Allergy, Stress and Sense of Coherence in Families with Children living in accordance with an ...

58 Pages·2014·0.83 MB·English

Digital Comprehensive Summaries of Uppsala Dissertations
from the Faculty of Medicine 992
Allergy, Stress and Sense of
Coherence in Families with
Children living in accordance with
an Anthroposophic Lifestyle
JACKIE SWARTZ
ACTA
UNIVERSITATIS
ISSN 1651-6206
UPSALIENSIS
ISBN 978-91-554-8934-2
UPPSALA
urn:nbn:se:uu:diva-221438
2014
Dissertation presented at Uppsala University to be publicly examined in Universitetshuset,
sal IX, S:t Olofsgatan, Uppsala, Thursday, 22 May 2014 at 13:00 for the degree of Doctor
of Philosophy. The examination will be conducted in Swedish. Faculty examiner: Assistent
professor Gösta Alfvén (Karolinska Institutet).
Abstract
Swartz, J. 2014. Allergy, Stress and Sense of Coherence in Families with Children living
in accordance with an Anthroposophic Lifestyle. Digital Comprehensive Summaries of
Uppsala Dissertations from the Faculty of Medicine 992. 58 pp. Uppsala: Acta Universitatis
Upsaliensis. ISBN 978-91-554-8934-2.
Background: Previous studies on anthroposophic lifestyle and allergy show that the children
have less risk of developing allergies. All studies so far have been retrospective and have
included children in school age. In view of the facts that this lifestyle seems to protect children
from allergies and that different symptoms of atopy have increased dramatically during the last
decades it is of general interest to study this group of children more in detail. The earlier findings
have now been followed up in a prospective research program ALADDIN (Assessment of Life
style and Allergic Disease During Infancy), applying different approaches. One of these is to
focus on stress (as measured by cortisol) as a factor that may underlie the decreased risk of
allergy in children from anthroposophic families.
Aim: This thesis is based on data from the ALADDIN study focusing on influence of family
lifestyle on allergy sensitization early in children’s life in relation to psychosocial factors and
salivary cortisol as an indicator of stress.
Methods: A total of 552 families were recruited during pregnancy or during the first month of
the child´s life in two recruitment waves, 330 families between September 2004 and November
2007 and another 222 families between March 2008 and January 2011. They were recruited
at anthroposophic maternal and child health care centers (MCHC) and from conventional
MCHCs. Data on demographics and exposures were obtained by questionnaires and interviews.
Parental capacity to adapt to stressors was evaluated by means of the questionnaire “Sense of
Coherence” (SOC; Antonovsky). Salivary samples were collected at home from the infants and
both parents for analyzes of cortisol. Blood samples were obtained from the parents and from
the children for analyzes of IgE.
Results: Many family related characteristics differed markedly between the groups before
and during pregnancy, during delivery and the first 12 months of age. Children from
anthroposophic families had lower levels of salivary cortisol compared to peers from families
with a more conventional lifestyle on all sampling occasions at 6 months of age and on some
of the occasions at 12 and 24 months of age. There were no differences concerning cortisol
between parents with different lifestyle and no significant differences concerning SOC-scores
between the three lifestyle groups. An anthroposophic lifestyle was associated with a lower
risk of allergic sensitization up to five years of age. This risk was partially explained by lower
cortisol levels during infancy. Children in families with a partly anthroposophic lifestyle also
had substantially lower risk of sensitization.
Conclusion: An anthroposophic lifestyle protects from development of allergy during
childhood, at least up to five years of age. This protective capacity is partly mediated by low
cortisol levels during infancy but is also dependent on unknown characteristics of this lifestyle.
These results call for further studies on health related effects of an anthroposophic lifestyle.
Keywords: Anthroposophic lifestyle, Allergy, Stress, Children, Sense of Coherence
Jackie Swartz, Department of Neuroscience, Box 593, Uppsala University, SE-75124
Uppsala, Sweden.
© Jackie Swartz 2014
ISSN 1651-6206
ISBN 978-91-554-8934-2
urn:nbn:se:uu:diva-221438 (http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-221438)
LIST OF PUBLICATIONS

1. Stenius F, Swartz J, Lindblad F, Pershagen G, Scheynius A,
Alm J, Theorell T. Low salivary cortisol levels in infants of
families with an anthroposophic lifestyle. Psychoneuroendo-
crinology. 2010 Nov; 35(10):1431-7.

