Karl E. Bergmann

Indoor allergen exposure is a risk factor for sensitization during the first three years of life

BACKGROUND The purpose of the study was to investigate the influence of environmental allergen exposure on allergic sensitization in infancy and early childhood. METHODS A cohort of 1314 newborns was recruited and followed up prospectively at the ages 12, 24, and 36 months. The levels of major mite (Der p 1 and Der f 1) and cat (Fel d 1) allergens were determined from domestic carpet dust samples by sandwich ELISA. Specific serum IgE antibodies to mite and cat allergens were determined by CAP fluoroimmunoassay (Pharmacia). Logistic regression was used to assess the effects of allergen exposure, age, family history, and cord blood IgE simultaneously on the risk of sensitization. RESULTS Children, who had been found to be sensitized at least once during the first 3 years of life, were found to be exposed to significantly higher house dust mite (median, 868 ng/gm vs 210 ng/mg; p = 0.001) and cat (median, 150 ng/gm vs 64 ng/gm; p = 0.011) allergen concentrations in domestic carpet dust compared with the group without sensitization. In homes with low (< or = 25th percentile) dust concentrations, the risk of sensitization to mite (1.6%), and cat (2.0%) is low, compared with 6.5% for mite and 6.3% for cat if the domestic exposure is above the 75th percentile. The dose-response relationships between allergen levels and sensitization indicate that the increase in sensitization risk at low allergen levels is more pronounced in cat allergy (p = 0.002) than in mite allergy (p = 0.026). In the group with a positive family history, lower mite and cat allergen concentrations are needed to achieve specific sensitization compared with the group with a negative family history. CONCLUSION Our data indicate that avoidance measures in the domestic environment aimed at the primary prevention of allergen-driven sensitization should be introduced at the earliest possible stage, if possible during infancy.

Early determinants of childhood overweight and adiposity in a birth cohort study: role of breast-feeding

BACKGROUND: The prevalence of adiposity in childhood is increasing. Is breast-feeding protective as suggested by cross-sectional studies?OBJECTIVE: In a longitudinal birth cohort study, we tested whether breast-feeding for more than 2 months has preventive effects against overweight and adiposity at 6 y.DESIGN: Of 1314 children representing the catchment areas of six delivery units, 918 could be followed up to the age of 6 y. Height, weight, and skin-fold thickness were measured at regular visits. As the criteria of overweight, obesity, and adiposity in the children, the 90th and the 97th percentiles of BMI and skin-fold values were used. Parents with a BMI at or above the 90th percentile, which was 27 kg/m2 or more, were considered overweight. Infants bottle-fed from birth or breast-fed for less than 3 months were classified as ‘bottle-fed’ (BO), and those breast-fed for 3 months and more as ‘breast-fed’ (BR). Univariate comparisons and logistic regression analysis were performed applying SAS 6.12. The final logistic model consisted of the 480 cases for whom complete data for all variables were available. The potential effect of loss to follow-up was analysed by the Cochran–Mantel–Haenzel test: the outcomes were not significantly influenced by loss to follow-up.RESULTS: At birth BMIs were nearly identical in both groups. By 3 months, BO had significantly higher BMIs and thicker skin folds than BR. From 6 months on, compared to BR, a consistently higher proportion of BO children exceeded the 90th and the 97th percentile of BMI and skin-fold thickness reference values. From the age of 4 y to 5 and 6 y, in BO the prevalence of obesity nearly doubled and tripled, respectively. With only minor changes of obesity prevalence in BR, the difference of BMI and skin-fold thickness between groups became statistically significant. Logistic regression analysis revealed that overweight of the mother, maternal smoking during pregnancy, bottle feeding, and low social status remained important risk factors for overweight and adiposity at 6 y of age.CONCLUSION: A maternal BMI of ≥27, bottle-feeding, maternal smoking during pregnancy, and low social status are risk factors for overweight and adiposity at 6 y of age. Early bottle-feeding brings forward the obesity rebound, predictive of obesity in later life.

Breastfeeding duration is a risk factor for atopic eczema

Background The results of numerous studies on the influence of breastfeeding in the prevention of atopic disorders are often contradictory. One of the most important problems is confounding by other lifestyle factors.

