title: Prediction and prevention of allergic rhinitis: A birth cohort study of 20 years.
abstract: BACKGROUND
  Allergic rhinitis (AR) is one of the most common chronic diseases, usually starting in the first 2 decades of life. Information on predictors, risk, and protective factors is missing because of a lack of long-term prospective studies.
  
  
  OBJECTIVE
  Our aim was to examine early-life environmental and lifestyle determinants for AR up to age 20 years.
  
  
  METHODS
  In 1990, the Multicenter Allergy Study included 1314 newborns in 5 German cities. Children were evaluated at 19 time points. A Cox regression model examined the associations between 41 independent early-life factors and onset of AR (as the primary outcome), including sensitization against aeroallergens and the secondary outcomes of nonallergic rhinitis and AR plus asthma.
  
  
  RESULTS
  Two hundred ninety subjects had AR within 13,179 person years observed. The risk of AR was higher with a parental history of AR (adjusted hazard ratio [aHR], 2.49; 95% CI, 1.93-3.21), urticaria (aHR, 1.32; 95% CI, 1.00-1.74), or asthma (aHR, 1.29; 95% CI, 0.95-1.75). Early allergic sensitization (aHR, 4.53; 95% CI, 3.25-6.32), eczema within the first 3 years of life (aHR, 1.83; 95% CI, 1.38-2.42), male sex (aHR, 1.28; 95% CI, 1.02-1.61), and birthday in summer or autumn (aHR, 1.26; 95% CI, 1.00-1.58) were independent predictors of AR up to age 20 years. None of the other socioeconomic, environmental, lifestyle, pregnancy, and birth-related factors were associated with AR.
  
  
  CONCLUSIONS
  Only nonmodifiable factors, particularly early allergic sensitization or eczema and parental AR, predicted AR up to age 20 years. No modifiable aspects of early-life environment or lifestyle were identified as targets for primary prevention.
authors.affiliation: Institute for Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Berlin, Germany. Electronic address: linus.grabenhenrich@charite.de.
authors.forename: Linus B
authors.initials: LB
authors.lastname: Grabenhenrich
authors.affiliation: Institute for Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Berlin, Germany; Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Keil
authors.affiliation: Institute for Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Reich
authors.affiliation: Institute for Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Hannah
authors.initials: H
authors.lastname: Gough
authors.affiliation: Department of Pediatrics, Westmecklenburg Hospital, Hagenow, Germany.
authors.forename: John
authors.initials: J
authors.lastname: Beschorner
authors.affiliation: Department of Pediatrics, Technical University of Munich, Munich, Germany.
authors.forename: Ute
authors.initials: U
authors.lastname: Hoffmann
authors.affiliation: Department of Pediatrics, Technical University of Munich, Munich, Germany.
authors.forename: Carl-Peter
authors.initials: CP
authors.lastname: Bauer
authors.affiliation: Department of Pediatrics, St Josefs Hospital, Freiburg, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Forster
authors.affiliation: Department of Pediatrics, Heinrich-Heine-University, Düsseldorf, Germany.
authors.forename: Antje
authors.initials: A
authors.lastname: Schuster
authors.affiliation: Department of Pediatrics, Heinrich-Heine-University, Düsseldorf, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Schramm
authors.affiliation: Center for Pediatric and Adolescent Medicine, University Medical Center Mainz, Mainz, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Nitsche
authors.affiliation: Center for Pediatric and Adolescent Medicine, University Medical Center Mainz, Mainz, Germany.
authors.forename: Fred
authors.initials: F
authors.lastname: Zepp
authors.affiliation: Max-Delbrück-Center, Berlin, Germany.
authors.forename: Young-Ae
authors.initials: YA
authors.lastname: Lee
authors.affiliation: Department of Obstetrics, Charité-Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Renate
authors.initials: R
authors.lastname: Bergmann
authors.affiliation: Department of Obstetrics, Charité-Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Karl
authors.initials: K
authors.lastname: Bergmann
authors.affiliation: Department of Pediatric Pneumology and Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Wahn
authors.affiliation: Department of Pediatric Pneumology and Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Lau
mesh_terms: D000293:Adolescent; D000328:Adult; D000485:Allergens / Q000276:immunology; D001249:Asthma / Q000175:diagnosis* / Q000517:prevention & control; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005500:Follow-Up Studies; D005858:Germany; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011379:Prognosis; D011446:Prospective Studies; D065631:Rhinitis, Allergic / Q000175:diagnosis* / Q000517:prevention & control; D012307:Risk Factors; D012621:Seasons; D012737:Sex Factors; D013997:Time Factors; D055815:Young Adult
chemical_list: D000485:Allergens
keywords: Infant; adolescent; epidemiologic factors; heredity; preschool child; primary prevention; risk factors; survival analysis