Haby M M, Marks G B, Peat J K, Leeder S R
Centre for Community Child Health, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.
Pediatr Pulmonol. 2000 Nov;30(5):377-84. doi: 10.1002/1099-0496(200011)30:5<377::aid-ppul3>3.0.co;2-3.
Early attendance at daycare has been shown to protect against atopy, as defined by a positive skin prick test. One proposed hypothesis for this association is that early exposure to other children protects against atopy by facilitating the spread of infections among children. An alternative hypothesis is that children attending daycare centers have less atopy due to lower levels of exposure to indoor allergens. Our aim was to determine whether attendance at daycare before age 2 years protects against atopy in Australian preschool age children and to test the two alternative hypotheses, as well as a number of potential confounding factors. We conducted a cross-sectional study of children aged 3-5 years living in one humid coastal city (Lismore, n = 286) and one dry, inland city (Wagga Wagga, n = 364) in New South Wales, Australia, in 1995. Atopy was assessed by skin prick tests to six common allergens. Daycare attendance and other possible risk factors for atopy were measured by a parent-completed questionnaire. Children who attended daycare before age 2 years had a reduced risk of atopy at 3-5 years. The greatest effect was seen in children who attended a daycare center (odds ratio (OR), 0.26; 95% CI, 0.14-0.50) rather than family daycare (OR, 0.66; 95% CI, 0.41-1.04). The results of this study do not support either of the proposed hypotheses, nor can the effect be explained by any of the other potential confounders measured. Further work is needed to determine the exposure that is responsible for the protective effect of daycare attendance on atopy.
早期入托已被证明可预防特应性疾病（以皮肤点刺试验阳性定义）。关于这种关联，一个提出的假说是，早期接触其他儿童通过促进儿童间感染传播来预防特应性疾病。另一种假说是，入托儿童患特应性疾病较少是因为接触室内过敏原的水平较低。我们的目的是确定2岁前入托是否能预防澳大利亚学龄前儿童患特应性疾病，并检验这两种替代假说以及一些潜在的混杂因素。1995年，我们对居住在澳大利亚新南威尔士州一个潮湿沿海城市（利斯莫尔，n = 286）和一个干燥内陆城市（瓦加瓦加，n = 364）的3至5岁儿童进行了一项横断面研究。通过对六种常见过敏原进行皮肤点刺试验来评估特应性疾病。通过家长填写的问卷来测量入托情况和其他可能导致特应性疾病的风险因素。2岁前入托的儿童在3至5岁时患特应性疾病风险降低。在入托中心的儿童中效果最为显著（比值比（OR），0.26；95%置信区间（CI），0.14 - 0.50），而非家庭日托（OR = 0.66；95% CI = 0.41 - 1.04）。本研究结果不支持所提出的任何一种假说，该效应也无法用所测量的任何其他潜在混杂因素来解释。需要进一步开展工作来确定导致入托对特应性疾病具有保护作用的接触因素。
