{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T19:56:16Z","timestamp":1787342176204,"version":"build-2736575974"},"reference-count":72,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,9,18]],"date-time":"2025-09-18T00:00:00Z","timestamp":1758153600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"European Union-NextGenerationEU","award":["No. BG-RRP-2.004-0009-C02."],"award-info":[{"award-number":["No. BG-RRP-2.004-0009-C02."]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medical Sciences"],"abstract":"<jats:p>Background: Allergic diseases in early childhood are influenced by genetic predisposition and modifiable early-life exposures, including epigenetic mechanisms. Understanding the interplay between environmental factors and allergy development in children with atopic heredity is critical for prevention strategies. Objective: To investigate the associations between selected early-life environmental exposures and the development of allergic conditions in children with a positive family history of atopy. Methods: A cross-sectional study was conducted among 120 children aged 2 years (\u00b15 months) with atopic heredity, recruited at the Medical University of Varna, Bulgaria (2017\u20132020). Data on sociodemographic background, prenatal exposures, birth mode, feeding practices, pet contact, daycare attendance, and infectious burden were collected via structured questionnaires and medical records. Allergic outcomes (food allergy and atopic dermatitis) were physician-confirmed. Statistical analyses included t-tests and chi-square tests. Results: Food allergy was diagnosed in 23.3% and atopic dermatitis in 21.7% of participants. Formula feeding was significantly more common in children with food allergy (66.7% vs. 38.1%; p = 0.020). A lower maternal pregnancy experience score was significantly associated with both food allergy (p = 0.021) and overall allergic outcomes (p = 0.004). Indoor smoking was more common in households of non-allergic children (p = 0.034). Children with food allergy had significantly more rhinopharyngitis episodes (p = 0.014) and longer infection duration. Higher gastroenteritis frequency and hospitalization rates were also noted in food-allergic children. Conclusions: In children with atopic heredity, early formula feeding, prenatal maternal stress, and infection burden were associated with increased risk of allergic conditions. This study underscores the importance of early-life psychosocial and environmental influences, possibly mediated by epigenetic mechanisms, in the development of childhood allergies. These findings highlight novel targets for early prevention and warrant further longitudinal research.<\/jats:p>","DOI":"10.3390\/medsci13030198","type":"journal-article","created":{"date-parts":[[2025,9,18]],"date-time":"2025-09-18T14:45:46Z","timestamp":1758206746000},"page":"198","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Early-Life Environmental Determinants of Allergic Conditions in Children with Atopic Heredity: A Single Center Cross-Sectional Study from Bulgaria"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1275-876X","authenticated-orcid":false,"given":"Antoniya","family":"Hachmeriyan","sequence":"first","affiliation":[{"name":"Department of Physiology and Pathophysiology, Medical University Varna, 9002 Varna, Bulgaria"},{"name":"NutriLect Research Group, Department of Neurosciences, Research Institute, Medical University Varna, 9002 Varna, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8916-5703","authenticated-orcid":false,"given":"Albena","family":"Toneva","sequence":"additional","affiliation":[{"name":"NutriLect Research Group, Department of Neurosciences, Research Institute, Medical University Varna, 9002 Varna, Bulgaria"},{"name":"Department of Hygiene and Epidemiology, Medical University Varna, 9002 Varna, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miglena","family":"Marinova-Achkar","sequence":"additional","affiliation":[{"name":"NutriLect Research Group, Department of Neurosciences, Research Institute, Medical University Varna, 9002 Varna, Bulgaria"},{"name":"Department of Hygiene and Epidemiology, Medical University Varna, 9002 Varna, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8286-3923","authenticated-orcid":false,"given":"Rouzha","family":"Pancheva","sequence":"additional","affiliation":[{"name":"NutriLect Research Group, Department of Neurosciences, Research Institute, Medical University Varna, 9002 Varna, Bulgaria"},{"name":"Department of Hygiene and Epidemiology, Medical University Varna, 9002 Varna, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Acevedo, N., Alashkar Alhamwe, B., Caraballo, L., Ding, M., Ferrante, A., Garn, H., Garssen, J., Hii, C.S., Irvine, J., and Llin\u00e1s-Caballero, K. (2021). Perinatal and early-life nutrition, epigenetics, and allergy. Nutrients, 13.","DOI":"10.3390\/nu13030724"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e2025071812","DOI":"10.1542\/peds.2025-071812","article-title":"Atopic dermatitis: Update on skin-directed management: Clinical