Birth by Cesarean Section, Allergic Rhinitis, and Allergic Sensitization Among Children with a Parental History of Atopy

Overview

Journal J Allergy Clin Immunol

Specialty Allergy & Immunology

Date 2008 Jun 24

PMID 18571710

Citations 66

Authors

Michael Pistiner

Diane R Gold

Hassen Abdulkerim

Elaine Hoffman

Juan C Celedon

Affiliations

Soon will be listed here.

Abstract

Background: Cesarean delivery can alter neonatal immune responses and increase the risk of atopy. Studies of the relation between cesarean delivery and allergic diseases in children not selected on the basis of a family history of atopy have yielded inconsistent findings.

Objective: We sought to examine the relation between birth by cesarean delivery and atopy and allergic diseases in children at risk for atopy.

Methods: We examined the relation between mode of delivery and the development of atopy and allergic diseases among 432 children with a parental history of atopy followed from birth to age 9 years. Asthma was defined as physician-diagnosed asthma and wheeze in the previous year, and allergic rhinitis was defined as physician-diagnosed allergic rhinitis and naso-ocular symptoms apart from colds in the previous year. Atopy was considered present at school age if there was 1 or more positive skin test response or specific IgE to common allergens. Stepwise logistic regression was used to study the relation between cesarean delivery and the outcomes of interest.

Results: After adjustment for other covariates, children born by cesarean section had 2-fold higher odds of atopy than those born by vaginal delivery (odds ratio, 2.1; 95% CI, 1.1-3.9). In multivariate analyses birth by cesarean section was significantly associated with increased odds of allergic rhinitis (odds ratio, 1.8; 95% CI, 1.0-3.1) but not with asthma.

Conclusions: Our findings suggest that cesarean delivery is associated with allergic rhinitis and atopy among children with a parental history of asthma or allergies. This could be explained by lack of contact with the maternal vaginal/fecal flora or reduced/absent labor during cesarean delivery.

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References

Kalliomaki M, Kirjavainen P, Eerola E, Kero P, Salminen S, Isolauri E . Distinct patterns of neonatal gut microflora in infants in whom atopy was and was not developing. J Allergy Clin Immunol. 2001; 107(1):129-34. DOI: 10.1067/mai.2001.111237. View

Celedon J, Wright R, Litonjua A, Sredl D, Ryan L, Weiss S . Day care attendance in early life, maternal history of asthma, and asthma at the age of 6 years. Am J Respir Crit Care Med. 2002; 167(9):1239-43. DOI: 10.1164/rccm.200209-1063OC. View

Menacker F . Trends in cesarean rates for first births and repeat cesarean rates for low-risk women: United States, 1990-2003. Natl Vital Stat Rep. 2005; 54(4):1-8. View

Weston S, Halbert A, Richmond P, Prescott S . Effects of probiotics on atopic dermatitis: a randomised controlled trial. Arch Dis Child. 2005; 90(9):892-7. PMC: 1720555. DOI: 10.1136/adc.2004.060673. View

Gold D, Burge H, Carey V, Milton D, Platts-Mills T, Weiss S . Predictors of repeated wheeze in the first year of life: the relative roles of cockroach, birth weight, acute lower respiratory illness, and maternal smoking. Am J Respir Crit Care Med. 1999; 160(1):227-36. DOI: 10.1164/ajrccm.160.1.9807104. View

Renz-Polster H, David M, Buist A, Vollmer W, OConnor E, Frazier E . Caesarean section delivery and the risk of allergic disorders in childhood. Clin Exp Allergy. 2005; 35(11):1466-72. DOI: 10.1111/j.1365-2222.2005.02356.x. View

Asher M, Montefort S, Bjorksten B, Lai C, Strachan D, Weiland S . Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC Phases One and Three repeat multicountry cross-sectional surveys. Lancet. 2006; 368(9537):733-43. DOI: 10.1016/S0140-6736(06)69283-0. View

McKeever T, Lewis S, Smith C, Hubbard R . Mode of delivery and risk of developing allergic disease. J Allergy Clin Immunol. 2002; 109(5):800-2. DOI: 10.1067/mai.2002.124046. View

Ly N, Ruiz-Perez B, Onderdonk A, Tzianabos A, Litonjua A, Liang C . Mode of delivery and cord blood cytokines: a birth cohort study. Clin Mol Allergy. 2006; 4:13. PMC: 1592116. DOI: 10.1186/1476-7961-4-13. View

10.

Kero J, Gissler M, Gronlund M, Kero P, Koskinen P, Hemminki E . Mode of delivery and asthma -- is there a connection?. Pediatr Res. 2002; 52(1):6-11. DOI: 10.1203/00006450-200207000-00004. View

11.

Neaville W, Tisler C, Bhattacharya A, Anklam K, Gilbertson-White S, Hamilton R . Developmental cytokine response profiles and the clinical and immunologic expression of atopy during the first year of life. J Allergy Clin Immunol. 2003; 112(4):740-6. DOI: 10.1016/s0091-6749(03)01868-2. View

12.

Sharp M, Rowe J, Kusel M, Sly P, Holt P . Specific patterns of responsiveness to microbial antigens staphylococcal enterotoxin B and purified protein derivative by cord blood mononuclear cells are predictive of risk for development of atopic dermatitis. Clin Exp Allergy. 2003; 33(4):435-41. DOI: 10.1046/j.1365-2222.2003.01627.x. View

13.

Eggesbo M, Botten G, Stigum H, Nafstad P, Magnus P . Is delivery by cesarean section a risk factor for food allergy?. J Allergy Clin Immunol. 2003; 112(2):420-6. DOI: 10.1067/mai.2003.1610. View

14.

Milton D, Johnson D, Park J . Environmental endotoxin measurement: interference and sources of variation in the Limulus assay of house dust. Am Ind Hyg Assoc J. 1998; 58(12):861-7. DOI: 10.1080/15428119791012199. View

15.

Kalliomaki M, Salminen S, Arvilommi H, Kero P, Koskinen P, Isolauri E . Probiotics in primary prevention of atopic disease: a randomised placebo-controlled trial. Lancet. 2001; 357(9262):1076-9. DOI: 10.1016/S0140-6736(00)04259-8. View

16.

Celedon J, Litonjua A, Ryan L, Weiss S, Gold D . Lack of association between antibiotic use in the first year of life and asthma, allergic rhinitis, or eczema at age 5 years. Am J Respir Crit Care Med. 2002; 166(1):72-5. DOI: 10.1164/rccm.2109074. View

17.

Xu B, Pekkanen J, Hartikainen A, Jarvelin M . Caesarean section and risk of asthma and allergy in adulthood. J Allergy Clin Immunol. 2001; 107(4):732-3. DOI: 10.1067/mai.2001.113048. View

18.

Raby B, Celedon J, Litonjua A, Phipatanakul W, Sredl D, Oken E . Low-normal gestational age as a predictor of asthma at 6 years of age. Pediatrics. 2004; 114(3):e327-32. DOI: 10.1542/peds.2003-0838-L. View

19.

Yunginger J, Reed C, OConnell E, Melton 3rd L, OFallon W, Silverstein M . A community-based study of the epidemiology of asthma. Incidence rates, 1964-1983. Am Rev Respir Dis. 1992; 146(4):888-94. DOI: 10.1164/ajrccm/146.4.888. View

20.

Nafstad P, Magnus P, Jaakkola J . Risk of childhood asthma and allergic rhinitis in relation to pregnancy complications. J Allergy Clin Immunol. 2000; 106(5):867-73. DOI: 10.1067/mai.2000.110558. View