The association of caesarean section delivery with asthma and atopy in children: Effect modification by family history of allergies
Ourania KolokotroniNicos MiddletonMarina GavathaDemetris LamnisosKostas Ν. PriftisPanayiotis K. Yiallouros
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Abstract:
Introduction: Studies on the association of birth by caesarean section and allergies have produced conflicting findings. Evidence on whether this relation may differ in those at risk of atopy is limited. Aim: To investigate the association of mode of delivery with asthma and atopic sensitization and the extend to which this effect is modified by family history of allergies Methods: Asthma outcomes were assessed cross-sectionally in 2216 children aged 8 using the ISAAC questionnaire whilst in a random subgroup of 746 skin prick tests to eleven allergens were also performed. Adjusted odds ratios of asthma and atopy by mode of delivery were estimated in multivariable logistic models. Results: After adjusting for potential confounders, children born by caesarean section as compared to vaginally had significantly higher odds of reporting ever having wheeze (OR 1.36, 95%CI 1.07-1.71), asthma diagnosis (OR 1.41, 95%CI 1.09-1.83) and atopic sensitization (OR 1.67, 95%CI 1.08-2.60). There was some evidence that family history of allergies may modify the effect of caesarean section delivery on atopy (p for effect modification=0.06) but not asthma. More specifically, children with a family history of allergies had double the odds of atopic sensitization if born by caesarean section (OR 2.34, 95%CI 1.20-4.54) whilst a non-significant association was observed in children without a family history of allergies (OR 1.27, 95%CI 0.69-2.36) Conclusion: Birth by caesarean section is associated with asthma and atopic sensitization in childhood. The association of caesarean delivery and atopy but not asthma is more pronounced in children with family history of allergies.Keywords:
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Objective To explore the risk factors of asthma in children with bronchiclitics.Methods One hundred and two cases hospita-lized patients with bronchiolitis were analyzed and followed-up for 2-7 years,items of follow-up included sex,morbidity age,food feeding,severity of disease,atopy physique,family history of atopy/asthma,environment exposure,passive smoking,and so on.The factors were carried on the Logistic regression analysis to determine the influence on later years to having recurrent asthma.Results Forty-seven cases had transferred asthma,which was remarkably higher than the domestic urban survey data(0.12%-3.34%).The multi-factors Logistic regression analysis demonstrated that environment(OR 6.099,95%CI 1.824～20.396),passive smoking(OR 49.222,95%CI 8.219-294.774),atopy physique (OR 45.548,95%CI 6.799-305.117)and family history of atopy/asthma(OR 47.921,95%CI 8.626-266.226)were the risk facter of asthma( Pa0.01).Conclusion The living condition,passive smoking,atopy physique and family history of atopy/asthma of children with bronchiolitis are important correlative factors of asthma recurrent in later years.
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Background:
Caesarean section might be a risk factor for asthma because of delayed microbial colonisation, but the association remains controversial. A study was undertaken to investigate prospectively whether children born by caesarean section are more at risk of having asthma in childhood and sensitisation at the age of 8 years, taking into account the allergic status of the parents.Methods:
2917 children who participated in a birth cohort study were followed for 8 years. The definition of asthma included wheeze, dyspnoea and prescription of inhaled steroids. In a subgroup (n = 1454), serum IgE antibodies for inhalant and food allergens were measured at 8 years.Results:
In the total study population, 12.4% (n = 362) of the children had asthma at the age of 8 years. Caesarean section, with a total prevalence of 8.5%, was associated with an increased risk of asthma (OR 1.79; 95% CI 1.27 to 2.51). This association was stronger among predisposed children (with two allergic parents: OR 2.91; 95% CI 1.20 to 7.05; with only one: OR 1.86; 95% CI 1.12 to 3.09) than in children with non-allergic parents (OR 1.36; 95% CI 0.77 to 2.42). The association between caesarean section and sensitisation at the age of 8 years was significant only in children of non-allergic parents (OR 2.14; 95% CI 1.16 to 3.98).Conclusions:
Children born by caesarean section have a higher risk of asthma than those born by vaginal delivery, particularly children of allergic parents. Caesarean section increases the risk for sensitisation to common allergens in children with non-allergic parents only.Wheeze
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Introduction
Infants with at least one biological parent who has allergic conditions are at risk for developing allergic disease. Caesarean born infants have a more slowly diversifying microbiota, with differences reported from normally born infants.This, in turn, can affect immunophysiological development with a heightened allergic disease risk. The aim of this study was to investigate the impact of birth mode of delivery on childhood asthma and allergic diseases in children from mothers with moderate persistent asthma. The study included 68 mother-child pairs. 22 children (main group) were born by Caesarean section, and 46 children (comparison group) were delivered vaginally. Pregnant women were included in the study with a gestation period of 32–38 weeks. Children were observed in the maternity hospital (1, 3–4 days), then monthly until the age of 1 year with a clinical assessment of the child's health. The presence, age of onset of symptoms, severity (prevalence) of skin (atopic dermatitis, urticaria, angioedema) and respiratory manifestations of allergy (rhinitis, wheezing with or without Viral Upper respiratory infection; croup; chronic cough). Mathematical-statistical data processing was carried out using the program Statistica 10.0 for Windows-10. The criterion for statistical significance was p <0.05.Results
In the group of children born by caesarean section, severe regurgitation was significantly more frequent (53% and 29%, p <0.05), flatulence persisting for up to 6 months (82% and 68%, p <0.05), colic lasting longer than 3 hours (93% and 28%, p <0.05), dyschezia (59% and 33%, p <0.05), loose stools (86% and 57%, p <0.05), mucus in the stool (100% and 73%, p <0.05), appeared in 1–2 weeks of life (68% and 45%, p <0.05), skin manifestations of allergy (95% and 74%, p <0.05), incl. diffuse (76% and 53%, p <0.05), chronic cough (18% and 2%, p <0.05), the presence of the first episode of weezing at 4–5 months (71% and 53%, p < 0.05), 2 episodes of weezing in the first year of life (86% and 20%, p <0.05), the presence of croup at the age of 3–6 months (80% and 0%, p <0.05), 2 episodes of croup in the first year of life (40% and 14%, p <0.05).Conclusion
For children with a positive family history of atopic diseases caesarean section can be assumed as an epigenetic factor, contributing to an earlier and pronounced manifestation of not only gastrointestinal, but skin and respiratory symptoms of allergic disease.Cite
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Asthma is the commonest chronic condition of children. Diagnosis remains difficult and many surrogate markers are used, such as documenting evidence of atopy.Two studies investigated the role of atopy in childhood asthma. The first documented the prevalence and nature of allergy sensitivities in a group of asthmatic children compared with non-asthmatic children in Pretoria, South Africa. The second enrolled a random sample of asthmatic children and their mothers attending the Children's Chest and Allergy Clinic at Steve Biko Academic Hospital, Pretoria. Children were classified as having atopic or non-atopic asthma. Mothers completed a questionnaire to reveal atopic features.In the first study, only 45.0% of asthmatic children had a positive skin-prick test (SPT), as opposed to 16.2% of control children. This is a lower proportion than in many reported international studies. In the second study, 64 children with atopic asthma and 36 with non-atopic asthma were studied, along with their mothers. The proportion of children with atopic asthma did not differ for mothers with and without a positive SPT (p=0.836), a history of asthma (p=0.045) or symptoms suggestive of an allergic disease (p=1.000), or who were considered to be allergic (p=0.806). The odds ratio (OR) of a child having atopic asthma when he or she had a mother with a doctor-diagnosed history of asthma was 4.76, but the sensitivity was low (21.9%).The data demonstrate that fewer asthmatic children in South Africa are atopic than was previously thought. Also, all maternal allergic or asthmatic associations are poor predictors of childhood atopic asthma. Despite the increased risk of atopic asthma in a child of a mother who has a doctor diagnosis of asthma (OR 4.76; p=0.045), this is a poor predictor of atopic asthma (sensitivity 21.9%).