2. Swartz J, Stenius F, Alm J, Theorell T, Lindblad F. Life
style and salivary cortisol at the age of 12 and 24 months.
Acta Paediatr. 2012 ;101(9):979-84.

3. Swartz J, Alm J, Theorell T, Lindblad F. Parental Sense of
Coherence in the first 2 years of life is not related to parental
and child diurnal cortisol rhythm or proxies of anthroposoph-
ic lifestyle. Acta Paediatr 2013;102(9):920-4.

4. Swartz J, Lindblad F, Arinell H, Theorell T, Alm J. An-
throposophic lifestyle and salivary cortisol predict sensitiza-
tion during childhood – The ALADDIN cohort. In manu-
script.
To all parents who are seeking to help their children to develop
according to Convention on the Rights of the Child Article 27
1. States Parties recognize the right of every child to a standard of
living adequate for the child's physical, mental, spiritual, moral and
social development.
CONTENTS

1 INTRODUCTION .............................................................................. 7

2 BACKGROUND ............................................................................. 10

2.1 Anthroposophic lifestyle ............................................................... 10
2.2 Allergy .......................................................................................... 11
2.2.1 Prevalence and clinical characteristics ...................................... 11
2.2.2 The hygiene hypothesis ............................................................. 13
2.2.3 Dietary factors ........................................................................... 14
2.2.4 Growing up at a farm with animals ........................................... 15
2.3 Stress and salivary cortisol ........................................................... 15
2.4 Ability to adapt to stressors – Sense of Coherence ...................... 18
2.5 Salivary cortisol and allergy ......................................................... 18

3 AIMS ............................................................................................... 21

4 SUBJECTS AND METHODS ........................................................ 22

4.1 Study population ........................................................................... 22
4.2 Study design .................................................................................. 23
4.3 Salivary cortisol ............................................................................. 25
4.4 Blood samples, sensitization data .................................................. 25
4.5 Sense of Coherence ....................................................................... 26
4.6 Statistical analyzes and ethics ....................................................... 26

5 RESULTS ........................................................................................ 29

5.1 Exposure characteristics in the lifestyle groups ............................ 29
5.2 Salivary cortisol levels in children at age 6 months and their
parents and the relation to lifestyle. ..................................................... 34
5.3 Salivary cortisol levels in children at 12 and 24 months of
age and in their parents and the relation to lifestyle. ........................... 34
5.4 Parental Sense of Coherence in relation to parental and child
cortisol levels as well as to lifestyle .................................................... 36
5.5 The relations between lifestyle group and sensitization in
children up to age 60 months, also taking cortisol levels at age 6
months into account. ............................................................................ 36
6 INTEGRATIVE DISCUSSION ...................................................... 38

7 CONCLUSION ............................................................................... 41

8 SVENSK SAMMANFATTNING ................................................... 42

9 ACKNOWLEDGMENTS ............................................................... 44

10 REFERENCES ............................................................................. 46
LIST OF ABBREVATIONS

ALADDIN Assessment of Lifestyle and Allergic Disease During
Infancy;
HPA Hypothalamic-pituitary-adrenal
OR Odds ratio
SOC Sense of Coherence
MCHC Maternal and child health care centers
IgE Immunoglobulin E
kUa/L Kilo units of allergens per liter

