BACKGROUND: Avoidance of individual risk factors have not been successful in preventing the development of asthma. OBJECTIVE: We sought to determine the effectiveness of a multifaceted intervention program in primary prevention of asthma in high-risk infants. METHODS: We identified 545 high-risk infants on the basis of an immediate family history of asthma. Families were randomized into intervention or control groups. Intervention measures included avoidance of house dust mite, pet allergen, and environmental tobacco smoke. Breast-feeding was encouraged with formula supplementation if necessary, and introduction of solid foods was delayed. RESULTS: At 2 years of age, 19.5% of the children had asthma, and 14.7% had atopy (positive skin test response to one or more common allergens). Significantly fewer children had asthma in the intervention group compared with in the control group (16.3% vs 23.0%), with 60% less persistent asthma at 2 years. There was a 90% reduction for recurrent wheeze in the intervention group compared with that seen in the control group. Exposure to maternal environmental tobacco smoke during pregnancy or the first year was a risk factor for asthma at 2 years of age. A positive skin test response, particularly to food, at 12 months predicted asthma at 2 years. There was no significant difference for atopy between the intervention and control groups, but daycare reduced atopy at 2 years. CONCLUSION: This multifaceted intervention program during a window of opportunity in the first year of life was effective in preventing asthma in high-risk children at 2 years of age. Future studies with this cohort at school age are important.
RCT Entities:
BACKGROUND: Avoidance of individual risk factors have not been successful in preventing the development of asthma. OBJECTIVE: We sought to determine the effectiveness of a multifaceted intervention program in primary prevention of asthma in high-risk infants. METHODS: We identified 545 high-risk infants on the basis of an immediate family history of asthma. Families were randomized into intervention or control groups. Intervention measures included avoidance of house dust mite, pet allergen, and environmental tobacco smoke. Breast-feeding was encouraged with formula supplementation if necessary, and introduction of solid foods was delayed. RESULTS: At 2 years of age, 19.5% of the children had asthma, and 14.7% had atopy (positive skin test response to one or more common allergens). Significantly fewer children had asthma in the intervention group compared with in the control group (16.3% vs 23.0%), with 60% less persistent asthma at 2 years. There was a 90% reduction for recurrent wheeze in the intervention group compared with that seen in the control group. Exposure to maternal environmental tobacco smoke during pregnancy or the first year was a risk factor for asthma at 2 years of age. A positive skin test response, particularly to food, at 12 months predicted asthma at 2 years. There was no significant difference for atopy between the intervention and control groups, but daycare reduced atopy at 2 years. CONCLUSION: This multifaceted intervention program during a window of opportunity in the first year of life was effective in preventing asthma in high-risk children at 2 years of age. Future studies with this cohort at school age are important.
Authors: Denise Daley; Mathieu Lemire; Loubna Akhabir; Moira Chan-Yeung; Jian Qing He; Treena McDonald; Andrew Sandford; Dorota Stefanowicz; Ben Tripp; David Zamar; Yohan Bosse; Vincent Ferretti; Alexandre Montpetit; Marie-Catherine Tessier; Allan Becker; Anita L Kozyrskyj; John Beilby; Pamela A McCaskie; Bill Musk; Nicole Warrington; Alan James; Catherine Laprise; Lyle J Palmer; Peter D Paré; Thomas J Hudson Journal: Hum Genet Date: 2009-02-27 Impact factor: 4.132
Authors: Albert M Levin; Rasika A Mathias; Lili Huang; Lindsey A Roth; Denise Daley; Rachel A Myers; Blanca E Himes; Isabelle Romieu; Mao Yang; Celeste Eng; Julie E Park; Karla Zoratti; Christopher R Gignoux; Dara G Torgerson; Joshua M Galanter; Scott Huntsman; Elizabeth A Nguyen; Allan B Becker; Moira Chan-Yeung; Anita L Kozyrskyj; Pui-Yan Kwok; Frank D Gilliland; W James Gauderman; Eugene R Bleecker; Benjamin A Raby; Deborah A Meyers; Stephanie J London; Fernando D Martinez; Scott T Weiss; Esteban G Burchard; Dan L Nicolae; Carole Ober; Kathleen C Barnes; L Keoki Williams Journal: J Allergy Clin Immunol Date: 2012-11-10 Impact factor: 10.793
Authors: Grace K LeMasters; Kimberly Wilson; Linda Levin; Jocelyn Biagini; Patrick Ryan; James E Lockey; Sherry Stanforth; Stephanie Maier; Jun Yang; Jeff Burkle; Manuel Villareal; Gurjit K Khurana Hershey; David I Bernstein Journal: J Pediatr Date: 2006-10 Impact factor: 4.406
Authors: James Krieger; David E Jacobs; Peter J Ashley; Andrea Baeder; Ginger L Chew; Dorr Dearborn; H Patricia Hynes; J David Miller; Rebecca Morley; Felicia Rabito; Darryl C Zeldin Journal: J Public Health Manag Pract Date: 2010 Sep-Oct
Authors: Kemp W Bundy; Janneane F Gent; William Beckett; Michael B Bracken; Kathleen Belanger; Elizabeth Triche; Brian P Leaderer Journal: Ann Allergy Asthma Immunol Date: 2009-07 Impact factor: 6.347