Health effects of passive smoking .5. Parental smoking and allergic sensitisation in children.

Author:

Strachan D P,Cook D G

Abstract

BACKGROUND: A systematic review was conducted of the effects of parental smoking on immunoglobulin (IgE) levels, skin prick positivity, and allergic rhinitis or eczema in children. Asthma was excluded in order to distinguish more clearly the effect of passive smoke exposure on allergic sensitisation. METHODS: Thirty six relevant publications were identified after consideration of 692 articles selected by electronic search of the Embase and Medline databases using keywords relevant to passive smoking in children. The search was completed in April 1997 and identified nine studies of IgE in neonates, eight of IgE in older children, 12 which included skin prick tests, and 10 describing symptoms of allergic disease other than asthma or wheezing. A quantitative meta-analysis was possible only for the studies reporting skin prick tests. RESULTS: Several large studies failed to confirm early reports of a substantial or statistically significant association of maternal smoking with concentrations of total serum IgE in neonates or in older children. No consistent association emerged between parental smoking and allergic rhinitis or eczema. Few of these studies adjusted for potential confounding variables. The quantity and quality of evidence was greatest for skin prick tests, and studies of parental smoking during pregnancy or infancy were broadly consistent in showing no adverse effect on prick positivity (pooled odds ratio 0.87, 95% confidence interval 0.62 to 1.24). There was much greater and statistically significant (p = 0.002) heterogeneity of odds ratios relating current parental smoking to skin prick positivity. CONCLUSIONS: Parental smoking, either before or immediately after birth, is unlikely to increase the risk of allergic sensitisation in children.

Publisher

BMJ

Subject

Pulmonary and Respiratory Medicine

Reference54 articles.

1. As part of a more general descriptive study Bergmann et al10 related cord blood IgE levels to parental smoking habits during pregnancy for 4793 German infants, representing 63% of all babies born in six hospitals during 1990. The prevalence of elevated IgE concentrations ([0.7 kU/l) was 11.6% among 3495 offspring of non-smoking mothers and 10.6% among 1298 babies whose mothers smoked during pregnancy (odds ratio 0.9, 95% CI 0.7 to 1.1). The equivalent odds ratio for paternal smoking was 1.0 (95% CI 0.8 to 1.2). This large study did not report upon possible effect modification by atopic family history

2. Two earlier studies5 12 of small samples (46 and 136 infants, respectively) also report no significant association of parental smoking with neonatal IgE concentrations, but another of 215 infants found a positive correlation between the number of cigarettes smoked in pregnancy and cord blood IgE levels.13 A somewhat larger study of 325 infants found no significant association using a more sensitive assay, but it appears to have been published only in abstract form.14 These studies offer insufficient quantitative information to be considered in detail in this review

3. Ronchetti et al21 measured total serum IgE concentrations in 159 nine year old children, 89% of a randomly selected sample in three Italian towns. An association of geometric mean IgE with one or more parents smoking emerged for boys (99 versus 39 kU/l) but not for girls (56 versus 59 kU/l). Statistical significance was achieved by subgroup analysis, but the interaction of sex and parental smoking was not formally assessed. The prevalence of eosinophilia ([4% leucocytes) was also increased in the offspring of smoking parents, independent of the common association with IgE level. This otherwise informative study does not provide an estimate of the effect of parental smoking on serum IgE levels in both sexes combined, although it is reported to be nonsignificant (p=0.2)

4. The relationship of current maternal smoking to atopy, defined as [5 mm erythema or a detectable weal ([0 mm) to any of four aeroallergens, was analysed among a population based cohort of 196 children aged 12–16 in Boston, Massachusetts.24 A positive association of similar strength to the Italian study was found (odds ratio 2.2, 95% CI 1.1 to 4.4). This was significant at the 2% level and the 95% confidence interval is derived from the published 2 value

5. A longitudinal study of consecutive births in the Isle of Wight during 1989–90 has reported on the association of environmental factors and allergic sensitisation at the ages of one26 and two years.27 Only the latter study is considered here. Among the offspring of 257 smoking mothers 4.7% had positive skin prick tests to one or more of five allergens at the age of two compared with 5.3% of 915 children of nonsmoking mothers, an odds ratio of 0.9 (95% CI 0.5 to 1.7). It is not clear from the publication whether this relates to current maternal smoking or smoking in pregnancy

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