Allergy development and the intestinal microflora during the first year of life

doi:10.1067/mai.2001.118130

Journal of Allergy and Clinical Immunology

Volume 108, Issue 4, October 2001, Pages 516-520

https://doi.org/10.1067/mai.2001.118130 Get rights and content

Abstract

Background: The intestinal microflora is a likely source for the induction of immune deviation in infancy. Objective: The purpose of this study was to prospectively relate the intestinal microflora to allergy development in 2 countries differing with respect to the prevalence of atopic diseases. Methods: Newborn infants were followed prospectively through the first 2 years of life in Estonia (n = 24) and Sweden (n = 20). By that age, 9 Estonian and 9 Swedish infants had developed atopic dermatitis and/or positive skin prick test results. Stool samples were obtained at 5 to 6 days and at 1, 3, 6, and 12 months, and 13 groups of aerobic and anaerobic microorganisms were cultivated through use of standard methods. Results: In comparison with healthy infants, babies who developed allergy were less often colonized with enterococci during the first month of life (72% vs 96%; P < .05) and with bifidobacteria during the first year of life (17% to 39% vs 42% to 69%; P < .05). Furthermore, allergic infants had higher counts of clostridia at 3 months (median value, 10.3 vs 7.2 log₁₀; P < .05). The prevalence of colonization with Staphylococcus aureus was also higher at 6 months (61% vs 23%; P < .05), whereas the counts of Bacteroides were lower at 12 months (9.9 vs 10.6 log₁₀; P < .05). Conclusion: Differences in the composition of the gut flora between infants who will and infants who will not develop allergy are demonstrable before the development of any clinical manifestations of atopy. Because the observations were made in 2 countries with different standards of living, we believe that our findings could indicate a role for the intestinal microflora in the development of and protection from allergy. (J Allergy Clin Immunol 2001;108:516-20.)

Section snippets

Study groups and design

The study group consisted of 18 allergic infants (9 Estonian and 9 Swedish) and 26 nonallergic infants (15 Estonian and 11 Swedish). The 24 Estonian babies (12 of whom were boys) were born at the Women's Clinic of Tartu University Clinics between February 1997 and June 1998. The 20 Swedish babies (12 of whom were boys) were born at the Linköping University hospital between March 1996 and August 1998. The 2 groups were selected from participants in a prospective study of the development of

Results

The prevalence of colonization with enterococci was lower at 1 week and 1 month in infants who developed allergy during the first 2 years of life than in those who did not (67% vs 96% [P = .02] and 72% vs 96% [P = .03]; Table I). Similarly, the prevalence of colonization with bifidobacteria was lower in allergic infants through the first year of life, though significantly so only at 1 week (17% vs 50% [P = .03]) and at 3 (28% vs 62% [P = .04]) and 12 months (22% vs 69% [P = .005]).

Discussion

This prospective study extends previous reports of differences in the composition of the intestinal flora between allergic infants and nonallergic infants8, 9 and demonstrates that they are already present during the first week of life. Differences in diet and antibiotic treatment cannot explain the findings; the allergic and nonallergic infants were similar with respect to diet and the use of antibiotic drugs in both countries.

In at least 3 recent studies, differences in the composition of the

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^☆: Supported by grants from the Swedish Foundation for Health Care Sciences and Allergy Research, the Swedish Medical Research Council (#7510), the Swedish National Heart and Lung Association, the National Association against Asthma, and Allergy and Glaxo-Wellcome Ltd (Stevenage, United Kingdom) and by the Estonian Ministry of Education (#0418).

^☆☆: Reprint requests: Bengt Björkstén, MD, PhD, Centre for Allergy Research, Karolinska Institutet, 171 77 Stockholm, Sweden.

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Asthma, Rhinitis, Other Respiratory DiseasesAllergy development and the intestinal microflora during the first year of life☆,☆☆

Abstract

Section snippets

Study groups and design

Results

Discussion

J Allergy Clin Immunol

Lancet

Lancet

Prevalence of childhood asthma, rhinitis and eczema in Scandinavia and Eastern Europe

Eur Resp J

Risk factors for respiratory symptoms and atopic sensitization in the Baltic area

Arch Dis Child

Skin test reactivity and number of siblings

Br Med J

Atopic versus infectious disease in childhood: a question of balance?

Pediatr Allergy Immunol

Microflora-associated characteristics (MACs) and germfree animal characteristics (GACs) in man and animals

Microecol Ther

Intestinal microflora of Estonian and Swedish infants

Acta Paediatr

Asthma, Rhinitis, Other Respiratory Diseases
Allergy development and the intestinal microflora during the first year of life☆,☆☆