Early Life Environmental Control: Effect on Symptoms, Sensitization, and Lung Function at Age 3 Years

• Published in: American journal of respiratory and critical care medicine Vol. 170; no. 4; pp. 433 - 439
• Main Authors: Woodcock, Ashley, Lowe, Lesley A, Murray, Clare S, Simpson, Bridget M, Pipis, Spyros D, Kissen, Patricia, Simpson, Angela, Custovic, Adnan
• Format: Journal Article
• Language: English
• Published: New York, NY Am Thoracic Soc 15.08.2004; American Lung Association; American Thoracic Society
• Subjects: Allergens - analysis; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Child, Preschool; Comorbidity; Dust - analysis; Environmental Exposure - statistics & numerical data; Female; Follow-Up Studies; Humans; Hypersensitivity - diagnosis; Hypersensitivity - epidemiology; Hypersensitivity - immunology; Hypersensitivity - prevention & control; Immunoglobulin E - blood; Infant, Newborn; Intensive care medicine; Lung Diseases, Obstructive - epidemiology; Lung Diseases, Obstructive - immunology; Male; Medical sciences; Pregnancy; Prenatal Exposure Delayed Effects; Prospective Studies; Respiratory Function Tests; United Kingdom - epidemiology; Allergy; Immunopathology; Lung disease; Intensive care; Respiratory disease; environmental control; Asthma; Atopy; Prevention; Lung function; primary prevention; Bronchus disease; Environmental effect; Obstructive pulmonary disease; Resuscitation
• ISSN: 1073-449X; 1535-4970
• DOI: 10.1164/rccm.200401-083OC

We investigated whether environmental control during pregnancy and early life affects sensitization and lung function at the age of 3 years. High-risk children (n = 251) were prenatally randomized to stringent environmental control (active) or no intervention (control). Questionnaires, skin testing, IgE, and specific airway resistance (sRaw) measurement were completed at the age of 3 years. Children in the active group were significantly more frequently sensitized compared with control subjects (at least one allergen by skin tests: risk ratio, 1.61; 95% confidence interval [CI], 1.02-2.55; p = 0.04; mite by IgE: risk ratio, 2.85; 95% CI, 1.02-7.97; p = 0.05). However, sRaw was significantly better in the active group (kiloPascal/second, geometric mean [95% CI]: 1.05 [1.01-1.10] vs. 1.19 [1.13-1.25], p < 0.0001, active vs. control). Maximal flow at functional residual capacity was measured using rapid thoracic compression at the age of 4 weeks in a subgroup. Prospective lung function data (at infancy and 3 years) were obtained in 32 children (14 active and 18 control). There was no difference in infant lung function between the groups, but at 3 years, sRaw was significantly lower in the active compared with control children (p = 0.003). Stringent environmental control was associated with increased risk of mite sensitization but better results for some measurements of lung function in high-risk children at the age of 3 years.