Prevalence of asthma symptoms among Turkish Cypriot schoolchildren

We assessed the prevalence of symptoms suggestive of asthma in Turkish Cypriot schoolchildren and the associated risk factors using a slightly modified version of the ISAAC (International Study of Asthma and Allergies in Childhood) questionnaire. The questionnaire and questions regarding risk factors were issued to the parents of 2,822 children aged six to 14 years. The response rate was 89.6 percent. The cumulative and 12-month prevalence of wheezing were 14.7 and 4.8 percent, respectively. The prevalence of physician-diagnosed asthma was 11.4 percent. Family history of atopy was the strongest risk factor for "ever wheezing" (odds ratio [OR] 1.71, 95% confidence interval [CI] 1.52-1.92) and physician-diagnosed asthma (OR 1.71, CI 1.53-1.93). This study demonstrates that symptoms suggestive of asthma are quite common and constitute a major health problem in Northern Cyprus.     

乌鲁木齐地区喘息患儿发生支气管哮喘的危险因素

目的 探讨乌鲁木齐地区喘息患儿发生支气管哮喘(哮喘)的危险因素.方法 对2008年1 -12月在新疆医科大学第五附属医院门诊及住院的300例喘息患儿的临床资料进行统计.用统一的调查表调查其年龄、性别、湿疹、变应性鼻炎、食物过敏、家族过敏史/哮喘史、运动相关性喘息等.出院后通过门诊或电话进行随访.采用 Logistic回归分析方法对各因素与哮喘发生的关系及相关程度进行分析.结果 随访2a,275例获得随访;25例失访.275例喘息患儿在随访期内86例(31.2％)发生哮喘.Logistic回归分析发现湿疹、变应性鼻炎、家族过敏史/哮喘史、运动相关性喘息、反复下呼吸道感染( LRTI)、外周血嗜酸性粒细胞(EOS)增高与喘息患儿发生哮喘有关(湿疹:OR=2.376,95％ CI0.098～0.935,P=0.039;变应性鼻炎:OR=1.052,95％ CI2.267 ～14.283,P =0.024;家族过敏史/哮喘史:OR=1.886,95％CI1.004～3.542,P =0.048;运动相关性喘息:OR=1.881,95％ CI2.267 ～18.983,P =0.001;LRTI:OR=5.341,95％ CI1.676～ 10.983,P =0.016;外周血EOS增高:OR=3.915,95％ CI1.459～ 10.501,P=0.002).结论 个人过敏史(湿疹和变应性鼻炎)、家族过敏史/哮喘史、运动相关性喘息、LRTI、外周血EOS增高是乌鲁木齐地区喘息患儿发生哮喘的危险因素.     

Prevalence and risk factors of allergies in Turkey: Results of a multicentric cross-sectional study in children

The Prevalence And Risk Factors of Allergies in Turkey (PARFAIT) study was planned to evaluate prevalence and risk factors of asthma and allergic diseases and also to find out which geographical variables and/or climatic conditions play a role determining the prevalence of allergic diseases in Turkish school children. Study was planned as cross-sectional questionnaire-based. About 25,843 questionnaires from 14 centers were appropriate for analysis. Parental history of allergy, having an atopic sibling and other atopic disease in index case was significant risk factors for all allergic diseases. Breast feeding decreased the risk of current asthma (OR: 0.92, CI: 0.86-0.99) and wheezing (OR: 0.93, CI: 0.87-0.99) but not allergic rhinitis and eczema. Respiratory infection in the past was an important risk factor for the occurrence of allergic diseases especially for asthma which was increased 4.53-fold. Children exposed to household smoke were significantly at higher risk of asthma, wheezing, and allergic rhinitis (OR: 1.20, CI: 1.08-1.33; OR: 1.21, CI: 1.09-1.34; and OR: 1.32, CI: 1.21-1.43, respectively). All allergic diseases were increased in those children living in areas which have altitude of below 1000 m and mean yearly atmospheric pressure above 1000 mb. The study has suggested that household and country-specific environmental factors are associated with asthma, wheezing, allergic rhinitis, and eczema risk during childhood in Turkey.     

