{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T23:24:00Z","timestamp":1788305040372,"version":"build-2803163510"},"reference-count":54,"publisher":"BMJ","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Thorax"],"published-print":{"date-parts":[[1998,2]]},"abstract":"<jats:p>BACKGROUND: A systematic review was conducted of the effects of parental smoking on immunoglobulin (IgE) levels, skin prick positivity, and allergic rhinitis or eczema in children. Asthma was excluded in order to distinguish more clearly the effect of passive smoke exposure on allergic sensitisation. METHODS: Thirty six relevant publications were identified after consideration of 692 articles selected by electronic search of the Embase and Medline databases using keywords relevant to passive smoking in children. The search was completed in April 1997 and identified nine studies of IgE in neonates, eight of IgE in older children, 12 which included skin prick tests, and 10 describing symptoms of allergic disease other than asthma or wheezing. A quantitative meta-analysis was possible only for the studies reporting skin prick tests. RESULTS: Several large studies failed to confirm early reports of a substantial or statistically significant association of maternal smoking with concentrations of total serum IgE in neonates or in older children. No consistent association emerged between parental smoking and allergic rhinitis or eczema. Few of these studies adjusted for potential confounding variables. The quantity and quality of evidence was greatest for skin prick tests, and studies of parental smoking during pregnancy or infancy were broadly consistent in showing no adverse effect on prick positivity (pooled odds ratio 0.87, 95% confidence interval 0.62 to 1.24). There was much greater and statistically significant (p = 0.002) heterogeneity of odds ratios relating current parental smoking to skin prick positivity. CONCLUSIONS: Parental smoking, either before or immediately after birth, is unlikely to increase the risk of allergic sensitisation in children.<\/jats:p>","DOI":"10.1136\/thx.53.2.117","type":"journal-article","created":{"date-parts":[[2010,1,11]],"date-time":"2010-01-11T19:40:22Z","timestamp":1263238822000},"page":"117-123","source":"Crossref","is-referenced-by-count":174,"title":["Health effects of passive smoking .5. Parental smoking and allergic sensitisation in children."],"prefix":"10.1136","volume":"53","author":[{"given":"D P","family":"Strachan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D G","family":"Cook","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[1998,2,1]]},"reference":[{"key":"ref_1","article-title":"As part of a more general descriptive study Bergmann et al10 related cord blood IgE levels to parental smoking habits during pregnancy for 4793 German infants, representing 63% of all babies born in six hospitals during 1990. The prevalence of elevated IgE concentrations ([0.7 kU\/l) was 11.6% among 3495 offspring of non-smoking mothers and 10.6% among 1298 babies whose mothers smoked during pregnancy (odds ratio 0.9, 95% CI 0.7 to 1.1). The equivalent odds ratio for paternal smoking was 1.0 (95% CI 0.8 to 1.2). This large study did not report upon possible effect modification by atopic family history","unstructured":"As part of a more general descriptive study Bergmann et al10 related cord blood IgE levels to parental smoking habits during pregnancy for 4793 German infants, representing 63% of all babies born in six hospitals during 1990. The prevalence of elevated IgE concentrations ([0.7 kU\/l) was 11.6% among 3495 offspring of non-smoking mothers and 10.6% among 1298 babies whose mothers smoked during pregnancy (odds ratio 0.9, 95% CI 0.7 to 1.1). The equivalent odds ratio for paternal smoking was 1.0 (95% CI 0.8 to 1.2). This large study did not report upon possible effect modification by atopic family history."