Birth order and paediatric allergic disease: A nationwide longitudinal survey
Birth order and paediatric allergic disease: A nationwide longitudinal survey
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DOI：
10.1111/cea.13100
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发表时间：
2018-05-01
影响因子：
6.1
通讯作者：
Tsukahara, H.
中科院分区：
文献类型：
--
作者：
Kikkawa, T.;Yorifuji, T.;Tsukahara, H.
背景：环境因素似乎与过敏性疾病的发生有关。出生顺序较晚的儿童经常暴露在可能存在病原体和内毒素的环境中，因此患传染病的风险更高。因此，出生顺序被认为是反映出生后环境的一个指标。然而，关于这一主题的纵向研究有限。本研究旨在阐明出生顺序与变态反应性疾病之间的关系。方法：从2001年出生的儿童(n=47015)的全国纵向研究中，选取3种变态反应性疾病--哮喘、食物过敏和特应性皮炎--从婴儿期到12岁就诊，并进行二项对数线性回归分析，以评价出生顺序与这些疾病的关系。我们调整了孩子和父母的因素，并对每个结果进行了估计风险比(RR)和95%可信区间(CI)。结果：出生顺序与哮喘的关系是多样的；出生顺序较晚的儿童早期的风险增加，但学龄期的风险降低。例如，在30到42个月之间，比较第三个或更大的孩子和第一个出生的孩子，调整后的RR为1.19(95%CI，1.05-1.35)，但在10-11岁之间，调整后的RR为0.76(95%CI，0.65-0.89)。较晚出生顺序一般对食物过敏有保护作用，但增加了特应性皮炎的风险。结论：出生顺序的影响取决于过敏性疾病的类型和童年时期。童年在身体和免疫发育方面是独一无二的，童年对出生后环境的免疫反应似乎是不同的。
Background: Environmental factors seem to be related to the incidence of allergic disease. Children with a later birth order are often exposed to environments, where pathogens and endotoxins can be found, and thus have a higher risk of developing infectious diseases. Therefore, birth order is regarded as an indicator that reflects post-natal environment. However, longitudinal studies are limited on this subject. This study sought to elucidate the relationships between birth order and allergic disease.Methods: From a nationwide longitudinal study that followed children born in 2001 (n = 47 015), we selected doctors' visits for 3 types of allergic disease-bronchial asthma, food allergy and atopic dermatitis-from infancy to 12 years of age and conducted binomial log-linear regression analysis to evaluate the associations between birth order and these diseases. We adjusted for the child and parental factors and estimated risk ratio (RR) and 95% confidence interval (CI) for each outcome.Results: The associations between birth order and bronchial asthma were diverse; later birth order increased the risk in early childhood, but decreased the risks during school age. For example, the adjusted RR comparing third-born or higher and first-born children was 1.19 (95% CI, 1.05-1.35) between 30 and 42 months of age, but was 0.76 (95% CI, 0.65-0.89) between 10 and 11 years. Later birth order was generally protective for food allergy but increased the risk of atopic dermatitis.Conclusion: The influence of birth order depended on the type of allergic disease and the childhood period. Childhood is unique in terms of physical and immunological development, and the immune response to the post-natal environment in childhood appears to be heterogeneous.