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• W1968776870 abstract "Susanne Lau and co-workers (Oct 21, p 1392)1Lau S Illi S Sommerfeld C et al.Early exposure to house-dust mite and cat allergens and development of childhood asthma: a cohort study.Lancet. 2000; 356: 1392-1397Summary Full Text Full Text PDF PubMed Scopus (606) Google Scholar state that exposure to environmental allergens does not cause asthma. An increasing number of reports show negative results for exposure to cat and dog allergen and sensitisation to such animals, or show no association between early exposure to pets and subsequent asthma.However, the design of such reports has not been the best to assess causation.2Roost HP Künzli N Schindler C et al.Role of current and childhood exposure to cat and atopic sensitization.J Allergy Clin Immunol. 1999; 104: 941-947Summary Full Text Full Text PDF PubMed Scopus (235) Google Scholar, 3Hesselmar B Aberg N Aberg B Eriksson B Bjorksten B Does early exposure to cat and dog protect against later allergy development?.Clin Exp Allergy. 1999; 29: 611-617Crossref PubMed Scopus (463) Google Scholar, 4Burr NIL Merret TG Dunstan FD Maguire MJ The development of allergy in high-risk children.Clin Exp Allergy. 1997; 27: 1247-1253Crossref PubMed Scopus (120) Google Scholar Lau and colleagues' German birth cohort Multicentre Allergy Study—one of few well designed prospective birth cohort studies—is therefore important. The investigators show a relation between exposure to mite and cat allergen and sensitisation, and between sensitisation and bronchial hyperresponsiveness.However, they saw no relation between early indoor allergen exposure (cat and house-dust mites) and the prevalence of asthma, wheeze, and bronchial hyper-responsiveness. We think this latter finding might be a consequence of inappropriate analysis.First, Lau and colleagues do not say whether they analysed parental tobacco smoking as a confounding factor. They have previously shown that keeping of pets and parental tobacco smoke are covariate factors. Besides this finding, prebirth selection with inclusion of children at high risk might have influenced the measurement of allergen levels. It is also unclear whether they adjusted for sensitisation to cat and house-dust mite at analysis of exposure and health effect. Third, and perhaps most important, they did not analyse the dose-response relation for early cat allergen exposure and diagnosed asthma, wheezing within the past 12 months, or wheezing ever (figure). Instead, Lau and colleagues limit themselves to calculation of the odds ratios for exposure to cat allergen at the age of 6 months and asthma at age 7 years. They compare three different exposure levels with a reference level without calculation for trend. without calculation for trend.We believe that Lau and colleagues' separation of exposure into quartiles, instead of two or three exposure groups, has led to too few observations in each exposure group with wide CIs. The precision of exposure has to be questioned, since the two lowest exposure levels are so low that they are lower than the cutoff value. With three exposure levels, a significant trend was likely to have been established.The degree of mite allergen exposure was very low compared with that found in other studies and levels at which contamination is the probable explanation. Furthermore, a relation between exposure to mites and health effects has been shown for exposure from mattresses and not carpet dust.5Wickman M Nordvall SL Pershagen G Sundell J Schwartz B House dust mite sensitization in children and residential characteristics in a temperate region.J Allergy Clin Immunol. 1991; 88: 89-95Summary Full Text PDF PubMed Scopus (143) Google ScholarLau and colleagues' results interpreted as evidence that exposure in early life to indoor allergens induces sensitisation and causes onset of asthma directly in children, which contrasts with the conclusion they come to in their report. Susanne Lau and co-workers (Oct 21, p 1392)1Lau S Illi S Sommerfeld C et al.Early exposure to house-dust mite and cat allergens and development of childhood asthma: a cohort study.Lancet. 2000; 356: 1392-1397Summary Full Text Full Text PDF PubMed Scopus (606) Google Scholar state that exposure to environmental allergens does not cause asthma. An increasing number of reports show negative results for exposure to cat and dog allergen and sensitisation to such animals, or show no association between early exposure to pets and subsequent asthma. However, the design of such reports has not been the best to assess causation.2Roost HP Künzli N Schindler C et al.Role of current and childhood exposure to cat and atopic sensitization.J Allergy Clin Immunol. 1999; 104: 941-947Summary Full Text Full Text PDF PubMed Scopus (235) Google Scholar, 3Hesselmar B Aberg N Aberg B Eriksson B Bjorksten B Does early exposure to cat and dog protect against later allergy development?.Clin Exp Allergy. 1999; 29: 611-617Crossref PubMed Scopus (463) Google Scholar, 4Burr NIL Merret TG Dunstan FD Maguire MJ The development of allergy in high-risk children.Clin Exp Allergy. 1997; 27: 1247-1253Crossref PubMed Scopus (120) Google Scholar Lau and colleagues' German birth cohort Multicentre Allergy Study—one of few well designed prospective birth cohort studies—is therefore important. The investigators show a relation between exposure to mite and cat allergen and sensitisation, and between sensitisation and bronchial hyperresponsiveness. However, they saw no relation between early indoor allergen exposure (cat and house-dust mites) and the prevalence of asthma, wheeze, and bronchial hyper-responsiveness. We think this latter finding might be a consequence of inappropriate analysis. First, Lau and colleagues do not say whether they analysed parental tobacco smoking as a confounding factor. They have previously shown that keeping of pets and parental tobacco smoke are covariate factors. Besides this finding, prebirth selection with inclusion of children at high risk might have influenced the measurement of allergen levels. It is also unclear whether they adjusted for sensitisation to cat and house-dust mite at analysis of exposure and health effect. Third, and perhaps most important, they did not analyse the dose-response relation for early cat allergen exposure and diagnosed asthma, wheezing within the past 12 months, or wheezing ever (figure). Instead, Lau and colleagues limit themselves to calculation of the odds ratios for exposure to cat allergen at the age of 6 months and asthma at age 7 years. They compare three different exposure levels with a reference level without calculation for trend. without calculation for trend. We believe that Lau and colleagues' separation of exposure into quartiles, instead of two or three exposure groups, has led to too few observations in each exposure group with wide CIs. The precision of exposure has to be questioned, since the two lowest exposure levels are so low that they are lower than the cutoff value. With three exposure levels, a significant trend was likely to have been established. The degree of mite allergen exposure was very low compared with that found in other studies and levels at which contamination is the probable explanation. Furthermore, a relation between exposure to mites and health effects has been shown for exposure from mattresses and not carpet dust.5Wickman M Nordvall SL Pershagen G Sundell J Schwartz B House dust mite sensitization in children and residential characteristics in a temperate region.J Allergy Clin Immunol. 1991; 88: 89-95Summary Full Text PDF PubMed Scopus (143) Google Scholar Lau and colleagues' results interpreted as evidence that exposure in early life to indoor allergens induces sensitisation and causes onset of asthma directly in children, which contrasts with the conclusion they come to in their report. Allergen exposure and asthmaAuthors' reply Full-Text PDF" @default.
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• W1968776870 title "Allergen exposure and asthma" @default.
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