FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 343:538-543 August 24, 2000 Number 8 Next

	Full Text PDF Editorial by Christiansen, S. C. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Young children with older siblings and those who attend day care are at increased risk for infections, which in turn may protect against the development of allergic diseases, including asthma. However, the results of studies examining the relation between exposure to other children and the subsequent development of asthma have been conflicting.

Methods In a study involving 1035 children followed since birth as part of the Tucson Children's Respiratory Study, we determined the incidence of asthma (defined as at least one episode of asthma diagnosed by a physician when the child was 6 to 13 years old) and the prevalence of frequent wheezing (more than three wheezing episodes during the preceding year) in relation to the number of siblings at home and in relation to attendance at day care during infancy.

Results The presence of one or more older siblings at home protected against the development of asthma (adjusted relative risk for each additional older sibling, 0.8; 95 percent confidence interval, 0.7 to 1.0; P=0.04), as did attendance at day care during the first six months of life (adjusted relative risk, 0.4; 95 percent confidence interval, 0.2 to 1.0; P=0.04). Children with more exposure to other children at home or at day care were more likely to have frequent wheezing at the age of 2 years than children with little or no exposure (adjusted relative risk, 1.4; 95 percent confidence interval, 1.1 to 1.8; P=0.01) but were less likely to have frequent wheezing from the age of 6 (adjusted relative risk, 0.8; 95 percent confidence interval, 0.6 to 1.0; P=0.03) through the age of 13 (adjusted relative risk, 0.3; 95 percent confidence interval, 0.2 to 0.5; P<0.001).

Conclusions Exposure of young children to older children at home or to other children at day care protects against the development of asthma and frequent wheezing later in childhood.

Source Information

From the Department of Pediatrics (T.M.B., C.J.H., F.D.M., A.L.W.) and the Respiratory Sciences Center (J.A.C.-R., K.A.G., C.J.H., F.D.M., A.L.W.), University of Arizona College of Medicine, Tucson.

Address reprint requests to Dr. Wright at the Respiratory Sciences Center, University of Arizona College of Medicine, 1501 N. Campbell Ave., P.O. Box 245073, Tucson, AZ 85724-5073, or at awright{at}resp-sci.arizona.edu.

Full Text of this Article

Related Letters:

Siblings, Day-Care Attendance, and the Risk of Asthma and Wheezing
Des Roches A., Paradis L., Paradis J., Morgan T. M., Dompeling E., Jobsis R., van Schayck O., Ball T. M., Holberg C. J., Wright A. L.
Extract | Full Text  
N Engl J Med 2000; 343:1967-1968, Dec 28, 2000. Correspondence

This article has been cited by other articles:

• Caudri, D., Wijga, A., Scholtens, S., Kerkhof, M., Gerritsen, J., Ruskamp, J. M., Brunekreef, B., Smit, H. A., de Jongste, J. C. (2009). Early Daycare Is Associated with an Increase in Airway Symptoms in Early Childhood but Is No Protection against Asthma or Atopy at 8 Years. Am. J. Respir. Crit. Care Med. 180: 491-498 [Abstract] [Full Text]  
• Boushey, H. A. (2009). Thomas L. Petty Aspen Lung Conference: Asthma: Insights and Expectations. Conference summary.. Proc Am Thorac Soc 6: 316-320 [Full Text]  
• Stein, R. T. (2008). Early-Life Viral Bronchiolitis in the Causal Pathway of Childhood Asthma: Is the Evidence There Yet?. Am. J. Respir. Crit. Care Med. 178: 1097-1098 [Full Text]  
• Landau, L. I (2008). Wheezing phenotypes. Thorax 63: 942-943 [Full Text]  
• Dunder, T., Tapiainen, T., Pokka, T., Uhari, M. (2007). Infections in Child Day Care Centers and Later Development of Asthma, Allergic Rhinitis, and Atopic Dermatitis: Prospective Follow-up Survey 12 Years After Controlled Randomized Hygiene Intervention. Arch Pediatr Adolesc Med 161: 972-977 [Abstract] [Full Text]  
• Horvat, J. C., Beagley, K. W., Wade, M. A., Preston, J. A., Hansbro, N. G., Hickey, D. K., Kaiko, G. E., Gibson, P. G., Foster, P. S., Hansbro, P. M. (2007). Neonatal Chlamydial Infection Induces Mixed T-Cell Responses That Drive Allergic Airway Disease. Am. J. Respir. Crit. Care Med. 176: 556-564 [Abstract] [Full Text]  
• Herbarth, O., Bauer, M., Fritz, G. J, Herbarth, P., Rolle-Kampczyk, U., Krumbiegel, P., Richter, M., Richter, T. (2007). Helicobacter pylori colonisation and eczema. J. Epidemiol. Community Health 61: 638-640 [Abstract] [Full Text]  
• Kline, J. N. (2007). Eat Dirt: CpG DNA and Immunomodulation of Asthma. Proc Am Thorac Soc 4: 283-288 [Abstract] [Full Text]  
• Bradley, R. H., Vandell, D. L. (2007). Child Care and the Well-being of Children. Arch Pediatr Adolesc Med 161: 669-676 [Abstract] [Full Text]  
• Goldberg, S., Israeli, E., Schwartz, S., Shochat, T., Izbicki, G., Toker-Maimon, O., Klement, E., Picard, E. (2007). Asthma Prevalence, Family Size, and Birth Order. Chest 131: 1747-1752 [Abstract] [Full Text]  
• Ferreira, M. U., Rubinsky-Elefant, G., de Castro, T. G., Hoffmann, E. H. E., da Silva-Nunes, M., Cardoso, M. A., Muniz, P. T. (2007). Bottle Feeding and Exposure to Toxocara as Risk Factors for Wheezing Illness among Under-five Amazonian Children: A Population-based Cross-sectional Study. J Trop Pediatr 53: 119-124 [Abstract] [Full Text]  
• Martinez, F. D. (2007). Gene-Environment Interactions in Asthma: With Apologies to William of Ockham. Proc Am Thorac Soc 4: 26-31 [Abstract] [Full Text]  
• Chung, E K, Miller, R L, Wilson, M T, McGeady, S J, Culhane, J F (2007). Antenatal risk factors, cytokines and the development of atopic disease in early childhood. Arch. Dis. Child. Fetal Neonatal Ed. 92: F68-F73 [Abstract] [Full Text]  
• Ly, N. P., Rifas-Shiman, S. L., Litonjua, A. A., Tzianabos, A. O., Schaub, B., Ruiz-Perez, B., Tantisira, K. G., Finn, P. W., Gillman, M. W., Weiss, S. T., Gold, D. R. (2007). Cord Blood Cytokines and Acute Lower Respiratory Illnesses in the First Year of Life. Pediatrics 119: e171-e178 [Abstract] [Full Text]  
