The Influence of Sunlight Exposure and Sun Protecting Behaviours on Allergic Outcomes in Early Childhood
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Direct UV Light Exposure Measurements
2.3. Sunlight Exposure and Sun Protecting Behaviours
- direct sunlight before 11 a.m., between 11 a.m. and 3 p.m., and after 3 p.m.
- in shade before 11 a.m., between 11 a.m. and 3 p.m., and after 3 p.m.
2.4. Vitamin D Supplementation
2.5. Allergic Disease Outcome Assessments
2.6. Statistical Methods
3. Results
3.1. Characteristics of the Study Population
3.2. Clinical Allergic Disease Outcomes
3.3. Association between Direct UV Light Exposure in Early Infancy and Allergic Disease Outcomes in the First 2.5 Years of Life
3.4. Cross-Sectional Associations between Behaviours Concerning Sun Exposure and Allergic Outcomes within the First 2.5 Years of Life
3.5. Longitudinal Associations between Behaviours Concerning Sun Exposure and Clinical Allergic Outcomes during Early Childhood: Mixed-Effects Logistic Regression Modeling
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristic | UV Dosimeter not Worn n (%) | UV Dosimeter Worn n (%) | p-Value |
---|---|---|---|
Mother completed high school | 100/108 (92.6) | 83/86 (96.5) | 0.35 |
Maternal white race | 90/109 (82.6) | 70/86 (81.4) | 0.96 |
Maternal allergic disease | 90/108 (83.3) | 60/86 (69.8) | 0.04 |
Paternal allergic disease | 78/108 (72.2) | 68/85 (80.0) | 0.24 |
Infant male sex | 58/109 (53.2) | 46/86 (53.5) | 0.99 |
Infant birth weight (grams) | 3438 ± 374 | 3395 ± 363 | 0.42 a |
Caesarean-section birth | 43/109 (39.4) | 32/86 (37.2) | 0.77 |
Infant season of birth | <0.001 | ||
Summer | 13/109 (11.9) | 17/86 (19.8) | |
Autumn | 18/109 (16.5) | 26/86 (30.2) | |
Winter | 24/109 (22.0) | 33/86 (38.4) | |
Spring | 54/109 (49.5) | 10/86 (11.6) | |
Infant Fitzpatrick Skin Type | 0.81 | ||
Type I | 1/95 (1.1) | 1/84 (1.2) | |
Type II | 27/95 (28.4) | 22/84 (26.2) | |
Type III | 51/95 (53.7) | 40/84 (47.6) | |
Type IV | 13/95 (13.7) | 17/84 (20.2) | |
Type V and VI | 3/95 (3.2) | 4/84 (4.8) | |
Smoking in home | 6/108 (5.6) | 8/85 (9.4) | 0.40 |
Pet cat indoors | 17/108 (15.7) | 15/85 (17.6) | 0.85 |
Pet dog indoors | 56/108 (51.9) | 51/85 (60.0) | 0.31 |
Outcome | No Eczema (n = 84) | Eczema (n = 81) | ||||
---|---|---|---|---|---|---|
n | Median (IQR) | n | Median (IQR) | p-Value | ||
UV exposure 0–3 months (J/m2) | 39 | 1204.0 (717–1843) | 40 | 747.0 (473–1439) | 0.038 | |
25(OH)D blood | 3 months | 65 | 71.0 (58–90) | 62 | 72.5 (55–88) | 0.75 |
levels (nmol/L) | 6 months | 69 | 89.0 (75–106) | 63 | 87.0 (65–112) | 0.61 |
12 months | 73 | 78.0 (66–92) | 70 | 78.0 (62–94) | 0.80 | |
30 months | 68 | 75.0 (65–88) | 56 | 74.0 (60–88) | 0.77 | |
Total outdoor exposure | 3 months | 84 | 75.0 (50–116) | 79 | 65.0 (42–105) | 0.41 |
time (minutes/day) | 6 months | 83 | 66.0 (40–115) | 76 | 75.0 (41–120) | 0.92 |
12 months | 81 | 100.0 (65–150) | 74 | 90.0 (60–125) | 0.48 | |
