title: Early childhood environment related to microbial exposure and the occurrence of atopic disease at school age.
abstract: BACKGROUND
  There is a growing body of evidence that the early childhood environment with respect to day care attendance, older siblings, pet ownership, and early life airway infections may protect from developing atopic disease. Few studies have distinguished between atopic sensitization and symptoms, and none have evaluated independent contributions for all of these different environmental conditions.
  
  
  OBJECTIVE
  Examine independent effects on atopic sensitization and symptoms of day care attendance, older siblings, pet ownership, and early infancy's airway disease.
  
  
  METHODS
  A cross-sectional survey among 8-13-year-old school children with complete data for 1555 children.
  
  
  RESULTS
  After adjustment for confounders, atopic sensitization occurred less frequently in children that had attended a day care centre (OR: 0.73, 95% CI: 0.55-0.98) or had a cat or dog before 2 years of age (OR: 0.78, 95% CI: 0.61-0.99). Having older siblings yielded a nonsignificant trend towards protection (OR: 0.88, 95% CI: 0.70-1.11). For symptoms, there was no relation with having older sibs, day care attendance and pet ownership, although there was a trend towards protection for the combination of atopy and symptoms. In contrast, children with doctors' treated airway disease before age 2, more frequently reported recent symptoms of wheeze, asthma, rhinitis, or dermatitis (all P < 0.05).
  
  
  CONCLUSIONS
  Early life environmental exposure to day care, or pets may protect against atopic sensitization. Protection against symptoms only occurred if atopic sensitization was present as well.
authors.affiliation: Institute for Risk Assessment Sciences, Environmental and Occupational Health, Utrecht University, Utrecht, The Netherlands.
authors.forename: G
authors.initials: G
authors.lastname: de Meer
authors.forename: N A H
authors.initials: NA
authors.lastname: Janssen
authors.forename: B
authors.initials: B
authors.lastname: Brunekreef
mesh_terms: D000391:Air Microbiology; D000818:Animals; D000829:Animals, Domestic; D002415:Cats; D002648:Child; D002656:Child Day Care Centers; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004285:Dogs; D004781:Environmental Exposure; D006801:Humans; D006967:Hypersensitivity / Q000453:epidemiology* / Q000503:physiopathology / Q000517:prevention & control; D015994:Incidence