},{"key":"ref_2","article-title":"Two earlier studies5 12 of small samples (46 and 136 infants, respectively) also report no significant association of parental smoking with neonatal IgE concentrations, but another of 215 infants found a positive correlation between the number of cigarettes smoked in pregnancy and cord blood IgE levels.13 A somewhat larger study of 325 infants found no significant association using a more sensitive assay, but it appears to have been published only in abstract form.14 These studies offer insufficient quantitative information to be considered in detail in this review","unstructured":"Two earlier studies5 12 of small samples (46 and 136 infants, respectively) also report no significant association of parental smoking with neonatal IgE concentrations, but another of 215 infants found a positive correlation between the number of cigarettes smoked in pregnancy and cord blood IgE levels.13 A somewhat larger study of 325 infants found no significant association using a more sensitive assay, but it appears to have been published only in abstract form.14 These studies offer insufficient quantitative information to be considered in detail in this review."},{"key":"ref_3","article-title":"Ronchetti et al21 measured total serum IgE concentrations in 159 nine year old children, 89% of a randomly selected sample in three Italian towns. An association of geometric mean IgE with one or more parents smoking emerged for boys (99 versus 39 kU\/l) but not for girls (56 versus 59 kU\/l). Statistical significance was achieved by subgroup analysis, but the interaction of sex and parental smoking was not formally assessed. The prevalence of eosinophilia ([4% leucocytes) was also increased in the offspring of smoking parents, independent of the common association with IgE level. This otherwise informative study does not provide an estimate of the effect of parental smoking on serum IgE levels in both sexes combined, although it is reported to be nonsignificant (p=0.2)","unstructured":"Ronchetti et al21 measured total serum IgE concentrations in 159 nine year old children, 89% of a randomly selected sample in three Italian towns. An association of geometric mean IgE with one or more parents smoking emerged for boys (99 versus 39 kU\/l) but not for girls (56 versus 59 kU\/l). Statistical significance was achieved by subgroup analysis, but the interaction of sex and parental smoking was not formally assessed. The prevalence of eosinophilia ([4% leucocytes) was also increased in the offspring of smoking parents, independent of the common association with IgE level. This otherwise informative study does not provide an estimate of the effect of parental smoking on serum IgE levels in both sexes combined, although it is reported to be nonsignificant (p=0.2)."},{"key":"ref_4","article-title":"The relationship of current maternal smoking to atopy, defined as [5 mm erythema or a detectable weal ([0 mm) to any of four aeroallergens, was analysed among a population based cohort of 196 children aged 12\u201316 in Boston, Massachusetts.24 A positive association of similar strength to the Italian study was found (odds ratio 2.2, 95% CI 1.1 to 4.4). This was significant at the 2% level and the 95% confidence interval is derived from the published 2 value","unstructured":"The relationship of current maternal smoking to atopy, defined as [5 mm erythema or a detectable weal ([0 mm) to any of four aeroallergens, was analysed among a population based cohort of 196 children aged 12\u201316 in Boston, Massachusetts.24 A positive association of similar strength to the Italian study was found (odds ratio 2.2, 95% CI 1.1 to 4.4). This was significant at the 2% level and the 95% confidence interval is derived from the published 2 value."},{"key":"ref_5","article-title":"A longitudinal study of consecutive births in the Isle of Wight during 1989\u201390 has reported on the association of environmental factors and allergic sensitisation at the ages of one26 and two years.27 Only the latter study is considered here. Among the offspring of 257 smoking mothers 4.7% had positive skin prick tests to one or more of five allergens at the age of two compared with 5.3% of 915 children of nonsmoking mothers, an odds ratio of 0.9 (95% CI 0.5 to 1.7). It is not clear from the publication whether this relates to current maternal smoking or smoking in pregnancy","unstructured":"A longitudinal study of consecutive births in the Isle of Wight during 1989\u201390 has reported on the association of environmental factors and allergic sensitisation at the ages of one26 and two years.27 Only the latter study is considered here. Among the offspring of 257 smoking mothers 4.7% had positive skin prick tests to one or more of five allergens at the age of two compared with 5.3% of 915 children of nonsmoking mothers, an odds ratio of 0.9 (95% CI 0.5 to 1.7). It is not clear from the publication whether this relates to current maternal smoking or smoking in pregnancy."