Day care attendance, respiratory tract illnesses, wheezing, asthma, and total serum IgE level in early childhood

BACKGROUND: It has been hypothesized that day care--related infections may explain the inverse relation between day care attendance in early life and asthma in childhood. OBJECTIVE: To examine the relation between day care attendance or respiratory tract illnesses in the first year of life and wheezing and asthma in the first 4 years of life among children with a parental history of atopy who were followed up from birth. RESULTS: Day care attendance in the first year of life was inversely associated with geometric mean total serum IgE level (12.9 [+/-1 SD = 3.3, 51.4] IU/mL for day care vs 18.5 [[+/-1 SD = 5.3, 64.7] IU/mL for no day care; P =.03) at 2 years of age but not significantly associated with wheezing at or after 2 years of age. Having at least 1 physician-diagnosed lower respiratory tract illness in the first year of life was significantly associated with recurrent wheezing (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.0-4.1) and asthma (OR, 2.5; 95% CI, 1.1-5.5) at 4 years of age, but not with any wheezing (infrequent and frequent) at 3 years or older. Illnesses of the upper respiratory tract (> or = 1 physician-diagnosed upper respiratory tract illness or > or = 3 episodes of nasal catarrh) in the first year of life were associated with any wheezing (frequent and infrequent) between the ages of 1 and 4 years, but not with recurrent wheezing or asthma at 4 years of age. CONCLUSIONS: Our results suggest that among children with a parental history of atopy the protective effect of day care attendance in early life against the development of atopy has begun by 2 years of age, and that a protective effect of day care attendance in early life against wheezing may not be observed until after 4 years of age.     

Epidemiologic characteristics of rhinitis in Turkish Children: the International Study of Asthma and Allergies in Childhood (ISAAC) phase 2

Rhinitis is a common problem with important comorbidities. In order to search the association between rhinitis, allergic phenotypes and other risk factors in Turkish children, a parental questionnaire about allergic diseases and risk factors, and skin prick test (SPT) with 13 inhalant allergens were performed in a population-based sample of 2774 children aged 9-11 yr. Bronchoprovocation testing with hypertonic saline (HS)and total IgE analysis were limited to a subsample of 350 children. Rhinitis was defined as a problem with sneezing, rhinorrhea, or nasal congestion when the child did not have a viral respiratory infection. The prevalences of ever rhinitis, current (last 12 months) rhinitis (CR), and ever hay fever were 36.3%, 30.6%, and 8.3%, respectively. SPT positivity rate was 20.4% among children with CR. Current wheezing and flexural dermatitis were significantly associated with CR. CR significantly increased the risk of asthma among both atopic and non-atopic subjects [odds ratio (OR), 3.98; 95% CI, 1.81-8.76; and OR, 2.79; 95% CI, 1.82-4.26, respectively]. The association between CR and bronchial hyperreactivity (BHR) was not significant. The multiple logistic regression analysis revealed family atopy (OR=2.25, 95% CI=1.79-2.83, p<0.001), current indoor heating with gas stove (OR=1.78, 95% CI=1.18-2.64, p=0.006) and dampness/molds at home during the first year of life (OR=1.70, 95% CI=1.25-2.31, p=0.001) as significant risk factors for CR. Turkish school children showed a high prevalence of rhinitis with a preponderance of non-atopics. The highly significant association between rhinitis and asthma independent of atopic sensitization emphasize the importance of non-atopic forms of rhinitis.     

Prevalence and risk factors of asthma and allergic diseases among schoolchildren in Bolu, Turkey

AIM: In this study we aimed to detect the prevalence and risk factors of asthma and allergic diseases in children aged between 7 and 14 years old at rural and urban areas of Bolu, Turkey. METHODS: Questionnaire of International Study of Asthma and Allergies in Childhood (ISAAC) phase one and questionnaire including questions about family, demographic, socio-economic characteristics of children were applied to 931 schoolchildren who were selected by randomized sampling. RESULTS: In children, the prevalence of diseases and symptoms were as follows: wheeze ever: 15.5%, asthma: 5.6%, nasal symptoms ever: 41.4%, allergic rhinitis: 23.2%, itchy rash ever: 5.9% and eczema: 5.0%. In multivariate regression analysis, presence of allergic disease in the family was risk factor for wheezing (OR=1.74, 95% CI=1.19-2.76), asthma (OR=2.19, CI=1.06-4.52), allergic rhinitis (OR=2.68, CI=1.80-3.98) and eczema (OR=2.33, CI=1.17-4.65); living in shanties was risk factor for allergic rhinitis (OR=5.26, CI=2.1-13.16); a monthly income below $300 was risk factor for asthma (OR=2.54, CI=1.06-6.08). CONCLUSION: It was detected that the prevalence of allergic rhinitis and its symptoms was more common in schoolchildren living in Bolu. Presence of allergic disease in fathers or mothers and low socio-economic level increase the risk of asthma and other allergic diseases in children.     