report","volume":"155","author":"Schoch","year":"2025","journal-title":"Pediatrics"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1016","DOI":"10.1016\/j.jaci.2014.05.013","article-title":"Food allergy: A practice parameter update\u20142014","volume":"134","author":"Sampson","year":"2014","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/j.jaci.2022.07.021","article-title":"Endotypes of atopic dermatitis and food allergy","volume":"151","author":"Goleva","year":"2023","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1071","DOI":"10.1016\/j.jaci.2015.10.049","article-title":"Does atopic dermatitis cause food allergy? A systematic review","volume":"137","author":"Tsakok","year":"2016","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.jaip.2012.11.005","article-title":"Evaluation of food allergy in patients with atopic dermatitis","volume":"1","author":"Bergmann","year":"2013","journal-title":"J. Allergy Clin. Immunol. Pract."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"S114","DOI":"10.1016\/S0091-6749(99)70053-9","article-title":"Food hypersensitivity and atopic dermatitis: Pathophysiology, epidemiology, diagnosis, and management","volume":"104","author":"Sicherer","year":"1999","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1159\/000533492","article-title":"Prediction of food sensitization in children with atopic dermatitis based on disease severity and epidermal layer impairment","volume":"185","author":"Tran","year":"2024","journal-title":"Int. Arch. Allergy Immunol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1001\/jama.2023.26857","article-title":"Management of food allergies and food-related anaphylaxis","volume":"331","author":"Iglesia","year":"2024","journal-title":"JAMA"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e1530","DOI":"10.1542\/peds.2015-1444","article-title":"Food allergy in infants with atopic dermatitis: Limitations of food-specific IgE measurements","volume":"136","author":"Spergel","year":"2015","journal-title":"Pediatrics"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Mija\u010d, S., Bani\u0107, I., Genc, A.M., Lipej, M., and Turkalj, M. (2024). The effects of environmental exposure on epigenetic modifications in allergic diseases. Medicina, 60.","DOI":"10.3390\/medicina60010110"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Fiuza, B.S.D., Fonseca, H.F., Meirelles, P.M., Marques, C.R., da Silva, T.M., and Figueiredo, C.A. (2021). Understanding asthma and allergies by the lens of biodiversity and epigenetic changes. Front. Immunol., 12.","DOI":"10.3389\/fimmu.2021.623737"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1186\/s12967-015-0690-y","article-title":"Short- and long-term health effects of parental tobacco smoking during pregnancy and lactation: A descriptive review","volume":"13","author":"Banderali","year":"2015","journal-title":"J. Transl. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1016\/S1081-1206(10)60598-4","article-title":"Smoking exposure and allergic sensitization in children according to maternal allergies","volume":"100","author":"Raherison","year":"2008","journal-title":"Ann. Allergy Asthma Immunol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1111\/j.1365-2222.2008.02939.x","article-title":"Caesarean delivery and risk of atopy and allergic disease: Meta-analyses","volume":"38","author":"Bager","year":"2008","journal-title":"Clin. Exp. Allergy"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"344","DOI":"10.2500\/aap.2015.36.3870","article-title":"Mode of delivery and risk for development of atopic diseases in children","volume":"36","author":"Cuppari","year":"2015","journal-title":"Allergy Asthma Proc."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1584","DOI":"10.1053\/j.gastro.2020.01.024","article-title":"Development of the microbiota and associations with birth mode, diet, and atopic disorders in a longitudinal analysis of stool samples, collected from infancy through early childhood","volume":"158","author":"Galazzo","year":"2020","journal-title":"Gastroenterology"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"285","DOI":"10.4168\/aair.2017.9.4.285","article-title":"Role of breast-feeding in the development of atopic dermatitis in early childhood","volume":"9","author":"Kim","year":"2017","journal-title":"Allergy Asthma Immunol. Res."