Decreased Asthma, Allergic Disease Risk Associated with Early-Life Daycare Attendance

Jonathan Witonsky, MD, MAS

Credit: American Lung Association

Daycare attendance during the period of early childhood may protect patients from sensitization to perennial aeroallergens and food allergens, according to recent findings.¹

This new research is set to be presented at the American Academy of Allergy, Asthma & Immunology Annual Meeting in 2024, and it was conducted by a team in Puerto Rico for the purpose of assessing the impact of daycare attendance on development of allergic conditions.

“Puerto Rican children bear a disproportionate burden of asthma and allergies, compounded by an overrepresentation of the socioeconomic and environmental determinants associated with these conditions,” the study’s primary author Jonathan Witonsky, MD, MAS, assistant professor in the pediatric division of allergy, immunology, and bone marrow transplant at the University of California, San Francisco, said in a statement.

To investigate such impacts, the investigators collected information related to patient demographics and clinical data. They involved participating mothers and their children as subjects in the Puerto Rican Infant Metagenomic and Epidemiologic Study of Respiratory Outcomes (PRIMERO) cohort, with the research occurring at the Hospital Interamericano de Medicina Avanzada-San Pablo in Puerto Rico.

There were a total of 2,100 children who took part in the ongoing study, and blood samples were gathered for total IgE and allergen-specific IgE tests by the research team over the course of the 2-year interaction. The team implemented regression analyses for their evaluation of the correlation between attendance of daycare in the first year of a patient’s life and levels of total IgE, in addition to allergen sensitization.

The investigators noted that among the 559 young patients for whom data on total IgE levels, daycare attendance status, and allergen-specific IgE measurements were accessible through the team’s research, 22% were shown to have been recipients of daycare.

The research team’s analysis showed that attending daycare in the first year of one’s life was associated with diminished IgE levels (coefficient: -0.41 log IU/mL, P < 0.01). It was also linked to a diminished likelihood of these individuals ending up with sensitization to perennial aeroallergens (OR: 0.57, 95% CI: 0.34 - 0.93) or food (OR: 0.56, 95% CI: 0.36 - 0.85).

The research team ended up finding that the effects of attending daycare in one’s early childhood years could have a major influence on the health of these individuals later in life. This was specifically the case in the development of allergic disease and of asthma.

These findings imply that exposure to the kind of environment seen in daycare settings in early life could allow for protective effects against sensitization to allergens.

This research also expands upon the existing literature on daycare attendance and its impact on health conditions among children. Prior research had shown that attendance to daycare was associated with greater odds of developing pneumonia, bronchiolitis, otitis media, and visits to emergency departments due to wheezing.²

While Witonsky and colleagues' new findings on asthma and allergic disease’s relationship do not directly contrast with these findings, both studies do highlight the complexity of the topic, as health outcomes among children are viewed to be an important topic of interest among allergists and most other fields.

Overall, the research team’s analysis represented a major step in expanding existing research on prevention strategies and the potential for mitigation of asthma and allergic disease risk among children.

"Findings from the PRIMERO birth cohort offer crucial insights into the impact of early-life exposures, including daycare attendance, on the development of childhood asthma and allergic diseases,” Witonsky concluded.¹

References

1. ^{Early-Life Daycare Attendance Potentially Linked to Lower Risk of Asthma and Allergic Diseases. American Academy of Allergy, Asthma & Immunology. February 5, 2024. https://www.aaaai.org/about/news/news/2024/daycare#:~:text=The%20findings%20suggest%20that%20early,learn%20more%20about%20childhood%20asthma. Date accessed: February 22, 2024.}
2. ^{Smith T. Daycare Attendance, Dense Traffic Linked to Elevated Childhood Respiratory Health Risk. HCPLive. September 17, 2023. https://www.hcplive.com/view/daycare-attendance-dense-traffic-linked-elevated-childhood-respiratory-health-risk. Date accessed: February 23, 2024.}