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Vaccination and Allergic Disease
Allergy & Clinical Immunology, July 2004 Journal Scan
American Journal of Public Health
June 2004 (Volume 94, Number 6)
Vaccination and Allergic Disease: A Birth Cohort Study
McKeever TM, Lewis SA, Smith C, Hubbard R
American Journal of Public Health. 2004;94(6):985-989
Studies have suggested that there is an association between childhood vaccination and allergic responses. There are 2 theories as to how this association may occur. The first theory states that vaccination directly alters the immune system itself. This hypothesis is supported by studies that show that the Bordetella pertussis vaccine increases histamines and immunoglobulin (Ig)E levels.[1,2] The second theory, also known as the hygiene hypothesis, suggests that exposure to infections in childhood enhances immune system development. Because vaccines reduce the child's risk of illness/infection, they inhibit immune system development and increase the risk of allergic disease.[3,4] This retrospective records review attempted to identify links between vaccination and allergic responses.
Researchers reviewed the records of 29,238 children (ages 0-11 years ) from the West Midlands General Practice Research Database (1988-1999). They identified children registered by their general practitioner within 3 months of birth, with a medical history of at least 1 physician visit, documentation of vaccination status, and diagnoses of asthma/wheeze or eczema. They then assessed the impact of groups of vaccines for diphtheria; polio; pertussis; tetanus (DPPT); and measles, mumps, and rubella (MMR) as well as hepatitis B, bacille Calmette-Guerin, meningococcal vaccine, and Haemophilus influenzae type B on allergic symptoms.
Of the 29,238 children, 27,701 (96%) had received the DPPT vaccine and 20,845 (71.3%) had received the MMR vaccine. Analysis showed that administration of the DPPT vaccine was associated with an increased risk of developing both asthma (hazard ratio, 9HR) = 14.0; 95% confidence interval [CI] = 7.3, 26.9) and eczema (HR = 9.40; 95% CI = 5.92, 14.92). The MMR vaccine also showed a strong association with an increased risk of asthma and eczema. However, the associations between the DPPT and MMR findings and allergic symptoms were significantly higher in the children who rarely seek care from their general practitioner. Some 83% of children not recorded as vaccinated within the first 6 months of life were in the lowest quartile of reported visits to their healthcare provider. The researchers called this an "ascertainment bias" in their data. They did note that of the children with documented vaccination status, there did not seem to be a relationship between the age at first injection of either DPPT or MMR and the risk of asthma or eczema.
Of interest, the researchers concluded that "although our results in an observational cohort study demonstrated a positive association between vaccination and allergic disease, this association can be explained by ascertainment bias. These data, together with other published evidence, suggest that current vaccination practices do not have an adverse effect on the incidence of allergic disease."
1. Sen DK, Arora S, Gupta S, Sanyal RK. Studies of adrenergic mechanisms in relation to histamine sensitivity in children immunized with Bordetella pertussis vaccine. J Allergy Clin Immunol. 1974;54:25-31.
2. Odelram H, Granstrom M, Hedenskog S, Duchen K, Bjorksten B. Immunoglobulin E and G responses to pertussis toxin after booster immunization in relation to atopy, local reactions and aluminium content of the vaccines. Pediatr Allergy Immunol. 1994;5:118-123.
3. Bobo JK, Gale JL, Thapa PB, Wassilak SG. Risk factors for delayed immunization in a random sample of 1163 children from Oregon and Washington. Pediatrics. 1993;91:308-314.
4. Kemp T, Pearce N, Fitzharris P, et al. Is infant immunization a risk factor for childhood asthma or allergy? Epidemiology. 1997;8:678-680.
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Medscape Allergy & Clinical Immunology 4(2), 2004.
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