Could prenatal vitamin D sufficiency curtail childhood allergic rhinitis risk?
Published: June 20, 2021
Allergic rhinitis is a highly pervasive disease that often begins in childhood and persists throughout adulthood. It is characterized by rhinoconjunctivitis associated with evidence of aeroallergen sensitization. While it is not a life-threatening condition, the spectrum of symptomatology can result in significant impacts on quality of life for those with severe disease. Furthermore, for patients with co-morbid asthma, allergic rhinitis is a risk factor for poor asthma control. Vitamin D has been shown to have important immunomodulatory effects and may reduce the risk of childhood allergic disease.
A recent study published by Chen et al. in The Journal of Allergy and Clinical Immunology: In Practice, reported an update on the role of prenatal vitamin D sufficiency and supplementation in the development of childhood allergic rhinitis with aeroallergen sensitization. The authors included 414 offspring with available allergic rhinitis and aeroallergen sensitization data at 6 years of age from the Vitamin D Antenatal Asthma Reduction Trial (VDAART), a randomized double-blind trial of pregnant women assigned to 4400 IU vitamin D or placebo multivitamin with 400 IU vitamin D daily.
The exposure of interest, vitamin D sufficiency during pregnancy, was defined as a 25(OH)D level > 30 ng/mL. Subjects were classified into four categories of vitamin D sufficiency based on vitamin D levels in the first and third trimesters: early and late insufficiency, early sufficiency and late insufficiency, early insufficiency and late sufficiency, and early and late sufficiency. Using logistic regression, the study authors tested associations between categories of prenatal vitamin D sufficiency with offspring allergic rhinitis, aeroallergen sensitization, and allergic rhinitis with aeroallergen sensitization at both 3 and 6 years of age.
When compared to offspring of mothers who were vitamin D insufficient in early and late pregnancy, offspring of mothers with early insufficiency and late sufficiency for vitamin D had an adjusted odds of 0.34 (95% CI 0.13, 0.82) of clinical allergic rhinitis with aeroallergen sensitization at 3 years of age and an adjusted odds of 0.54 (95% CI 0.29, 0.98) allergic rhinitis with aeroallergen sensitization at 6 years of age. Similarly, offspring of mothers who had been assigned to high dose prenatal vitamin D also had a decreased odds of 0.54 (95% CI 0.32,0.91) allergic rhinitis with aeroallergen sensitization at 6 years of age when compared to offspring of mothers assigned to low dose prenatal vitamin D. The authors conclude that prenatal vitamin D sufficiency and supplementation may be protective against the development of offspring allergic rhinitis with aeroallergen sensitization.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.