Number of siblings and allergic rhinitis in children

Main Article Content

Soewira Sastra
Lily Irsa
Muhammad Sjabaroeddin Loebis
Rita Evalina

Abstract

Background Allergic rhinitis is one of the most common chronic diseases of childhood. Recent studies have suggested that having fewer siblings was associated with allergic rhinitis and atopic diseases in children. Previous studies also indicated that older siblings was associated with higher incidence of allergic rhinitis.
Objectives To assess for a possible association between number of siblings and allergic rhinitis and to assess for an effect of birth order on allergic rhinitis in children.
Methods We performed a cross-sectional study among school children aged 7 to 15 years, in the West Medan District from July to August 2011. Children with moderate or high risk of allergy were included. Subjects were divided into two groups, those with <3 siblings or ≥3 siblings. Children with acute respiratory tract infections, septal deviation, choanal atresia, nasal polyps, nasal tumors, or nasal foreign body were excluded. Risk of allergy was determined using the Indonesian Pediatrics Allergy Immunology Working Group trace card scoring system. Identification of allergic rhinitis and evaluation of its severity were done by use of the International Study of Asthma and Allergies in Childhood (ISAAC) core questionnaire. Allergic rhinitis was diagnosed based on history, physical examination, and anterior rhinoscopy.
Results A total of 78 subjects were enrolled. Allergic rhinitis was significantly higher in children with <3 siblings than those with ≥3 siblings (OR 10.33; 95%CI 3.569 to 29.916). Furthermore, allergic rhinitis was significantly higher in first-born children than in their younger siblings (P=0.0001).
Conclusion Larger number of siblings and non-first-born children are associated with lower incidence of allergic rhinitis in children.

Article Details

How to Cite
1.
Sastra S, Irsa L, Loebis M, Evalina R. Number of siblings and allergic rhinitis in children. PI [Internet]. 12May2016 [cited 17Sep.2019];56(1):1-. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/71
Section
Pediatric Allergy Immunology
Received 2016-03-30
Accepted 2016-03-30
Published 2016-05-12

