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PATTERNS OF ALLERGIC SENSITIZATION AND FACTORS ASSOCIATED WITH EMERGENCE OF SENSITIZATION IN THE RURAL TROPICS EARLY IN THE LIFE COURSE: FINDINGS OF AN ECUADORIAN BIRTH COHORT
Autor
Afiliación
Institute of Infection and Immunity. St George's University of London. London, United Kingdom / Universidade Internacional do Equador. Escola de Medicina. Quito, Equador / Fundacion Ecuatoriana Para Investigacion en Salud. Quito, Equador.
Institute of Infection and Immunity. St George's University of London. London, United Kingdom.
Fundacion Ecuatoriana Para Investigacion en Salud. Quito, Equador.
Fundacion Ecuatoriana Para Investigacion en Salud. Quito, Equador.
Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Centro de Integração de Dados e Conhecimento para a Saúde. Salvador, BA, Brasil.
Population Health Research Institute. St George's University of London. London, United Kingdom.
Institute of Infection and Immunity. St George's University of London. London, United Kingdom.
Fundacion Ecuatoriana Para Investigacion en Salud. Quito, Equador.
Fundacion Ecuatoriana Para Investigacion en Salud. Quito, Equador.
Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Centro de Integração de Dados e Conhecimento para a Saúde. Salvador, BA, Brasil.
Population Health Research Institute. St George's University of London. London, United Kingdom.
Resumen en ingles
Introduction: There are limited data on emergence of allergic sensitization (or atopy) during childhood in tropical regions.
Methods: We followed a birth cohort of 2,404 newborns to 8 years in tropical Ecuador and collected: risk factor data by maternal questionnaires periodically from birth; atopy was measured by skin prick test reactivity (SPT) to aeroallergens in parents, and aeroallergens and food allergens in children at 2, 3, 5, and 8 years; and stool samples for soil-transmitted helminths (STH) from children periodically to 8 years and from parents and household members at the time of recruitment of cohort children. Data on risk factors were measured either at birth or repeatedly (time-varying) from birth to 8 years. Longitudinal repeated-measures analyses were done using generalized estimating equations to estimate the age-dependent risk of positive SPT (SPT+) to any allergen or mite during early childhood.
Results: SPT+ to any allergen was present in 29.0% of fathers and 24.8% of mothers, and in cohort children increased with age, initially to mite but later to cockroach, reaching 14.8% to any allergen (10.7% mite and 5.3% cockroach) at 8 years. Maternal SPT+, particularly presence of polysensitization (OR 2.04, 95% CI 1.49–2.77) significantly increased the risk of SPT+ during childhood, while household overcrowding at birth decreased the risk (OR 0.84, 95% CI 0.72–0.98). For mite sensitization, maternal polysensitization increased (OR 2.14, 95% CI 1.40–3.27) but rural residence (OR 0.69, 95% CI 0.50–0.94) and birth order (3rd−4th vs. 1st−2nd: OR 0.71, 95% CI 0.52–0.98) decreased the risk. Time-varying exposures to agricultural activities (OR 0.77, 95% CI 0.60–0.98) and STH parasites (OR 0.70, 95% CI 0.64–0.91) during childhood decreased while anthelmintics increased the childhood risk (OR 1.47, 95% CI 1.05–2.05) of mite sensitization.
Conclusion: Our data show the emergence of allergic sensitization, primarily to mite and cockroach allergens, during childhood in tropical Ecuador. A role for both antenatal and post-natal factors acting as potential determinants of SPT+ emergence was observed.
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