Pediatr Allergy Respir Dis.  2011 Sep;21(3):197-206.

Prevalence of Allergic Diseases in Children according to Mode of Delivery

• Lee YJ
• Jee HM
• Kim BJ
• Kim HB
• Yu J
• Lee SY
• Kim WK
• Sohn MH
• Kim KE
• Hong SJ
• Kim KW

Abstract

PURPOSE
It has been suggested that caesarean section is a risk factor for allergic diseases under the 'hygiene hypothesis', but it remains controversial. In this study, we examined the association between mode of delivery and development of allergic diseases.
METHODS
The Korean International Study of Asthma and Allergies in Childhood questionnaire was used to survey 8,404 elementary and middle-school students in Seoul between April and October 2008. We categorized children into a caesarean section group and a vaginal delivery group, and surveyed the prevalence of asthma, allergic rhinitis, and atopic dermatitis.
RESULTS
No differences in the prevalence of "wheeze ever" (P=0.418), "wheezing the last 12 months" (P=0.152), and "diagnosis of asthma ever" (P=0.382) were observed between the caesarean section group and the vaginal delivery group. The prevalence of "rhinitis ever" (P=0.609), "rhinitis the last 12 months" (P=0.788), and "diagnosis of allergic rhinitis ever" (P=0.700) was also similar between the two groups. The prevalence of "itchy eczema ever" (P=0.065), "itchy eczema last 12 months" (P=0.381), and a "diagnosis of atopic dermatitis ever" (P=0.162) also did not show any differences between the two groups. However, in subjects with a family history of allergic disease, the caesarean section group had the higher prevalence of "diagnosis of asthma ever" (11.3% vs. 9.2%, P=0.032) than that in the vaginal delivery group.
CONCLUSION
We found an association between mode of delivery and the subsequent development of asthma in children with a family history of allergic disease in Seoul, Korea.

Keyword

Caesarean section; Mode of delivery; Children; Asthma; Allergic rhinitis; Atopic dermatitis

MeSH Terms

Asthma
Cesarean Section
Child
Dermatitis, Atopic
Eczema
Female
Humans
Hypersensitivity
Korea
Pregnancy
Prevalence
Surveys and Questionnaires
Rhinitis
Rhinitis, Allergic, Perennial
Risk Factors

Reference

References

1. Strachan DP. Hay fever, hygiene, and household size. BMJ. 1989; 299:1259–60.

2. Wold AE. The hygiene hypothesis revised: is the rising frequency of allergy due to changes in the intestinal flora? Allergy. 1998; 53(46 Suppl):20–5.

3. Mitsou EK, Kirtzalidou E, Oikonomou I, Liosis G, Kyriacou A. Fecal microflora of Greek healthy neonates. Anaerobe. 2008; 14:94–101.

4. Björkstén B, Naaber P, Sepp E, Mikelsaar M. The intestinal microflora in allergic Estonian and Swedish 2-year-old children. Clin Exp Allergy. 1999; 29:342–6.

5. Menacker F. Trends in cesarean rates for first births and repeat cesarean rates for low-risk women: United States, 1990–2003. Natl Vital Stat Rep. 2005; 54:1–8.

6. Annual report on the appropriacy of the caesarean section delivery. Reston: Health Insurance Review & Assessment Service;2008.

7. Eder W, Ege MJ, von Mutius E. The asthma epidemic. N Engl J Med. 2006; 355:2226–35.

8. Jee HM, Kim KW, Kim CS, Sohn MH, Shin DC, Kim KE. Prevalence of asthma, rhinitis and eczema in Korean children using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaires. Pediatr Allergy Respir Dis(Korea). 2009; 19:165–72.

9. Xu B, Pekkanen J, Hartikainen AL, Järvelin MR. Caesarean section and risk of asthma and allergy in adulthood. J Allergy Clin Immunol. 2001; 107:732–3.

10. Roduit C, Scholtens S, de Jongste JC, Wijga AH, Gerritsen J, Postma DS, et al. Asthma at 8 years of age in children born by caesarean section. Thorax. 2009; 64:107–13.

11. Salam MT, Margolis HG, McConnell R, McGregor JA, Avol EL, Gilliland FD. Mode of delivery is associated with asthma and allergy occurrences in children. Ann Epidemiol. 2006; 16:341–6.

