Clin Exp Otorhinolaryngol.  2024 May;17(2):168-176. 10.21053/ceo.2024.00024.

Perinatal Risk Factors for Asthma and Allergic Rhinitis in Children and Adolescents

• Hwang SH
• Shin H
• Stybayeva G
• Kim DH

• KMID: 2556007
• DOI: http://doi.org/10.21053/ceo.2024.00024

Abstract

Objectives
. In this study, we evaluated the associations between birth-related exposures, postnatal factors, and the risk of allergic rhinitis and asthma in children and adolescents.
Methods
. We performed a comprehensive search of five literature databases up to May 2023. To quantify the associations of birth-related exposures (birth weight, delivery mode, prematurity, sex, maternal age, and parental allergy history) and postnatal factors (birth order, number of siblings, breastfeeding exclusivity, and breastfeeding duration) with allergic disease, we calculated pooled odds ratios and 95% confidence intervals. We conducted subgroup analyses for allergic disease type, birth order, number of siblings, and parental allergy history. The methodological quality of the identified studies was evaluated using the Newcastle-Ottawa Scale.
Results
. This meta-analysis included 31 studies, encompassing 218,899 patients in total. The birth-related exposures of low birth weight, maternal age, and prematurity (less than 37 weeks gestation) were not significantly associated with the risk of asthma or allergic rhinitis during childhood or adolescence. Male sex, family history of allergy, and cesarean delivery were linked to an elevated risk of asthma or allergic rhinitis. Among postnatal factors, exclusive breastfeeding, breastfeeding for longer than 6 months, second or later birth order, and having siblings exhibited protective effects against allergic diseases in offspring.
Conclusion
. The risks of allergic rhinitis and asthma were elevated in male patients, those delivered by cesarean section, and those with a family history of allergy. Conversely, exclusive breastfeeding, breastfeeding for longer than 6 months, and having siblings corresponded to a reduced risk of respiratory allergic diseases.

Keyword

Adolescent; Asthma; Child; Allergic Rhinitis; Risk Factors

Figure

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  Fig. 1. Flow diagram of the article selection process.

Reference

1. Bousquet J, Schunemann HJ, Togias A, Bachert C, Erhola M, Hellings PW, et al. Next-generation Allergic Rhinitis and Its Impact on Asthma (ARIA) guidelines for allergic rhinitis based on Grading of Recommendations Assessment, Development and Evaluation (GRADE) and real-world evidence. J Allergy Clin Immunol. 2020; Jan. 145(1):70–80.

2. Gutowska-Slesik J, Samolinski B, Krzych-Falta E. The increase in allergic conditions based on a review of literature. Postepy Dermatol Alergol. 2023; Feb. 40(1):1–7.

3. D’Amato G, Vitale C, Lanza M, Molino A, D’Amato M. Climate change, air pollution, and allergic respiratory diseases: an update. Curr Opin Allergy Clin Immunol. 2016; Oct. 16(5):434–40.

4. Montgomery SM, Wakefield AJ, Morris DL, Pounder RE, Murch SH. The initial care of newborn infants and subsequent hay fever. Allergy. 2000; Oct. 55(10):916–22.

5. Xu B, Jarvelin MR, Pekkanen J. Prenatal factors and occurrence of rhinitis and eczema among offspring. Allergy. 1999; Aug. 54(8):829–36.

6. Tulic MK, Hodder M, Forsberg A, McCarthy S, Richman T, D’Vaz N, et al. Differences in innate immune function between allergic and nonallergic children: new insights into immune ontogeny. J Allergy Clin Immunol. 2011; Feb. 127(2):470–8.

7. Bager P, Melbye M, Rostgaard K, Benn CS, Westergaard T. Mode of delivery and risk of allergic rhinitis and asthma. J Allergy Clin Immunol. 2003; Jan. 111(1):51–6.

8. Bedolla-Barajas M, Javier Ramirez-Cervantes F, Morales-Romero J, Jesus Perez-Molina J, Meza-Lopez C, Delgado-Figueroa N. A rural environment does not protect against asthma or other allergic diseases amongst Mexican children. Allergol Immunopathol (Madr). 2018; Jan-Feb. 46(1):31–8.

9. Bion V, Lockett GA, Soto-Ramirez N, Zhang H, Venter C, Karmaus W, et al. Evaluating the efficacy of breastfeeding guidelines on longterm outcomes for allergic disease. Allergy. 2016; May. 71(5):661–70.

10. Chu S, Zhang Y, Jiang Y, Sun W, Zhu Q, Wang B, et al. Cesarean section without medical indication and risks of childhood allergic disorder, attenuated by breastfeeding. Sci Rep. 2017; Aug. 7(1):9762.