• Latzin, P., Kuehni, C. E., Baldwin, D. N., Roiha, H. L., Casaulta, C., Frey, U. (2006). Elevated Exhaled Nitric Oxide in Newborns of Atopic Mothers Precedes Respiratory Symptoms. Am. J. Respir. Crit. Care Med. 174: 1292-1298 [Abstract] [Full Text]  
• Normann, E, Gnarpe, J, Wettergren, B, Janson, C, Wickman, M, Nordvall, L (2006). Association between Chlamydia pneumoniae antibodies and wheezing in young children and the influence of sex. Thorax 61: 1054-1058 [Abstract] [Full Text]  
• Kitagaki, K., Businga, T. R., Racila, D., Elliott, D. E., Weinstock, J. V., Kline, J. N. (2006). Intestinal Helminths Protect in a Murine Model of Asthma. J. Immunol. 177: 1628-1635 [Abstract] [Full Text]  
• Hjern, A. (2006). Chapter 5.8: Major public health problems -- allergic disorders. Scand J Public Health 34: 125-131  
• Bush, A (2006). Coughs and wheezes spread diseases: but what about the environment?. Thorax 61: 367-369 [Full Text]  
• Flaherman, V, Rutherford, G W (2006). A meta-analysis of the effect of high weight on asthma. Arch. Dis. Child. 91: 334-339 [Abstract] [Full Text]  
• Piitulainen, E., Carlson, J., Ohlsson, K., Sveger, T. (2005). α1-Antitrypsin Deficiency in 26-Year-Old Subjects: Lung, Liver, and Protease/Protease Inhibitor Studies. Chest 128: 2076-2081 [Abstract] [Full Text]  
• (2005). Pharmacotherapy -- treatment of intermittent asthma with ICSs. CMAJ 173: S33-S36 [Full Text]  
• Weston, S, Halbert, A, Richmond, P, Prescott, S L (2005). Effects of probiotics on atopic dermatitis: a randomised controlled trial. Arch. Dis. Child. 90: 892-897 [Abstract] [Full Text]  
• Nafstad, P., Brunekreef, B., Skrondal, A., Nystad, W. (2005). Early Respiratory Infections, Asthma, and Allergy: 10-Year Follow-up of the Oslo Birth Cohort. Pediatrics 116: e255-e262 [Abstract] [Full Text]  
• Bush, A. (2004). Small is beautiful: but may be breathless. Chronic Respiratory Disease 1: 181-182  
• Cohet, C., Cheng, S., MacDonald, C., Baker, M., Foliaki, S., Huntington, N., Douwes, J., Pearce, N. (2004). Infections, medication use, and the prevalence of symptoms of asthma, rhinitis, and eczema in childhood. J. Epidemiol. Community Health 58: 852-857 [Abstract] [Full Text]  
• Copenhaver, C. C., Gern, J. E., Li, Z., Shult, P. A., Rosenthal, L. A., Mikus, L. D., Kirk, C. J., Roberg, K. A., Anderson, E. L., Tisler, C. J., DaSilva, D. F., Hiemke, H. J., Gentile, K., Gangnon, R. E., Lemanske, R. F. Jr. (2004). Cytokine Response Patterns, Exposure to Viruses, and Respiratory Infections in the First Year of Life. Am. J. Respir. Crit. Care Med. 170: 175-180 [Abstract] [Full Text]  
• Potts, A. L., Reagan, C. B. (2004). Thinking Outside the Inhaler: Potential Barriers to Controlled Asthma in Children. Journal of Pharmacy Practice 17: 211-220 [Abstract]  
• Eldeirawi, K., Persky, V. W. (2004). History of Ear Infections and Prevalence of Asthma in a National Sample of Children Aged 2 to 11 Years: The Third National Health and Nutrition Examination Survey, 1988 to 1994. Chest 125: 1685-1692 [Abstract] [Full Text]  
• Fredrickson, D. D., Molgaard, C. A., Dismuke, S. E., Schukman, J. S., Walling, A. (2004). Understanding Frequent Emergency Room Use by Medicaid-Insured Children with Asthma: A Combined Quantitative and Qualitative Study. J Am Board Fam Med 17: 96-100 [Abstract] [Full Text]  
