Influence of smoking on asthmatic symptoms and allergen sensitisation in early childhood
S M Tariq, E A Hakim, S M Matthews, S H Arshad
David Hide Asthma
and Allergy Research Centre, St Mary's Hospital, Newport, Isle of
Wight PO30 5TG, UK
Correspondence to: Dr Arshad (sha{at}soton.ac.uk)
Submitted 2 December
1999;
Accepted 6 March 1999
BACKGROUND
Apart from heredity,
several early life environmental factors are implicated in the
development of childhood asthma. Maternal smoking is believed to
increase asthmatic symptoms but its influence on the development of
allergen sensitisation is debatable.
STUDY DESIGNA whole population
birth cohort was reviewed at ages 1, 2, and 4 years. Of 1218 children
seen at 4 years, 981 (80.5%) were skin prick tested with a battery of
common food and aeroallergens. Smoking history was recorded at birth
and updated at each follow up and its impact on the development of
asthma and allergen sensitisation in the children was assessed.
RESULTSTwo hundred and fifty
mothers smoked during pregnancy (20.5%) and 307 (25.2%) after
childbirth. Maternal smoking in pregnancy was associated with low birth
weight (mean (SD): 3.3 (0.5) v 3.5 (0.5) kg;
p<0.001). Smoking mothers were more often from lower social classes
(31.8% v 16%, p<0.001) and they breast
fed their babies for a shorter duration (8.5 (11.4)
v 16.6 (15.2) weeks; p<0.001). The
difference in breast feeding duration was partly due to a higher
proportion of smoking mothers who never breast fed their babies.
Although at age 2 years asthmatic symptoms were associated with
exposure to maternal tobacco smoke (odds ratio 2.2, 95% confidence
interval 1.5 to 3.4; p<0.001), this association was lost by 4 years.
However, maternal smoking was a significant risk factor in a subgroup
of children with asthmatic symptoms but negative skin prick test.
Maternal smoking did not increase allergen sensitisation at age 4 years. No effect of paternal smoking on asthma was observed in the children.
Keywords: maternal smoking; asthma; allergen sensitisation
© 2000 by The Fellowship of Postgraduate Medicine
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