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Original article
The effects of growing up on a farm on adult lung function and allergic phenotypes: an international population-based study
  1. B Campbell1,
  2. C Raherison2,
  3. C J Lodge1,3,
  4. A J Lowe1,3,
  5. T Gislason4,5,
  6. J Heinrich6,7,
  7. J Sunyer8,9,10,
  8. F Gómez Real11,12,
  9. D Norbäck13,
  10. M C Matheson1,
  11. M Wjst14,
  12. J Dratva15,16,
  13. R de Marco17,
  14. D Jarvis18,
  15. V Schlünssen19,
  16. C Janson11,
  17. B Leynaert20,
  18. C Svanes11,
  19. S C Dharmage1
  1. 1Allergy & Lung Health Unit, Centre for Epidemiology & Biostatistics, The University of Melbourne, Melbourne, Victoria, Australia
  2. 2Unité Epidémiologie et Biostatistique, Université Bordeaux Segalen, Bordeaux, France
  3. 3Murdoch Children's Research Institute, Melbourne, Australia
  4. 4Department of Respiratory Medicine and Sleep, Landspitali University Hospital, Reykjavik, Iceland
  5. 5Faculty of Medicine, University of Iceland, Reykjavik, Iceland
  6. 6Instititute of Epidemiology I, German Research Centre for Environmental Health, Helmholtz Zentrum München, Neuherberg, Germany
  7. 7Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital Munich, Ludwig-Maximilians University Munich, Munich, Germany
  8. 8Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
  9. 9CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
  10. 10Departament de Ciències Experimentals i de la Salut (UPF), Universitat Pompeu Fabra, Barcelona, Spain
  11. 11Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway
  12. 12Centre for International Health, University of Bergen, Norway
  13. 13Department of Medical Sciences; Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden
  14. 14Institute of Lung Biology and Health (iLBD), Comprehensive Pneumology Center (CPC), Helmholtz Zentrum München, Munich-Neuherberg, Germany
  15. 15Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
  16. 16University of Basel, Basel, Switzerland
  17. 17Epidemiology and Medical Statistics, University of Verona, Verona, Italy
  18. 18National Heart and Lung Institute, Imperial College, London, UK
  19. 19Section for Environment Occupation and Health, Department of Public Health, Aarhus University, Aarhus, Denmark
  20. 20Centre de Recherche Albert Bonniot, Grenoble, France
  1. Correspondence to Professor Shyamali C Dharmage, Allergy & Lung Health Unit, Centre for Epidemiology & Biostatistics, The University of Melbourne, 207 Bouverie St, Carlton, VIC 3053, Australia


Rationale Evidence has suggested that exposure to environmental or microbial biodiversity in early life may impact subsequent lung function and allergic disease risk.

Objectives To investigate the influence of childhood living environment and biodiversity indicators on atopy, asthma and lung function in adulthood.

Methods and measurements The European Community Respiratory Health Survey II investigated ∼10 201 participants aged 26–54 years from 14 countries, including participants' place of upbringing (farm, rural environment or inner city) before age 5 years. A ‘biodiversity score’ was created based on childhood exposure to cats, dogs, day care, bedroom sharing and older siblings. Associations with lung function, bronchial hyper-responsiveness (BHR), allergic sensitisation, asthma and rhinitis were analysed.

Main results As compared with a city upbringing, those with early-life farm exposure had less atopic sensitisation (adjusted OR 0.46, 95% CI 0.37 to 0.58), atopic BHR (0.54 (0.35 to 0.83)), atopic asthma (0.47 (0.28 to 0.81)) and atopic rhinitis (0.43 (0.32 to 0.57)), but not non-atopic outcomes. Less pronounced protective effects were observed for rural environment exposures. Women with a farm upbringing had higher FEV1 (adjusted difference 110 mL (64 to 157)), independent of sensitisation and asthma. In an inner city environment, a higher biodiversity score was related to less allergic sensitisation.

Conclusions This is the first study to report beneficial effects of growing up on a farm on adult FEV1. Our study confirmed the beneficial effects of early farm life on sensitisation, asthma and rhinitis, and found a similar association for BHR. In persons with an urban upbringing, a higher biodiversity score predicted less allergic sensitisation, but to a lesser magnitude than a childhood farm environment.

  • Asthma Epidemiology
  • Allergic lung disease
  • Respiratory Measurement

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  • CS and SCD are equal senior authors.

  • Competing interests None declared.

  • Ethics approval Multinational study with various approving bodies.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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