},{"key":"ref_6","article-title":"A second German study in three south-western towns performed skin prick tests to seven aeroallergens on 1470 (81%) of 1812 children aged 6\u20138 years.31 Children with a positive reaction ([3 mm) to any allergen \u2013 and specifically to grass pollen, dust mites, and cat dander \u2013 were less likely than non-atopic children to have been exposed to maternal smoking in pregnancy, in the first year of life, or in the previous year. After adjustment for parental atopy, gestational age, and sex the odds ratio for maternal smoking in pregnancy was 0.6 (95% CI 0.3 to 1.1) for any skin test positivity, and ranged from 0.4 to 0.8 for sensitisation to specific allergens. The unadjusted effect of maternal smoking during pregnancy was similar in children of non-atopic parents (0.5, 95% CI 0.3 to 1.1) and those with a parental history of asthma, hay fever or eczema (0.4, 95%","volume-title":"CI","unstructured":"A second German study in three south-western towns performed skin prick tests to seven aeroallergens on 1470 (81%) of 1812 children aged 6\u20138 years.31 Children with a positive reaction ([3 mm) to any allergen \u2013 and specifically to grass pollen, dust mites, and cat dander \u2013 were less likely than non-atopic children to have been exposed to maternal smoking in pregnancy, in the first year of life, or in the previous year. After adjustment for parental atopy, gestational age, and sex the odds ratio for maternal smoking in pregnancy was 0.6 (95% CI 0.3 to 1.1) for any skin test positivity, and ranged from 0.4 to 0.8 for sensitisation to specific allergens. The unadjusted effect of maternal smoking during pregnancy was similar in children of non-atopic parents (0.5, 95% CI 0.3 to 1.1) and those with a parental history of asthma, hay fever or eczema (0.4, 95% CI 0.2 to 1.1)."},{"key":"ref_7","article-title":"In a prospective study of physician-diagnosed allergic rhinitis in a birth cohort of 747 infants in Tucson, Arizona followed to the age of six years38 maternal smoking was equally common in children with and without a diagnosis of allergic rhinitis (8% in each group). Early diagnosis was more common in children of smoking parents, possibly because they were more likely to seek medical help for lower respiratory illnesses in infancy and thereby to receive investigations for allergy. In contrast, in a national British cohort born in 1970 and followed to five years of age39 a lifetime history of hay fever (reported by parents) was slightly more common in children of non-smoking mothers (4.6%) than in those whose mothers smoked [15 cigarettes per day (4.0%). Insufficient detail is given to calculate confidence intervals and the results are not adjusted for possible confounding variables such as birth rank, socioeconomic status, and breast feeding","unstructured":"In a prospective study of physician-diagnosed allergic rhinitis in a birth cohort of 747 infants in Tucson, Arizona followed to the age of six years38 maternal smoking was equally common in children with and without a diagnosis of allergic rhinitis (8% in each group). Early diagnosis was more common in children of smoking parents, possibly because they were more likely to seek medical help for lower respiratory illnesses in infancy and thereby to receive investigations for allergy. In contrast, in a national British cohort born in 1970 and followed to five years of age39 a lifetime history of hay fever (reported by parents) was slightly more common in children of non-smoking mothers (4.6%) than in those whose mothers smoked [15 cigarettes per day (4.0%). Insufficient detail is given to calculate confidence intervals and the results are not adjusted for possible confounding variables such as birth rank, socioeconomic status, and breast feeding."