High prevalence of atopy, but not of asthma, among children in an industrialized area in North Italy: The role of familial and environmental factors – a population-based study

The prevalence of atopy and asthma, and their association with familial and environmental factors were investigated among 13- to 14-yr-old children living in Brescia, an industrialized town in North Italy. All the 1450 children attending primary school in the town were invited to participate, and 967 of them (66.7%, 493 males) provided a valid questionnaire filled in by their parents at home. We used a modified version of the questionnaire adopted in the Italian Study of Respiratory Disorders in Childhood and Environment, which is an extended version of the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. Six hundred and twenty-eight subjects underwent skin prick test (SPT), and 308 of them (49%) were positive for at least one of the 12 allergen extracts commonly employed. Ninety-nine children (10.2%) had a physician's diagnosis of asthma - 12.4% of the males and 8.0% of the females (p = 0.03). The prevalence of wheezing in the past 12 months was 6.2%. Atopy was found in 76.8% of the subjects with, and in 45.6% of those without physician's diagnosis of asthma (p < 0.001). Analysis by multiple logistic regression showed an inverse association between physician-diagnosed asthma and female sex (odds ratio, OR = 0.5); presence of relatives in the bedroom in initial years of life (OR = 0.6); attending day care (OR = 0.4) and infant school (OR = 0.4); a positive association with parental history of wheezing (OR = 2.5) and asthma (OR = 3.8); and the child's history of asthmatic bronchitis (OR = 31.9) and atopic eczema (OR = 3.8) in the first 2 yr of life. The strength of the associations did not change when restricting the analysis to atopic asthma. In conclusion, atopy and clinical asthma among 13- to 14-yr-old adolescents are significantly associated with some familial and environmental factors, providing further support for the hygiene hypothesis. Prevalence of atopy, but not of asthma, is high in this industrialized area. The strong association found between atopy and clinical asthma suggests that atopy may play a role in causing asthma in genetically predisposed children only.     

中国三城市儿童个人过敏原与喘息及气道高反应性的相关性研究

目的 了解个人过敏原阳性与喘息及气道高反应性的关系。方法 在北京、广州及香港三城市中采用整群抽样的方法,在9～11岁在校学龄儿童中,应用国际间儿童哮喘与过敏性疾病研究的第二阶段研究方案进行研究,内容包括(1)家长书面问卷(共收集问卷10902份),(2)儿童皮肤过敏原点刺试验(3478例),(3)乙酰甲胆碱支气管激发试验(608例)。结果 近期喘息(在12个月内有发作)发生率：北京3．8％、广州3．4％、香港5．8％。特应性(即≥1种过敏原阳性)阳性率北京23．9％、广州30．8％、香港41．2％。乙酰甲胆碱支气管激发试验阳性率：北京33．2％、广州45．8％、香港30．7％。多因素logistic回归分析显示,屋尘螨P[相对危险度(OR)=4．48;95％可信限(CI)：3．02—6．66]、猫毛(OR=2．59;95％CI：1．67～4．02)、粉尘螨F(OR=2．41;95％CI：1．65～3．51)及混合草花粉过敏(OR=2．85;95％CI：1．24～6．50)是近期喘息显著相关的危险因素;特应性(OR=1．29;95％CI：0．74～2．24)与近期喘息无显著相关性。特应性(OR=2．53;95％CI：1．07～5．97)、猫毛(OR：3．01;95％CI：1．39～6．52)及粉尘螨F(OR=3．67;95％CI：1．93～6．97)是气道高反应性显著相关的危险因素。结论 屋尘螨P、粉尘螨F、猫毛、混合草花粉是9-ll岁组儿童近期喘息的危险因素,而特应性不是近期喘息的独立危险因素。特应性、猫毛、粉尘螨F是气道高反应性的危险因素。     

The impact of early lifestyle factors on wheezing and asthma in Austrian preschool children