• Guerra, S., Lohman, I. C., Halonen, M., Martinez, F. D., Wright, A. L. (2004). Reduced Interferon {gamma} Production and Soluble CD14 Levels in Early Life Predict Recurrent Wheezing by 1 Year of Age. Am. J. Respir. Crit. Care Med. 169: 70-76 [Abstract] [Full Text]  
• Kurtaran, H., Karadag, A., Catal, F., Avci, Z., Huang, J.-L. (2003). A Reappraisal of Nasal Saline Solution Use in Chronic Sinusitis. Chest 124: 2036-2038 [Full Text]  
• Brooks, G. D., Buchta, K. A., Swenson, C. A., Gern, J. E., Busse, W. W. (2003). Rhinovirus-induced Interferon-{gamma} and Airway Responsiveness in Asthma. Am. J. Respir. Crit. Care Med. 168: 1091-1094 [Abstract] [Full Text]  
• Gilliland, F. D., Berhane, K., Islam, T., McConnell, R., Gauderman, W. J., Gilliland, S. S., Avol, E., Peters, J. M. (2003). Obesity and the Risk of Newly Diagnosed Asthma in School-age Children. Am J Epidemiol 158: 406-415 [Abstract] [Full Text]  
• Cardwell, C. R., Shields, M. D., Carson, D. J., Patterson, C. C. (2003). A Meta-Analysis of the Association Between Childhood Type 1 Diabetes and Atopic Disease. Diabetes Care 26: 2568-2574 [Abstract] [Full Text]  
• McCarthy, C. A., Hall, C. B. (2003). Respiratory Syncytial Virus: Concerns and Control. Pediatr. Rev. 24: 301-309 [Full Text]  
• Singh, S. P., Barrett, E. G., Kalra, R., Razani-Boroujerdi, S., Langley, R. J., Kurup, V., Tesfaigzi, Y., Sopori, M. L. (2003). Prenatal Cigarette Smoke Decreases Lung cAMP and Increases Airway Hyperresponsiveness. Am. J. Respir. Crit. Care Med. 168: 342-347 [Abstract] [Full Text]  
• Etzel, R. A. (2003). How Environmental Exposures Influence the Development and Exacerbation of Asthma. Pediatrics 112: 233-239 [Abstract] [Full Text]  
• Hart, C L, Davey Smith, G (2003). Relation between number of siblings and adult mortality and stroke risk: 25 year follow up of men in the Collaborative study. J. Epidemiol. Community Health 57: 385-391 [Abstract] [Full Text]  
• Celedon, J. C., Wright, R. J., Litonjua, A. A., Sredl, D., Ryan, L., Weiss, S. T., Gold, D. R. (2003). Day Care Attendance in Early Life, Maternal History of Asthma, and Asthma at the Age of 6 Years. Am. J. Respir. Crit. Care Med. 167: 1239-1243 [Abstract] [Full Text]  
• Offit, P. A., Hackett, C. J. (2003). Addressing Parents' Concerns: Do Vaccines Cause Allergic or Autoimmune Diseases?. Pediatrics 111: 653-659 [Abstract] [Full Text]  
• Cole Johnson, C., Ownby, D. R., Zoratti, E. M., Hensley Alford, S., Williams, L. K., Joseph, C. L. M. (2002). Environmental Epidemiology of Pediatric Asthma and Allergy. Epidemiol Rev 24: 154-175 [Full Text]  
• Douwes, J., Pearce, N. (2002). Asthma and the westernization 'package'. Int J Epidemiol 31: 1098-1102 [Full Text]  
• van Noord, P. A. H. (2002). Does the sibling effect have its origin in utero? Investigating birth order, cord blood immunoglobulin E concentration, and allergic sensitization at age 4 years.. Am J Epidemiol 156: 882-883 [Full Text]  
• Maziak, W. (2002). RE: "DOES THE SIBLING EFFECT HAVE ITS ORIGIN IN UTERO? INVESTIGATING BIRTH ORDER, CORD BLOOD IMMUNOGLOBULIN E CONCENTRATION, AND ALLERGIC SENSITIZATION AT AGE 4 YEARS". Am J Epidemiol 156: 882-882 [Full Text]  
