Prenatal and early-life predictors of atopy and allergic disease in Canadian children: results of the Family Atherosclerosis Monitoring In earLY life (FAMILY) Study.

Prenatal and early-life environmental exposures play a key role in the development of atopy and allergic disease. The Family Atherosclerosis Monitoring In earLY life Study is a general, population-based Canadian birth cohort that prospectively evaluated prenatal and early-life traits and their association with atopy and/or allergic disease. The study population included 901 babies, 857 mothers and 530 fathers. Prenatal and postnatal risk factors were evaluated through questionnaires collected during the antenatal period and at 1 year. The end points of atopy and allergic diseases in infants were evaluated through questionnaires and skin prick testing. Key outcomes included atopy (24.5%), food allergy (17.5%), cow's milk allergy (4.8%), wheezing (18.6%) and eczema (16%). The association between infant antibiotic exposure [odds ratio (OR): 2.04, 95% confidence interval (CI): 1.45-2.88] and increased atopy was noted in the multivariate analysis, whereas prenatal maternal exposure to dogs (OR: 0.60, 95% CI: 0.42-0.84) and acetaminophen (OR: 0.68, 95% CI: 0.51-0.92) was associated with decreased atopy. This population-based birth cohort in Canada demonstrated high rates of atopy, food allergy, wheezing and eczema. Several previously reported and some novel prenatal and postnatal exposures were associated with atopy and allergic diseases at 1 year of age.

Systemic aspects of allergic disease: the role of the bone marrow.

In recent years, there has been an increasing appreciation of the important contribution of bone-marrow-related, hemopoietic mechanisms to allergic diseases. Eosinophil/basophil-progenitor levels fluctuate in the peripheral blood during allergen exposure and the cells home to peripheral tissue, where they differentiate. It is becoming apparent that several cytokines, particularly IL-5, have multiple effects on progenitors and allergic inflammation. Within the past few years, studies of the therapeutic implications of this bone marrow contribution to atopy have been initiated; the effects of corticosteroids, leukotriene-receptor blockers, antagonism of IL-5 and modulation of differentiation by retinoic acid on progenitors will be reviewed.