Environmental factors associated with allergy in urban and rural children from the South African Food Allergy (SAFFA) cohort

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY

卷:145

Article

Levin, Michael E.^1,5  Botha, Maresa¹  Basera, Wisdom²  Facey-Thomas, Heidi E.¹  Gaunt, Ben^3,6  Gray, Claudia L.¹  Kiragu, Wanjiku⁷  Ramjith, Jordache^4,8  Watkins, Alexandra¹  Genuneit, Jon^9,10 

[1] Univ Cape Town, Dept Paediat, Div Paediat Allergy, Cape Town, South Africa

[2] Univ Cape Town, Fac Hlth Sci, Sch Publ Hlth & Family Med, Cape Town, South Africa

[3] Univ Cape Town, Hlth Sci Fac, Div Primary Hlth Care, Cape Town, South Africa

[4] Univ Cape Town, Sch Publ Hlth & Family Med, Div Epidemiol & Biostat, Cape Town, South Africa

[5] InVIVO Planetary Hlth Grp Worldwide Univ Network, Bisho, South Africa

[6] Zithulele Hosp, Eastern Cape Dept Hlth, Bisho, South Africa

[7] Aga Khan Univ Hosp, Dept Paediat, Nairobi, Kenya

[8] Radboud Univ Nijmegen, Radboud Inst Hlth Sci, Dept Hlth Evidence, Biostat Res Grp,Med Ctr, Nijmegen, Netherlands

[9] Ulm Univ, Inst Epidemiol & Med Biometry, Ulm, Germany

[10] Univ Leipzig, Med Ctr, Ctr Pediat Res Leipzig, Hosp Children & Adolescents, Leipzig, Germany

关键词: Aeroallergen;    aeroallergen sensitization;    Africa;    allergic rhinitis;    asthma;    atopic dermatitis;    eczema;    food allergy;    prevalence;    food sensitization;    environmental exposures;    fast foods;    advanced glycation end-products;    smoking;    probiotics;    prebiotics;    unpasteurized milk;    antibiotics;    antihelminthics;    pets;    farm animals;    sunlight;    delivery mode;    cesarean section;    cooking fuel;    heating fuel;    rural;    urban;    urbanization;   

DOI  :  10.1016/j.jaci.2019.07.048

来源: Elsevier

【 摘 要 】

Background: The prevalence of allergic diseases differs in urban and rural populations. Objective: We sought to assess associations between environmental and dietary factors with allergic diseases in urban and rural South African children. Methods: Toddlers aged 12 to 36 months were assessed for food allergen and aeroallergen sensitization, atopic dermatitis, allergic rhinitis, asthma, and challenge-proved food allergy. Information was collected on family history of allergic diseases, household size, socioeconomic status, delivery mode, antibiotic and probiotic use, exposure to fermented and unpasteurized milk, antihelminth treatment, sunlight exposure, pet and farm animal exposure, cigarette smoke, and household cooking and heating fuels. Antenatal exposures to pets, livestock, and cigarette smoke were assessed. A subsection completed questions on consumption of fruits and vegetables, fast foods, soft drinks/fruit juices, and fried/microwaved meat. Results: Risk and protective factors differed between urban and rural settings. Exposure to farm animals in infants and their mothers during pregnancy was protective against allergic outcomes in the rural population. Consumption of unpasteurized milk is uncommon in this group of rural children and is unlikely to be an important factor in rural protection. In urban children birth by cesarean section is associated with food allergy, and consumption of fermented milk products is associated with reduced asthma and atopic dermatitis. In both cohorts antenatal maternal smoking and environmental smoking exposure were predominantly associated with asthma, and consumption of fast foods and fried meats were associated with allergy. Conclusion: In this rural environment exposure to livestock is the strongest protective factor. In urban communities, where animal contact is rare, risk factors include cesarian section, and protective factors include consumption of fermented milk products. Modifiable risk factors urgently require interventions to prevent increasing allergy rates in countries undergoing rapid urbanization.

【 授权许可】

Free