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Early endotoxin exposure and atopy development in infants: results of a birth cohort study
Insights
Early endotoxin exposure may increase the risk of allergies in infants, particularly those with a family history of atopy. This finding challenges the idea that childhood endotoxin exposure protects against allergic diseases.
Area of Science:
- Environmental Health
- Pediatric Allergy
- Immunology
Background:
- Childhood endotoxin exposure is debated for its protective role against allergic diseases.
- Investigating the impact of early environmental exposures on infant health outcomes.
Purpose of the Study:
- To assess the effect of early endotoxin exposure on atopic sensitization, atopic dermatitis, and wheezing up to age 2.
- To analyze these effects in infants with varying parental atopy risk.
Main Methods:
- Analysis of data from 1942 infants in a birth cohort study using logistic regression.
- Measurement of endotoxin in maternal mattress dust at 3 months.
- Collection of allergic symptom data via questionnaires and assessment of specific serum IgE for allergen sensitization.
Main Results:
- High endotoxin levels correlated with increased risk of repeated wheeze (OR 1.52).
- No association found between endotoxin levels and food allergen sensitization or atopic dermatitis.
- In infants with parental atopy, endotoxin exposure was linked to increased risk of repeated wheeze and inhalant allergen sensitization.
Conclusions:
- Early endotoxin exposure, indicated by mattress dust levels, may elevate the risk of atopic reactions to inhalant allergens by age 2.
- This risk is particularly pronounced in infants with a parental history of atopy.
- The findings contradict the hypothesis of an early protective effect of endotoxin on atopy development.
Background:
Exposure to endotoxin in childhood is currently discussed to protect from the development of allergic diseases.
Objective:
To study the effect of early endotoxin exposure on incidence of atopic sensitization, atopic dermatitis and wheezing until the age of 2 years in infants with different risk status in terms of parental atopy.
Methods:
Data of 1942 infants of an ongoing birth cohort study were analysed by logistic regression. Endotoxin was measured in settled dust of the mothers' mattresses at infants' age of 3 months. Data on allergic symptoms and physicians' diagnoses were gathered by questionnaire. Sensitization to common food and inhalant allergens was assessed by specific serum IgE.
Results:
High endotoxin levels increased the risk of repeated wheeze [adjusted odds ratio (OR) for 4th exposure quartile (Q4) 1.52, 95% confidence interval (CI) 1.08-2.14], but were associated with neither sensitization to food allergens nor atopic dermatitis. Stratification by parental atopy showed that there was an association of endotoxin exposure with incidence of repeated wheeze as well as with sensitization to inhalant allergens (P for trend = 0.008 and 0.044, respectively) only in infants with parental atopy, with the highest risk in the 4th exposure quartile (repeated wheeze: ORQ4 1.77, 95% CI 1.14-2.73; sensitization to inhalant allergens: ORQ4 1.69, 95% CI 0.70-4.11).
Conclusion:
Early endotoxin exposure in terms of mattress dust endotoxin levels seemed to increase the risk of atopic reactions to inhalant allergens at the age of 2 years, especially in infants at risk due to parental atopy. Our data disagree with an early protective effect of endotoxin on atopy development until the age of 2 years.