12. Negele K, Heinrich J, Borte M, von Berg A, Schaaf B, Lehmann I, et al. Mode of delivery and development of atopic disease during the first 2 years of life. Pediatr Allergy Immunol. 2004; 15:48–54.

13. Mallen CD, Mottram S, Wynne-Jones G, Thomas E. Birth-related exposures and asthma and allergy in adulthood: a population-based cross-sectional study of young adults in North Staffordshire. J Asthma. 2008; 45:309–12.

14. Maitra A, Sherriff A, Strachan D, Henderson J. ALSPAC Study Team. Mode of delivery is not associated with asthma or atopy in childhood. Clin Exp Allergy. 2004; 34:1349–55.

15. Menezes AM, Hallal PC, Matijasevich AM, Barros AJ, Horta BL, Araujo CL, et al. Caesarean sections and risk of wheezing in childhood and adolescence: data from two birth cohort studies in Brazil. Clin Exp Allergy. 2011; 41:218–23.

16. Park YH, Kim KW, Choi BS, Jee HM, Sohn MH, Kim KE. Relationship between mode of delivery in childbirth and prevalence of allergic diseases in Korean children. Allergy Asthma Immunol Res. 2010; 2:28–33.

17. Hong SJ, Kim SW, Oh JW, Rah YH, Ahn YM, Kim KE, et al. The validity of the ISAAC written questionnaire and the ISAAC video questionnaire (AVQ 3.0) for predicting asthma associated with bronchial hyperreactivity in a group of 13–14 year old Korean schoolchildren. J Korean Med Sci. 2003; 18:48–52.

18. Bager P, Wohlfahrt J, Westergaard T. Caesarean delivery and risk of atopy and allergic disease: metaanalyses. Clin Exp Allergy. 2008; 38:634–42.

19. Thavagnanam S, Fleming J, Bromley A, Shields MD, Cardwell CR. A metaanalysis of the association between Caesarean section and childhood asthma. Clin Exp Allergy. 2008; 38:629–33.

20. Ly NP, Ruiz-Pérez B, Onderdonk AB, Tziana-bos AO, Litonjua AA, Liang C, et al. Mode of delivery and cord blood cytokines: a birth cohort study. Clin Mol Allergy. 2006; 4:13.

21. Tadaki H, Arakawa H, Sugiyama M, Ozawa K, Mizuno T, Mochizuki H, et al. Association of cord blood cytokine levels with wheezy infants in the first year of life. Pediatr Allergy Immunol. 2009; 20:227–33.

22. Smith GC, Wood AM, White IR, Pell JP, Cameron AD, Dobbie R. Neonatal respiratory morbidity at term and the risk of childhood asthma. Arch Dis Child. 2004; 89:956–60.

23. Schaubel D, Johansen H, Dutta M, Desmeules M, Becker A, Mao Y. Neonatal characteristics as risk factors for preschool asthma. J Asthma. 1996; 33:255–64.

24. Tollånes MC, Moster D, Daltveit AK, Irgens LM. Cesarean section and risk of severe childhood asthma: a population-based cohort study. J Pediatr. 2008; 153:112–6.

25. Pistiner M, Gold DR, Abdulkerim H, Hoffman E, Celedón JC. Birth by cesarean section, allergic rhinitis, and allergic sensitization among children with a parental history of atopy. J Allergy Clin Immunol. 2008; 122:274–9.

26. Al-Kubaisy W, Ali SH, Al-Thamiri D. Risk factors for asthma among primary school children in Baghdad, Iraq. Saudi Med J. 2005; 26:460–6.

27. Sugiyama M, Arakawa H, Ozawa K, Mizuno T, Mochizuki H, Tokuyama K, et al. Early-life risk factors for occurrence of atopic dermatitis during the first year. Pediatrics. 2007; 119:e716–23.

28. Bager P. Birth by caesarean section and wheezing, asthma, allergy, and intestinal disease. Clin Exp Allergy. 2011; 41:147–8.

29. Crump C, Winkleby MA, Sundquist J, Sundquist K. Risk of asthma in young adults who were born preterm: a Swedish national cohort study. Pediatrics. 2011; 127:e913–20.

30. Hikino S, Nakayama H, Yamamoto J, Kinukawa N, Sakamoto M, Hara T. Food allergy and atopic dermatitis in low birthweight infants during early childhood. Acta Paediatr. 2001; 90:850–5.