Revision Bottema et al IL13, CD14, pet and tobacco smoke influence atopy in 3 Dutch birth cohorts; The Allergenic study Renske W.B. Bottema, Naomi E. Reijmerink, Marjan Kerkhof, Gerard H. Koppelman, Foekje F. Stelma, Jorrit Gerritsen, Carel Thijs, Bert Brunekreef, Constant P. van Schayck, Dirkje S. Postma Online Data Supplement Revision Bottema et al Summarized description of the cohorts presented in the study PIAMA The primary aim of the PIAMA study is to investigate the incidence and risk factors, and prevention of asthma and inhalant atopy[1]. The study includes a natural history part and an intervention part, i.e. a double-blind placebo-controlled study on the primary preventive effect of the use of mattress covers. At baseline, 4,146 children were included, 1,327 children of allergic mothers and 2,819 children of non-allergic mothers. Recruitment took place during the first trimester of pregnancy with a validated short screening questionnaire[2] and was conducted by 52 midwife practices in 3 different regions in the Netherlands: north (Groningen and surroundings), central (Bilthoven and Wageningen and surroundings), and southwest (Rotterdam and surroundings). Women reporting any of the following self-reported symptoms were defined as allergic (i.e. a history of asthma, current hay fever, current atopy to house dust house dust mite, or pets) and their children were defined as ‘high-risk’. Women reporting none of these symptoms were defined as nonallergic and their children were defined as ‘lowrisk’. 472 high-risk children and 2,819 low-risk children were included in the natural history part of the study. 855 high-risk children were included into the intervention part of the study. The participating children were born between May 1996 and December 1997. PREVASC The PREVASC study addresses the primary prevention of asthma in infants and small children. The objective of this study is to investigate whether a multifaceted prenatally started intervention strategy in high-risk infants prevents asthma development[3, 4]. ‘High-risk’ for asthma and atopy was defined as at least one first-degree family member affected with asthma as registered by their general practitioner. At baseline, 476 children were recruited by primary caregivers (general practitioners and midwives) and advertisements, and randomised to either: Revision Bottema et al 1) a control group (n=234), receiving usual care; or 2) an intervention group (n=242) in which families followed the primary prevention program. The latter included house dust mite impermeable bed coverings, education on breast and hypoallergenic feeding, timing of solid food introduction and smoking cessation. In addition, a separate group of 317 children at ‘low-risk’ for asthma were followed without intervention for the natural history of asthma and atopy. ‘Low-risk’ was defined as the absence of asthma in first-degree family members of the children. Children participating in the intervention study were born between July 1997 and July 2000 and the ‘low-risk’ children were born between March 1999 and October 2002. KOALA The primary aim of the KOALA Birth Cohort Study[5] is to identify factors that influence the clinical expression of atopic disease, the main focus being