Birth order, atopy, and symptoms of allergy and asthma among inner-city children attending Head Start in New York City

doi:10.1111/j.1365-2222.2008.02967.x

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Wiley InterScience

Clinical & Experimental Allergy

Volume 38 Issue 6, Pages 968 - 976

Published Online: 19 Mar 2008

The Official Journal of the British Society for Allergy & Clinical Immunology

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Editor's Choice: ORIGINAL PAPER/Epidemiology of Allergic Disease

Birth order, atopy, and symptoms of allergy and asthma among inner-city children attending Head Start in New York City

M. S. Perzanowski ^* , S. M. Canfield ^† , G. L. Chew ^* , R. B. Mellins ^‡ , L. A. Hoepner ^* , J. S. Jacobson ^§ and I. F. Goldstein ^§

^* Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA, ^† Division of Pulmonary, Allergy, Critical Care Medicine, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA, ^‡ Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY, USA and ^§ Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA

Correspondence:
M. S. Perzanowski, Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, 60 Haven Avenue, B-1 New York, NY 10032, USA. E-mail: mp2217@columbia.edu

KEYWORDS

allergic rhinitis • asthma • atopy • birth order • IgE • inner-city • otitis media • wheeze

ABSTRACT

Background In past research, children with older siblings were more likely than others to wheeze at age 2 years, but less likely by age 6 years. Higher infection transmission and a down-regulated allergic immune response as a result of these infections, respectively, were suggested as the causes. However, in a study of children aged 0–3 years in a low-income urban community in New York City, USA, with high asthma prevalence, we observed no birth-order effect.

Objective To evaluate the association between birth order and atopy and respiratory symptoms in 4-year-old children attending Head Start programs in NYC.

Methods Respiratory symptoms were assessed by questionnaire for 1005 children (mean age 4.0 years) living in high asthma prevalence neighbourhoods. Serum was collected from a subgroup of the children (n=494) and specific IgE responses to dust mite, cockroach, mouse, and cat allergens were measured.

Results Prevalence of specific IgE (0.35 IU/mL) did not differ significantly among first (35%), second (35%), and later-born children (28%) (P=0.23). Increasing birth order was associated with increasing prevalence of respiratory symptoms in the prior year, including wheeze (first 20%, second 27%, third or later 35%; P<0.001), being awakened at night by cough (28%, 33%, 38%; P=0.005), emergency department visits (14%, 17%, 21%; P=0.02) and hospitalizations for difficulty breathing (6.1%, 6.6%, 10%; P=0.04). The associations of birth order with respiratory symptoms were statistically significant only for the non-seroatopic children and those without an asthmatic parent.

Conclusions Non-seroatopic children with older siblings were more likely than those without older siblings to have respiratory symptoms at age 4 years. Although the stability of these associations over time remains to be determined, the differences in findings between this study and our previous NYC birth cohort study suggest that patterns of asthma development may vary even among low-income populations within the same city.

Submitted 30 March 2007; revised 16 January 2008; accepted 22 January 2008

DIGITAL OBJECT IDENTIFIER (DOI)

10.1111/j.1365-2222.2008.02967.x About DOI