Childhood Vaccination and Allergy: A Systematic Review and Meta-analyses.

Navaratna, Samidi; Estcourt, Marie J; Burgess, John; Waidyatillake, Nilakshi; Enoh, Elizabeth; Lowe, Adrian J; Peters, Rachel; Koplin, Jennifer; Dhamage, Shyamali C; Lodge, Caroline J

BACKGROUND AND OBJECTIVE As the rise in prevalence of allergic diseases worldwide corresponds in time with increasing infant vaccination, it has been hypothesized that childhood vaccination may increase the risk of allergic disease. We aimed to synthesize the literature on the association between childhood vaccination and allergy. DESIGN We searched the electronic databases PubMed and EMBASE (January 1946- January 2018) using vaccination and allergy terms. METHODS Two authors selected papers according to inclusion criteria. Pooled effects across studies were estimated using random-effects meta-analysis. Due to inadequate number of homogeneous publications on newer and underused vaccines, meta-analysis was limited to allergic outcomes following administration of (Bacillus-Calmette-Guérin) BCG, measles or pertussis vaccination. The review was prospectively registered in the PROSPERO systematic review registry (NO: CRD42017071009). RESULTS A total of 35 publications based on cohort studies and 7 publications based on randomized controlled trials (RCTs) met the inclusion criteria. RCTs: From 2 studies, early vaccination with BCG vaccine was associated with a reduced risk of eczema (RR= 0.83; 95% CI= 0.73 - 0.93; I2 = 0%) but not food allergy or asthma. No association was found between pertussis vaccine and any allergic outcome based on a single RCT. Cohort studies: Childhood measles vaccination was associated with a reduced risk of eczema (RR= 0.65; 95% CI= 0.47 - 0.90, I2 = 0.0%), asthma (RR= 0.78; 95% CI= 0.62 - 0.98, I2 = 93.9%) and, with a similar, statistically non-significant reduction in sensitisation (RR= 0.78; 95% CI= 0.61 - 1.01, I2 = 19.4%). CONCLUSIONS We found no evidence that childhood vaccination with commonly administered vaccines were associated with increased risk of later allergic disease. Our results from pooled analysis of both RCTs and cohort studies suggest that vaccination with BCG, and measles vaccines were associated with a reduced risk of eczema.