Asthma, rhinitis, other respiratory diseasesThe Canadian asthma primary prevention study: outcomes at 2 years of age☆
Section snippets
Study population
Our Canadian Asthma Primary Prevention study is a prospective, prenatally randomized, controlled clinical trial in a cohort of children at high risk for development of asthma on the basis of an immediate family history. This cohort has been described in a previous communication.16 Briefly, high-risk infants, defined as those with at least one first-degree relative with asthma or 2 first-degree relatives with other classic IgE-mediated allergic diseases, had families identified during the
Efficacy of interventions
We previously reported the success of our multifaceted intervention program.16., 20. In summary, we successfully decreased HDM exposure in the first and second year (first-year average Der p 1 plus Der f 1: intervention vs control, 1.69 vs 2.70 μg/g; second year: 1.28 vs 2.45 μg/g). Although prevalence of pets did not change, there was significantly less cat allergen exposure at 2 weeks and 4 months in intervention homes (first-year average Fel d 1, 1.68 vs 2.09 μg/g; second year, 2.24 vs 2.5
Discussion
We have undertaken a prospective, randomized, controlled study of a multifaceted intervention designed to decrease exposure to allergens (both inhaled and ingested) and exposure to ETS in the first year of life of infants at high risk for asthma because of their family history. We previously reported a significant reduction in asthma in the intervention group at 12 months of age.16 We now report a significant difference in the prevalence of asthma at 2 years of age between the children in the
Acknowledgements
We thank Marilyn Lilley, Michelle Ditrick, Maureen Sigurdson, Joan Brooks, Roxanne Rousseau, Henry Chan, Anne DyBuncio, Judy Passante, Homa Ahmed, Kathy Lee, and Brenda Gerwing for their hard work, which made this study possible.
References (38)
- et al.
Trends in physician-diagnosed asthma prevalence in Manitoba between 1980 and 1990
Chest
(1993) - et al.
Indoor allergens and asthma: report of the Third International Workshop
J Allergy Clin Immunol
(1997) - et al.
Early life risk factors for adult asthma: a birth cohort study of subjects at risk
J Allergy Clin Immunol
(2001) - et al.
The effect of cigarette smoke from the mother on bronchial responsiveness and severity of symptoms in children with asthma
J Allergy Clin Immunol
(1986) - et al.
Effect of allergen avoidance on development of allergic disorders in infancy
Lancet
(1992) - et al.
Effect of allergen avoidance in infancy on allergic manifestations at age two years
J Allergy Clin Immunol
(1994) - et al.
Reversing the trend: reducing the prevalence of asthma
J Allergy Clin Immunol
(1999) - et al.
A two-site monoclonal antibody ELISA for the quantification of the major Dermatophagoides spp. Allergens, Der p 1 and Der f 1
J Immunol Methods
(1989) - et al.
Airborne dust mite allergens: comparison of group II allergens with group I mite allergen and cat-allergen
J Allergy Clin Immunol
(1991) - et al.
Effectiveness of and compliance to intervention measures in reducing house dust and cat allergen levels
Ann Allergy Asthma Immunol
(2002)
Manchester Asthma and Allergy Study: low-allergen environment can be achieved and maintained during pregnancy and in early life
J Allergy Clin Immunol
Effect of environmental manipulation in pregnancy and early life on respiratory symptoms and atopy during first year of life: a randomized trial
Lancet
Eighteen-month outcomes of house dust mite avoidance and dietary fatty acid modification in the childhood asthma prevention study (CAPS)
J Allergy Clin Immunol
Role of current and childhood exposure to cat and atopic sensitization
J Allergy Clin Immunol
Childhood environment and adult atopy: results from the European Community Respiratory Health Survey
J Allergy Clin Immunol
Dog exposure in infancy decreases the subsequent risk of frequent wheeze but not of atopy
J Allergy Clin Immunol
Exposure to cat allergen, maternal history of asthma, and wheezing in first 5 years of life
Lancet
Long-term relation between breastfeeding and development of atopy and asthma in children and young adults: a longitudinal study
Lancet
Development and prevention of allergic disease in childhood
Cited by (109)
Immunologic Strategies for Prevention of Asthma
2020, Journal of Allergy and Clinical Immunology: In PracticeCitation Excerpt :In addition, early-life aeroallergen exposure was low in the high-wheeze phenotypes.75 The Canadian Asthma Primary Prevention Study was designed to determine the effectiveness of a multifaceted intervention program in primary prevention of asthma in high-risk infants.76 Interventions included avoidance of house dust mite, pet allergen, and environmental tobacco smoke along with encouraging breastfeeding and delayed introduction of solid foods (this was done before the Learning Early About Peanut study).77
Environmental Control
2016, Pediatric Allergy: Principles and Practice: Third EditionHouse Dust Mite Respiratory Allergy: An Overview of Current Therapeutic Strategies
2015, Journal of Allergy and Clinical Immunology: In PracticeCitation Excerpt :To illustrate the inconsistency of results, a randomized study of the effects of a multifaceted intervention, including HDM avoidance during pregnancy and early life, resulted in increased risk of HDM sensitization, but better lung function in the intervention group at age 3 years.123 In contrast, for tertiary prevention in particular, multifaceted avoidance strategies early in life are likely to show the greatest effect when used to modify and potentially prevent allergic progression.124-127 A progressive intervention would identify infants with a genetic predisposition using familial asthma as a “genetic” proxy, then would recommend breast-feeding, allergen avoidance strategies, and timely use of appropriate medication to control early symptoms.127,128
Probability of successful inhaled corticosteroids cessation in preschool wheezers: a predictive score
2023, European Journal of PediatricsImpact of time-varying confounders on the association between early-life allergy sensitization and the risk of current asthma: A post hoc analysis of a birth cohort
2022, Allergy: European Journal of Allergy and Clinical Immunology
- ☆
Supported by The Respiratory Health Network of Centres of Excellence, Canada; Vancouver General Hospital Foundation; Children's Hospital Foundation of British Columbia; and the British Columbia Lung Association.