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Early childhood infectious diseases and the development of asthma up to school age: a birth cohort study

BMJ 2001; 322 doi: (Published 17 February 2001) Cite this as: BMJ 2001;322:390
  1. Sabina Illi, research assistant (sabina.illi{at},
  2. Erika von Mutius, head of asthma outpatient clinica,
  3. Susanne Lau, research assistant, paediatricianb,
  4. Renate Bergmann, research assistant, paediatricianb,
  5. Bodo Niggemann, senior staff clinicianb,
  6. Christine Sommerfeld, mathematicianb,
  7. Ulrich Wahn, head of departmentb

    the MAS Group

  1. a Department of Pulmonology and Allergology, University Children's Hospital, Lindwurmstrasse 4, 80337 Munich, Germany
  2. b Department of Paediatric Pneumology and Immunology, Charité, Humboldt University, Augustenburger Platz 1, 13353 Berlin, Germany
  1. Correspondence to: Sabina Illi
  • Accepted 27 November 2000


Objective: To investigate the association between early childhood infections and subsequent development of asthma.

Design: Longitudinal birth cohort study.

Setting: Five children's hospitals in five German cities.

Participants: 1314 children born in 1990 followed from birth to the age of 7 years.

Main outcome measures: Asthma and asthmatic symptoms assessed longitudinally by parental questionnaires; atopic sensitisation assessed longitudinally by determination of IgE concentrations to various allergens; bronchial hyperreactivity assessed by bronchial histamine challenge at age 7 years.

Results: Compared with children with 1 episode of runny nose before the age of 1 year, those with 2 episodes were less likely to have a doctor's diagnosis of asthma at 7 years old (odds ratio 0.52 (95% confidence interval 0.29 to 0.92)) or to have wheeze at 7 years old (0.60 (0.38 to 0.94)), and were less likely to be atopic before the age of 5 years. Similarly, having 1 viral infection of the herpes type in the first 3 years of life was inversely associated with asthma at age 7 (odds ratio 0.48 (0.26 to 0.89)). Repeated lower respiratory tract infections in the first 3 years of life showed a positive association with wheeze up to the age of 7 years (odds ratio 3.37 (1.92 to 5.92) for 4 infections v 3 infections).

Conclusion: Repeated viral infections other than lower respiratory tract infections early in life may reduce the risk of developing asthma up to school age.


  • Members of the MAS Group are listed at the end of the article

  • Funding This work was funded by the German Ministry of Education and Research (BMBF), grant-number 01GC9702/0.

  • Competing interests None declared.

  • Accepted 27 November 2000
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