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Vitamin A supplementation and BCG vaccination at birth may affect atopy in childhood: long‐term follow‐up of a randomized controlled trial
Author(s) -
Kiraly N.,
Benn C. S.,
BieringSørensen S.,
Rodrigues A.,
Jensen K. J.,
Ravn H.,
Allen K. J.,
Aaby P.
Publication year - 2013
Publication title -
allergy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.363
H-Index - 173
eISSN - 1398-9995
pISSN - 0105-4538
DOI - 10.1111/all.12216
Subject(s) - atopy , medicine , allergy , randomized controlled trial , vaccination , asthma , wheeze , vitamin , immunology , house dust mite , atopic dermatitis , pediatrics , allergen
Background Recent evidence suggests that immunogenic interventions such as vaccines and micronutrients may affect atopic sensitization and atopic disease. We aimed to determine whether neonatal BCG vaccination, vitamin A supplementation and other vaccinations affect atopy in childhood. Methods In Guinea–Bissau, low‐birthweight infants were randomized to early (intervention) or delayed (usual policy) BCG . A subgroup was also randomly assigned vitamin A supplementation or placebo in a two‐by‐two factorial design. Participants were followed up at age 3–9 years. The main outcome was atopy defined as skin prick test reaction ≥3 mm. Secondary outcomes were symptoms of eczema, asthma and food allergy. Results Two hundred eighty‐one children had valid skin prick tests performed, and 14% (39/281) were atopic. There was no significant difference in atopy between the early and delayed BCG groups ( OR , 0.71; 95% CI , 0.34–1.47). Atopy was significantly reduced in children who had responded to BCG with a scar ( OR , 0.42; 0.19–0.94). Vitamin A supplementation was associated with increased atopy ( OR , 2.88; 1.26–6.58), especially in those who received simultaneous BCG (5.99; 1.99–18.1, P = 0.09 for interaction between vitamin A supplementation and BCG ). Early vs delayed BCG was not associated with symptoms of atopic disease, but vitamin A supplementation increased odds of wheeze within the past 12 months ( OR , 2.45; 1.20–4.96). Conclusions There were no statistically significant effects of early vs delayed BCG on atopy or symptoms of atopic disease. Having a BCG scar was associated with reduced atopy, whereas neonatal vitamin A supplementation was associated with increased atopy. Study Registration Clinicaltrials.gov NCT 01420705.