Prediction and prevention of allergy in infants and children
1995 (English)Doctoral thesis, comprehensive summary (Other academic)
Atopic disposition is hereditary with varying penetrance. A carefully obtained family history of atopic disease (FH) is useful as a predictor but has low sensitivity. Other tested predictors such as cord blood (CB) IgE, counts of different CB cell elements and combinations of predictors all have a similar, or even lower sensitivity and specificity.
Family history, CB IgE, CB IgG anti-IgE, CB white blood cell differential count, platelet count, CB mononuclear leukocyte cAMP-phosphodiesterase, skin dryness, histamine reactivity and occurrence of erythema toxicum in newborns were all tested as predictors of atopy development up to 18 months of age (I, IT, Ill). Eosinophil counts in peripheral blood were also studied as predictor in infants at 3 to 18 months of age (IV). Pertussis toxin as a potential trigger factor for atopy development was studied by following atopy development afterpertussis vaccination (V). The atopy/allergy preventive effect of ultrafiltrated whey hydrolysate formula compared to cow's milk based after about 6 months of exclusive breast feeding was also investigated (VI).
None of the single predictors were considered as clinically useful. According to logistic regression analysis FH, CB IgE, CB eosinophil count, and skin dryness in combination, however, predicted atopy with high probability (p = 0.001). Newborns with a high CB concentration of IgG anti-IgE showed decreased prevalence of atopic disease before 18 months of age which, if confirmed, may indicate that IgG anti-IgE antibodies, transferred from the mother transplacentally, may protect the infant from becoming atopic.
No obvious influence of pertussis toxin on atopy development could be demonstrated. No significant difference in atopy development could be seen when comparing the two formula groups.
A carefully taken family history is still the best method to identify infants who are likely to develop allergic disease. Possibly, a combination with e.g. clinical assessment of skin dryness and/or determination of CB IgE or CB eosinophils may increase screening efficiency. Vaccination with aluminium adsorbed pertussis toxin gave so many local side effects that the use of aluminium should be reconsidered even if no significant effect on atopic development could be shown, As kind of formula feeding following exclusive breast-feeding during the fist six months did not influence the development of atopic disease in infants at high risk there seems to be no reason for laying a burden of special formula at this age on these families.
Place, publisher, year, edition, pages
Linköping: Linköpings universitet , 1995. , 71 p.
Linköping University Medical Dissertations, ISSN 0345-0082 ; 451
Medical and Health Sciences
IdentifiersURN: urn:nbn:se:liu:diva-28618Local ID: 13774ISBN: 91-7871-301-3OAI: oai:DiVA.org:liu-28618DiVA: diva2:249429
1995-05-19, Berzeliussalen, Universitetssjukhuset, Linköping, 13:00 (Swedish)
Foucard, Tony, Docent
Papers, included in the Ph.D. thesis, are not registered and included in the posts from 1999 and backwards.2009-10-092009-10-092012-07-24Bibliographically approved