Breast-feeding, aeroallergen sensitization, and environmental exposures during infancy are determinants of childhood allergic rhinitis.
BACKGROUND
Infant predictors of early childhood allergic rhinitis (AR) are poorly understood.


OBJECTIVE
We sought to identify environmental exposures and host factors during infancy that predict AR at age 3 years.


METHODS
High-risk children from greater Cincinnati were followed annually from ages 1 to 3 years. AR was defined as sneezing, runny, or blocked nose in the prior 12 months and a positive skin prick test (SPT) response to 1 or more aeroallergens. Environmental and standardized medical questionnaires determined exposures and clinical outcomes. Primary activity area dust samples were analyzed for house dust endotoxin (HDE) and (1-3)-beta-D-glucan. Fine particulate matter sampled at 27 monitoring stations was used to estimate personal elemental carbon attributable to traffic exposure by using a land-use regression model.


RESULTS
Of 361 children in this analysis, 116 had AR, and 245 were nonatopic and nonsymptomatic. Prolonged breast-feeding in African American children (adjusted odds ratio [aOR], 0.8; 95% CI, 0.6-0.9) and multiple children in the home during infancy was protective against AR (aOR, 0.4; 95% CI, 0.2-0.8). Food SPT response positivity and tree SPT response positivity in infancy increased the risk of AR at age 3 years (aOR of 4.4 [95% CI, 2.1-9.2] and aOR of 6.8 [95% CI, 2.5-18.7], respectively). HDE exposure was associated with AR; the effect was dependent on exposure level. Elemental carbon attributable to traffic and environmental tobacco smoke exposure showed no effect on AR.


CONCLUSIONS
Prolonged breast-feeding in African American subjects and multiple children in the home during infancy reduced the risk of AR at age 3 years. SPT response positivity to food and tree allergens enhanced risk. The HDE effect on AR was related to exposure.
Codispoti
Christopher D
CD
Department of Internal Medicine, Division of Immunology, Allergy and Rheumatology, University of Cincinnati, Cincinnati, Ohio 4267-0563, USA.
Levin
Linda
L
LeMasters
Grace K
GK
Ryan
Patrick
P
Reponen
Tiina
T
Villareal
Manuel
M
Burkle
Jeff
J
Stanforth
Sherry
S
Lockey
James E
JE
Khurana Hershey
Gurjit K
GK
Bernstein
David I
DI
D000393:Air Pollutants; D016902:Air Pollution, Indoor; D000485:Allergens / Q000009:adverse effects / Q000276:immunology; D001942:Breast Feeding; D002675:Child, Preschool; D004391:Dust / Q000276:immunology; D004781:Environmental Exposure; D005260:Female; D005502:Food / Q000009:adverse effects; D006798:Housing; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000209:etiology*; D019570:Inhalation Exposure; D008297:Male; D012220:Rhinitis / Q000209:etiology*; D012307:Risk Factors; D012882:Skin Tests; D014197:Trees / Q000009:adverse effects / Q000276:immunology
D000393:Air Pollutants; D000485:Allergens; D004391:Dust
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