Cooper Philip J, Chis Ster Irina, Chico Martha E, Vaca Maritza, Oviedo Yisela, Maldonado Augusto, Barreto Mauricio L, Platts-Mills Thomas A E, Strachan David P
Institute of Infection and Immunity, St George's University of London, London, UK.
School of Medicine, Universidad Internacional del Ecuador, Quito, Ecuador.
Allergy. 2021 Sep;76(9):2765-2775. doi: 10.1111/all.14821. Epub 2021 Apr 7.
Early-life exposures to geohelminths may protect against development of wheeze/asthma and atopy.
To study the effect of maternal geohelminths and infections in children during the first 5 years on atopy, wheeze/asthma and airways reactivity/inflammation at 8 years.
Birth cohort of 2404 neonates followed to 8 years in rural Ecuador. Data on wheeze/asthma were collected by questionnaire and atopy by skin prick test (SPT) reactivity to 9 allergens. We measured airways reactivity to bronchodilator, fractional exhaled nitric oxide (FeNO) and nasal eosinophilia. Stool samples were examined for geohelminths by microscopy.
1933 (80.4%) children were evaluated at 8 years. Geohelminths were detected in 45.8% of mothers and 45.5% of children to 5 years. Frequencies of outcomes at 8 years were as follows: wheeze (6.6%), asthma between 5 and 8 years (7.9%), SPT (14.7%), airways reactivity (10%) and elevated FeNO (10.3%) and nasal eosinophilia (9.2%). Any maternal geohelminth was associated with reduced SPT prevalence (OR 0.72). Childhood Trichuris trichiura infections during the first 5 years were associated with reduced wheeze (OR 0.57) but greater parasite burdens with Ascaris lumbricoides at 5 years were associated with increased wheeze (OR 2.83) and asthma (OR 2.60). Associations between maternal geohelminths and wheeze/asthma were modified by atopy. Parasite-specific effects on wheeze/asthma and airways reactivity and inflammation were observed in non-atopic children.
Our data provide novel evidence for persistent effects of in utero geohelminth exposures on childhood atopy but highlight the complex nature of the relationship between geohelminths and the airways. Registered as an observational study (ISRCTN41239086).
早年接触土源性蠕虫可能预防喘息/哮喘和特应性疾病的发生。
研究母亲感染土源性蠕虫及儿童在5岁前感染对8岁时特应性疾病、喘息/哮喘及气道反应性/炎症的影响。
对厄瓜多尔农村地区2404名新生儿进行出生队列研究，随访至8岁。通过问卷收集喘息/哮喘数据，采用皮肤点刺试验（SPT）检测对9种变应原的反应性来评估特应性疾病。我们测量了气道对支气管扩张剂的反应性、呼出一氧化氮分数（FeNO）和鼻嗜酸性粒细胞增多情况。通过显微镜检查粪便样本中土源性蠕虫。
1933名（80.4%）儿童在8岁时接受了评估。45.8%的母亲和45.5%的儿童在5岁前检测出土源性蠕虫。8岁时各结局的发生率如下：喘息（6.6%）、5至8岁哮喘（7.9%）、SPT阳性（14.7%）、气道反应性（10%）、FeNO升高（10.3%）和鼻嗜酸性粒细胞增多（9.2%）。母亲感染任何土源性蠕虫均与SPT患病率降低相关（比值比0.72）。5岁前儿童感染毛首鞭形线虫与喘息减少相关（比值比0.57），但5岁时蛔虫负担较重与喘息增加（比值比2.83）和哮喘（比值比2.60）相关。母亲感染土源性蠕虫与喘息/哮喘之间的关联因特应性疾病而改变。在非特应性儿童中观察到寄生虫对喘息/哮喘、气道反应性和炎症的特异性影响。
我们的数据为子宫内接触土源性蠕虫对儿童特应性疾病的持续影响提供了新证据，但也突出了土源性蠕虫与气道之间关系的复杂性。注册为观察性研究（ISRCTN41239086）。
