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Børn i Danmark

Også i høj-indkomstlande som Danmark har børn under et år betydelig sygelighed og som følge heraf mange lægebesøg, et højt medicinforbrug og mange indlæggelser. Gennem tre årtier har forekomsten af eksem, astma og allergi desuden været støt stigende verden over. Således er eksem og astma nu de hyppigst forekommende kroniske sygdomme blandt børn i høj-indkomstlande, og 25% af den voksne befolkning lider af astma, høfeber eller allergi. 

Mange studier har forsøgt at undersøge hvorfor. Flere har peget på, at vores immunforsvar er under- eller fejl-stimuleret som følge af vores tilværelse i tiltagende hygiejniske omgivelser med færre infektioner, den såkaldte hygiejne-hypotese, kan være en del af forklaringen. 

Det er velkendt at Calmette medfører en stærk påvirkning af immunforsvaret. Der er derfor også gennem de seneste 10 år lavet en række mindre studier, både i høj- og lav-indkomstlande, hvor man har forsøgt at undersøge om individer, der er blevet Calmette-vaccinerede, har nedsat forekomst af eksem, astma og allergi.

Studierne har desværre været for små og for forskelligartede til at kunne give et klart svar(16-33). Studierne har retrospektive, ikke-randomiserede studier. 

Så vidt vi ved, er der kun et studie, der hidtil har undersøgt calmette-vaccinens effekt i et høj-indkomstland i et randomiseret design. Det var et mindre hollandsk studie, der fandt, at calmette-vaccine reducerede forekomsten af atopisk dermatitis med omkring 40%. 

(13) Strachan DP. Family size, infection and atopy: the first decade of the "hygiene hypothesis". Thorax 2000 Aug;55 Suppl 1:S2-10.

(14) Marchant A, Goetghebuer T, Ota MO, Wolfe I, Ceesay SJ, De Groote D, et al. Newborns develop a Th1-type immune response to Mycobacterium bovis bacillus Calmette-Guerin vaccination. Journal of Immunology 1999 Aug 15;163(4):2249-55.

(15) Prescott SL, Macaubas C, Smallacombe T, Holt BJ, Sly PD, Holt PG. Development of allergen-specific T-cell memory in atopic and normal children [see comments]. Lancet 1999 Jan 16;353(9148):196-200.

(16) Eifan AO, Akkoc T, Ozdemir C, Bahceciler NN, Barlan IB. No association between tuberculin skin test and atopy in a bacillus Calmette-Guerin vaccinated birth cohort. Pediatric Allergy and Immunology 2009 Sep;20(6):545-50.

(17) Dilli D, Bostanci I, Dallar Y. Do different vaccination regimens for BCG and hepatitis B affect the development of allergic disorders in early childhood? Journal of Asthma 2008 Mar;45(2):155-9.

(18) Soysal A, Bahceciler N, Barlan I, Bakir M. Lack of an inverse association between tuberculosis infection and atopy: by T-cell-based immune assay (RD1-ELISpot). Pediatric Allergy and Immunology 2008 Dec;19(8):709-15.

(19) Li J, Zhou Z, An J, Zhang C, Sun B, Zhong N. Absence of relationships between tuberculin responses and development of adult asthma with rhinitis and atopy. Chest 2008 Jan;133(1):100-6.

(20) Ahmadiafshar A, Parchegani MR, Moosavinasab N, Koosha A. A Study of Relation between BCG Scar and Atopy in Schoolchildren of Zanjan City. Iranian Journal of Allergy, Asthma and Immunology 2005 Dec;4(4):185-8.

(21) Omar MT, Ahmed SH, Sarkis NN. A study of the association between delayed type hypersensitivity reaction to mycobacterium tuberculosis and atopy in asthmatic children. Journal of the Egyptian Public Health Association 2005;80(3-4):463-74. 

(22) Obihara CC, Beyers N, Gie RP, Potter PC, Marais BJ, Lombard CJ, et al. Inverse association between Mycobacterium tuberculosis infection and atopic rhinitis in children. Allergy 2005 Sep;60(9):1121-5.

(23) Annus T, Montgomery SM, Riikjarv MA, Bjorksten B. Atopic disorders among Estonian schoolchildren in relation to tuberculin reactivity and the age at BCG vaccination. Allergy 2004 Oct;59(10):1068-73.

(24) da Cunha SS, Cruz AA, Dourado I, Barreto ML, Ferreira LD, Rodrigues LC. Lower prevalence of reported asthma in adolescents with symptoms of rhinitis that received neonatal BCG. Allergy 2004 Aug;59(8):857-62.

(25) Townley RG, Barlan IB, Patino C, Vichyanond P, Minervini MC, Simasathien T, et al. The effect of BCG vaccine at birth on the development of atopy or allergic disease in young children. Annals of Allergy, Asthma and Immunology 2004 Mar;92(3):350-5.

(26) Bager P, Rostgaard K, Nielsen NM, Melbye M, Westergaard T. Age at bacille Calmette-Guerin vaccination and risk of allergy and asthma. Clinical and Experimental Allergy 2003 Nov;33(11):1512-7. 

(27) Ota MO, Van Der Sande MA, Walraven GE, Jeffries D, Nyan OA, Marchant A, et al. Absence of association between delayed type hypersensitivity to tuberculin and atopy in children in The Gambia. Clinical and Experimental Allergy 2003 Jun;33(6):731-6. 

(28) Marks GB, Ng K, Zhou J, Toelle BG, Xuan W, Belousova EG, et al. The effect of neonatal BCG vaccination on atopy and asthma at age 7 to 14 years: an historical cohort study in a community with a very low prevalence of tuberculosis infection and a high prevalence of atopic disease. Journal of Allergy and Clinical Immunology 2003 Mar;111(3):541-9.

(29) Krause TG, Hviid A, Koch A, Friborg J, Hjuler T, Wohlfahrt J, et al. BCG vaccination and risk of atopy. JAMA 2003 Feb 26;289(8):1012-5.

(30) Jang AS, Son MH. The association of airway hyperresponsiveness and tuberculin responses. Allergy 2002 Apr;57(4):341-5.

(31) Wong GW, Hui DS, Tam CM, Chan HH, Fok TF, Chan-Yeung M, et al. Asthma, atopy and tuberculin responses in Chinese schoolchildren in Hong Kong. Thorax 2001 Oct;56(10):770-3.

(32) Gruber C, Kulig M, Bergmann R, Guggenmoos-Holzmann I, Wahn U. Delayed hypersensitivity to tuberculin, total immunoglobulin E, specific sensitization, and atopic manifestation in longitudinally followed early Bacille Calmette-Guerin-vaccinated and nonvaccinated children. Pediatrics 2001 Mar;107(3):E36.

(33) Yilmaz M, Bingol G, Altintas D, Kendirli SG. Correlation between atopic diseases and tuberculin responses. Allergy 2000 Jul;55(7):664-7.

(34) Steenhuis TJ, van Aalderen WM, Bloksma N, Nijkamp FP, van der LJ, van LH, et al. Bacille-Calmette-Guerin vaccination and the development of allergic disease in children: a randomized, prospective, single-blind study. Clinical and Experimental Allergy 2008 Jan;38(1):79-85.

 

Sidst redigeret 10. september 2012

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Lone Graff Stensballe
Børnelæge, ph.d.
Børnemodtagelsen 4064
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