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Birth by cesarean section, allergic rhinitis, and allergic sensitization among children with a parental history of atopyMichael Pistiner, MD,a,b,d Diane R. Gold, MD, MPH,b,e Hassen Abdulkerim, MS,b Ellaine Hoffman, PhD,f and Juan C. Celedón, MD, DrPH Isn't it fascinating to see the ways the immune system morphs over time? Current theories are being tested to explain the shifting immune expression as due to various forces such as mankind's drift toward urbanization, away from the rural landscape with its livestock rich in microbes; or the purification of our food and water supply which was once the source of disease from contamination with bacteria, parasites, and viruses. Whether we mean to or not, our actions sometimes change the way our immune system functions. Here, the authors look at the moment of birth where two paths diverge. The route of Caesarian delivery is the one less traveled, and that can make all the difference. This study published in the August 2008 Journal of Allergy and Clinical Immunology starts with the premise that birth by Caesarean delivery can alter the newborn's immune responses and increase its risk of developing allergic diseases. Studies done to date have not looked closely at those children at greater risk of allergic disease due to family history. This study specifically examines the relationship between the at-risk child's birth by C-section and subsequent development of allergic disease. The authors found that C-section is associated with allergic rhinitis and atopy in children with a parental history of atopy. An alteration in perinatal exposures might have a role in the development of atopic diseases such as asthma and allergic rhinitis, which often begin in early childhood. Children born by Caesarean section are not exposed to the maternal vaginal flora, gut flora, or both, which partly explains changes in the neonatal microbial flora by mode of delivery. It also offers another example of how we affect the immune system unintentionally in very interesting ways. While the study provides some confirming evidence about development of atopy, it also presents a quandary. Although the data showed that birth by Caesarean section was associated with increased risks of allergic rhinitis and atopy, there was no correlation with asthma in high risk children at school age. |
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