1 INTRODUCTION

In contrast to the increasing incidence of allergy in children it
seemed as if children in Steiner schools had a lower prevalence of
allergic diseases than expected during the mid-90´s. Emanating from
this personal observation a contact was established with a project
group at Karolinska Institutet studying possible explanations of al-
lergy in infants. In the first – cross-sectional – study from the col-
laboration to follow, 295 children aged 5-13 years from two Steiner
schools in Järna and 380 children of the same ages from two munic-
ipal schools in the same area participated (1) Children from Steiner
schools had a lower prevalence of allergy, both by clinical and by
serological or skin-prick test (1). This study was followed by a large
European multicentre study, PARSIFAL, with the same model as the
national one, where the results were confirmed (2).

None of the previous studies on anthroposophic lifestyle, which had
been focused on the physical environment like different kinds of
diets, material of clothes, vaccination etc. had found any separate
characteristic that was able to explain the decreased risk of child-
hood allergy. Results from other studies indicating a relation be-
tween psychosocial factors during pregnancy or early life and aller-
gic diseases (3) gave an impulse to search for psychosocial qualities
of the anthroposophic lifestyle with a special focus on stress related
issues. All earlier studies on health aspects of an anthroposophic
lifestyle had been retrospective but in order to find causal explana-
tions, prospective studies are needed. Since 2004, an on-going pro-
ject, ALADDIN (Assessment of Life style and Allergic Disease Dur-
ing Infancy), is collecting information from a cohort group, which
implies better prospects of examining the connection between life-
style, allergy, psychosocial environment and underlying immunolog-
ical mechanisms. This thesis is based on data from the ALADDIN
study focusing on influence of family lifestyle on allergy sensitiza-
tions early in children’s life in relation to psychosocial factors and
salivary cortisol as an indicator of stress.

9
2 BACKGROUND

2.1 Anthroposophic lifestyle

The philosopher and scientist Rudolf Steiner (1861-1925) developed
Anthroposophy as a «science of the spirit.» The word “anthroposo-
phy” means “wisdom of the human being,” or the awareness of one’s
humanity – in line with the demands described in Convention on the
Rights of the Child. Anthroposophy has inspired people around the
world to look at life in a wider perspective. Over time, about 10,000
institutions and initiatives around the world have been founded that
endeavor to apply anthroposophy: schools (often called Rudolf Steiner
schools, Waldorf schools or independent schools), and schools work-
ing within therapeutic education and sociotherapy, medical units,
pharmaceutical companies, biodynamic farms, banks, art schools,
stage groups, etc. The anthroposophic movement has its world centre
at Goetheanum, Dornach in Switzerland. In Sweden anthroposophy
has its centre in Järna, situated about 50 kilometers south of Stock-
holm with, inter alia, biodynamic farming, Rudolf Steiner schools, a
medical clinic, a mother and child health care centre, several institu-
tions for psychiatric treatment and/or or psychosocial training, bank-
ing and a culture centre with performances by artists from all around
the world.

Most children in Steiner schools grow up in families with a view of
life inspired from anthroposophy, which constitutes a lifestyle with
many characteristics different from a more conventional one. Among
other things many children are born at home, they eat more biodynam-
ic/organic vegetables and fermented vegetables with unpasteurized
lacto bacteria, use less antibiotics and antipyretics and their parents
are more restrictive regarding child vaccination (4). Furthermore the
infants are protected from technical equipments including strong light
and sound with the intention to reduce stressful stimuli from the envi-
ronment early in life, starting already during pregnancy. The body is
kept warm with clothes made by wool or silk worn day and night from
head to feet, indoor as well as outdoors. The skin is stimulated not
only by close body contact with use of a baby sling but also by appli-
cation of etheric oils almost every day. Already from pregnancy par-
ents try to find a rhythm in the day, which will be emphasized after
the birth for both mother and child. The rhythm becomes as a “hous-
ing” where the child can feel safe and come to rest (4)). This lifestyle
10