Elsevier

The Lancet

Volume 353, Issue 9163, 1 May 1999, Pages 1485-1488
The Lancet

Articles
Atopy in children of families with an anthroposophic lifestyle

https://doi.org/10.1016/S0140-6736(98)09344-1Get rights and content

Summary

Background

Increased prevalence of atopic disorders in children may be associated with changes in types of childhood infections, vaccination programmes, and intestinal microflora. People who follow an anthroposophic way of life use antibiotics restrictively, have few vaccinations, and their diet usually contains live lactobacilli, which may affect the intestinal microflora. We aimed to study the prevalence of atopy in children from anthroposophic families and the influence of an anthroposophic lifestyle on atopy prevalence.

Methods

In a cross-sectional study, 295 children aged 5–13 years at two anthroposophic (Steiner) schools near Stockholm, Sweden, were compared with 380 children of the same age at two neighbouring schools in terms of history of atopic and infectious diseases, use of antibiotics and vaccinations, and social and environmental variables. Skin-prick tests were done for 13 common allergens, and we took blood samples from children and their parents for analysis of allergen-specific serum IgE-antibodies.

Findings

At the Steiner schools, 52% of the children had had antibiotics in the past, compared with 90% in the control schools. 18% and 93% of children, respectively, had had combined immunisation against measles, mumps, and rubella, and 61% of the children at the Steiner schools had had measles. Fermented vegetables, containing live lactobacilli, were consumed by 63% of the children at Steiner schools, compared with 4·5% at the control schools. Skin-prick tests and blood tests showed that the children from Steiner schools had lower prevalence of atopy than controls (odds ratio 0·62 [95% CI 0·43–0·91]). There was an inverse relation between the number of characteristic features of an anthroposophic lifestyle and risk of atopy (p for trend=0·01).

Interpretation

Prevalence of atopy is lower in children from anthroposophic families than in children from other families. Lifestyle factors associated with anthroposophy may lessen the risk of atopy in childhood.

Introduction

Every third child in many industrialised countries has an atopic disorder.1 Although hereditary factors are important for the risk of developing allergic disorders, the increase in prevalence observed in recent years2, 3 suggests that non-hereditary risk factors must play a substantial part. Immunological data show that different infections can either promote atopy (respiratory syncytial virus infections)4 or inhibit atopy (measles, hepatitis A, tuberculosis).5, 6, 7 A change in childhood infectious diseases, vaccination programmes, or both could partly explain this increase, although studies in Sweden8, 9 did not show that BCG vaccination protected against atopy.

The immunological role of intestinal microflora in the development of allergy has also been investigated. Children in Estonia have lower rates of atopy than Swedish children and their intestinal microflora contains a larger amount of lactobacilli.10 Lactobacillus plantarum, most common in spontaneously fermented vegetables, can colonise the human intestinal mucosa and affect indigenous strains.11 Animal experiments and studies in vitro have shown that lactobacilli can change the interleukin profile and inhibit antigen-induced IgE production.12, 13 Infants with milk allergy and atopic dermatitis had milder symptoms and fewer markers of intestinal inflammation if their milk formula was fortified with lactobacilli.14 Thus, intestinal microflora could play a part in the development of atopy.

The school of antroposophy (Greek: wisdom about man) was founded in the early 20th century by Rudolf Steiner.15 Anthroposophy has been applied to education (Steiner schools), medicine, art, architecture, and agriculture (biodynamic farming).16 Anthroposophical doctors restrict the use of antibiotics, antipyretics, and vaccinations.17 Most children are vaccinated only against tetanus and polio, and most vaccinations are given later than recommended by the Swedish health authorities. As a result, in Sweden, measles occurs primarily in anthroposophic families.18 They also consume mostly local foods produced according to biodynamic principles. Vegetables preserved by spontaneous fermentation are a common dietary element, even for small children.19

We aimed to compare the prevalence of atopy in children from anthroposophic families, who attend Steiner schools, with that of children at conventional schools.

Section snippets

Methods

In a cross-sectional study, children from two Steiner schools (A, B) in a village located 60 km south of Stockholm, Sweden, were compared with children from two control schools (C, D) in the same area. Steiner school A is situated in the countryside, in buildings constructed in the 1970s in the typical anthroposophic style. School B is located in a traditional school building from the 1930s in a built-up area. School C, adjacent to school B, was built in the 1960s, and school D is in a nearby

Results

675 children aged 5–13 years took part in the study. In the Steiner schools, parents of 13 (4·2%) of 309 children refused to participate, 296 families were sent the questionnaire, and only one family refused to take part in the clinical study. In control schools, parents of 16 (3·9%) of 413 children refused to participate, 397 families were sent the questionnaire, and 17 (4·3%) refused the clinical study.

Demographic data and risk factors for atopic disease in children at the four schools are

Discussion

We have shown that factors associated with an anthroposophic way of life are also associated with a lowered prevalence of atopy in children, both by clinical diagnosis and by serological or skin-prick diagnosis. However, several issues have to be considered in the interpretation of these findings. Measles has been inversely related to atopy,5, 24 and a measles epidemic in 1995 could have played a part in the lower prevalence of atopic dermatitis in children at the Steiner schools than in

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