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Tuberculosis, bacillus Calmette-Guérin vaccination, and allergic disease: findings from the International Study of Asthma and Allergies in Childhood Phase Two.
Pediatr Allergy Immunol. 2012 Jun; 23(4):324-31.PA

Abstract

Some have suggested a protective effect of tuberculosis (TB) infection on allergic disease risk, but few studies have examined the association between the two. We therefore investigated whether TB disease and bacillus Calmette-Guérin (BCG) vaccination in early life protect against allergic disease. Information on allergic disease symptoms, past TB disease, and BCG vaccination as well as potential confounding factors was gathered by parental questionnaire from a randomly selected subset of 23,901 8- to 12-yr-old schoolchildren in 20 centers in both developed and developing countries. Children were also physically examined for flexural eczema and underwent skin prick testing. Pooled odds ratio (OR) estimates and corresponding 95% confidence intervals (CIs) across study centers were calculated, using random effects meta-analysis models. There were 245 (1.0%) reported cases of TB disease, and 66.3% (15,857) of all children received the BCG vaccine. Asthma, hay fever, and flexural eczema symptoms in the past year as well as flexural eczema on skin examination were all positively linked to a history of TB (adjusted pooled OR 'wheeze in the past year' = 2.27, 95% CI 1.52-3.41; adjusted pooled OR 'hay fever symptoms in the past year' = 2.23, 1.22-4.09; adjusted pooled OR 'flexural eczema symptoms in the past year' = 3.21, 2.01-5.12; adjusted pooled OR 'flexural eczema on skin examination' = 4.04, 1.71-9.56). Even higher risk estimates were seen for severe asthma and eczema symptoms [adjusted OR = 4.02 (2.17-7.47) and adjusted OR = 6.31 (2.19-18.17), respectively]. There was no significant association between past TB and skin prick test positivity (adjusted pooled OR = 1.32, 0.87-2.02). BCG vaccination during the first year of life was also not associated with any of the allergy outcomes. We found a uniform positive association between TB and all allergic disease outcomes, including eczema on skin examination. As this was a cross-sectional study, it is unclear whether this positive association is attributable to a causal relationship, and further longitudinal studies are required.

Authors+Show Affiliations

Department of Paediatric Allergy & Dermatology, St John's Institute of Dermatology, St Thomas' Hospital and King's College London, London, UK. carsten.flohr@kcl.ac.ukNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22192272

Citation

Flohr, Carsten, et al. "Tuberculosis, Bacillus Calmette-Guérin Vaccination, and Allergic Disease: Findings From the International Study of Asthma and Allergies in Childhood Phase Two." Pediatric Allergy and Immunology : Official Publication of the European Society of Pediatric Allergy and Immunology, vol. 23, no. 4, 2012, pp. 324-31.
Flohr C, Nagel G, Weinmayr G, et al. Tuberculosis, bacillus Calmette-Guérin vaccination, and allergic disease: findings from the International Study of Asthma and Allergies in Childhood Phase Two. Pediatr Allergy Immunol. 2012;23(4):324-31.
Flohr, C., Nagel, G., Weinmayr, G., Kleiner, A., Williams, H. C., Aït-Khaled, N., & Strachan, D. P. (2012). Tuberculosis, bacillus Calmette-Guérin vaccination, and allergic disease: findings from the International Study of Asthma and Allergies in Childhood Phase Two. Pediatric Allergy and Immunology : Official Publication of the European Society of Pediatric Allergy and Immunology, 23(4), 324-31. https://doi.org/10.1111/j.1399-3038.2011.01248.x
Flohr C, et al. Tuberculosis, Bacillus Calmette-Guérin Vaccination, and Allergic Disease: Findings From the International Study of Asthma and Allergies in Childhood Phase Two. Pediatr Allergy Immunol. 2012;23(4):324-31. PubMed PMID: 22192272.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Tuberculosis, bacillus Calmette-Guérin vaccination, and allergic disease: findings from the International Study of Asthma and Allergies in Childhood Phase Two. AU - Flohr,Carsten, AU - Nagel,Gabriele, AU - Weinmayr,Gudrun, AU - Kleiner,Andrea, AU - Williams,Hywel C, AU - Aït-Khaled,Nadia, AU - Strachan,David P, AU - ,, Y1 - 2011/12/23/ PY - 2011/12/24/entrez PY - 2011/12/24/pubmed PY - 2012/9/19/medline SP - 324 EP - 31 JF - Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology JO - Pediatr Allergy Immunol VL - 23 IS - 4 N2 - Some have suggested a protective effect of tuberculosis (TB) infection on allergic disease risk, but few studies have examined the association between the two. We therefore investigated whether TB disease and bacillus Calmette-Guérin (BCG) vaccination in early life protect against allergic disease. Information on allergic disease symptoms, past TB disease, and BCG vaccination as well as potential confounding factors was gathered by parental questionnaire from a randomly selected subset of 23,901 8- to 12-yr-old schoolchildren in 20 centers in both developed and developing countries. Children were also physically examined for flexural eczema and underwent skin prick testing. Pooled odds ratio (OR) estimates and corresponding 95% confidence intervals (CIs) across study centers were calculated, using random effects meta-analysis models. There were 245 (1.0%) reported cases of TB disease, and 66.3% (15,857) of all children received the BCG vaccine. Asthma, hay fever, and flexural eczema symptoms in the past year as well as flexural eczema on skin examination were all positively linked to a history of TB (adjusted pooled OR 'wheeze in the past year' = 2.27, 95% CI 1.52-3.41; adjusted pooled OR 'hay fever symptoms in the past year' = 2.23, 1.22-4.09; adjusted pooled OR 'flexural eczema symptoms in the past year' = 3.21, 2.01-5.12; adjusted pooled OR 'flexural eczema on skin examination' = 4.04, 1.71-9.56). Even higher risk estimates were seen for severe asthma and eczema symptoms [adjusted OR = 4.02 (2.17-7.47) and adjusted OR = 6.31 (2.19-18.17), respectively]. There was no significant association between past TB and skin prick test positivity (adjusted pooled OR = 1.32, 0.87-2.02). BCG vaccination during the first year of life was also not associated with any of the allergy outcomes. We found a uniform positive association between TB and all allergic disease outcomes, including eczema on skin examination. As this was a cross-sectional study, it is unclear whether this positive association is attributable to a causal relationship, and further longitudinal studies are required. SN - 1399-3038 UR - https://www.unboundmedicine.com/medline/citation/22192272/Tuberculosis_bacillus_Calmette_Guérin_vaccination_and_allergic_disease:_findings_from_the_International_Study_of_Asthma_and_Allergies_in_Childhood_Phase_Two_ L2 - https://doi.org/10.1111/j.1399-3038.2011.01248.x DB - PRIME DP - Unbound Medicine ER -