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No day-care visits during the first year of life for infants with atopic parents?

2007; Elsevier BV; Volume: 121; Issue: 2 Linguagem: Inglês

10.1016/j.jaci.2007.07.064

1097-6825

Maarten O. Hoekstra,

Respiratory viral infections research

To the Editor: With interest I read the manuscript by Kusel et al.1Kusel M.M.H. de Klerk N.H. Kebadze T. Vohma V. Holt P.G. Johnston S.L. et al.Early-life respiratory viral infections, atopic sensitization, and risk of subsequent development of persistent asthma.J Allergy Clin Immunol. 2007; 119: 1105-1110Abstract Full Text Full Text PDF PubMed Scopus (576) Google Scholar The authors performed a prospective, community-based cohort study in children with a high risk to develop atopic disease to answer the question of whether respiratory infections early in life might influence the diagnosis of asthma at the age of 5 years. In order to answer this question, parents kept a diary recording the presence of symptoms of acute respiratory infecions (ARIs). Whenever an ARI was suspected, parents called the hospital, and a nasopharyngeal aspirate sample was collected, which was studied by PCR for the presence of the most prevalent respiratory viruses. At the age of 6 months and 2 and 5 years, skin prick tests were performed to detect sensitizations. Indeed, it was found that, especially in infants who developed atopic sensitization before the age of 2 years, lower respiratory infections with either rhinovirus or respiratory syncytial virus were associated with an increased risk to develop asthma by the age of 5 years. The authors conclude that the present study indicates that protection of high-risk children against the effects of severe respiratory infections during infancy is warranted as an effective strategy for primary asthma prevention. However, this important and well-carried-out study raises a number of questions. First, how can we identify the high-risk infants before the age of 1 year (in order to take preventive measures), because in this study, the high-risk infants could only be identified by the age of 2 years? Second, what exactly is the definition of a severe respiratory infection (see the conclusion section of the abstract1Kusel M.M.H. de Klerk N.H. Kebadze T. Vohma V. Holt P.G. Johnston S.L. et al.Early-life respiratory viral infections, atopic sensitization, and risk of subsequent development of persistent asthma.J Allergy Clin Immunol. 2007; 119: 1105-1110Abstract Full Text Full Text PDF PubMed Scopus (576) Google Scholar)? Is that equivalent to every lower respiratory infection? Third, how does the advice as stated in the paper relate to the previously reported protective effects of (airway) infections in early life?2Strachan D.P. Taylor E.M. Carpenter R.G. Family structure, neonatal infection, and hay fever in adolescence.Arch Dis Child. 1996; 74: 422-426Crossref PubMed Scopus (174) Google Scholar, 3Ball T.M. Castro-Rodriguez J.A. Griffith K.A. Holberg C.J. Martinez F.D. Wright A.L. Siblings, day-care attendance, and the risk of asthma and wheezing during childhood.N Engl J Med. 2000; 343: 538-543Crossref PubMed Scopus (764) Google Scholar Would this beneficial effect be limited to upper airway infections? Fourth, could this advice be specified? For instance, would it be wise specifically for atopic parents not to send their offspring to day-care centers during the first year of life and to avoid contact with other infants who suffer from acute lower respiratory tract disease?