The Prevention and Incidence of Asthma and Mite Allergy (PIAMA) study: novel strategies for prevention of asthma and allergy in children
Samenvatting van de aanvraag
The PIAMA (Prevention and Incidence of Asthma and Mite Allergy) study was initiated in 1996. Over 4,000 pregnant women were enrolled, and their children were followed from birth until age 8 (clinical investigation at age 8 is ongoing). There are two components to the study: an intervention study, evaluating to what extent application of mite impermeable mattress covers reduces the incidence of asthma and mite allergy in children born to allergic mothers in a double blind, placebo controlled fashion; and a natural history component, investigating the development of asthma and allergy in a cohort of children born to allergic and non-allergic mothers. Altogether, over 4,000 subjects were enrolled, making the PIAMA study one of the largest asthma/allergy birth cohorts in the world with follow-up until age 8. Loss to follow up so far is low at about 10%. The cohort is being followed for 8 years because only at that age, a reliable diagnosis of asthma and allergy is possible. So far, data have been collected on asthma and allergy endpoints on a yearly basis using questionnaires, and in sub-populations with objective measurements at ages 1, 4 and 8. Data have been collected on a wide range of environmental, dietary and lifestyle exposures, using yearly questionnaires in the full cohort, and using measurements of indoor and outdoor pollutants in large subpopulations. The cohort is also being genotyped. A large subpopulation of parents has also been sampled for genotyping. Current funding extends to data collection at age 8, and only partial analysis of serum samples, both in terms of numbers of samples to be analysed, and numbers of (antibodies to) allergens to be assayed. Current funding permits basic analysis and reporting, but not harvesting of the full potential of the collected data to identify novel prevention strategies that are applicable in usual health care settings in the Netherlands (prenatal health care and well-baby clinics). We propose to fully analyse all collected serum samples for antibodies to relevant allergens. We also propose to use the data to identify novel prevention strategies, by systematically evaluating the extent to which (combinations of) simple questionnaire items can be used to identify high risk groups; and predict development of asthma and allergy over an 8 year period. In addition, we will identify simple methods for classifying exposures to the environmental, dietary and lifestyle factors that are most likely to prevent the development of asthma and allergy. The end result will be a multifacetted strategy for prevention of asthma and allergy in children that can be evaluated in intervention trials; and that is targeted to specific risk groups, and can be implemented in the usual health care setting for unborn and young, preschool children in the Netherlands.