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1097\/MPG.0b013e31819f1e05","article-title":"Breast-feeding: A commentary by the ESPGHAN Committee on Nutrition","volume":"49","author":"Agostoni","year":"2009","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1007\/s10911-012-9261-5","article-title":"Lactation and neonatal nutrition: Defining and refining the critical questions","volume":"17","author":"Neville","year":"2012","journal-title":"J. Mammary Gland Biol. Neoplasia"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Munblit, D., Treneva, M., Peroni, D.G., Colicino, S., Chow, L.Y., Dissanayeke, S., Pampura, A., Boner, A.L., Geddes, D.T., and Boyle, R.J. (2017). Immune components in human milk are associated with early infant immunological health outcomes: A prospective three-country analysis. Nutrients, 9.","DOI":"10.3390\/nu9060532"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Munblit, D., Treneva, M., Peroni, D.G., Colicino, S., Chow, L., Dissanayeke, S., Abrol, P., Sheth, S., Pampura, A., and Boner, A. (2016). Colostrum and mature human milk of women from London, Moscow, and Verona: Determinants of immune composition. Nutrients, 8.","DOI":"10.3390\/nu8110695"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Danielewicz, H. (2022). Breastfeeding and allergy: Effect modified by genetic, environmental, dietary, and immunological factors. Nutrients, 14.","DOI":"10.3390\/nu14153011"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1097\/00130832-200312000-00015","article-title":"Does exposure to dogs and cats in the first year of life influence the development of allergic sensitization? Curr","volume":"3","author":"Ownby","year":"2003","journal-title":"Opin. Allergy Clin. Immunol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1007\/s12519-013-0412-6","article-title":"Controversial role of pets in the development of atopy in children","volume":"9","author":"Fretzayas","year":"2013","journal-title":"World J. Pediatr."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"200","DOI":"10.4168\/aair.2017.9.3.200","article-title":"Prenatal maternal distress and allergic diseases in offspring: Review of evidence and possible pathways","volume":"9","author":"Suh","year":"2017","journal-title":"Allergy Asthma Immunol. Res."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Chan, C.W.H., Law, B.M.H., Liu, Y.H., Ambrocio, A.R.B., Au, N., Jiang, M., and Chow, K.M. (2018). The association between maternal stress and childhood eczema: A systematic review. Int. J. Environ. Res. Public Health, 15.","DOI":"10.3390\/ijerph15030395"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1111\/all.12762","article-title":"Prenatal maternal stress and atopic diseases in the child: A systematic review of observational human studies","volume":"71","author":"Andersson","year":"2016","journal-title":"Allergy"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Senter, C.C., Bush, N.R., Loftus, C.T., Szpiro, A.A., Fitzpatrick, A.L., Carroll, K.N., LeWinn, K.Z., Mason, W.A., Sathyanarayana, S., and Akingbade, O.A. (2021). Maternal stressful life events during pregnancy and atopic dermatitis in children aged approximately 4\u20136 years. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18189696"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1016\/j.ejphar.2007.11.071","article-title":"Central effects of stress hormones in health and disease: Understanding the protective and damaging effects of stress and stress mediators","volume":"583","author":"McEwen","year":"2008","journal-title":"Eur. J. Pharmacol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1159\/000216539","article-title":"Prenatal stress and neurodevelopment of the child: Focus on the HPA axis and role of the placenta","volume":"31","author":"Glover","year":"2009","journal-title":"Dev. Neurosci."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Wada, T., Adachi, Y., Murakami, S., Ito, Y., Itazawa, T., Tsuchida, A., Matsumura, K., Hamazaki, K., and Inadera, H. (2024). Maternal exposure to smoking and wheezing phenotypes in children: A cohort study of the Japan Environment and Children\u2019s Study. BMC Pediatr., 24.","DOI":"10.1186\/s12887-024-05101-6"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1037","DOI":"10.1164\/rccm.201203-0501OC","article-title":"Maternal smoking in pregnancy and asthma in preschool children: A pooled analysis of eight birth cohorts","volume":"186","author":"Neuman","year":"2012","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1007\/s00281-024-01020-x","article-title":"Early-life risk factors which govern pro-allergic immunity","volume":"46","author":"Ptaschinski","year":"2024","journal-title":"Semin. Immunopathol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1378\/chest.127.2.502","article-title":"Early life risk factors for current wheeze, asthma, and bronchial hyperresponsiveness at 10 years of age","volume":"127","author":"Arshad","year":"2005","journal-title":"Chest"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Grijincu, M., Buzan, M.R., Zb\u00eercea, L.E., P\u0103unescu, V., and Panaitescu, C. (2024). Prenatal factors in the development of allergic diseases. Int. J. Mol. Sci., 25.","DOI":"10.3390\/ijms25126359"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Yang, X., Zhou, C., Guo, C., Wang, J., Chen, I., Wen, S.W., Krewski, D., Yue, L., and Xie, R.H. (2023). The prevalence of food allergy in cesarean-born children aged 0\u20133 years: A systematic review and meta-analysis of cohort studies. Front. Pediatr., 10.","DOI":"10.3389\/fped.2022.1044954"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1111\/pai.12552","article-title":"Cesarean section delivery and development of food allergy and atopic dermatitis in early childhood","volume":"27","author":"Papathoma","year":"2016","journal-title":"Pediatr. Allergy Immunol."