},{"key":"ref_8","article-title":"Discussion Previous reviews have concluded that parental smoking adversely affects risk of allergic disease.44 This conclusion may be misleading because it does not adequately distinguish between the well established association of parental smoking with lower respiratory illnesses in early childhood,6 which may include forms of asthma,24 33 and the effect of prenatal or postnatal tobacco smoke exposure on allergic sensitisation which in turn may lead to asthma. This review has deliberately excluded asthma and other wheezing disorders in order to concentrate on IgE mediated allergic manifestations","unstructured":"Discussion Previous reviews have concluded that parental smoking adversely affects risk of allergic disease.44 This conclusion may be misleading because it does not adequately distinguish between the well established association of parental smoking with lower respiratory illnesses in early childhood,6 which may include forms of asthma,24 33 and the effect of prenatal or postnatal tobacco smoke exposure on allergic sensitisation which in turn may lead to asthma. This review has deliberately excluded asthma and other wheezing disorders in order to concentrate on IgE mediated allergic manifestations."},{"key":"ref_9","article-title":"Much of the evidence reviewed is imperfect because of the play of chance in small studies, lack of control for potential confounders in most of the published analyses, and the potential for bias towards an inverse association if parents of atopic children selectively avoid smoking at critical periods of prenatal or postnatal development. Each of these limitations has been addressed in one or more publications, but no single study offers the ideal design or analysis","unstructured":"Much of the evidence reviewed is imperfect because of the play of chance in small studies, lack of control for potential confounders in most of the published analyses, and the potential for bias towards an inverse association if parents of atopic children selectively avoid smoking at critical periods of prenatal or postnatal development. Each of these limitations has been addressed in one or more publications, but no single study offers the ideal design or analysis."},{"key":"ref_10","article-title":"The evidence is much less consistent with regard to current exposure (table 2). There is marked and statistically significant heterogeneity across studies which is not readily explained by location, design, age group, or method of exposure assessment. There is uncertainty about both the direction and magnitude of this association and a quantitative summary is problematic. Further studies are required to shed further light on the relationship of parental smoking after the perinatal period to allergic sensitisation, taking into account confounding variables and possible smoking cessation in response to the child\u2019s illnesses","unstructured":"The evidence is much less consistent with regard to current exposure (table 2). There is marked and statistically significant heterogeneity across studies which is not readily explained by location, design, age group, or method of exposure assessment. There is uncertainty about both the direction and magnitude of this association and a quantitative summary is problematic. Further studies are required to shed further light on the relationship of parental smoking after the perinatal period to allergic sensitisation, taking into account confounding variables and possible smoking cessation in response to the child\u2019s illnesses."},{"key":"ref_11","first-page":"523","article-title":"The relationship of serum immunoglobulin E to cigarette smoking","volume":"124","year":"1981","unstructured":"Burrows B, Halonen M, Barbee RA, Lebowitz MD. The relationship of serum immunoglobulin E to cigarette smoking. Am Rev Respir Dis 1981;124:523\u20135.","journal-title":"Am Rev Respir Dis"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1215","DOI":"10.1136\/bmj.283.6301.1215","article-title":"Another smoking hazard: raised serum IgE concentration and increased risk of occupational allergy","volume":"283","author":"Zetterstrom, O.; Osterman, K.; Machado, L.; Johansson, S.G.O.","year":"1981","unstructured":"Zetterstrom O, Osterman K, Machado L, Johansson SGO. Another smoking hazard: raised serum IgE concentration and increased risk of occupational allergy. BMJ 1981;283: 1215.","journal-title":"BMJ"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1136\/bmj.290.6463.201","article-title":"Interaction of smoking and atopy in producing specific IgE antibody against a hapten-protein conjugate","volume":"290","author":"Venables, K.M.; Topping, M.D.; Howe, W.; Luczynska, C.M.; Hawkins, R.; Newman-Taylor, A.J.","year":"1985","unstructured":"Venables