The Centre for MEGA Epidemiology, Melbourne School of Population Health, The University of Melbourne, Melbourne, Australia.
Pediatr Allergy Immunol. 2010 Nov;21(7):1076-85. doi: 10.1111/j.1399-3038.2010.01018.x.
The role of early childhood infections and immunisation in the development of allergic diseases remains controversial. To examine these associations, six hundred and twenty infants with first-degree relatives with allergic diseases were recruited into the Melbourne Atopy Cohort Study. Information on risk factors and outcomes was collected by interviewer administered questionnaire and was based on parental report and/or a physician's diagnosis. Risk factors examined included early childhood infections (including gastroenteritis, otitis media and lower respiratory tract infections) and immunisations in the first 2 yr of life. Outcomes were current asthma, allergic rhinitis and eczema at 6 yr of age. Univariate and multivariate regression analysis were used to estimate relative risk (RR) and assess confounding. By 6 yr, 79% of the original cohort remained in the study. Those with at least three episodes of gastroenteritis showed an increased risk (crude RR 2.36, 95%CI 1.41 3.95; adjusted RR 2.03 95%CI 1.50 2.75) for the later development of asthma at age 6. Of the scheduled immunisations, Sabin immunisation in the second year had a reduced risk of asthma at 6 yr (crude RR 0.60, 95%CI 0.37 0.98; adjusted RR 0.63 95%CI 0.39 1.02). Combined diphtheria and tetanus (CDT) immunisation in the first year had an increased risk of asthma at 6 yr (RR 1.76, 95%CI 1.11 2.78; adjusted RR 1.88 95%CI 1.28 2.77). Recurrent gastroenteritis in early childhood is associated with a later risk of asthma. This may reflect a cause and effect relationship, or exposure to common risk factors. In contrast, Sabin immunisation in the second year is associated with a decreased risk of asthma in later childhood. CDT immunisation in the first year may be a risk factor for asthma, but the need for CDT immunisation may also be a marker of increased risk of asthma in later childhood.
婴幼儿时期的感染和免疫接种在过敏性疾病的发展中的作用仍存在争议。为了研究这些关联，我们招募了 620 名一级亲属患有过敏性疾病的婴儿，纳入墨尔本过敏队列研究。通过访谈员管理的问卷收集了危险因素和结局信息，基于父母报告和/或医生诊断。研究的危险因素包括婴幼儿时期（包括胃肠炎、中耳炎和下呼吸道感染）和生命的头 2 年中的免疫接种。结局是 6 岁时的当前哮喘、过敏性鼻炎和湿疹。采用单变量和多变量回归分析来估计相对风险（RR）和评估混杂因素。在 6 岁时，原始队列中有 79%的婴儿仍在研究中。那些有至少 3 次胃肠炎发作的婴儿，以后发展为哮喘的风险增加（粗 RR 2.36，95%CI 1.41-3.95；调整 RR 2.03，95%CI 1.50-2.75）。在计划免疫中，第二年的 Sabin 免疫接种可降低 6 岁时哮喘的风险（粗 RR 0.60，95%CI 0.37-0.98；调整 RR 0.63，95%CI 0.39-1.02）。第一年的白喉和破伤风联合疫苗（DT）免疫接种会增加 6 岁时哮喘的风险（RR 1.76，95%CI 1.11-2.78；调整 RR 1.88，95%CI 1.28-2.77）。婴幼儿时期反复发生胃肠炎与以后发生哮喘的风险相关。这可能反映了因果关系，或者暴露于共同的危险因素。相反，第二年的 Sabin 免疫接种与以后儿童期哮喘的风险降低相关。第一年的 DT 免疫接种可能是哮喘的危险因素，但需要 DT 免疫接种也可能是以后儿童期哮喘风险增加的标志。
