TABLE 4 Evidence Table: Controlled Epidemiological Studies—Vaccines and Allergic Disorders

Citation

Design

Population

Vaccines

Outcome Measures

Results

Comment

Contribution to Causality Argument

Wickens et al. (2001)

Case- control

233 cases with wheezing or asthma; 241 controls; ages 7–9 years (New Zealand)

DTP,* DT, polio, MMR, measles, BCG, HepB from medical records

Wheezing or asthma in last 12 months by proxy or self-report

Unadjusted ORs (95% CI):

DTP = 1.51 (0.77-2.97)

DT/DTP = 1.43 (0.69-2.96)

HepB = 0.72 (0.50-1.06)

Polio = 2.11 (0.90-4.90)

Measles/MMR = 1.52 (0.89-2.58)

MMR = 1.62 (1.06-2.47)

BCG = 1.23 (0.41-3.72)

Adjusted ORs (95% CI)

HepB = 0.66 (0.42-1.05)

Polio = 2.48 (0.83-7.41)

MMR = 1.43 (0.85-2.41)

Potential selection bias, exposure misclassification, or multiple comparisons

weak evidence relevant to causality; favors no effect of any vaccine

Hurwitz & Morgenstern (2000)

cross-sectional survey (NHAN ES III)

13,944 infants and children ages 2 months through 16 years (United States)

DTP* or tetanus, by proxy (information obtained from children’s parent or guardian)

history of physician-diagnosed asthma, hay fever; self-report of allergic reactions by proxy; atopy by skin testing with 10 allergens

Estimated Crude ORs (95% CI)/Adjusted ORs (95% CI) of DTP or tetanus vaccination on following

Asthma = 2.20 (0.70-6.84)/2.00 (0.59-6.74)

Hay fever = 1.21 (0.21-6.83)/ 0.82 (0.16-4.35)

Severe allergic reaction = 2.11 (9.42-10.45)/1.50 (0.33-6.89)

Any allergy/allergic reaction = 2.11 (0.81-5.49)/1.66 (0.67-4.14)

Sinusitis/sinus problems = 2.16 (0.77-6.06)/1.81 (0.69-4.71)

Wheezing/whistling = 1.03 (0.68- 1.57)/1.23 (0.78?1.95)

Nose & eye symptoms = 2.44

Study limitations included the following: cross-sectional design, recall bias; missing data on 2.4% of unvaccinated subjects; small number of unvaccinated children; lack of clinical information; selection bias for care-seeking behavior; unmeasured confounding; limited ability to control for con

weak evidence relevant to causality; favors effect of DTP or tetanus vaccine on clinical history of allergic disorder but no effect on atopy defined by skin test reactivity



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