Mode of delivery and the risk of allergic disorders in childhood

Αντωνίου Πόυγκουρα Αναστασία

Ιατρός, Ωτορινολαρυγγολόγος, Καβάλα, τηλ. 2510833399, 6944182373, .(JavaScript must be enabled to view this email address), Μέλος της Ελληνικής Εταιρείας ΩΡΛ Αλλεργίας Ανοσολογίας και Ρογχοπαθειών

Early onset of  allergic rhinitis (AR) is poorly described, and rhinitis symptoms are often attributed to infections. In several past studies it was not supported the hypothesis that cesarean section or other complicated modes of delivery are associated with the development of allergic rhinitis [1].

However in other studies it is described that the risk of being diagnosed with AR is significantly higher in the children born by C-section than in those delivered vaginally [2].

Herr M, et all (2011) in their study analysed the relations between AR-like symptoms and atopy in infancy in the PARIS (Pollution and Asthma Risk: an Infant Study) birth cohort. Their findings support the hypothesis that AR could begin as early as 18 months of life.

Suspicion of AR should be reinforced in infants with parental history of AR or biological evidence of atopy, particularly blood eosinophilia and sensitization to inhalant allergens [3] . This could be explained by lack of contact with the maternal vaginal/fecal flora or reduced/absent labor during cesarean delivery.

Cesarean delivery can alter neonatal immune responses and increase the risk of atopy. Pistiner M, et al (2008) examined the relation between birth by cesarean delivery and atopy and allergic diseases in children at risk for atopy. Their findings suggest that cesarean delivery is associated with allergic rhinitis and atopy among children with a parental history of asthma or allergies.

This could be explained by lack of contact with the maternal vaginal/fecal flora or reduced/absent labor during cesarean delivery [4].

References

1. Bager P, Melbye M, Rostgaard K, Benn CS, Westergaard T. Mode of delivery and risk of allergic rhinitis and asthma. J Allergy Clin Immunol. 2003 Jan;111(1):51-6.

2. Renz-Polster H, David MR, Buist AS, Vollmer WM, O'Connor EA, Frazier EA, Wall MA. Caesarean section delivery and the risk of allergic disorders in childhood. Clin Exp Allergy. 2005 Nov;35(11):1466-72.

3. Herr M, Clarisse B, Nikasinovic L, Foucault C, Le Marec AM, Giordanella JP, Just J, Momas I. Does allergic rhinitis exist in infancy? Findings from the PARIS birth cohort. Allergy. 2011 Feb;66(2):214-21. doi: 10.1111/j.1398-9995.2010.02467.x.

4. Pistiner M, Gold DR, Abdulkerim H, Hoffman E, Celedón JC. Birth by cesarean section, allergic rhinitis, and allergic sensitization among children with a parental history of atopy. J Allergy Clin Immunol. 2008 Aug;122(2):274-9. Epub 2008 Jun 20.

Copyright: Dr Dimitrios N. Gelis, MD, PhD, DDS, ORL. Allergopedia, Korinthos, Greece, 2011.