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Kolokotroni, O., Middleton, N., Gavatha, M., Lamnisos, D., Priftis, K.N., and Yiallouros, P.K. (2012). Asthma and atopy in children born by caesarean section: Effect modification by family history of allergies\u2014A population-based cross-sectional study. BMC Pediatr., 12.","DOI":"10.1186\/1471-2431-12-179"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1016\/j.jaci.2008.05.007","article-title":"Birth by cesarean section, allergic rhinitis, and allergic sensitization among children with a parental history of atopy","volume":"122","author":"Pistiner","year":"2008","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1349","DOI":"10.1111\/j.1365-2222.2004.02048.x","article-title":"Mode of delivery is not associated with asthma or atopy in childhood","volume":"34","author":"Maitra","year":"2004","journal-title":"Clin. Exp. Allergy"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Zhong, Z., Chen, M., Dai, S., Wang, Y., Yao, J., Shentu, H., Huang, J., Yu, C., Zhang, H., and Wang, T. (2023). Association of cesarean section with asthma in children\/adolescents: A systematic review and meta-analysis based on cohort studies. BMC Pediatr., 23.","DOI":"10.1186\/s12887-023-04396-1"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1218","DOI":"10.1016\/j.jaad.2014.08.038","article-title":"Guidelines of care for the management of atopic dermatitis: Section 4. Prevention of disease flares and use of adjunctive therapies and approaches","volume":"71","author":"Sidbury","year":"2014","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1097\/ACI.0000000000000638","article-title":"Atopic dermatitis and its relation to food allergy","volume":"20","author":"Graham","year":"2020","journal-title":"Curr. Opin. Allergy Clin. Immunol."},{"key":"ref_45","first-page":"159","article-title":"Food allergies: Diagnosis, treatment, and prevention","volume":"108","author":"Bright","year":"2023","journal-title":"Am. Fam. Physician"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"66","DOI":"10.2500\/aap.2014.35.3716","article-title":"Effect of prolonged breast-feeding on risk of atopic dermatitis in early childhood","volume":"35","author":"Hong","year":"2014","journal-title":"Allergy Asthma Proc."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1016\/j.jaci.2005.04.028","article-title":"Breast-feeding reduces the risk for childhood eczema","volume":"116","author":"Kull","year":"2005","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1067\/mjd.2001.114741","article-title":"Breast-feeding and the onset of atopic dermatitis in childhood: A systematic review and meta-analysis of prospective studies","volume":"45","author":"Gdalevich","year":"2001","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1111\/j.1365-2133.2009.09049.x","article-title":"Exclusive breastfeeding and incident atopic dermatitis in childhood: A systematic review and meta-analysis of prospective cohort studies","volume":"161","author":"Yang","year":"2009","journal-title":"Br. J. Dermatol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1111\/apa.13132","article-title":"Breastfeeding and asthma and allergies: A systematic review and meta-analysis","volume":"104","author":"Lodge","year":"2015","journal-title":"Acta Paediatr."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"566","DOI":"10.1097\/00001648-199709000-00015","article-title":"Socioeconomic status, number of siblings, and respiratory infections in early life as determinants of atopy in children","volume":"8","author":"Forastiere","year":"1997","journal-title":"Epidemiology"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"e12270","DOI":"10.1002\/clt2.12270","article-title":"Birth order, sibship size, and risk of atopic dermatitis, food allergy, and atopy: A systematic review and meta-analysis","volume":"13","author":"Lisik","year":"2023","journal-title":"Clin. Transl. Allergy"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1080\/21556660.2019.1619570","article-title":"Epidemiology of atopic dermatitis in Europe","volume":"8","author":"Czarnecka","year":"2019","journal-title":"J. Drug Assess."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1347","DOI":"10.1016\/j.jaci.2021.10.018","article-title":"Food allergy across the globe","volume":"148","author":"Sampath","year":"2021","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1016\/j.anai.2017.10.037","article-title":"The atopic march","volume":"120","author":"Hill","year":"2018","journal-title":"Ann. Allergy Asthma Immunol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1002\/iid3.267","article-title":"Cat and dog ownership during\/after the first year of life and risk for sensitization and reported allergy symptoms at age 13","volume":"7","author":"Malin","year":"2019","journal-title":"Immun. Inflamm. Dis."