lifestyle, dietary habits and infections during the first year of life and gene-environment interaction. At baseline, 2,343 children were recruited among pregnant women who were invited for a prospective cohort study on pregnancy-related pelvic girdle pain[6]. In addition, a group of 491 children was recruited among pregnant women who had an ‘alternative lifestyle’ with regard to child rearing practices, dietary habits, vaccination schemes and use of antibiotics, through organic food shops, anthropologic doctors and midwives, Steiner schools, and magazines. All children were enrolled between 14 and 18 weeks of gestation and were born between February 2001 and August 2003. Revision Bottema et al Genotyping and quality assessment Genomic DNA was extracted from buccal swabs or blood using standard methods[7]. DNA was amplified by using REPLI-g UltraFast technology (Qiagen™). Genotyping was performed by Competitive Allele-Specific PCR using KASPar™ genotyping chemistry, performed under contract by K-Biosciences[8]. Quality of genotype data was guaranteed by standards of K-Biosciences and verified. We verified the genotyping quality by three steps: 1) 16 samples were genotyped in both genomic and amplified DNA; 2) inheritance of alleles between parents and children was checked using FBAT (http://biostat.harvard.edu), data of both parents were available for 331 children; 3) genotype data were analyzed for deviations from Hardy-Weinberg equilibrium using χ2 statistics. Comparison of genotypes between genomic and amplified DNA and evaluation of inheritance patterns between parents and children revealed an excellent quality of the genotypes with a genotyping error of <1%. All IL13 and CD14 genotypes were in Hardy-Weinberg equilibrium (p>0.01). Revision Bottema et al Table E1. Definitions of the Allergenic study, potential confounders and environmental exposures. Variable Definition Dutch Ethnicity Mother born in the Netherlands and has the Dutch Nationality (PIAMA) Mother and >1 parent of the mother born in the Netherlands (KOALA) Father and mother Caucasian (PREVASC) Education level mother Low: primary, lower vocational and lower general Intermediate: senior high school and intermediate vocational High: higher vocational and university Family history Atopy mother / father Asthma ever or current hay fever or current allergy to pets or house dust (mite) Asthma mother / father Self-reported ‘asthma ever’ Breast feeding Never: never breast feeding < 3 months: duration breast feeding < 13 weeks > 3 months: duration breast feeding > 13 weeks ETS at home first year Family members smoking > 1 cigarette / day or visitors smoking > 1 time / week in the home at age 3 months or 1 year (PIAMA) Mother or her partner smoking in the home or visitors smoking > 1 time / week in the first year (PREVASC) Somebody > 1 hour /week smoking in the presence of the child at age 3 or 7 months or 1 year (KOALA). Day care at age 1 > 4 hour / week day-care attendance at age 1 (PIAMA and KOALA) > 4 hour / week day-care attendance in > 7 of the last 13 weeks or > 26 weeks of the first year of life (PREVASC) Pet (dog and/or cat) first year Dog and / or cat at home at 3 months (PIAMA), 7 months (KOALA) or after delivery (PREVASC) Presence older siblings at