Children with East Asian-Born Parents Have an Increased Risk of Allergy but May Not Have More Asthma in Early Childhood

doi:10.1016/j.jaip.2018.07.042

The Journal of Allergy and Clinical Immunology: In Practice

Volume 7, Issue 2, February 2019, Pages 539-547.e3

https://doi.org/10.1016/j.jaip.2018.07.042 Get rights and content

Background

We previously reported that infants with Asian-born parents are 3 times more likely to have IgE-mediated food allergy than those with Australian-born parents. It is unknown whether this translates to the increased risk of other allergic diseases later in childhood and whether ancestry interacts with other risk factors for allergic disease development.

Objective

To compare prevalence and risk factors for allergic rhinitis, asthma, and aeroallergen sensitization at age 6 between children with East Asian-born and Caucasian-born parents.

Methods

A total of 5276 1-year-old infants were recruited into a population-based longitudinal study of allergy. A total of 4455 children participated in age 6 follow-up (84.4%), including 3015 with Caucasian-born parents and 415 with East Asian-born parents. Children underwent skin prick tests to aeroallergens and questionnaires captured data on asthma, eczema, and allergic rhinitis.

Results

Compared with children with Caucasian-born parents, children of East Asian-born parents had more allergic rhinitis (19.9% [95% confidence interval (CI) 14.9-26] vs 9.3% [95% CI 8-10.8], P < .001) and aeroallergen sensitization (64.3% [95% CI 57.5-70.5] vs 34.4% [95% CI 32.2-36.7], P < .001) at age 6. Asthma was similar in both groups (9.1% [95% CI 6.2-13.2] vs 11.7% [95% CI 10.4-13.1]), P = .21. Children with IgE-mediated food allergy and eczema in infancy were 3 times more likely to have asthma and 2 times more likely to have allergic rhinitis at age 6, irrespective of ancestry.

Conclusions

Children of East Asian ancestry born in Australia have a higher burden of most allergic diseases in the first 6 years of life, whereas asthma may follow a different pattern. IgE-mediated food allergy and eczema at age 1 increase the risk of asthma and allergic rhinitis irrespective of ancestry.

Section snippets

Study population

The HealthNuts study is a longitudinal population-based cohort study of allergic disease in Melbourne, Australia. The recruitment process has previously been described in detail.¹¹ Briefly, 5276 twelve-month-old infants were recruited from immunization clinics around Melbourne (74% participation rate). All infants underwent a skin prick test (SPT) at recruitment to 4 foods (egg, peanut, sesame, shrimp/cow's milk) (ALK-Abello, Madrid, Spain). Infants with a detectable wheal size ≥1 mm to any of

Study population

Of the 5276 infants recruited at 12 months, 84% participated in the age 6 follow-up, with a majority answering the full questionnaire (n = 3663). An additional 605 participants completed the short questionnaires and were included in our sensitivity analyses (see Figure E1, available in this article's Online Repository at www.jaci-inpractice.org). Assessments including SPT were completed by 3233 children at age 6 years. Demographic and baseline characteristics of the study population are

Discussion

We have shown through this study that East Asian children have a higher prevalence of most allergic diseases at 6 years of age. Asthma appears to be similar between East Asian and Caucasian children. However, there was no evidence of a differential progression of the atopic march in East Asian children compared with Caucasian children. Children with both IgE-mediated food allergy and eczema during infancy had an increased risk of allergic rhinitis and asthma at age 6, regardless of ancestry.

Conclusions

High rates of allergy among East Asian children in infancy appear to be maintained into early childhood, with a high prevalence of eczema and allergic rhinitis at 6 years of age. Atopic asthma appears to be similar between East Asian and Caucasian children. Our findings identify East Asian children as a high-risk allergic group not just in infancy but throughout early childhood. We also showed that IgE-mediated food allergy and eczema in infancy increase the risk of asthma and allergic rhinitis

Acknowledgment

The HealthNuts study group is made up of the HealthNuts investigators, including Professor Melissa Wake, Professor Colin Robertson, and Professor Terry Dwyer. We thank the parents and children who participated in the HealthNuts study as well as the staff of Melbourne's Local Government Areas for access to community Immunization Clinics. We would also like to thank the HealthNuts safety committee: Associate Professor Noel Cranswick (Australian Paediatric Pharmacology Research Unit, Murdoch

