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The National Asthma Campaign Manchester Asthma and Allergy Study
Adnan Custovic1, Bridget M Simpson, Clare S Murray
1North West Lung Centre, Wythenshawe Hospital, UK. acustovic@fs1.with.man.ac.uk
Insights
This study tracked 995 children to understand childhood asthma and allergy development. Environmental factors and genetics significantly influence lung function by age three.
Area of Science:
- Pediatric Allergy and Immunology
- Environmental Health
- Respiratory Medicine
Background:
- Childhood asthma and allergies are significant public health concerns.
- Understanding the interplay of genetic predisposition and environmental exposures is crucial for prevention.
- Early life environmental factors are hypothesized to play a key role in disease development.
Purpose of the Study:
- To prospectively investigate the development of asthma and allergies in a cohort of children.
- To assess the impact of defined environmental exposures and genetic risk on early childhood lung function.
- To evaluate the effectiveness of stringent environmental control measures in high-risk infants.
Main Methods:
- Recruitment of 995 children in utero based on parental atopic status.
- Stratification into high, medium, and low genetic risk groups.
- Randomization of a high-risk subgroup to stringent environmental controls (e.g., allergen covers, HEPA filtration).
- Prospective follow-up with detailed environmental exposure measurements (allergens, endotoxin, diet, etc.).
- Objective assessment of preschool lung function using specific airways resistance at age 3 years.
Main Results:
- Lung function at age 3 years in preschool children reflects both genetic and environmental influences.
- Detailed measurements captured various environmental exposures during pregnancy and early life.
- The study design allowed for clear definition and assessment of environmental influences on asthma and allergy development.
Conclusions:
- Early life environmental factors, alongside genetic predisposition, significantly shape the development of asthma and allergies.
- Objective lung function measures in early childhood provide valuable insights into these complex interactions.
- Further analysis is warranted to elucidate the specific impact of interventions and exposures.
Abstract:
The NACManchester Asthma and Allergy Study is a prospective study of the development of asthma and allergies in childhood. The subjects (995 children at age 3 years) were recruited in utero by screening parents in the antenatal clinic using skin prick testing and a questionnaire regarding allergic diseases. Children were assigned to risk groups according to parental atopic status (high risk, both parents atopic; medium risk, one parent atopic; low risk, neither parent atopic). A subgroup of those at high risk (with no pets in the home) was randomized to stringent environmental control (allergen impermeable covers for the parental and infant bed, hot washing of bedding weekly, HEPA vacuum cleaner, hard floor for the nursery), and the remainder followed a normal regime. The children have been followed prospectively. The environmental influences are very clearly defined. Measurements of environmental exposures include levels of house dust mite; cat and dog allergens during pregnancy and early life; pet ownership and exposure; childcare arrangements; number of siblings; vaccination uptake; thorough dietary questionnaire; and endotoxin exposure. Further unique objective outcome in the cohort is the assessment of lung function in preschool children using specific airways resistance, which at age 3 years clearly reflects both genetic and environmental influences.