11. Ehlayel MS, Bener A. Duration of breast-feeding and the risk of childhood allergic diseases in a developing country. Allergy Asthma Proc. 2008; Jul-Aug. 29(4):386–91.

12. Gorris A, Bustamante G, Mayer KA, Kinaciyan T, Zlabinger GJ. Cesarean section and risk of allergies in Ecuadorian children: a crosssectional study. Immun Inflamm Dis. 2020; Dec. 8(4):763–73.

13. Han DH, Shin JM, An S, Kim JS, Kim DY, Moon S, et al. Long-term breastfeeding in the prevention of allergic rhinitis: Allergic Rhinitis Cohort Study for Kids (ARCO-Kids study). Clin Exp Otorhinolaryngol. 2019; Aug. 12(3):301–7.

14. Hu Y, Chen Y, Liu S, Jiang F, Wu M, Yan C, et al. Breastfeeding duration modified the effects of neonatal and familial risk factors on childhood asthma and allergy: a population-based study. Respir Res. 2021; Feb. 22(1):41.

15. Goycochea Valdivia WA, Hidalgo Tunque CM, Hernandez Diaz H, Centeno Huaman J. Association among prematurity, low birth weight and exclusive breastfeeding with allergic rhinitis in 2 to 7 year-old pediatric patients from Hospital Nacional Cayetano Heredia, Peru. Bol Med Hosp Infant Mex. 2010; Aug. 67(4):315–26.

16. Jelding-Dannemand E, Malby Schoos AM, Bisgaard H. Breast-feeding does not protect against allergic sensitization in early childhood and allergy-associated disease at age 7 years. J Allergy Clin Immunol. 2015; Nov. 136(5):1302–8.

17. Kim HI, Nam S, Park Y, Jung YJ, Kim HY, Kim KW, et al. Cesarean section does not increase the prevalence of allergic disease within 3 years of age in the offsprings. Obstet Gynecol Sci. 2019; Jan. 62(1):11–8.

18. Krzych-Falta E, Furmanczyk K, Lisiecka-Bielanowicz M, Sybilski A, Tomaszewska A, Raciborski F, et al. The effect of selected risk factors, including the mode of delivery, on the development of allergic rhinitis and bronchial asthma. Postepy Dermatol Alergol. 2018; Jun. 35(3):267–73.

19. Li Y, Jiang Y, Li S, Shen X, Liu J, Jiang F. Pre- and postnatal risk factors in relation to allergic rhinitis in school-aged children in China. PLoS One. 2015; Feb. 10(2):e0114022.

20. Lu HY, Chiu CW, Kao PH, Tsai ZT, Gau CC, Lee WF, et al. Association between maternal age at delivery and allergic rhinitis in schoolchildren: a population-based study. World Allergy Organ J. 2020; Jun. 13(6):100127.

21. 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; May. 45(4):309–12.

22. Matheson MC, Erbas B, Balasuriya A, Jenkins MA, Wharton CL, Tang ML, et al. Breast-feeding and atopic disease: a cohort study from childhood to middle age. J Allergy Clin Immunol. 2007; Nov. 120(5):1051–7.

23. McKeever TM, Lewis SA, Smith C, Hubbard R. Mode of delivery and risk of developing allergic disease. J Allergy Clin Immunol. 2002; May. 109(5):800–2.

24. Meza-Lopez C, Bedolla-Barajas M, Morales-Romero J, JimenezCarrillo CE, Bedolla-Pulido TR, Santos-Valencia EA. Prevalence of allergic diseases and their symptoms in schoolchildren according to the birth mode. Bol Med Hosp Infant Mex. 2021; Mar. 78(2):130–5.

25. Miyake Y, Arakawa M, Tanaka K, Sasaki S, Ohya Y. Cross-sectional study of allergic disorders associated with breastfeeding in Japan: the Ryukyus Child Health Study. Pediatr Allergy Immunol. 2007; Aug. 18(5):433–40.

26. Nafstad P, Magnus P, Jaakkola JJ. Risk of childhood asthma and allergic rhinitis in relation to pregnancy complications. J Allergy Clin Immunol. 2000; Nov. 106(5):867–73.

27. 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; Feb. 15(1):48–54.

28. 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; Jan. 2(1):28–33.

29. Pistiner M, Gold DR, Abdulkerim H, Hoffman E, Celedon JC. Birth by caesarean section, allergic rhinitis, and allergic sensitization among children with a parental history of atopy. J Allergy Clin Immunol. 2008; Aug. 122(2):274–9.

30. Renz-Polster H, David MR, Buist AS, Vollmer WM, O’Connor EA, Frazier EA, et al. Caesarean section delivery and the risk of allergic disorders in childhood. Clin Exp Allergy. 2005; Nov. 35(11):1466–72.