birth Other children in the household at 3 months (PIAMA), 7 months (KOALA) or at inclusion during pregnancy (PREVASC) Revision Bottema et al Table E2. Association of IL-13 SNPs with total serum IgE levels at all ages in (A) Pooled data (Allergenic), and in (B) PIAMA, (C) PREVASC and (D) KOALA separately. (A) Pooled data (Allergenic) 1 year SNP 3’UTR Arg130Gln -1512 A/C -1111 C/T Genotype IgE* 2 years 4 years 8 years N P IgE* N P IgE* N P 0.0000002 10.00 643 0.000001 27.54 571 0.03 IgE* N P 54.95 448 0.0004 CC 5.75 783 CT 8.32 362 14.79 297 37.15 249 87.10 219 TT 12.30 61 27.54 55 38.90 45 114.82 35 GG 5.75 727 10.00 597 26.92 555 54.95 444 GA 8.32 350 14.79 291 37.15 247 87.10 218 AA 11.22 62 26.92 54 38.90 45 104.71 35 AA 6.03 746 10.47 617 28.18 556 58.88 448 CA 7.76 377 14.13 306 34.67 270 81.28 222 CC 8.71 48 26.92 38 38.90 33 77.62 29 CC 6.03 755 10.47 624 28.18 551 60.26 443 CT 7.94 374 14.45 308 33.88 277 74.13 228 TT 9.55 42 28.84 35 48.98 28 81.28 29 0.000001 0.008 0.001 0.000003 0.0002 0.00007 *Geometric mean IgE values (IU/ml). N=number of children per genotype. 0.01 0.13 0.08 0.001 0.04 0.23 Revision Bottema et al (B) PIAMA 1 year SNP 3’UTR Arg130Gln -1512 A/C -1111 C/T Genotype IgE* 2 years 4 years 8 years N P IgE* N P IgE* N P 0.03 - - - 31.62 441 0.08 IgE* N P 54.95 448 0.0004 CC 6.03 222 CT 9.55 108 - - - 43.65 196 87.10 219 TT 9.33 17 - - - 42.66 32 114.82 35 GG 5.89 219 - - - 30.20 434 54.95 444 GA 9.33 106 - - - 43.65 193 87.10 218 AA 8.13 18 - - - 42.66 32 104.71 35 AA 6.46 224 - - - 33.88 431 58.88 448 CA 8.71 107 - - - 38.02 210 81.28 222 CC 6.76 14 - - - 42.66 27 77.62 29 CC 6.46 220 - - - 33.11 428 60.26 443 CT 8.71 105 - - - 38.02 210 74.13 228 TT 7.24 13 - - - 48.98 25 81.28 29 0.04 0.23 0.21 0.03 0.53 0.36 * Geometric mean IgE values (IU/ml). N= number of children per genotype. - = No IgE measurements. 0.0009 0.04 0.23 Revision Bottema et al (C) PREVASC 1 year SNP 3’UTR Arg130Gln -1512 A/C -1111 C/T Genotype IgE* 2 years 4 years 8 years N P IgE* N P IgE* N P IgE* N P 0.006 10.47 222 0.040 16.60 130 0.20 - - - CC 6.76 141 CT 11.75 61 13.18 99 20.42 53 - - - TT 15.49 13 22.91 19 31.62 13 - - - GG 6.76 130 10.47 210 16.60 121 - - - GA 12.02 62 13.18 101 20.89 54 - - - AA 15.49 13 22.91 19 31.62 13 - - - AA 6.76 134 10.23 224 14.79 125 - - - CA 10.72 69 13.49 100 24.55 60 - - - CC 17.78 6 30.20 8 25.70 6 - - - CC 6.61 128 10.47 220 15.49 123 - - - CT 12.02 78 14.45 108 23.99 67 - - - TT 41.69 3 25.70 6 44.67 3 - - - 0.005 0.02 0.0005 0.04 0.03 0.05 0.21 0.05 0.06 * Geometric mean IgE values (IU/ml). N= number of children per genotype. - = No IgE measurements. Revision Bottema et al (D) KOALA 1 year SNP 3’UTR Arg130Gln -1512 A/C -1111 C/T Genotype IgE* 2 years N P 0.0001 IgE* 4 years 8 years N P IgE N P IgE N P 9.77 421 0.00002 - - - - - - CC 5.25 420 CT 7.08 193 15.85 198 - - - - - - TT 12.88 31 30.90 36 - - - - - - GG 5.37 378 9.77 387 - - - - - - GA 6.92 182 15.85 190 - - - - - - AA 12.02 31 29.51 35 - - - - - - AA 5.75 388 10.47 393 - - - - - - CA 6.46 201 14.13 206 - - - - - - CC 8.51 28 26.30 30 - - - - - - CC 5.62 407 10.47 404 - - - - - - CT 6.31 191 14.45 200 - - - - - - TT 9.33 26 29.51 29 - - - - - - 0.0009 0.17 0.12 0.00007 0.006 0.002 * Geometric mean IgE values (IU/ml). N= number