Not all farming environments protect against the development of asthma and wheeze in children

Ege, Markus; Frei, Remo; Bieli, Christian; Schram-Bijkerk, Dieneke; Waser, Marco; Benz, Marcus R.; Weiss, Gertraud; Nyberg, Fredrik; Hage, Marianne van; Pershagen, Göran; Brunekreef, Bert; Riedler, Josef; Lauener, Roger; Braun‐Fahrländer, Charlotte; Mutius, Erika von

doi:10.1016/j.jaci.2007.01.037

Cited by 265 publications

(266 citation statements)

References 39 publications

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“…Only one farm child was allergic at 3 years of age, as compared with ten in the non-farm group. The protective effect of growing up on a small, family-owned dairy farm is in line with previous studies [2,4,36]. Recent randomized trials point to postponement of introduction of solid foods as a strong risk factor for development of food allergy [15,16] and several observational studies have pointed to delayed introduction of fish as predictive of high risk of becoming allergic [22–29].…”

Section: Discussionsupporting

confidence: 82%

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Late introduction of fish and eggs is associated with increased risk of allergy development – results from the FARMFLORA birth cohort

Jönsson

Barman

Brekke

et al. 2017

Food & Nutrition Research

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The prevalence of allergy is markedly low in children growing up on farms. An increasing number of studies indicate that the timing of food introduction may affect allergy development. We aimed to investigate if protection against allergy in farm environments may be mediated through differences in food-introduction practices between farm and non-farm families, using an explorative approach. Twenty-eight farm and 37 non-farm children were included in the FARMFLORA birth cohort. Practices of breastfeeding and introduction of formulas and complementary foods were collected by questionnaires at 6, 12, and 18 months of age. Allergy was diagnosed by pediatricians at 3 years of age. The only difference in food-introduction practices observed between farm and non-farm children was an earlier introduction of nuts in farmers (median month: 11 [IQR: 8–6] in farmers, 15 [12–19] in non-farmers). One farm child (4%) and 10 non-farm children (27%) were allergic at 3 years of age. Lower risk of allergy development was associated with early exclusive breastfeeding (continuous variable; OR = 0.59, 95% CI: 0.39–0.89), but also having received eggs (OR = 0.08, 95% CI: 0.13–0.54) and fish (logistic regression not applicable, P = 0.01 in likelihood ratio testing [χ2]) at 10 months of age or earlier compared to later. Our results were not affected by reverse causation, as judged by a questionnaire sent to the families in retrospect. Timing of introduction of complementary foods is unlikely to contribute to the lower risk of allergy among farm children. Although early exclusive breastfeeding was associated with a lower rate of allergy development, postponed introduction of complementary foods might increase the risk of developing allergy. Owing to the limited sample size, our results are only indicative, but support prior findings.

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Section: Discussionsupporting

confidence: 82%

“…Frequent contact with livestock and fodder [4] and consumption of unpasteurized milk [5] have been associated with protection. However, other factors may contribute, such as differences in diet between farming and non-farming families.…”

Section: Introductionmentioning

confidence: 99%

Late introduction of fish and eggs is associated with increased risk of allergy development – results from the FARMFLORA birth cohort

Jönsson

Barman

Brekke

et al. 2017

Food & Nutrition Research

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“…KARADAG et al [71] and colleagues found that exposure to EPS from children's mattresses was negatively associated with physician-diagnosed eczema but not with eczema symptoms. In the second investigation by EGE et al [72], EPS was found to significantly decrease the risk of asthma ever and current wheeze. However, there was no effect on atopic sensitisation against inhalant and food allergens.…”

Section: Atopic Sensitisationmentioning

confidence: 91%

Association between domestic mould and mould components, and asthma and allergy in children: a systematic review

Tischer¹,

Cm²,

Heinrich³

2011

Eur Respir J

146

108

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Critical reviews over the past 10 yrs have found increased respiratory and allergic health outcomes for children living in damp and mouldy environments. However, recent studies have suggested that early childhood exposure to specific mould components may actually protect children from developing allergy.We conducted a systematic review of observational studies published in English from January 1980 to July 2010. This review was conducted according to systematic guidelines for Metaanalyses of Observational Studies in Epidemiology (MOOSE). The literature was searched using a computerised bibliographic database, PubMed. In order to increase the quality of the reviewed studies, meta-analyses of the effects of visible mould exposure on allergic health outcomes were performed and we evaluated the findings according to the Bradford Hill criteria for evidence of causation.The literature search identified 1,398 peer-reviewed scientific publications, and 61 studies that fulfilled the inclusion criteria were included in this review. We observed increased risks of allergic respiratory health outcomes in children exposed to visible mould and mould spores. These findings were confirmed by the results of the meta-analysis and in line with the evaluation criteria according to Bradford Hill. Visible mould was positively associated with asthma (OR 1.49 (95% CI 1.28-1.72)), wheeze (OR 1.68 (95% CI 1.48-1.90)) and allergic rhinitis (OR 1.39 (95% CI 1.28-1.51)). However, there was a tendency of lower risk for allergic health outcomes in children exposed to mouldderived components such as (1,3)-b-D-glucan and extracellular polysaccharides.These findings suggest that home environments with visible mould and mould spore exposure increase the risk of allergic respiratory health outcomes in children. However, further investigations are needed to examine the effects of exposure to mould-derived components as the current literature is inconclusive. In order to disentangle the different effects of overall microbial exposure on children's health, research should focus on specific microbial markers in the home, in combination with new assessment techniques including molecular methods.

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“…A relationship between helminth infections and protection against hyperinflammatory disorders has also been established in various mouse models for food allergy (Nagler-Anderson 2006), asthma (Smits, Hammad et al 2007;Amu, Saunders et al 2010), T1D (Zaccone, Fehervari et al 2003;Liu, Sundar et al 2009), CIA (Osada, Shimizu et al 2009) and EAE (La Flamme, Ruddenklau et al 2003;Wilson, Taylor et al 2010). Furthermore, different cross-sectional studies show that children living in farming environments are protected from childhood asthma and atopy and this correlation has been attributed to contact with livestock (Ege, Frei et al 2007) and hay and the consumption of raw cow's milk (Douwes, Cheng et al 2008;Loss, Apprich et al 2011). In farming environments, both outdoor and indoor microbial exposure are higher and more diverse compared to nonfarming environments (von Mutius, Braun-Fahrlander et al 2000;Ege, Mayer et al 2011).…”

Section: Hyperinflammatory Disorders and The 'Hygiene Hypothesis'mentioning

confidence: 92%

Regulatory B Cells - Implications in Autoimmune and Allergic Disorders

Sattler¹,

Vlugt²,

Hussaarts³

et al. 2012

Recent Advances in Immunology to Target Cancer, Inflammation and Infections

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Not all farming environments protect against the development of asthma and wheeze in children

Cited by 265 publications

References 39 publications

Late introduction of fish and eggs is associated with increased risk of allergy development – results from the FARMFLORA birth cohort

Late introduction of fish and eggs is associated with increased risk of allergy development – results from the FARMFLORA birth cohort

Association between domestic mould and mould components, and asthma and allergy in children: a systematic review

Regulatory B Cells - Implications in Autoimmune and Allergic Disorders

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