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Day Care Attendance, Respiratory Tract Illnesses, Wheezing, Asthma, and Total Serum IgE Level in Early Childhood
Juan C. Celedón, MD, DrPH;
Augusto A. Litonjua, MD, MPH;
Louise Ryan, PhD;
Scott T. Weiss, MD, MS;
Diane R. Gold, MD, MPH
Arch Pediatr Adolesc Med. 2002;156:241-245.
Background It has been hypothesized that day care–related infections may
explain the inverse relation between day care attendance in early life and
asthma in childhood.
Objective To examine the relation between day care attendance or respiratory tract
illnesses in the first year of life and wheezing and asthma in the first 4
years of life among children with a parental history of atopy who were followed
up from birth.
Results Day care attendance in the first year of life was inversely associated
with geometric mean total serum IgE level (12.9 [±1 SD = 3.3, 51.4]
IU/mL for day care vs 18.5 [±1 SD = 5.3, 64.7] IU/mL for no day care; P = .03) at 2 years of age but not significantly associated
with wheezing at or after 2 years of age. Having at least 1 physician-diagnosed
lower respiratory tract illness in the first year of life was significantly
associated with recurrent wheezing (odds ratio [OR], 2.0; 95% confidence interval
[CI], 1.0-4.1) and asthma (OR, 2.5; 95% CI, 1.1-5.5) at 4 years of age, but
not with any wheezing (infrequent and frequent) at 3 years or older. Illnesses
of the upper respiratory tract ( 1 physician-diagnosed upper respiratory
tract illness or 3 episodes of nasal catarrh) in the first year of life
were associated with any wheezing (frequent and infrequent) between the ages
of 1 and 4 years, but not with recurrent wheezing or asthma at 4 years of
age.
Conclusions Our results suggest that among children with a parental history of atopy
the protective effect of day care attendance in early life against the development
of atopy has begun by 2 years of age, and that a protective effect of day
care attendance in early life against wheezing may not be observed until after
4 years of age.
From the Channing Laboratory, Department of Medicine, Brigham and Women's
Hospital (Drs Celedón, Litonjua, Weiss, and Gold), the Division of
Pulmonary and Critical Care Medicine, Beth Israel Deaconess Medical Center
(Drs Celedón, Litonjua, Weiss, and Gold), Department of Medicine, Harvard
Medical School (Drs Celedón, Litonjua, and Weiss), and the Department
of Biostatistics, Harvard School of Public Health (Dr Ryan), Boston, Mass.
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