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Prevalence of Allergic Disease in Foreign-Born American Children

Jonathan I. Silverberg, MD, PhD, MPH; Eric L. Simpson, MD, MCR; Helen G. Durkin, PhD; Rauno Joks, MD
JAMA Pediatr. 2013;167(6):554-560. doi:10.1001/jamapediatrics.2013.1319.
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Importance Improved understanding of allergic disease epidemiology lead to novel therapeutic and prevention strategies.

Objectives To study the association between US birthplace and prevalence of childhood allergic disease and to determine the effects of prolonged US residence on allergic disease.

Design, Setting, Participants Cross-sectional questionnaire distributed to 91 642 children aged 0 to 17 years enrolled in the 2007-2008 National Survey of Children's Health.

Exposure Place of birth.

Main Outcome and Measure Prevalence of allergic disease, including asthma, eczema, hay fever, and food allergies.

Results Children born outside the United States had significantly lower odds of any atopic disorders than those born in the United States (logistic regression OR, 0.48; 95% CI, 0.38-0.61), including ever-asthma (0.53; 0.39-0.72), current-asthma (0.34; 0.23-0.51), eczema (0.43; 0.30-0.61), hay fever (0.39; 0.27-0.55), and food allergies (0.60; 0.37-0.99). The associations between child's birthplace and atopic disorders remained significant in multivariate models including age, sex, race/ethnicity, annual household income, residence in metropolitan areas, and history of child moving to a new address. Children born outside the United States whose parents were also born outside the United States had significantly lower odds of any atopic disorders than those whose parents were born in the United States (P = .005). Children born outside the United States who lived in the United States for longer than 10 years when compared with those who resided for only 0 to 2 years had significantly higher odds of developing any allergic disorders (adjusted OR, 3.04; 95% CI, 1.08-8.60), including eczema (4.93; 1.18-20.62; P = .03) and hay fever (6.25; 1.70-22.96) but not asthma or food allergies (P ≥ .06).

Conclusions and Relevance Children born outside the United States have a lower prevalence allergic disease that increases after residing in the United States for 1 decade.

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Pathogens being replaced with Allergens or Immunogens: A Theoretical Perspective
Posted on June 3, 2013
Deepak Gupta
Clinical Assistant Professor, Department of Anesthesiology, Wayne State University/Detroit Medical Center
Conflict of Interest: None Declared
It is highly appreciable that Silverberg et al.[1] reinstated the skewed epidemiology of allergic diseases across the continents. Though there results bring to attention the hygiene hypothesis [2-3] as the underlying mechanism, it is important to realize how the hygiene hypothesis evolves into this observed transcontinental skew. First of all, the human cells have evolved to counter biological pathogens wherein sometimes these cells fail to adequately counter these pathogens resulting in self-limiting diseases or complicated illnesses. Secondly, these same human cells become confused when dealing with the abundance of chemical “pathogens” (allergens or immunogens) because the cidal (killer) activity that is stimulated by living biological pathogens to eventually annihilate the inciting stimulants, cannot direct its killing power to non-living chemical “pathogens”. Therefore, this induced-killing power is often misdirected to the invaded human body itself resulting in allergy or auto-immunity. This does not mean that we should revert back to pre-hygiene era with rampant epidemics caused by the biological pathogens. However, the community at large should be aware of the concerns related to non-living chemical “pathogens”. For example, when an overly cautious mother cleans her hands with waterless hand rinses before feeding her children, she may be eliminating her kids’ exposure to the biological agents, but in the process, she may be exposing her kids to the molecules of chemicals transferred from her hands. These chemical pathogens, in spite of being miniscule to the naked eyes, may have adequate potential to induce cidal activity in the exposed kids leading to allergenicity, immunogenicity and possibly eventual auto-immunity in them. Cleanliness is the answer for better survival and longevity of human populations but it is not clear whether replacing biological agents with chemical agents serves this purpose appropriately or perfectly. In summary, the world may never be perfect and the world may not be able to undo societal evolutions; but understanding the inherent imperfections and the consequences of evolutions may guide the improvements in human survival a tidbit better and a tidbit longer at a single historical time-point. Reference:1. Silverberg JI, Simpson EL, Durkin HG, Joks R. Prevalence of Allergic Disease in Foreign-Born American Children. JAMA Pediatr. 2013 April 29.2. Strachan DP. Hay fever, hygiene, and household size. BMJ. 1989;299(6710):1259-1260.3. Prokopakis E, Vardouniotis A, Kawauchi H, et al. The pathophysiology of the hygiene hypothesis. Int J Pediatr Otorhinolaryngol. 2013 May 20.
Follow up study
Posted on May 1, 2013
Tina Lavy
Health Department
Conflict of Interest: None Declared
I would be interested in knowing if the children in the study were breastfed or not.
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