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Studies on the association of birth by caesarean section (C/S) and allergies have produced conflicting findings. Furthermore, evidence on whether this association may differ in those at risk of atopy is limited. This study aims to investigate the association of mode of delivery with asthma and atopic sensitization and the extent to which any effect is modified by family history of allergies. Asthma outcomes were assessed cross-sectionally in 2216 children at age 8 on the basis of parents' responses to the ISAAC questionnaire whilst skin prick tests to eleven aeroallergens were also performed in a subgroup of 746 children. Adjusted odds ratios of asthma and atopy by mode of delivery were estimated in multivariable logistic models while evidence of effect modification was examined by introducing interaction terms in the models. After adjusting for potential confounders, children born by C/S appeared significantly more likely than those born vaginally to report ever wheezing (OR 1.36, 95% CI 1.07-1.71), asthma diagnosis (OR 1.41, 95% CI 1.09-1.83) and be atopic (OR 1.67, 95% CI 1.08-2.60). There was modest evidence that family history of allergies may modify the effect of C/S delivery on atopy (p for effect modification=0.06) but this was not the case for the asthma outcomes. Specifically, while more than a two-fold increase in the odds of being a topic was observed in children with a family history of allergies if born by C/S (OR 2.62, 95% CI 1.38-5.00), no association was observed in children without a family history of allergies (OR 1.16, 95% CI 0.64-2.11). Birth by C/S is associated with asthma and atopic sensitization in childhood. The association of C/S and atopy appears more pronounced in children with family history of allergies.
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Background Caesarean delivery has been suggested to alterneonatal immune respon ses and increase the risk of atopicdiseases. Howevei; previous studies have reported inconsistentfindings.Objective To investigate a possible association between caesareandelivery and the development of atopic diseases in children.Methods This case-control study involved 100 children aged 3months-12 years, in Sanglah Hospital, Denpasai; Indonesia. Fiftyinfants and children with a confirmed diagnosis of atopic diseasesand 50 sex-paired controls (non-atopic infants and children)were enrolled. Demographic data was obtained, including modeof delivery and relevant history connected to atopic diseases.Skin prick test to four common aeroallergens was performed inall subjects. Possible confounding factors were considered in amultivariable logis tic regression model.Results Caesarean section was not significant as a risk factor foratopic diseases in a multivariate analysis [OR 2.4 (95%CI 0.7 to8.4; P=0.164)]. Howevei; multiple logistic regression analysisshowed that atopic diseases was significantly associated with apositive family history of atopy. Furthermore, caesarean sectionwas associated with a higher risk of atopic diseases in a subgroupanalysis for family history of atopy [OR= 4 (95%CI 1 to 16.2;P= 0.04)].Conclusion Children delivered by caesarean section and have afamily history of atopy have a 4-fo ld higher risk of atopic diseases.
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Birth cohort studies in some countries have shown a link between caesarean section and asthma.To determine if there is an association between asthma and delivery via caesarean section in Malaysian children.This is a case-control study involving 156 children aged 3-15 years old, in a tertiary hospital in Kuala Lumpur, Malaysia. Seventy-eight children with a confirmed diagnosis of asthma and seventy-eight age-matched controls (no history of asthma or wheezing) were enrolled. Demographic data including mode of delivery and family history of allergic disorders was obtained. Total serum immunoglobulin E (IgE) was measured and skin prick tests (SPT) to 6 common aeroallergens were performed.The median age of the patients was 8 years old. One hundred and three (66%) children were delivered via normal vaginal delivery, 8 (5.1%) via assisted vaginal delivery and 45 children (28.9%) via caesarean section. Delivery via caesarean section was not significantly associated with asthma (OR = 1.21 [95% CI 0.60-2.41], p = 0.596). Children delivered via caesarean section did not have higher IgE levels nor were they more sensitized to aeroallergens. Multiple logistic regression showed that asthma was significantly associated with a positive family history of atopy (OR = 13.8 [95% CI 5.96, 32.1], p < 0.001). Introduction of semi-solid food after 6 months old had a protective effect against asthma (OR = 0.97 [95% CI 0.94, 0.99], p = 0.034).Childhood asthma in Malaysian children was not associated with delivery by caesarean section.
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