31. 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; May. 16(5):341–6.

32. Tong H, Gao L, Deng Y, Kong Y, Xiang R, Tan L, et al. Prevalence of allergic rhinitis and associated risk factors in 6 to 12 years schoolchildren from Wuhan in Central China: a cross-sectional study. Am J Rhinol Allergy. 2020; Sep. 34(5):632–41.

33. Tong X, Tong H, Gao L, Deng Y, Xiang R, Cen R, et al. A multicenter study of prevalence and risk factors for allergic rhinitis in primary school children in 5 cities of Hubei province, China. Int Arch Allergy Immunol. 2022; 183(1):34–44.

34. Wang T, Shi H, Qi H, Jiang L, Lin Y, Yao J, et al. Parental, gestational, and early-life exposure to indoor environmental hazardous factors on allergic rhinitis among preschool children in Urumqi City: a case-control study. J Pediatr (Rio J). 2023; Jul-Aug. 99(4):348–54.

35. Westergaard T, Rostgaard K, Wohlfahrt J, Andersen PK, Aaby P, Melbye M. Sibship characteristics and risk of allergic rhinitis and asthma. Am J Epidemiol. 2005; Jul. 162(2):125–32.

36. Xu B, Pekkanen J, Hartikainen AL, Jarvelin MR. Caesarean section and risk of asthma and allergy in adulthood. J Allergy Clin Immunol. 2001; Apr. 107(4):732–3.

37. Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015; Jan. 4(1):1.

38. Hwang SH, Kim SW, Basurrah MA, Kim DH. Efficacy of steroid-impregnated spacers after endoscopic sinus surgery in chronic rhinosinusitis: a systematic review and meta-analysis. Clin Exp Otorhinolaryngol. 2023; May. 16(2):148–58.

39. Brandao HV, Vieira GO, de Oliveira Vieira T, Camargos PA, de Souza Teles CA, Guimaraes AC, et al. Increased risk of allergic rhinitis among children delivered by cesarean section: a cross-sectional study nested in a birth cohort. BMC Pediatr. 2016; Apr. 16:57.

40. Brozek JL, Bousquet J, Agache I, Agarwal A, Bachert C, Bosnic-Anticevich S, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines: 2016 revision. J Allergy Clin Immunol. 2017; Oct. 140(4):950–8.

41. Rhodes HL, Thomas P, Sporik R, Holgate ST, Cogswell JJ. A birth cohort study of subjects at risk of atopy: twenty-two-year follow-up of wheeze and atopic status. Am J Respir Crit Care Med. 2002; Jan. 165(2):176–80.

42. Stikker BS, Hendriks RW, Stadhouders R. Decoding the genetic and epigenetic basis of asthma. Allergy. 2023; Apr. 78(4):940–56.

43. Bousquet J, Melen E, Haahtela T, Koppelman GH, Togias A, Valenta R, et al. Rhinitis associated with asthma is distinct from rhinitis alone: the ARIA-MeDALL hypothesis. Allergy. 2023; May. 78(5):1169–203.

44. Frohlich M, Pinart M, Keller T, Reich A, Cabieses B, Hohmann C, et al. Is there a sex-shift in prevalence of allergic rhinitis and comorbid asthma from childhood to adulthood?: a meta-analysis. Clin Transl Allergy. 2017; Dec. 7:44.

45. Kneepkens CM, Brand PL. Clinical practice: breastfeeding and the prevention of allergy. Eur J Pediatr. 2010; Aug. 169(8):911–7.

46. Spiekermann GM, Walker WA. Oral tolerance and its role in clinical disease. J Pediatr Gastroenterol Nutr. 2001; Mar. 32(3):237–55.

47. Madar J, Richmond S, Hey E. Surfactant-deficient respiratory distress after elective delivery at ‘term’. Acta Paediatr. 1999; Nov. 88(11):1244–8.

48. Lunjani N, Satitsuksanoa P, Lukasik Z, Sokolowska M, Eiwegger T, O’Mahony L. Recent developments and highlights in mechanisms of allergic diseases: microbiome. Allergy. 2018; Dec. 73(12):2314–27.

49. Betran AP, Ye J, Moller AB, Souza JP, Zhang J. Trends and projections of caesarean section rates: global and regional estimates. BMJ Glob Health. 2021; Jun. 6(6):e005671.

50. Hobbs AJ, Mannion CA, McDonald SW, Brockway M, Tough SC. The impact of caesarean section on breastfeeding initiation, duration and difficulties in the first four months postpartum. BMC Pregnancy Childbirth. 2016; Apr. 16:90.