of children per genotype. - = No IgE measurements. Revision Bottema et al Table E3. Interaction of CD14 genotypes and combined pet exposure (cat and/or dog) with respect to total serum IgE levels at ages 4 and 8 years. Pet exposure† No pet exposure† Age CD14 SNP Genotype Interaction IgE* 4 years 8 years N P IgE* N P P‡ 3’UTR CC+CA AA 29.4 41.3 304 24 0.30 30.1 38.6 481 44 0.33 0.79 -159 C/T CC + CT TT 31.6 28.1 257 69 0.58 28.5 40.2 431 99 0.05 0.04 -1145 T/C TT + CT CC 31.7 25.7 256 74 0.32 28.4 40.2 429 99 0.05 0.01 -1619 T/C TT + CT CC 32.0 23.8 255 48 0.23 29.0 39.8 422 69 0.13 0.06 -550 C/T CC CT TT 30.5 28.1 35.2 192 118 13 0.84 33.1 29.8 17.9 279 202 31 0.12 0.15 3’UTR CC+CA AA 57.7 83.1 240 22 0.31 73.2 55.4 402 34 0.35 0.25 -159 C/T CC + CT TT 59.2 65.6 209 53 0.68 64.8 99.1 341 92 0.03 0.17 -1145 T/C TT + CT CC 58.4 62.3 209 56 0.79 65.1 94.8 344 95 0.05 0.18 -1619 T/C TT + CT CC 60.6 62.4 212 37 0.91 70.4 86.7 347 62 0.36 0.48 -550 C/T CC CT TT 55.7 54.7 82.3 152 98 13 0.68 71.4 72.3 49.0 248 168 19 0.62 0.63 * Geometric mean IgE values. N= number of children per genotype. †Pet exposure = pet (dog and/or cat) exposure at home in the first year of life; No pet exposure = neither cat nor dog exposure at home in the first year of life; ‡ P-values were adjusted for gender, atopy mother, atopy father, siblings, breastfeeding and ETS exposure. Revision Bottema et al Table E4. Interaction of CD14 genotypes with combined pet exposure (cat and/or dog) in the development of sensitisation to any allergen at age 8 years. CD14 SNP Genotype Sensitisation to any allergen§ Interaction yes / no* (proportion) Pet exposure † No pet exposure † P‡ 3’UTR CC+CA AA 87 / 153 (0.57) 12 / 9 (1.33) 193 / 207 (0.93) 10 / 24 (0.42) 0.002 -159 C/T CC + CT TT 89 / 119 (0.75) 13 / 40 (0.33) 153 / 187 (0.82) 50 / 41 (1.22) 0.002 -1145 T/C TT + CT CC 88 / 120 (0.73) 12 / 44 (0.27) 154 / 189 (0.81) 50 / 44 (1.14) 0.001 -1619 T/C TT + CT CC 88 / 123 (0.72) 10 / 27 (0.37) 159 / 188 (0.85) 34 / 27 (1.26) 0.03 -550 C/T CC CT TT 58 / 93 (0.62) 37 / 61 (0.61) 6 / 7 (0.86) 119 / 128 (0.93) 78 / 90 (0.87) 6 / 13 (0.46) 0.60 § Specific IgE >0.35 IU/ml to house dust mite, cat, dog, Dactylis glomerata, Betula verrucosa, Alternaria alternata, egg, or milk allergens. * Number of children sensitised / number of non-sensitised children; †Pet exposure = pet (cat and/or dog) exposure at home in the first year of life; No pet exposure = neither cat nor dog exposure at home in the first year of life; ‡ P-value for interaction, adjusted for gender, atopy mother, atopy father, siblings, breastfeeding and ETS exposure. Revision Bottema et al Table E5. Interaction of CD14 genotypes with dog exposure with respect to total serum IgE levels at age 4 and 8 years. Age CD14 SNP Genotype Dog exposure No dog exposure Interaction IgE* 4 years 8 years N P IgE* N P P† 3’UTR CC+CA AA 30.2 23.4 127 11 0.59 29.5 43.7 658 57 0.08 0.20 -159 C/T CC + CT TT 33.9 18.6 103 33 0.04 28.8 40.7 585 135 0.03 0.005 -1145 T/C TT + CT CC 34.7 17.0 102 36 0.01 28.8 39.8 583 137 0.04 0.002 -1619 T/C TT + CT CC 33.1 14.1 106 21 0.01 29.5 38.9 571 96 0.13 0.02 -550 C/T CC CT TT 21.9 38.9 117.5 83 44 7 0.004 34.7 27.5 15.8 388 276 37 0.008 0.00001 3’UTR CC+CA AA 55.0 74.1 85 5 0.70 