ENVIRONMENTAL DETERMINANTS OF CHILDHOOD ASTHMA

Project: Research project

Project Details

Description

The objective of this proposal is to investigate the relationships
between multiple variables: cord blood IgE concentration, family
history, intensity of early allergen exposure, passive cigarette smoke
exposure, allergic sensitivity, bronchial hyperresponsiveness, and
asthma, in children 6 to 7 years of age. The cohort of children to be
studied were initially selected prenatally from families enrolled in a
large HMO. Previous research has been directed toward the 141 children,
from the cohort of 797 children, who were born with cord blood IgE
concentrations of greater than or equal to 0.56 IU/mL. These children
were thought to be at higher risk for allergic disease and were followed
monthly until 2 years, then every other month until 4 years of age.
Those felt to be at lower risk of allergy (IgE < 0.56 IU/ml) have been
followed yearly. For this proposal, we plan to use the entire cohort of
797 children. At 5 and 6 years of age the families of the children will
be contacted for telephone interviews and brief telephone contacts will
be made at 4.5 and 5.5 years. As soon as possible after 6 years of age
all children will be invited to undergo a clinical evaluation to
determine if the child has current asthma. The evaluation will include:
a review of the family allergic history, a standardized medical history,
physical examination, allergen skin testing, in vitro testing for total
and allergen specific IgE, urine analysis for cotinine, pulmonary
function testing (FVC, FEV1, PEFR, and FEF25-75%), and methacholine
challenge. The information from the clinical evaluation will be combined
with previously obtained data including: measurements of allergen
(mites, Der f l, Der p l; cat, Fel d l; ragweed Amb a l; and grass, Lol
p l) concentrations in bedroom air and dust samples, cord blood IgE
concentrations, family histories, health histories, housing records, and
urinary cotinine measurements to answer the following questions. 1) What
is the prevalence of diagnosed and undiagnosed asthma and of bronchial
hyperresponsiveness in this cohort of children? 2) What is the
relationship between asthma and bronchial responsiveness in this cohort
of children? 3) Do cord blood IgE concentration, intensity of allergen
exposure in infancy, family allergic history, month of birth, or degree
of passive cigarette smoke exposure significantly contribute to the risk
of current asthma in 6 year old children? 4) Do cord blood IgE
concentration, intensity of allergen exposure in infancy, family allergic
history, month of birth, or degree of passive cigarette smoke exposure
significantly contribute to the risk of bronchial hyperresponsiveness or
the risk of allergic sensitivity in children? 5) How much do urinary
cotinine concentrations vary in children over a 4 year period and how
well do reports of cigarette smoke exposure correlate with continine
measurements? 6) To what degree do in home allergen concentrations vary
over 4 years and what factors influence the degree of allergen variation?
7) To what degree do allergen measurements from longitudinally collected
air and dust samples correlate? The strengths of this proposal are the
importance of asthma as a cause of morbidity in children, the prospective
and comprehensive nature of the study design, and the high probability
that significant new information will be obtained about variables
influencing the development of asthma in children.
StatusNot started

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