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Does neonatal BCG vaccination prevent allergic disease in later life?
  1. Bridget Freyne1,2,3,
  2. Nigel Curtis1,2,3
  1. 1 Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
  2. 2 Infectious Diseases Unit, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
  3. 3 Murdoch Children's Research Institute, Parkville, Victoria, Australia
  1. Correspondence to Professor Nigel Curtis, Department of Paediatrics, The University of Melbourne, Royal Children's Hospital Melbourne, 50 Flemington Rd, Parkville, VIC 3052 Australia; nigel.curtis{at}rch.org.au

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Clinical scenario

You are working on the postnatal ward of a busy maternity hospital. While doing a routine discharge check of a newborn baby, the mother asks you about the availability of BCG vaccination. Her two older children have severe eczema, asthma and food allergies, and she has read on the internet that BCG may reduce the risk of allergic disease.

Structured clinical question

In a newborn infant (patient), does BCG vaccination (intervention) prevent the development of allergic disease in later life (outcome)?

Search strategy and outcome

Medline and Embase were searched (1946 to current date) using the keywords ((bacille Calmette-Guérin) OR (BCG)) AND (allergy OR asthma). Restrictions were human subjects, randomised controlled trials, systematic reviews and meta-analyses. This search yielded 64 articles. A search of the Cochrane Library revealed a further five articles. Of these 69 articles, one randomised controlled trial and four systematic reviews (three with meta-analyses) of observational studies were relevant and selected for full text review. Excluded articles included 10 randomised controlled trials of BCG as an immune therapy for asthma and allergic rhinitis in childhood as they did not relate to the question of prevention.

Commentary

The hygiene hypothesis proposes that diminished microbial exposure in early life prevents the switch from the T helper 2 (Th2) immune response that predominates in neonates to a T helper 1 (Th1) response.1 A persistent …

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