Predictability of early atopy by cord blood‐IgE and parental history

Background Atopic family history and cord blood IgE have been used as predictors of atopic disease in newborns for about 20 years, but at least for cord blood IgE the sensitivity has been shown to be very low. The objective of this paper was to evaluate whether parental history and cord blood‐IgE were more accurate predictors for the appropriate atopic phenotypes in the infants rather than for any atopy.

Socioeconomic status is a risk factor for allergy in parents but not in their children.

Allergic diseases are more prevalent in affluent countries, which has been attributed to life‐style factors. Life‐style habits may also differ between socioeconomic (SES) classes. The objective of this paper therefore was to evaluate if SES had an impact on the development of atopic disorders.

Determinants of cord-blood IgE concentrations in 6401 German neonates.

For screening atopy risk in 6401 (84%) of all infants born during the year 1990 in six obstetric departments of five German cities, cord‐blood IgE values were determined with CAP‐RAST‐FEIA. After cases with elevated IgA values had been excluded, 25 % of the values were above the detection limit of 0.35 kU/1, and 8.5% were above 0.9 kU/1. Boys had significantly higher values than girls (P≤0.001). The distribution of values was significantly different for different nationalities of mothers (P≤0.001). The percentage of elevated values (≥0.9kU/l) increased significantly with the number of close family members with atopic history (P≤0.001). Regarding the atopic history of the father, siblings, and mother separately, only the mothers history had a significant association with the cord‐blood IgE class (P≤0.001). The IgE values of 81 twin pairs correlated significantly with a coefficient of r = 0.4909 (P≤0.001). The smoking history of the parents during pregnancy showed an association with cord‐blood IgE values (P≤0.02). No significant association could be shown between cord‐blood IgE distribution and other variables, i.e., gestational age, birth size, birth modus, Apgar score, cord‐blood pH value, neonatal problems, parity, age of the mother, medication during pregnancy, educational level of mother or father, time of year, or obstetric department. It is hypothesized that, in addition to some postpartum contamination or placental transfer of maternal IgE, cord‐blood IgE values are also determined by the fetal immunologic reaction to intrauterine exposure to allergens and trigger factors, and by genetic influences.

Supplementation with 200 mg/Day Docosahexaenoic Acid from Mid-Pregnancy through Lactation Improves the Docosahexaenoic Acid Status of Mothers with a Habitually Low Fish Intake and of Their Infants

Background/Aims: The supply of docosahexaenoic acid (DHA, 22:6ω–3), important for fetal/infant neurodevelopment, depends on the maternal fatty acid (FA) status, which may be marginal in central Europe. Therefore, we investigated the effect of a daily vitamin/mineral supplement with and without 200 mg DHA from mid-pregnancy through lactation on the DHA concentrations in maternal and infant red blood cell phospholipids (RBC%), and in breast milk FA (%). Methods: At 21 weeks’ gestation, 144 women were enrolled into a randomised, double-blind clinical trial receiving daily: (1) a basic vitamin-mineral supplement (Vit/Min group), (2) Vit/Min plus 4.5 g fructo-oligosaccharide (FOS group), or (3) Vit/Min plus 4.5 g FOS plus 200 mg fish oil-derived DHA (DHA-FOS group). FAs were determined by capillary gas-liquid chromatography. Results: While maternal RBC-DHA% at enrolment was not different, at 37 weeks gestation, and 3 months after delivery RBC-DHA% were significantly higher in the DHA-FOS group. The breast milk DHA% was twice as high in the DHA-FOS group (0.50%) than in the two others (0.25 %) (p < 0.001), and the ratio ARA/DHA in the DHA-FOS group was 1.0 ± 0.43, in the others 2.1 ± 0.43 (p < 0.001). The RBC-DHA% of the infants in the DHA-FOS group was also significantly higher, and correlated significantly with maternal RBC-DHA% before and 3 months after delivery. Conclusions: In central Europe, a dose of 200 mg/day DHA from mid-pregnancy through lactation seems appropriate to improve the DHA status of mothers and infants.

Allergic multimorbidity of asthma, rhinitis and eczema over 20 years in the German birth cohort MAS.

The occurrence of allergic multimorbidity (coexistence of asthma, allergic rhinitis and eczema) has not been evaluated longitudinally from early childhood up to adulthood in a population‐based study sample. We aimed to determine the prevalence of allergic multimorbidity up to age 20 stratified by parental allergies and sex/gender using extensive prospective follow‐up data from two decades of a birth cohort study.