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At age 6 years, all parents were mailed a full questionnaire collecting information about their child's asthma and allergy status, ongoing feeding practices, and environmental exposures. Children were also invited to participate in a health assessment that included SPT.26 If parents did not respond after reminders, they were invited to complete a short 5-minute telephone questionnaire obtaining key information regarding their child's current asthma status.
Longer duration of breastfeeding may be protective against asthma. However, early manifestations of allergic disease, such as eczema, are risk factors for asthma and can influence the duration of breastfeeding, and hence, may bias observable associations.
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A total of 3663 children participated in the 6-year-old follow-up of the HealthNuts study, a population-based, longitudinal study of allergic diseases in Australia. At age 1 year, breastfeeding and eczema data were collected and at age 6 years, information on wheeze, medication use, and parental report of doctor-diagnosed asthma were obtained, both via questionnaire. Skin prick test responses to food and aeroallergens at age 6 years further distinguished asthmatic children into allergic and nonallergic phenotypes.
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Adverse food reactions occurred in almost half of all food-allergic 6-year-old children and anaphylaxis occurred in 1 in 10 children over a 12-month period. Anaphylaxis was poorly recognized and adrenaline autoinjectors were not used appropriately. Improved regular education on the prevention, recognition, and management of adverse food reactions is urgently needed.
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: This work was supported by funding from the National Health and Medical Research Council (NHMRC) of Australia, Ilhan Food Allergy Foundation, AnaphylaxiStop, the Charles and Sylvia Viertel Medical Research Foundation, the Victorian Government's Operational Infrastructure Support Program, and the NHMRC Centre for Food and Allergy Research.

: Conflicts of interest: M. L. K. Tang is on the Nestle Nutrition Institute Medical Advisory Board Oceania; is a past member of the Danone Nutricia Global Scientific Advisory Board; has received consultancy fees from Deerfield Consulting, GLG Consulting, and Bayer; is employed by and has stock/stock options in ProTA Therapeutics; has received lecture fees from Danone Nutricia and Nestle Health Sciences; has a patent owned by Murdoch Children's Research Institute; received royalties from Wilkinson Publishing; and has received payment for developing educational presentations from MD Linx. K. J. Allen serves as a consultant for Nestle, ThermoFisher, AspenCare, Before Brands, and Nutricia. The rest of the authors declare that they have no relevant conflicts of interest.

View full text

Original ArticleChildren with East Asian-Born Parents Have an Increased Risk of Allergy but May Not Have More Asthma in Early Childhood

Background

Objective

Methods

Results

Conclusions

Section snippets

Study population

Study population

Discussion

Conclusions

Acknowledgment

J Allergy Clin Immunol

Immunol Allergy Clin North Am

J Allergy Clin Immunol Pract

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

Nut allergy prevalence and differences between Asian-born children and Australian-born children of Asian descent: a state-wide survey of children at primary school entry in Victoria, Australia

Clin Exp Allergy

The prevalence and socio-demographic risk factors of clinical eczema in infancy: a population-based observational study

Clin Exp Allergy

Increased risk of peanut allergy in infants of Asian-born parents compared to those of Australian-born parents

Allergy

Personal and parental nativity as risk factors for food sensitization

J Allergy Clin Immunol

Food hypersensitivity among Caucasian and non-Caucasian children

Pediatr Allergy Immunol

Atopic dermatitis and the atopic march revisited

Allergy

The role of food allergy in the atopic march

Clin Exp Allergy

The HealthNuts population-based study of paediatric food allergy: validity, safety and acceptability

Clin Exp Allergy

International Study of Asthma and Allergies in Childhood (ISAAC): rationale and methods

Eur Respir J

The skin barrier function gene SPINK5 is associated with challenge-proven IgE-mediated food allergy in infants

Allergy

Standard Australian Classification of Countries. 2011. Second Edition, Revision 1

How much asthma is really attributable to atopy?

Thorax

Original Article
Children with East Asian-Born Parents Have an Increased Risk of Allergy but May Not Have More Asthma in Early Childhood