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"980","DOI":"10.1159\/000516057","article-title":"Dog ownership in early life increased the risk of nonatopic asthma in children","volume":"182","author":"Park","year":"2021","journal-title":"Int. Arch. Allergy Immunol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1111\/pai.13186","article-title":"Early exposure to cats, dogs and farm animals and the risk of childhood asthma and allergy","volume":"31","author":"Ojwang","year":"2020","journal-title":"Pediatr. Allergy Immunol."},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Indolfi, C., D\u2019Addio, E., Bencivenga, C.L., Rivetti, G., Bettini, I., Licari, A., Manti, S., Mori, F., Miraglia Del Giudice, M., and Klain, A. (2023). The primary prevention of atopy: Does early exposure to cats and dogs prevent the development of allergy and asthma in children? A comprehensive analysis of the literature. Life, 13.","DOI":"10.3390\/life13091859"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"1377","DOI":"10.1111\/j.1365-2222.2012.04032.x","article-title":"Pets at birth do not increase allergic disease in at-risk children","volume":"42","author":"Lodge","year":"2012","journal-title":"Clin. Exp. Allergy"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1016\/j.jaci.2022.01.023","article-title":"Associations of early-life pet ownership with asthma and allergic sensitization: A meta-analysis of more than 77,000 children from the EU Child Cohort Network","volume":"150","author":"Bishop","year":"2022","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1067\/mai.2003.1654","article-title":"Exposure and sensitization to indoor allergens: Association with lung function, bronchial reactivity, and exhaled nitric oxide measures in asthma","volume":"112","author":"Langley","year":"2003","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1056\/NEJM200008243430803","article-title":"Siblings, day-care attendance, and the risk of asthma and wheezing during childhood","volume":"343","author":"Ball","year":"2000","journal-title":"N. Engl. J. Med."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"317","DOI":"10.2332\/allergolint.10-OA-0246","article-title":"Risk factors for wheezing, eczema and rhinoconjunctivitis in the previous 12 months among six-year-old children in Himeji City, Japan: Food allergy, older siblings, day-care attendance and parental allergy history","volume":"60","author":"Kurosaka","year":"2011","journal-title":"Allergol. Int."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"578","DOI":"10.1016\/j.aller.2018.03.006","article-title":"Day-care center attendance and risk of asthma\u2014A systematic review","volume":"46","author":"Sangrador","year":"2018","journal-title":"Allergol. Immunopathol."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"1301","DOI":"10.1111\/j.1365-2222.2005.02350.x","article-title":"Atopic dermatitis, extrinsic atopic dermatitis and the hygiene hypothesis: Results from a cross-sectional study","volume":"35","author":"Zutavern","year":"2005","journal-title":"Clin. Exp. Allergy"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"2009","DOI":"10.1093\/ije\/dyx098","article-title":"How much atopy is attributable to common childhood environmental exposures? A population-based birth cohort study followed to adulthood","volume":"46","author":"Shin","year":"2017","journal-title":"Int. J. Epidemiol."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1111\/pai.12064","article-title":"Is there an association between microbial exposure and food allergy? A systematic review","volume":"24","author":"Marrs","year":"2013","journal-title":"Pediatr. Allergy Immunol."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1016\/j.anai.2019.04.020","article-title":"Comorbidities and the impact of atopic dermatitis","volume":"123","author":"Silverberg","year":"2019","journal-title":"Ann. Allergy Asthma Immunol."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1016\/j.anai.2017.10.019","article-title":"Association between atopic dermatitis and serious cutaneous, multiorgan and systemic infections in US adults","volume":"120","author":"Narla","year":"2018","journal-title":"Ann. Allergy Asthma Immunol."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1111\/bjd.19825","article-title":"Risk of systemic infections requiring hospitalization in children with atopic dermatitis: A Danish retrospective nationwide cohort study","volume":"185","author":"Droitcourt","year":"2021","journal-title":"Br. J. Dermatol."},{"key":"ref_72","doi-asserted-by":"crossref","unstructured":"Zhang, P. (2023). The role of diet and nutrition in allergic diseases. Nutrients, 15.","DOI":"10.3390\/nu15173683"}],"container-title":["Medical Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3271\/13\/3\/198\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:48:17Z","timestamp":1760035697000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3271\/13\/3\/198"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,18]]},"references-count":72,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["medsci13030198"],"URL":"https:\/\/doi.org\/10.3390\/medsci13030198","relation":{},"ISSN":["2076-3271"],"issn-type":[{"value":"2076-3271","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,18]]}}}