30 months | 83 | 150.0 (105–225) | 75 | 160.0 (120–210) | 0.50 | |
n (%) | n (%) | p-value | ||||
Sunscreen used (3 months) | Always | 2/84 (2.4) | 3/79 (3.8) | |||
Sometimes | 22/84 (26.2) | 14/79 (17.7) | 0.46 a | |||
Never | 60/84 (71.4) | 62/79 (78.5) | ||||
Sunscreen used (6 months) | Always | 10/83 (12.0) | 8/78 (10.3) | |||
Sometimes | 41/83 (49.4) | 29/78 (37.2) | 0.21 | |||
Never | 32/83 (38.6) | 41/78 (52.6) | ||||
Sunscreen used (12 months) | Always | 14/81 (17.3) | 14/78 (17.9) | |||
Sometimes | 52/81 (64.2) | 41/78 (52.6) | 0.24 | |||
Never | 15/81 (18.5) | 23/78 (29.5) | ||||
Sunscreen used (30 months) | Always | 29/84 (34.5) | 28/76 (36.8) | |||
Sometimes | 53/84 (63.1) | 44/76 (57.9) | 0.58 | |||
Never | 2/84 (2.4) | 4/76 (5.3) | ||||
Skin exposed (3 months) | Face | 34/84 (40.5) | 37/79 (46.8) | |||
Face, hands and arms | 10/84 (11.9) | 8/79 (10.1) | 0.73 | |||
Face, hands, arms and legs | 40/84 (47.6) | 34/79 (43.0) | ||||
Skin exposed (6 months) | Face | 32/83 (38.6) | 26/78 (33.3) | |||
Face, hands and arms | 12/83 (14.5) | 9/78 (11.5) | 0.58 | |||
Face, hands, arms and legs | 39/83 (47.0) | 43/78 (55.1) | ||||
Skin exposed (12 months) | Face | 27/80 (33.8) | 25/78 (32.1) | |||
Face, hands and arms | 22/80 (27.5) | 19/78 (24.4) | 0.84 | |||
Face, hands, arms and legs | 31/80 (38.8) | 34/78 (43.6) | ||||
Skin exposed (30 months) | Face | 7/84 (8.3) | 10/76 (13.2) | |||
Face, hands and arms | 37/84 (44.0) | 35/76 (46.1) | 0.51 | |||
Face, hands, arms and legs | 40/84 (47.6) | 31/76 (40.8) | ||||
Season of birth | summer | 13/84 (15.5) | 15/81 (18.5) | |||
autumn | 19/84 (22.6) | 18/81 (22.2) | 0.89 | |||
winter | 23/84 (27.4) | 24/81 (29.6) | ||||
spring | 29/84 (34.5) | 24/81 (29.6) |
Outcome | Non-Allergic (n = 69) | Allergic (n = 92) | ||||
---|---|---|---|---|---|---|
n | Median (IQR) | n | Median (IQR) | p-Value | ||
UV exposure 0–3 months (J/m2) | 32 | 1174.5 (581–1818) | 46 | 812.5 (511–1380) | 0.11 | |
25(OH)D blood | 3 months | 51 | 67.0 (56–83) | 73 | 73.0 (57–91) | 0.24 |
levels (nmol/L) | 6 months | 54 | 89.5 (74–106) | 75 | 86.0 (67–107) | 0.50 |
12 months | 60 | 78.0 (66–92) | 79 | 78.0 (61–92) | 0.99 | |
30 months | 52 | 74.5 (62–87) | 72 | 75.0 (65–89) | 0.44 | |
Total outdoor exposure | 3 months | 69 | 65.0 45–93) | 90 | 70.0 (50–111) | 0.63 |
time (minutes/day) | 6 months | 67 | 70.0 (40–125) | 88 | 75.0 (46–104) | 0.68 |
12 months | 66 | 105.0 (65–166) | 85 | 90.0 (63–125) | 0.33 | |
30 months | 68 | 150.0 (113–210) | 91 | 150.0 (120–240) | 0.64 | |
n (%) | n (%) | p-value | ||||
Sunscreen (3 months) | Always | 0/69 (0.0) | 5/90 (5.6) | |||
Sometimes | 16/69 (23.2) | 18/90 (20.0) | 0.13 | |||
Never | 53/69 (76.8) | 67/90 (74.4) | ||||
Sunscreen (6 months) | Always | 6/68 (8.8) | 11/89 (12.4) | |||
Sometimes | 32/68 (47.1) | 37/89 (41.6) | 0.74 | |||
Never | 30/68 (44.1) | 41/89 (46.1) | ||||
Sunscreen (12 months) | Always | 10/67 (14.9) | 17/88 (19.3) | |||
Sometimes | 46/67 (68.7) | 47/88 (53.4) | 0.16 | |||