Prevalence and risk factors for early postpartum anemia

OBJECTIVE To assess the prevalence and evaluate the most important risk factors for early postpartum anemia. STUDY DESIGN The perinatal process data of 43,807 women delivering between 1993 and 2008 (90.1% of all deliveries) in the largest university obstetric department in Germany were analyzed, and the associations of Hb<8 g/dl with maternal characteristics, pregnancy risks, delivery mode and estimated delivery blood loss were calculated. Multivariable logistic regression models were applied to compute odds ratios. Additionally, the impact of these risk factors for delivery blood loss was estimated with multivariable linear regression analysis. RESULTS Twenty-two percent of mothers had Hb<10 g/dl, and 3% had Hb<8 g/dl. The adjusted odds ratios (OR) for Hb<8 g/dl were 4.8 (p=0.001) for placenta previa, 2.9 (p<0.001) for mothers of African origin, 2.7 (p<0.001) for diagnosed anemia in pregnancy, 2.2 (p<0.001) for multiple pregnancy, and 2.1 (p=0.021) for bleeding in late pregnancy. However, the delivery blood loss was the most important risk factor for postpartum anemia. The adjusted OR for an estimated blood loss of 500-1000 ml was 15.3 (p<0.001), and for a loss of >1000 ml was 74.7 (p<0.001). CONCLUSION The estimated obstetric blood loss is the most important risk factor for severe postpartum anemia, and the volume of blood lost is especially high in cesarean deliveries, which should be considered when electing delivery procedures. Also, measures to boost iron stores in pregnancy should be established.

Die Gesundheit von Kindern und Jugendlichen in Deutschland

ZusammenfassungDie aktuelle epidemiologische Datenlage zur Gesundheit von Kindern und Jugendlichen offenbart die Notwendigkeit einer repräsentativen Gesundheitserhebung für die 0- bis 17-Jährigen. Ein über mehrere Jahre entwickeltes Konzept für einen Kinder- und Jugendgesundheitssurvey wurde in einer einjährigen Pilotphase mit 1630 Kindern und Jugendlichen getestet. Die dabei gewonnenen Erfahrungen sowie Gutachterempfehlungen werden in einem im Jahr 2003 beginnenden Gesundheitssurvey für ca. 20.000 Kinder und Jugendliche umgesetzt. Diese bislang größte repräsentative Studie zur Gesundheit der heranwachsenden Generation in Deutschland wird gemeinsam vom Bundesministerium für Gesundheit, dem Bundesministerium für Bildung und Forschung und dem Robert Koch-Institut finanziert. Dabei sollen über drei Jahre in der ganzen Bundesrepublik zufällig ausgewählte Kinder und Jugendliche im Alter von 0 bis 17 Jahren gesundheitlich untersucht und befragt werden. Bei den jüngeren Kindern sind die Angaben der Eltern wesentliche Informationsquelle zum Gesundheitszustand der Kinder. Die durch den Survey gewonnenen Informationen werden nicht nur die Basis für eine fundierte bundesweite Gesundheitsberichterstattung zu Kindern und Jugendlichen sein, sondern auch Ansatzpunkte für Interventions- und Präventionsstrategien liefern. Die Daten werden schnellstmöglich der Fachöffentlichkeit als Public Use File zur weiteren Analyse zur Verfügung gestellt.AbstractThe deficits in our knowledge of the health status of infants, children, and adolescents in Germany are large and significant. To close the gaps, the concept for a national, representative health interview and examination survey of the young generation has been developed by the Robert Koch Institute supported by the expertise of German and international specialists. The development of the concept, study design and methodology took several years. After a pilot study, which took place over a period of 12 months and involved 1,630 young people aged between 0 and 17 years, the concept, design and materials were thoroughly revised. The survey will start in 2003, and include about 20,000 individuals in this age range. It will be the most comprehensive health study of young people ever undertaken in Germany. The funding comes from the German Federal Ministries of Health and of Research and Education, as well as from the Robert Koch Institute. Over a period of 3 years, participants, randomly selected from the registries of inhabitants, will be medically examined and their parents interviewed. From the age of 11, the youngsters themselves will also fill in a questionnaire serving as an additional source of information. The data obtained will form the basis for a National Health Report on children and adolescents, open new fields of prevention and intervention, and support the research of the scientific community as a Public Use File which will be available 1 year after the end of data collection.