69.2 64.6 557 51 0.76 0.52 -159 C/T CC + CT TT 60.3 43.7 68 21 0.42 63.1 95.5 482 124 0.01 0.08 -1145 T/C TT + CT CC 60.3 38.0 67 25 0.21 63.1 93.3 486 126 0.01 0.04 -1619 T/C TT + CT CC 67.6 24.5 74 11 0.03 66.1 89.1 485 88 0.13 0.03 -550 C/T CC CT TT 35.5 81.3 134.9 52 31 7 0.01 70.8 63.1 47.9 348 235 25 0.42 0.006 * Geometric mean IgE values. N= number of children per genotype. † P-values were adjusted for gender, atopy mother, atopy father, siblings, breastfeeding and ETS. Revision Bottema et al Table E6. Interaction of CD14 genotypes with dog exposure in the development of sensitisation to any allergen at age 8 years. CD14 SNP Genotype Sensitisation to any allergen§ Interaction yes / no* (proportion) Dog exposure † No dog exposure † P‡ 3’UTR CC+CA AA 31 / 54 (0.57) 3 / 2 (1.5) 249 / 306 (0.81) 19 / 31 (0.61) 0.20 -159 C/T CC + CT TT 30 / 38 (0.79) 4 / 17 (0.24) 212 / 268 (0.79) 59 / 64 (0.92) 0.04 -1145 T/C TT + CT CC 30 / 37 (0.81) 4 / 21 (0.19) 212 / 272 (0.78) 58 / 67 (0.87) 0.02 -1619 T/C TT + CT CC 32 / 42 (0.76) 2 / 9 (0.22) 215 / 269 (0.80) 42 / 45 (0.93) 0.13 -550 C/T CC CT TT 14 / 38 (0.37) 17 / 14 (1.21) 3 / 4 (0.75) 163 / 183 (0.89) 98 / 137 (0.72) 9 / 16 (0.56) 0.04 § Specific IgE >0.35 IU/ml to house dust mite, cat, dog, Dactylis glomerata, Betula verrucosa, Alternaria alternata, egg, or milk allergens. * Number of children sensitised / number of non-sensitised children; †Dog exposure = dog exposure at home in the first year of life; No dog exposure = no dog exposure at home in the first year of life. ‡ P-value for interaction, adjusted for gender, atopy mother, atopy father, siblings, breastfeeding and ETS exposure. Revision Bottema et al Table E7. Interaction of CD14 genotypes and cat exposure with respect to total serum IgE levels at ages 4 and 8 years. Cat exposure† No cat exposure† Age CD14 SNP Genotype Interaction IgE* 4 years 8 years N P IgE* N P P‡ 3’UTR CC+CA AA 29.4 71.4 200 17 0.02 30.0 32.4 585 51 0.74 0.19 -159 C/T CC + CT TT 32.1 37.5 175 41 0.56 28.8 33.8 513 127 0.31 0.72 -1145 T/C TT + CT CC 32.0 34.0 175 44 0.82 28.8 33.0 510 129 0.39 0.56 -1619 T/C TT + CT CC 32.8 33.3 172 30 0.96 29.2 31.9 505 87 0.64 0.67 -550 C/T CC CT TT 39.0 24.2 11.6 128 81 7 0.02 29.8 31.1 24.7 343 239 37 0.71 0.04 3’UTR CC+CA AA 59.1 95.6 176 20 0.20 70.2 52.4 466 36 0.31 0.20 -159 C/T CC + CT TT 60.7 75.4 157 39 0.44 63.4 89.1 393 106 0.06 0.52 -1145 T/C TT + CT CC 59.4 75.9 158 40 0.38 63.8 83.1 395 111 0.14 0.72 -1619 T/C TT + CT CC 58.8 85.0 157 30 0.25 69.7 73.3 402 69 0.82 0.53 -550 C/T CC CT TT 67.2 48.0 60.4 116 74 8 0.35 64.1 73.4 60.5 284 192 24 0.65 0.30 * Geometric mean IgE values. N= number of children per genotype. ‡ P-values were adjusted for gender, atopy mother, atopy father, siblings, breastfeeding and ETS exposure. Revision Bottema et al Table E8. Interaction of CD14 genotypes with cat exposure in the development of sensitisation to any allergen at age 8 years. CD14 SNP Genotype Sensitisation to any allergen§ Interaction yes / no* (proportion) Cat exposure † No cat exposure † P‡ 3’UTR CC+CA AA 62 / 114 (0.54) 11 / 8 (1.38) 218 / 246 (0.89) 11 / 25 (0.44) 0.005 -159 C/T CC + CT TT 66 / 90 (0.73) 10 / 29 (0.34) 176 / 216 (0.81) 53 / 52 (1.02) 0.02 -1145 T/C TT + CT CC 65 / 92 (0.71) 