Does a higher number of siblings protect against the development of allergy and asthma? A review
Open accessAbstract
Study objective: To review the “protective” effects of having a higher number of siblings for the risk of atopic eczema, asthma wheezing, hay fever, and allergic sensitisation. Method: Review of the literature (Medline since 1965 and references). Main results: 53 different studies were identified. For eczema, 9 of 11 studies reported an inverse relation with number of siblings; for asthma and wheezing, 21 of 31 reported the inverse association; for hay fever, all 17 studies showed the effect; for allergic sensitisation or immunoglobulin E reactivity 14 of 16 studies supported the “protective” effect of a higher number of siblings. The studies emphasise a “theory” that is based exclusively on epidemiological associations. Conclusions: Research has not yet answered the question of which causal factors explain the sibling effect. Causal factors must meet two criteria; they must vary with sibship size and they must protect against atopic manifestations. The prevailing “hygiene hypothesis” failed to explain the findings adequately. Alternative explanations include in utero programming or endocrine explanatory models. The epidemiology research into siblings and atopic disorders has entered an intellectually challenging phase. Possessing sufficient knowledge about the causal factors might prevent at least 30% of all cases of asthma, eczema, and hay fever.
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A meta-analysis of 53 studies found that 48 studies demonstrated higher number of siblings associated with decreased atopy, an effect more evident for allergic rhinitis than for sensitization and asthma.
“In a meta-analysis of 53 studies, 48 studies demonstrated that higher number of siblings was associated with decreased atopy, an effect that was more evident for AR than for sensitization and asthma645”
From International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (2018) · cites this paper as [645]
The Discussion reports that 48 of 53 reviewed studies found a negative association between number of siblings and atopic outcomes. The Key points report an inverse association in all 17 hay-fever studies, compared with 14 of 16 sensitisation studies and 22 of 31 asthma studies. However, the Discussion explicitly says the authors did not perform a meta-analysis; this was a literature review. (LLM, conf=0.90)
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- Authors
- Karmaus, W., & Botezan, C.
- Affiliations
- Michigan State University (US)
- Corresponding author
- Karmaus, W
- Venue
- Journal of Epidemiology and Community Health
- Publisher
- BMJ
- Published
- 2002-03
- Volume
- 56
- Issue
- 3
- Pages
- 209-217
- ISSN
- 0141-7681 (ISSN-L)
- 0143-005X
- 1470-2738
- PMC
- PMC1732088
- OpenAlex
- W2163216482
- Cited by
- 319
- References
- 123
- Citations by year
- 2026: 1 · 2025: 7 · 2024: 5 · 2023: 6 · 2022: 13 · 2021: 12 · 2020: 10 · 2019: 11 · 2018: 11 · 2017: 13 · 2016: 14 · 2015: 13 · 2014: 12 · 2013: 17 · 2012: 18
- FWCI
- 1.80
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Epidemiology & Community Health (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Michigan State University
- College of Engineering, Michigan State University
- Topics
- Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
- Health Sciences › Medicine › Immunology and Allergy › Allergic Rhinitis and Sensitization
- Health Sciences › Medicine › Dermatology › Dermatology and Skin Diseases
- Keywords
- number of siblings, atopic dermatitis, asthma, wheezing, allergic rhinitis, allergen sensitization, immunoglobulin E, hygiene hypothesis, in utero programming, atopic disease prevention
- MeSH terms
- Asthma, Eczema, Family Characteristics, Rhinitis, Allergic, Seasonal, Humans, Hypersensitivity, Respiratory Sounds, Risk Factors
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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