KM, Topping MD, Howe W, Luczynska CM, Hawkins R, Newman-Taylor AJ. Interaction of smoking and atopy in producing specific IgE antibody against a hapten-protein conjugate. BMJ 1985;290:201\u20134.","journal-title":"BMJ"},{"key":"ref_14","first-page":"5","article-title":"Occupational asthma","volume":"98","author":"Chang-Yeung, M.","year":"1990","unstructured":"Chang-Yeung M. Occupational asthma. Chest 1990; 98(Suppl 5):148\u201361.","journal-title":"Chest"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"993","DOI":"10.1016\/S0140-6736(81)91749-9","article-title":"Effect of parental smoking on IgE levels in children","volume":"i:","author":"Kjellman, N.I.M.","year":"1981","unstructured":"Kjellman NIM. Effect of parental smoking on IgE levels in children. Lancet 1981;i:993.","journal-title":"Lancet"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"905","DOI":"10.1136\/thx.52.10.905","article-title":"Health effects of passive smoking \u2013 1. Parental smoking and lower respiratory illness in infancy and early childhood","volume":"52","author":"Strachan, D.P.; Cook, D.G.","year":"1997","unstructured":"Strachan DP, Cook DG. Health effects of passive smoking \u2013 1. Parental smoking and lower respiratory illness in infancy and early childhood. Thorax 1997;52:905\u201314.","journal-title":"Thorax"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"898","DOI":"10.1016\/0091-6749(86)90237-X","article-title":"Maternal smoking influences cord serum IgE and IgD levels and increases the risk for subsequent infant allergy","volume":"78","author":"Magnusson, C.G.","year":"1986","unstructured":"Magnusson CG. Maternal smoking influences cord serum IgE and IgD levels and increases the risk for subsequent infant allergy. J Allergy Clin Immunol 1986;78:898\u2013904.","journal-title":"J Allergy Clin Immunol"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1111\/j.1399-3038.1995.tb00288.x","article-title":"Do parental smoking and history of allergy influence cord-serum IgE?","volume":"6","author":"Atici, A.; Altintas, D.; Yuksel, B.","year":"1995","unstructured":"Atici A, Altintas D, Yuksel B, et al. Do parental smoking and history of allergy influence cord-serum IgE? Pediatr Allergy Immunol 1995;6:213\u20135.","journal-title":"Pediatr Allergy Immunol"},{"key":"ref_19","first-page":"723","article-title":"Influence of smoking in the family on cord blood IgE level of newborn infants","volume":"70","author":"Oldak, E.","year":"1995","unstructured":"Oldak E. Influence of smoking in the family on cord blood IgE level of newborn infants. Pediatria Polska 1995;70: 723\u20136.","journal-title":"Pediatria Polska"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1111\/j.1398-9995.1995.tb02484.x","article-title":"Determinants of cord-blood IgE concentrations in 6401 German neonates","volume":"50","author":"Bergmann, R.L.; Schulz, J.; Gunther, S.","year":"1995","unstructured":"Bergmann RL, Schulz J, Gunther S, et al. Determinants of cord-blood IgE concentrations in 6401 German neonates. Allergy 1995;50:65\u201371.","journal-title":"Allergy"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1169","DOI":"10.1016\/0091-6749(91)92163-U","article-title":"In utero exposure to parental smoking, cotinine measurements, and cord blood IgE","volume":"87","author":"Oryszczyn, M.P.; Godin, J.; Annesi, I.; Hellier, G.; Kauffmann, F.","year":"1991","unstructured":"Oryszczyn MP, Godin J, Annesi I, Hellier G, Kauffmann F. In utero exposure to parental smoking, cotinine measurements, and cord blood IgE. J Allergy Clin Immunol 1991;87:1169\u201374.","journal-title":"J Allergy Clin Immunol"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1016\/0091-6749(80)90234-1","article-title":"Comparison of cord blood IgE concentrations and maternal allergy for the prediction of atopic diseases in infancy","volume":"65","author":"Michel, F.B.; Bousquet, J.; Grellier, P.; Robinet-Levy, M.; Coulomb, Y.","year":"1980","unstructured":"Michel FB, Bousquet J, Grellier P, Robinet-Levy M, Coulomb Y. Comparison of cord blood IgE concentrations and maternal allergy for the prediction of atopic diseases in infancy. 