9 / 31 (0.29) 177 / 217 (0.82) 53 / 57 (0.93) 0.02 -1619 T/C TT + CT CC 63 / 93 (0.68) 9 / 21 (0.43) 184 / 218 (0.84) 35 / 33 (1.06) 0.13 -550 C/T CC CT TT 47 / 68 (0.69) 25 / 49 (0.51) 3 / 5 (0.60) 130 / 153 (0.85) 90 / 102 (0.88) 9 / 15 (0.60) 0.61 § Specific IgE >0.35 IU/ml to house dust mite, cat, dog, Dactylis glomerata, Betula verrucosa, Alternaria alternata, egg, or milk allergens. * Number of children sensitised / number of non-sensitised children; †Cat exposure = cat exposure at home in the first year of life; No cat exposure = no cat exposure at home in the first year of life; ‡ P-value for interaction, adjusted for gender, atopy mother, atopy father, siblings, breastfeeding and ETS exposure. Revision Bottema et al Table E9. Interaction of CD14 genotypes and environmental tobacco smoke exposure (ETS) with respect to total serum IgE levels at age 4 years. ETS exposure† No ETS exposure† CD14 SNP Genotype Interaction IgE* 4 years 3’UTR N P IgE* N P P‡ CC+CA AA 29.0 14.8 170 16 0.12 29.6 47.6 575 49 0.04 0.04 -159 C/T CC + CT TT 26.6 28.8 145 42 0.77 30.1 34.6 507 119 0.38 0.79 -1145 T/C TT + CT CC 26.1 27.8 143 44 0.82 30.2 33.1 506 122 0.56 0.84 -1619 T/C TT + CT CC 24.7 30.1 141 30 0.55 31.0 31.1 501 82 0.98 0.59 -550 C/T CC CT TT 24.3 33.1 13.9 113 59 13 34.2 27.5 26.0 341 243 26 0.22 0.64 0.17 * Geometric mean IgE values. N= number of children per genotype. †ETS = environmental tobacco smoke exposure at home in the first year of life; ‡ P-values were adjusted for gender, atopy mother, atopy father, siblings, breastfeeding, cat and dog exposure. Revision Bottema et al Reference List 1. Brunekreef B, Smit J, de JJ, Neijens H, Gerritsen J, Postma D, Aalberse R, Koopman L, Kerkhof M, Wilga A, van SR. The prevention and incidence of asthma and mite allergy (PIAMA) birth cohort study: design and first results. Pediatr Allergy Immunol 2002; 13 Suppl 15: 55-60. 2. Lakwijk N, Van Strien RT, Doekes G, Brunekreef B, Gerritsen J. Validation of a screening questionnaire for atopy with serum IgE tests in a population of pregnant Dutch women. Clin Exp Allergy 1998; 28: 454-458. 3. Schonberger HJ, Dompeling E, Knottnerus JA, Maas T, Muris JW, van WC, van Schayck CP. The PREVASC study: the clinical effect of a multifaceted educational intervention to prevent childhood asthma. Eur Respir J 2005; 25: 660-670. 4. Kuiper S, Maas T, van Schayck CP, Muris JW, Schonberger HJ, Dompeling E, Gijsbers B, van WC, Knottnerus JA. The primary prevention of asthma in children study: design of a multifaceted prevention program. Pediatr Allergy Immunol 2005; 16: 321-331. 5. Kummeling I, Thijs C, Penders J, Snijders BE, Stelma F, Reimerink J, Koopmans M, Dagnelie PC, Huber M, Jansen MC, de BR, van den Brandt PA. Etiology of atopy in infancy: the KOALA Birth Cohort Study. Pediatr Allergy Immunol 2005; 16: 679-684. 6. Bastiaanssen JM, de Bie RA, Bastiaenen CH, Heuts A, Kroese ME, Essed GG, van den Brandt PA. Etiology and prognosis of pregnancy-related pelvic girdle pain; design of a longitudinal study. BMC Public Health 2005; 5: 1. 7. Sambrook, J. and Russell, D. Molecular Cloning. 3rd Edition 2007. Preparation of plasmid DNA by lysis with SDS. Revision Bottema et al 8. K-Biosciences, Cambridge, UK; URL: http://www.kbiosciences.co.uk