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Published on: August 7, 2017
Development of seasonal allergic rhinitis during the first 7 years of life
1Institute of Social Medicine and Epidemiology, Charité Hospital, Humboldt University at Berlin, Berlin, Germany.
Insights
Seasonal allergic rhinitis (SAR) affects 15% of children by age seven, with incidence rising after age two. Development requires genetic predisposition and at least two pollen seasons for clinical manifestation.
Area of Science:
- Pediatrics
- Allergology
- Immunology
Background:
- Limited longitudinal data exists on the development of IgE-mediated seasonal allergic rhinitis (SAR) from birth to school age.
- Understanding the prevalence and incidence of SAR in early childhood is crucial due to rising allergy rates.
Purpose of the Study:
- To prospectively investigate the development of SAR, including sensitization and symptoms, in a birth cohort.
- To define SAR with high specificity and identify associated risk factors.
Main Methods:
- Annual longitudinal data collected from 587 children from birth to age seven.
- SAR definition based on combined exposure-related symptoms and sensitization.
- Risk factor analysis using multiple logistic regression.
Main Results:
- SAR developed in 15% of children by age seven, with low early childhood prevalence (<2%) increasing steadily.
- Children developing SAR by age two were born in spring/summer, experiencing at least two pollen seasons.
- Risk factors included male sex, maternal/paternal history of allergic rhinitis, first-born status, early food sensitization, and atopic dermatitis.
Conclusions:
- SAR prevalence and incidence significantly increase after the second year of life.
- Clinical manifestation of SAR requires both allergic predisposition and at least two seasons of pollen allergen exposure.
- Identified risk factors can aid in early identification and intervention strategies.
Background:
Against the background of the controversial discussion about an increase in allergic rhinitis in recent years, intraindividual longitudinal data is lacking for IgE-mediated seasonal allergic rhinitis (SAR). Little is known about the development of SAR in terms of prevalence and incidence rates from birth to school age.
Objective:
In a prospective birth cohort, we investigated the development of sensitization and symptoms of SAR. SAR should be defined with high specificity, and associated risk factors should be determined.
Methods:
Annual longitudinal data about seasonal allergic symptoms and sensitization was available for 587 children from birth to their seventh birthday. The definition of SAR was based on a combination of exposure-related symptoms and sensitization.
Results:
Up to 7 years of age, SAR developed in 15% of the children. Incidence and prevalence of symptoms and sensitization were low during early childhood (<2%) and increased steadily with age. Children in which SAR had already developed in the second year all were born in spring or early summer, resulting in at least two seasons of pollen exposure before manifestation of SAR. Risk factors assessed by multiple logistic regression analysis were male sex (odds ratio [OR] = 2.4), atopic mothers (OR = 2.6) and fathers (OR = 3.6) having allergic rhinitis themselves, first-born child (OR = 2.0), early sensitization to food (OR = 3.3), and atopic dermatitis (OR = 2.5), whereas early wheezing was not associated with SAR.
Conclusion:
The development of SAR is characterized by a marked increase in prevalence and incidence after the second year of life. Our longitudinal data further indicate that in combination with the risk of allergic predisposition, at least 2 seasons of pollen allergen exposure are needed before allergic rhinitis becomes clinically manifest.
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