• Svanes, C, Jarvis, D, Chinn, S, Omenaas, E, Gulsvik, A, Burney, P (2002). Early exposure to children in family and day care as related to adult asthma and hay fever: results from the European Community Respiratory Health Survey. Thorax 57: 945-950 [Abstract] [Full Text]  
• Bach, J.-F. (2002). The Effect of Infections on Susceptibility to Autoimmune and Allergic Diseases. NEJM 347: 911-920 [Full Text]  
• Shapiro, S. D., Owen, C. A. (2002). ADAM-33 Surfaces as an Asthma Gene. NEJM 347: 936-938 [Full Text]  
• McKeever, T. M., Lewis, S. A., Smith, C., Hubbard, R. (2002). The Importance of Prenatal Exposures on the Development of Allergic Disease: A Birth Cohort Study Using the West Midlands General Practice Database. Am. J. Respir. Crit. Care Med. 166: 827-832 [Abstract] [Full Text]  
• Hizawa, N., Yamaguchi, E., Konno, S., Tanino, Y., Jinushi, E., Nishimura, M. (2002). A Functional Polymorphism in the RANTES Gene Promoter Is Associated with the Development of Late-Onset Asthma. Am. J. Respir. Crit. Care Med. 166: 686-690 [Abstract] [Full Text]  
• Parkin, P C, Taylor, C Y, Petric, M, Schuh, S, Goldbach, M, Ipp, M (2002). Controlled study of respiratory viruses and wheezing. Arch. Dis. Child. 87: 221-222 [Full Text]  
• Ownby, D. R., Johnson, C. C., Peterson, E. L. (2002). Exposure to Dogs and Cats in the First Year of Life and Risk of Allergic Sensitization at 6 to 7 Years of Age. JAMA 288: 963-972 [Abstract] [Full Text]  
• Platts-Mills, T. A. E. (2002). Paradoxical Effect of Domestic Animals on Asthma and Allergic Sensitization. JAMA 288: 1012-1014 [Full Text]  
• Wood, R. A. (2002). Pediatric Asthma. JAMA 288: 745-747 [Full Text]  
• Hylkema, M. N., Timens, W., Luinge, M., van der Werf, N., Hoekstra, M. O. (2002). The Effect of Bacillus Calmette-Guerin Immunization Depends on the Genetic Predisposition to Th2-Type Responsiveness. Am. J. Respir. Cell Mol. Bio. 27: 244-249 [Abstract] [Full Text]  
• Marcovitch, H., Williamson, A. (2002). Paediatric Asthma---a new virtual journal. BMJ 324: 1052-1052 [Full Text]  
• Varner, A. E. (2002). The Increase in Allergic Respiratory Diseases : Survival of the Fittest?. Chest 121: 1308-1316 [Abstract] [Full Text]  
• Karmaus, W, Botezan, C (2002). Does a higher number of siblings protect against the development of allergy and asthma? A review. J. Epidemiol. Community Health 56: 209-217 [Abstract] [Full Text]  
• Message, S. D, Johnston, S. L (2002). Viruses in asthma: The role of viruses in childhood respiratory infections. Br Med Bull 61: 29-43 [Abstract] [Full Text]  
• Celedon, J. C., Litonjua, A. A., Ryan, L., Weiss, S. T., Gold, D. R. (2002). Day Care Attendance, Respiratory Tract Illnesses, Wheezing, Asthma, and Total Serum IgE Level in Early Childhood. Arch Pediatr Adolesc Med 156: 241-245 [Abstract] [Full Text]  
• Perez-G., M., Melo, M., Keegan, A. D., Zamorano, J. (2002). Aspirin and Salicylates Inhibit the IL-4- and IL-13-Induced Activation of STAT6. J. Immunol. 168: 1428-1434 [Abstract] [Full Text]  
• LEYNAERT, B., NEUKIRCH, C., JARVIS, D., CHINN, S., BURNEY, P., NEUKIRCH, F. (2001). Does Living on a Farm during Childhood Protect against Asthma, Allergic Rhinitis, and Atopy in Adulthood?. Am. J. Respir. Crit. Care Med. 164: 1829-1834 [Abstract] [Full Text]  