References

1. Stone KD. Atopic diseases of childhood. CurrOpinPediatr. 2003;15:495-511.
2. McRae WM, Wong CS. Asthma, allergy, and the hygiene hypothesis. NZFP. 2002;29:31-6.
3. Scadding GK, Durham SR, Mirakian R, Jones NS, Leech SC, Farooque S, et al. BSACI guidelines for the management of allergic and non-allergic rhinitis. ClinExp Allergy. 2008;38:19-42.
4. Nency YM. Prevalensi dan factor risiko alergi pada anak usia 6-7 tahun di Semarang. [thesis]. [Semarang]: Program Pendidikan Dokter Spesialis I Ilmu Kesehatan Anak Fakultas Kedokteran Universitas Diponegoro; 2005.
5. Widodo P. Hubungan antara rhinitis alergi dengan faktor-faktor risiko yang mempengaruhi pada siswa SLTP kota Semarang usia 13-14 tahun dengan mempergunakan kuesioner International Studies of Asthma and Allergies in Childhood (ISAAC). [thesis]. [Semarang]: Program Pendidikan Dokter Spesialis I Ilmu Kesehatan Telinga Hidung Tenggorok–Bedah Kepala dan Leher Fakultas Kedokteran Universitas Diponegoro; 2004.
6. Gary A, Hendra S. Clinical manifestations of allergic rhinitis in children at Denpasar Hospital. Paediatr Indones. 2001;41:160-5.
7. Khaled NA, Pearce N, Anderson HR, Ellwood P, Montefort S, Shah J, et al. Global map of the prevalence of symptoms of rhinoconjunctivitis in children: the International Study of Asthma and Allergies in Childhood (ISAAC) Phase Three. Allergy. 2009;64:123–48.
8. Strachan DP. Hay fever, hygiene, and household size. BMJ. 1989;299:1259-60.
9. Bousquet J, Van Cauwenberge P, Khaltaev N; Aria Workshop Group; World Health Organization. Allergic rhinitis and its impact on asthma. J Allergy Clin Immunol. 2001;108(Suppl):S147-334.
10. Dykewicz MS, Fineman S, Skoner DP, Nicklas R, Lee R, Blessing-Moore J, et al. Diagnosis and management of rhinitis: complete guidelines of the Joint Task Force on Practice Parameters in Allergy, Asthma, and Immunology. Ann Allergy Asthma Immunol. 1998;81:478–518.
11. Wallace DV, Dyokewicz MS, Bernstein DI, Blessing-Moore J, Cox L, Khan DA, et al. The diagnosis and management of rhinitis: an updated practice parameter. J Allergy Clin Immunol. 2008;122(Suppl):S1-84.
12. Asher MI, Keil U, Anderson HR, Beasley R, Crane J, Martinez F, et al. International Study of Asthma and Allergies in Childhood (ISAAC): rationale and methods. EurRespir J. 1995;8:483-91.
13. Munasir Z, Rakun MW. Rinitis alergik. In: Akib AAP, Munasir Z, Kurniati N, editors. Buku ajar alergi imunologi anak. 2nd ed. Jakarta: Balai Penerbit IDAI; 2007. p. 246-52.
14. Ikatan Dokter Anak Indonesia, Perhimpunan Obstetri dan Ginekologi. Deteksi dini risiko alergi. [cited 2011 January 20]. Available from: http://www.scribd.com/doc/36656568/Kartu-Deteksi-Resiko-Alergi.
15. Strachan DP. Family size, infection, and atopy: the first decade of the ‘hygiene hypothesis’. Thorax. 2000;55:2-10.
16. Smith RS, Bloomfield S, editors. The hygiene hypothesis and implications for home hygiene. Milan: The International Scientific Forum on Home Hygiene (IFH); 2004. p. 17-20.
17. von Mutius E, Weiland SK, Fritzsch C, Duhme H, Keil U. Increasing prevalence of hay fever and atopy among children in Leipzig, East Germany. Lancet. 1998;351:862-6.
18. Bodner C, Godden D, Seaton A. Family size, childhood infections, and atopic diseases. The Aberdeen WHEASE Group. Thorax. 1998;53:28-32.
19. Svanes C, Jarvis D, Chinn S, Omenaas O, Gulsvik A, Burney P, et al. Early exposure to children in family care and day care as related to adult asthma and hay fever: results from the European Community Respiratory Health Survey. Thorax. 2002;57:945-50.
20. Ponsonby AL, Couper D, Dwyer T, Carmichael A. Cross sectional study of the relation between sibling number and asthma, hay fever, and eczema. Arch Dis Child. 1998;79:328-33.
21. Ponsonby AL, Couper D, Dwyer T, Carmichael A, Kemp A. Relationship between early life respiratory illness, family size over time, and the development of asthma and hay fever: a seven year follow up study. Thorax. 1999;54:664-9.
22. McKeever TM, Lewis SA, Smith C, Collins J, Heatlie H, Frischer M, et al. Siblings, multiple births, and the incidence of allergic disease: a birth cohort study using the West Midlands general practice research database. Thorax. 2001;56:758-62.
23. Svanes C, Jarvis D, Chinn S, Burney P. Childhood environment and adult atopy: results from the European Community Respiratory Health Survey. J Allergy Clin Immunol. 1999;103:415-20.
24. Strachan DP, Taylor EM, Carpenter RG. Family structure, neonatal infection, and hay fever in adolescence. Arch Dis Child. 1996;74:422-6.
25. Karmaus W, Botezan C. Does a higher number of siblings protect against the development of allergy and asthma? A review. J Epidemiol Community Health. 2002;56:209-17
26. Karmaus W, Arshad SH, Sadeghnejad A, Twiselton R. Does maternal immunoglobulin E decrease with increasing order of live offspring? Investigation into maternal immune tolerance. Clin Exp Allergy. 2004;34:853-9.
27. Karmaus W, Arshad H, Mattes J. Does the sibling effect have its origin in utero? Investigating birth order, cord blood immunoglobulin E concentration, and allergic sensitization at age 4 years. Am J Epidemiol. 2001;154:909-15.
28. Zeiger RS. Food allergen avoidance in the prevention of food allergy in infants and children. Pediatrics. 2003;111:1662-71.
29. Boguniewicz M. Allergic rhinoconjunctivitis. In: Hay WW, Levin MJ, Sondheimer JM, Deterding RR, editors. Current diagnosis & treatment in pediatrics. 18th ed. New York Toronto: McGraw-Hill; 2007. p. 1060-2.
30. Vanna AT, Yamada E, Arruda LK, Naspitz CK, Sole D. International Study of Asthma and Allergies in Childhood: validation of the rhinitis symptom questionnaire and prevalence of rhinitis in schoolchildren in Sao Paulo, Brazil. Pediatr Allergy Immunol. 2001;12:95–101.
31. Murray AB, Milner RA. The accuracy of features in the clinical history for predicting atopic sensitization to airborne allergens in children. J Allergy Clin Immunol. 1995;96:588-96.
32. Braun-Fahrlander C, Wuthrich B, Gassner M, Grize L, Sennhauser FH, Varonier HS, et al. Validation of a rhinitis symptom questionnaire (ISAAC core questions) in a population of Swiss school children visiting the school health services. Pediatr Allergy Immunol. 1997;8:75-82.
33. Skoner DP. Allergic rhinitis: definition, epidemiology, pathophysiology, detection, and diagnosis. J Allergy Clin Immunol. 2001;108:S2-8.
34. Visness CM, London SJ, Daniels JL, Kaufman JS, Yeatts KB, Siega-Riz AM, et al. Association of obesity with IgE levels and allergy symptoms in children and adolescents: results from the National Health and Nutrition Examination Survey 2005-2006. J Allergy Clin Immunol. 2009;123:1163-9.
35. Apandi PR, Setiabudiawan B, Sukadi A. Correlation between obesity with atopy and family history of atopy in children. Paediatr Indones. 2011;51:227-33.
36. Eldin LB, Algamal HA, El-Dory GF, Rashad M, El-Arab SE, Al-Ella NAA, et al. Relation between obesity, lipid profile, leptin, and atopic disorders in children. Egypt J Pediatr Allergy Immunol. 2008;6:27-34.
37. Jarvis D, Chinn S, Potts J, Burney P. Association of body mass index with respiratory symptoms and atopy: results from the European Community Respiratory Health Survey. Clin Exp Allergy. 2002;32:831-7.
38. Tantisira KG, Litonjua AA, Weiss ST, Fuhlbrigge AL. Association of body mass with pulmonary function in the Childhood Asthma Management Program (CAMP). Thorax. 2003;58:1036-41.