Never | 11/67 (16.4) | 24/88 (27.3) | ||||
Sunscreen (30 months) | Always | 24/69 (34.8) | 34/92 (37.0) | |||
Sometimes | 43/69 (62.3) | 54/92 (58.7) | 0.84 | |||
Never | 2/69 (2.9) | 4/92 (4.3) | ||||
Skin exposed (3 months) | Face | 29/69 (42.0) | 42/90 (46.7) | |||
Face, hands and arms | 8/69 (11.6) | 8/90 (8.9) | 0.78 | |||
Face, hands, arms + legs | 32/69 (46.4) | 40/90 (44.4) | ||||
Skin exposed (6 months) | Face | 25/68 (36.8) | 32/89 (36.0) | |||
Face, hands and arms | 10/68 (14.7) | 11/89 (12.4) | 0.88 | |||
Face, hands, arms + legs | 33/68 (48.5) | 46/89 (51.7) | ||||
Skin exposed (12 months) | Face | 26/66 (39.4) | 27/88 (30.7) | |||
Face, hands and arms | 17/66 (25.8) | 21/88 (23.9) | 0.39 | |||
Face, hands, arms + legs | 23/66 (34.8) | 40/88 (45.5) | ||||
Skin exposed (30 months) | Face | 7/69 (10.1) | 11/92 (12.0) | |||
Face, hands and arms | 30/69 (43.5) | 43/92 (46.7) | 0.85 | |||
Face, hands, arms + legs | 32/69 (46.4) | 38/92 (41.3) | ||||
Season of birth | summer | 10/69 (14.5) | 16/92 (17.4) | |||
autumn | 16/69 (23.2) | 21/92 (22.8) | 0.92 | |||
winter | 21/69 (30.4) | 24/92 (26.1) | ||||
spring | 22/69 (31.9) | 31/92 (33.7) |
Model Term | p-Value | OR | 95% CI for OR | |
---|---|---|---|---|
Lower | Upper | |||
Any Allergic Disease Model | ||||
Daily sun exposure | <0.001 | 0.987 | 0.981 | 0.992 |
Sunscreen always a | 0.05 | 0.494 | 0.244 | 1.000 |
Sunscreen sometimes a | 0.02 | 0.499 | 0.279 | 0.892 |
Skin exposed face b | 0.06 | 0.589 | 0.339 | 1.025 |
Skin exposed face, hands and arms b | 0.01 | 0.469 | 0.261 | 0.841 |
Vitamin D supplementation | 0.11 | 0.992 | 0.983 | 1.002 |
Eczema Model | ||||
Sunscreen always a | 0.40 | 1.239 | 0.752 | 2.039 |
Sunscreen sometimes a | 0.009 | 1.566 | 1.117 | 2.196 |
Wheeze Model | ||||
Season of birth summer c | 0.64 | 1.197 | 0.569 | 2.516 |
autumn c | 0.009 | 0.417 | 0.217 | 0.800 |
winter c | 0.49 | 0.810 | 0.444 | 1.478 |
Outdoor exposure | 0.005 | 0.996 | 0.993 | 0.999 |
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Rueter, K.; Jones, A.P.; Siafarikas, A.; Chivers, P.; Prescott, S.L.; Palmer, D.J. The Influence of Sunlight Exposure and Sun Protecting Behaviours on Allergic Outcomes in Early Childhood. Int. J. Environ. Res. Public Health 2021, 18, 5429. https://doi.org/10.3390/ijerph18105429
Rueter K, Jones AP, Siafarikas A, Chivers P, Prescott SL, Palmer DJ. The Influence of Sunlight Exposure and Sun Protecting Behaviours on Allergic Outcomes in Early Childhood. International Journal of Environmental Research and Public Health. 2021; 18(10):5429. https://doi.org/10.3390/ijerph18105429
Chicago/Turabian StyleRueter, Kristina, Anderson P. Jones, Aris Siafarikas, Paola Chivers, Susan L. Prescott, and Debra J. Palmer. 2021. "The Influence of Sunlight Exposure and Sun Protecting Behaviours on Allergic Outcomes in Early Childhood" International Journal of Environmental Research and Public Health 18, no. 10: 5429. https://doi.org/10.3390/ijerph18105429