title: Relationship between all fevers or fever after vaccination, and atopy and atopic disorders at 18 and 36 months.
abstract: BACKGROUND
  Studies have reported that early febrile episodes and febrile episodes with infections are associated with a decreased risk of developing atopy.
  
  
  OBJECTIVE
  To examine further the association between presence of and number of febrile episodes are with atopy and atopic diseases and if there was a difference between all fevers and fever after vaccination.
  
  
  METHODS
  We studied 448 infants in a Singapore mother-offspring cohort study (Growing Up in Singapore Towards Healthy Outcomes) which had complete data for the exposures and outcomes of interest. Fever was defined as more than 38.0℃ and was self-reported. The presence of and number of febrile episodes were examined for association with outcome measures, namely parental reports of doctor-diagnosed asthma and eczema, and rhinitis, which was evaluated by doctors involved in the study at 18 and 36 months. These outcomes were considered atopic if there were 1 or more positive skin prick tests.
  
  
  RESULTS
  The presence of all fevers from 0-6 months of age was associated with reduced odds of having atopy at 36 months of age (unadjusted odds ratio [OR], 0.628; 95% confidence interval [CI], 0.396-0.995). The presence of fever after vaccination from 0-24 months of age was associated with reduced odds of having atopy at 36 months of age (OR, 0.566; 95% CI, 0.350-0.915). The presence of all fevers from 0-6 months of age was associated with reduced odds of having atopic eczema at 36 months (OR, 0.430; 95% CI, 0.191-0.970). Fever was associated with increased odds of having doctor-diagnosed asthma and rhinitis.
  
  
  CONCLUSIONS
  There was an inverse relationship between the presence of all fevers from 0-6 months of age and the development of atopy and eczema at 36 months of age. Fever after vaccination might be considered a subclinical infection that did not show the same effect in early life.
authors.affiliation: National University Health System, Singapore 119228, Singapore.
authors.forename: Hong Hui
authors.initials: HH
authors.lastname: Wong
authors.affiliation: National University Health System, Singapore 119228, Singapore.
authors.forename: Jaslyn Jie Lin
authors.initials: JJ
authors.lastname: Lee
authors.affiliation: Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore.
authors.forename: Lynette Pei-Chi
authors.initials: LP
authors.lastname: Shek
authors.affiliation: Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore.
authors.forename: Bee Wah
authors.initials: BW
authors.lastname: Lee
authors.affiliation: Department of Paediatric Medicine, Allergy Service, KK Women's and Children's Hospital, Singapore 229899, Singapore.
authors.forename: Anne
authors.initials: A
authors.lastname: Goh
authors.affiliation: KK Women's and Children's Hospital, Singapore 229899, Singapore.
authors.forename: Oon Hoe
authors.initials: OH
authors.lastname: Teoh
authors.affiliation: Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (ASTAR), Singapore 138632, Singapore.; Liggins Institute, University of Auckland, Auckland 1010, New Zealand.
authors.forename: Peter D
authors.initials: PD
authors.lastname: Gluckman
authors.affiliation: MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom.; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
authors.forename: Keith M
authors.initials: KM
authors.lastname: Godfrey
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, Singapore 119077, Singapore.
authors.forename: Seang Mei
authors.initials: SM
authors.lastname: Saw
authors.affiliation: Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore 229899, Singapore.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Kwek
authors.affiliation: Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore.; Brenner Centre for Molecular Medicine, Singapore Institute for Clinical Sciences (SICS), Singapore 117609, Singapore.
authors.forename: Yap Seng
authors.initials: YS
authors.lastname: Chong
authors.affiliation: Department of Paediatric Medicine, Allergy Service, KK Women's and Children's Hospital, Singapore 229899, Singapore.
authors.forename: Hugo Ps
authors.initials: HP
authors.lastname: Van Bever
keywords: Asthma; Eczema; Fever; Rhinitis