Abstract
Introduction: Following the “hygiene hypothesis” and the
increase in prevalence of atopic diseases such as allergic rhinitis, a
plethora of studies have investigated the role of sibship composition as
a protective factor, but findings are conflicting. Aim: To
synthesize the global literature linking birth order and sibship size
(number of siblings) to the risk of allergic rhinitis. Methods:
Fifteen databases were systematically searched, with no restrictions on
publication date or language. Observational studies with defined sibship
composition (birth order or sibship size) as exposure and allergic
rhinitis or allergic rhinoconjunctivitis (self-reported or clinically
diagnosed) as outcome were eligible. Study selection, data extraction,
and quality assessment was performed independently in pairs. Relevant
data were summarized in tables. Comparable numerical data were analyzed
using meta-analysis with robust variance estimation (RVE).
Results: Seventy-six reports with >2 million
subjects were identified. Being second- or later-born child was
associated with protection against both current (pooled risk ratio
[RR] 0.79, 95%CI 0.73-0.86) and ever (RR 0.77, 95%CI 0.68-0.88)
allergic rhinitis. Having siblings, regardless of birth order, was
associated with a decreased risk of current allergic rhinitis (RR 0.89,
95% CI 0.83-0.95) and allergic rhinoconjunctivitis (RR 0.92, 95%CI
0.86-0.98). These effects were unchanged across age, time period, and
geographical regions. Conclusion: Our findings indicate that
primarily, a higher birth order, and to a lesser extent the number of
siblings, is associated with a lower risk of developing allergic
rhinitis.