smoking.


RESULTS
The childhood farm environment independently reduced the risk for physician-diagnosed allergic rhinitis and/or allergic conjunctivitis (adjusted odds ratio 0.63, 95% CI 0.50-0.79, P < 0.001), and for diagnosed asthma and episodic wheezing analysed together (OR 0.71, 95% CI 0.54-0.93, P < 0.05), but not for atopic dermatitis during lifetime. Urban childhood environment did not show independent increased risk when compared with rural non-farm residence. The inverse association of sibship size with the occurrence of allergic rhinitis and/or allergic conjunctivitis was found among subjects with one (OR 0.86, 95% CI 0.77-0.96, P < 0.01) or at least four older siblings (OR 0.47, 95% CI 0.26-0.84, P < 0.05).


CONCLUSIONS
Childhood farm environment seems to have a protective effect against allergic rhinitis and/or conjunctivitis, and more weakly against asthma and wheezing irrespective of family size. Environmental exposure to immune modulating agents, such as environmental mycobacteria and actinomycetes, favouring manifestation of a nonatopic phenotype could explain the finding.
Kilpeläinen
M
M
Departments of Pulmonary Diseases and Clinical Allergology, University of Turku, Finland. maritta.kilpelainen@utu.fi
Terho
E O
EO
Helenius
H
H
Koskenvuo
M
M
D000293:Adolescent; D000328:Adult; D001249:Asthma / Q000453:epidemiology; D003233:Conjunctivitis, Allergic / Q000453:epidemiology; D003876:Dermatitis, Atopic / Q000453:epidemiology; D005191:Family Characteristics; D005260:Female; D006801:Humans; D006967:Hypersensitivity / Q000453:epidemiology*; D016015:Logistic Models; D008297:Male; D012221:Rhinitis, Allergic, Perennial / Q000453:epidemiology; D012307:Risk Factors; D012423:Rural Health; D011795:Surveys and Questionnaires; D014504:Urban Health