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Observational Study
. 2021 Sep;76(9):2765-2775.
doi: 10.1111/all.14821. Epub 2021 Apr 7.

Impact of early life geohelminths on wheeze, asthma and atopy in Ecuadorian children at 8 years

Philip J Cooper  1   2   3 , Irina Chis Ster  1 , Martha E Chico  3 , Maritza Vaca  3 , Yisela Oviedo  3 , Augusto Maldonado  3   4 , Mauricio L Barreto  5 , Thomas A E Platts-Mills  6 , David P Strachan  7
Affiliations
Observational Study

Impact of early life geohelminths on wheeze, asthma and atopy in Ecuadorian children at 8 years

Philip J Cooper et al. Allergy. 2021 Sep.

Abstract

Background: Early-life exposures to geohelminths may protect against development of wheeze/asthma and atopy.

Objective: To study the effect of maternal geohelminths and infections in children during the first 5 years on atopy, wheeze/asthma and airways reactivity/inflammation at 8 years.

Methods: Birth cohort of 2404 neonates followed to 8 years in rural Ecuador. Data on wheeze/asthma were collected by questionnaire and atopy by skin prick test (SPT) reactivity to 9 allergens. We measured airways reactivity to bronchodilator, fractional exhaled nitric oxide (FeNO) and nasal eosinophilia. Stool samples were examined for geohelminths by microscopy.

Results: 1933 (80.4%) children were evaluated at 8 years. Geohelminths were detected in 45.8% of mothers and 45.5% of children to 5 years. Frequencies of outcomes at 8 years were as follows: wheeze (6.6%), asthma between 5 and 8 years (7.9%), SPT (14.7%), airways reactivity (10%) and elevated FeNO (10.3%) and nasal eosinophilia (9.2%). Any maternal geohelminth was associated with reduced SPT prevalence (OR 0.72). Childhood Trichuris trichiura infections during the first 5 years were associated with reduced wheeze (OR 0.57) but greater parasite burdens with Ascaris lumbricoides at 5 years were associated with increased wheeze (OR 2.83) and asthma (OR 2.60). Associations between maternal geohelminths and wheeze/asthma were modified by atopy. Parasite-specific effects on wheeze/asthma and airways reactivity and inflammation were observed in non-atopic children.

Conclusions: Our data provide novel evidence for persistent effects of in utero geohelminth exposures on childhood atopy but highlight the complex nature of the relationship between geohelminths and the airways. Registered as an observational study (ISRCTN41239086).

Keywords: Ecuador; asthma; atopy; geohelminths; wheeze.

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Conflict of interest statement

None of the authors had any conflict of interest.

Figures

FIGURE 1
FIGURE 1
Participant flow through follow‐up to 8 years of age and those included and excluded from the analysis. FU, follow‐up
FIGURE 2
FIGURE 2
Adjusted associations between maternal and childhood geohelminths and study outcomes among all children and stratified by atopy (SPT). Shown are adjusted ORs and 95% CIs. Air React., airways reactivity; FeNO, fractional exhaled nitric oxide; Nas eosin, nasal eosinophilia; SPT, allergen skin prick test reactivity
FIGURE 3
FIGURE 3
Adjusted associations between geohelminth parasite species and parasite burdens in mothers and children up to and at 5 years of age, and wheeze, asthma and atopy (SPT). Y = yes (infected); N = no (uninfected); L, light parasite burdens; M‐H, moderate to heavy parasite burdens. Shown are adjusted ORs and 95% CIs. SPT, allergen skin prick test reactivity
FIGURE 4
FIGURE 4
Adjusted associations between geohelminths, geohelminth parasite species and parasite burdens in mothers and children up to 5 years of age and wheeze/asthma stratified by atopy (SPT). L, light parasite burdens; M‐H, moderate to heavy parasite burdens. Shown are adjusted ORs and 95% CIs. SPT, allergen skin prick test reactivity
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