Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden; Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
J Allergy Clin Immunol. 2018 Nov;142(5):1510-1514.e2. doi: 10.1016/j.jaci.2018.06.044. Epub 2018 Sep 10.
Little is known about early-life risk factors for food allergy in children.
We examined the association between perinatal characteristics and future risk of food allergy in offspring.
This nationwide Swedish cohort study of 1,086,378 children born in Sweden in 2001-2012 used prospectively recorded data from health care registers. Using Cox regression, we estimated hazard ratios (HRs) with 95% CIs for the association between perinatal characteristics (eg, cesarean delivery and preterm birth) and food allergy as defined by diagnoses in the National Patient Register, adjusting for infant sex and maternal factors (age at delivery, country of birth, parity, smoking, body mass index, and asthma/pulmonary disease).
During the 13-year follow-up, 26,732 (2.5%) children were given a diagnosis of food allergy. Food allergy was positively associated with cesarean delivery (HR, 1.21; 95% CI, 1.18-1.25), large for gestational age (HR, 1.15; 95% CI, 1.10-1.19), and low 5-minute Apgar score (HR, 1.22; 95% CI, 1.10-1.36) but negatively associated with very preterm birth (<32 weeks of gestation: HR, 0.74; 95% CI, 0.56-0.98). No association was found between food allergy and moderately preterm birth, low birth weight, or small for gestational age. Risk estimates were similar when the outcome was restricted to 2 records of diagnosed food allergy. In 1,000 children undergoing cesarean delivery, an extra 5 developed food allergy compared with the reference group, suggesting that 17% of food allergy in children born by means of cesarean delivery can be explained by this exposure (attributable fraction).
Cesarean delivery was associated with increased risk of food allergy, whereas very preterm birth decreased risk.
儿童食物过敏的早期危险因素知之甚少。
我们研究了围产期特征与后代食物过敏风险之间的关系。
这是一项在瑞典进行的全国性队列研究，纳入了 2001 年至 2012 年期间出生的 1086378 名儿童，使用健康登记处的前瞻性记录数据。我们使用 Cox 回归估计了围产期特征（如剖宫产和早产）与国家患者登记处诊断的食物过敏之间的关联的风险比（HR），并调整了婴儿性别和产妇因素（分娩年龄、出生国、产次、吸烟、体重指数和哮喘/肺部疾病）。
在 13 年的随访期间，26732 名（2.5%）儿童被诊断为食物过敏。食物过敏与剖宫产（HR，1.21；95%CI，1.18-1.25）、大于胎龄（HR，1.15；95%CI，1.10-1.19）和低 5 分钟 Apgar 评分（HR，1.22；95%CI，1.10-1.36）呈正相关，但与极早产（<32 周：HR，0.74；95%CI，0.56-0.98）呈负相关。食物过敏与中度早产、低出生体重或小于胎龄无关联。将结局限制为 2 次确诊的食物过敏记录，风险估计值相似。在 1000 名接受剖宫产的儿童中，与对照组相比，额外有 5 名儿童发生食物过敏，这表明 17%的剖宫产儿童的食物过敏可以用这种暴露来解释（归因分数）。
剖宫产与食物过敏风险增加相关，而极早产则降低风险。