• von Mutius, E. (2001). Infection: friend or foe in the development of atopy and asthma? The epidemiological evidence. Eur Respir J 18: 872-881 [Abstract] [Full Text]  
• Olsen, J., Melbye, M., Olsen, S. F., Sorensen, T. I.A., Aaby, P., Nybo Andersen, A.-M., Taxbol, D., Hansen, K. D., Juhl, M., Schow, T. B., Sorensen, H. T., Andresen, J., Mortensen, E. L., Wind Olesen, A., Sondergaard, C. (2001). The Danish National Birth Cohort - its background, structure and aim. Scand J Public Health 29: 300-307 [Abstract]  
• von Mutius, E. (2001). The Increase in Asthma Can Be Ascribed to Cleanliness. Am. J. Respir. Crit. Care Med. 164: 1106-1107 [Full Text]  
• Platts-Mills, T. A. E., Woodfolk, J. A., Sporik, R. B. (2001). The Increase in Asthma Cannot Be Ascribed to Cleanliness. Am. J. Respir. Crit. Care Med. 164: 1107-1108 [Full Text]  
• McKeever, T M, Lewis, S A, Smith, C, Collins, J, Heatlie, H, Frischer, M, Hubbard, R (2001). Siblings, multiple births, and the incidence of allergic disease: a birth cohort study using the West Midlands general practice research database. Thorax 56: 758-762 [Abstract] [Full Text]  
• Koopman, L. P., Smit, H. A., Heijnen, M.-L. A., Wijga, A., van Strien, R. T., Kerkhof, M., Gerritsen, J., Brunekreef, B., de Jongste, J. C., Neijens, H. J. (2001). Respiratory Infections in Infants: Interaction of Parental Allergy, Child Care, and Siblings---The PIAMA Study. Pediatrics 108: 943-948 [Abstract] [Full Text]  
• Nicod, L.P., Spiteri, M.A. (2001). How infections can modify lung immunity. Eur Respir J 18: 442-443 [Full Text]  
• Woodruff, P. G., Fahy, J. V. (2001). Asthma: Prevalence, Pathogenesis, and Prospects for Novel Therapies. JAMA 286: 395-398 [Full Text]  
• Hall, C. B. (2001). Respiratory Syncytial Virus and Parainfluenza Virus. NEJM 344: 1917-1928 [Full Text]  
• Anderson, W. J.A., Watson, L., Lemanske, R. F. Jr., Busse, W. W. (2001). Asthma and the Hygiene Hypothesis. NEJM 344: 1643-1644 [Full Text]  
• Wright, A L, Holberg, C J, Taussig, L M, Martinez, F D (2001). Factors influencing the relation of infant feeding to asthma and recurrent wheeze in childhood. Thorax 56: 192-197 [Abstract] [Full Text]  
• Johnston, S. L, Openshaw, P. J M (2001). The protective effect of childhood infections. BMJ 322: 376-377 [Full Text]  
• Illi, S., von Mutius, E., Lau, S., Bergmann, R., Niggemann, B., Sommerfeld, C., Wahn, U., the MAS Group, (2001). Early childhood infectious diseases and the development of asthma up to school age: a birth cohort study. BMJ 322: 390-395 [Abstract] [Full Text]  
• Busse, W. W., Lemanske, R. F. (2001). Asthma. NEJM 344: 350-362 [Full Text]  
• Kay, A.B. (2001). Allergy and Allergic Diseases- First of Two Parts. NEJM 344: 30-37 [Full Text]  
• Des Roches, A., Paradis, L., Paradis, J., Morgan, T. M., Dompeling, E., Jobsis, R., van Schayck, O., Ball, T. M., Holberg, C. J., Wright, A. L. (2000). Siblings, Day-Care Attendance, and the Risk of Asthma and Wheezing. NEJM 343: 1967-1968 [Full Text]  
• Gereda, J. E., Leung, D. Y. M., Liu, A. H. (2000). Levels of Environmental Endotoxin and Prevalence of Atopic Disease. JAMA 284: 1652-1653 [Full Text]  
• Christiansen, S. C. (2000). Day Care, Siblings, and Asthma -- Please, Sneeze on My Child. NEJM 343: 574-575 [Full Text]