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J Allergy Clin Immunol 1989;83:266.","journal-title":"J Allergy Clin Immunol"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1111\/j.1398-9995.1987.tb02364.x","article-title":"Atopic babies with wheezy bronchitis. Followup study relating prognosis to sequential IgE values, type of early infant feeding, exposure to parental smoking and incidence of lower respiratory tract infections","volume":"42","author":"Geller-Bernstein, G.; Kenett, R.; Weisglass, L.; Tsur, S.; Lahav, M.; Levin, S.","year":"1987","unstructured":"Geller-Bernstein G, Kenett R, Weisglass L, Tsur S, Lahav M, Levin S. Atopic babies with wheezy bronchitis. Followup study relating prognosis to sequential IgE values, type of early infant feeding, exposure to parental smoking and incidence of lower respiratory tract infections. 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J Allergy Clin Immunol 1988;82:634\u20138.","journal-title":"J Allergy Clin Immunol"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1111\/j.1442-200X.1994.tb03176.x","article-title":"Influence of smoke exposure on serum IgE levels of atopic patients","volume":"36","author":"Atici, A.; Guneser, S.; Alparslan, N.; Antmen, B.; Yilmaz, M.; Onenli, N.","year":"1994","unstructured":"Atici A, Guneser S, Alparslan N, Antmen B, Yilmaz M, Onenli N. Influence of smoke exposure on serum IgE levels of atopic patients. Acta Paediatr Japonica 1994;36: 266\u20137.","journal-title":"Acta Paediatr Japonica"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"766","DOI":"10.1111\/j.1398-9995.1994.tb02100.x","article-title":"Indoor factors and IgE levels in children","volume":"49","author":"Wjst, M.; Heinrich, J.; Liu, P.","year":"1994","unstructured":"Wjst M, Heinrich J, Liu P, et al. Indoor factors and IgE levels in children. Allergy 1994;49:766\u201371.","journal-title":"Allergy"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1093\/tropej\/42.3.166","article-title":"Effect of passive smoking on frequency of respiratory illnesses and serum immunoglobulin-E (IgE) and interleukin-4 (IL-4) concentrations in exposed children","volume":"42","author":"El-Nawawy, A.; Soliman, A.T.; El-Azzouni, O.; El-Sayed, A.; Demian, S.; El-Sayed, M.","year":"1996","unstructured":"El-Nawawy A, Soliman AT, El-Azzouni O, El-Sayed A, Demian S, El-Sayed M. Effect of passive smoking on frequency of respiratory illnesses and serum immunoglobulin-E (IgE) and interleukin-4 (IL-4) concentrations in exposed children. 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Parental smoking enhances bronchial responsiveness in nine-year-old children. Am Rev Respir Dis 1988;138:518\u201323.","journal-title":"Am Rev Respir Dis"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1136\/adc.67.4.496","article-title":"Enhanced allergic sensitisation related to parental smoking","volume":"67","author":"Ronchetti, R.; Bonci, E.; Cutrera, R.","year":"1992","unstructured":"Ronchetti R, Bonci E, Cutrera R, et al. Enhanced allergic sensitisation related to parental smoking. Arch Dis Child 1992;67:496\u2013500.","journal-title":"Arch Dis Child"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1164\/arrd.1985.131.4.573","article-title":"The relationship of respiratory infections in early childhood to the occurrence of increased levels of bronchial responsiveness and atopy","volume":"131","author":"Weiss, S.T.; Tager, I.B.; Munoz, A.; Speizer, F.E.","year":"1985","unstructured":"Weiss ST, Tager IB, Munoz A, Speizer FE. The relationship of respiratory infections in early childhood to the occurrence of increased levels of bronchial responsiveness and atopy. Am Rev Respir Dis 1985;131:573\u20138.","journal-title":"Am Rev Respir Dis"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1786","DOI":"10.1164\/ajrccm.151.6.7767521","article-title":"Correlates of recurrent wheezing in school-age children","volume":"151","author":"Henderson, F.W.; Henry, M.M.; Ivins, S.S.","year":"1995","unstructured":"Henderson FW, Henry MM, Ivins SS, et al. Correlates of recurrent wheezing in school-age children. Am J Respir Crit Care Med 1995;151:1786\u201393.","journal-title":"Am J Respir Crit Care Med"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1016\/0091-6749(92)90077-F","article-title":"Arshad SH, Hide DW. Effect of environmental factors on the development of allergic disorders in infancy","volume":"90","year":"1992","unstructured":"Arshad SH, Hide DW. 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