AIM: This study investigated the influence of early lifestyle factors on the prevalence of asthma and wheezing in preschool children in Tyrol, Austria. METHODS: A cross-sectional questionnaire survey was performed in 1761 preschool children to obtain information on wheezing and asthma in the light of early lifestyle factors. RESULTS: Factors independently associated with an increased risk for wheezing in the past 12 months included high parental education (OR: 1.5, 95% CI: 1.1-2.1) and parental hay fever (OR: 1.5, 95%CI: 1.1-2.2). Risk factors for doctor-diagnosed asthma (DDA) were early pet contact (OR: 2.2, 95% CI: 1.1-4.8) and parental asthma (OR: 3.0, 95%CI: 1.0-9.1), whereas breastfeeding decreased the risk (OR: 0.5, 95% CI: 0.2-1.0). Boiling the pacifier/sucker daily increased the risk for wheezing in the past 12 months (OR: 1.4, 95%CI: 1.0-2.0) and revealed a tendency towards DDA (OR: 1.9, 95% CI: 0.9-4.0). CONCLUSION: In preschool children, we established an independent association between wheezing in the past 12 months, DDA and boiling frequency of the pacifier/bottle sucker during infancy. The impact of pacifier boiling frequency on atopic diseases on the basis of the hygiene hypothesis needs further investigation.     

Asthma and lung function 20 years after wheezing in infancy: results from a prospective follow-up study

OBJECTIVE: To determine the outcome until adulthood after wheezing in infancy, compared with pneumonia in infancy and with controls. DESIGN: An 18- to-20-year prospective cohort study. SETTING: Pediatric department at a university hospital, providing primary hospital care for a defined population.Patients Fifty-four children hospitalized for bronchiolitis and 34 for pneumonia at younger than 2 years, and 45 controls with no early-life wheezing or hospitalization, were studied at median age 19 years. MAIN OUTCOME MEASURES: A questionnaire on asthma symptoms and medication, physical examination, flow volume spirometry (FVS), methacholine inhalation challenge (MIC), home peak expiratory flow (PEF) monitoring, and skin prick testing (SPT) to common inhalant allergens. The 2 asthma definitions were physician-diagnosed asthma and previously diagnosed asthma with recent asthmatic symptoms (physician-diagnosed asthma included). RESULTS: By the 2 definitions, asthma was present in 30% (odds ratio [OR], 3.37; 95% confidence interval [CI], 1.12-10.10) and in 41% (OR 1.38; 95% CI, 0.37-5.21) in the bronchiolitis group, in 15% (OR, 5.50; 95% CI, 1.87-16.14) and in 24% (OR, 2.07; 95% CI, 0.59-7.22) in the pneumonia group, and in 11% in the control group. After bronchiolitis, the FVS values were forced vital capacity (FVC), 108% (SD, 13%) of predicted; forced expiratory volume in 1 second, 98% (SD, 12%); forced expiratory volume in 1 second divided by FVC, 91% (SD, 7.6%); midexpiratory flow at 50% of the FVC, 74% (SD, 19%); and midexpiratory flow at 25% of the FVC, 74% (SD, 22%). Bronchial reactivity by MIC was present in 25 (48%) of 52 subjects in the bronchiolitis group, in 13 (42%) of 31 in the pneumonia group, and in 14 (32%) of 44 in the control group. The prevalence of atopy (positive SPTs) was 48% to 63% in the 3 groups. In a logistic regression adjusted for atopy and smoking, infantile bronchiolitis was an independent risk factor for asthma by both definitions. CONCLUSION: The increased risk for asthma persists until adulthood after bronchiolitis in infancy.     

Sodium cromoglycate therapy in wheezing infants: preliminary evidence of beneficial outcome at early school age

BACKGROUND: In order to affect the natural course of childhood wheezing and asthma, anti-inflammatory therapy is often prescribed for young wheezing children, but there is lack of long-term follow-up data. METHODS: Eighty-two of the original 100 children, hospitalized for wheezing under the age of 2 years in 1992-1993, were re-examined at school age in 1999. The children had participated in an open, randomized, parallel-group trial including a 4-month intervention with inhaled sodium cromoglycate (SCG) or budesonide (BUD). The baseline data, including data on atopy, eosinophilia and viral etiology, were prospectively collected on admission. RESULTS: At early school age (median 7.2 years), asthma was present in 33 (40%) children. There was less asthma in the original SCG (21%) than in the control group (54%) (OR 0.23; 95% CI 0.07-0.77). The figure was 46% in the BUD group. When the analyses were performed separately for atopic and non-atopic infants, the difference was significant only among atopics. The lowered risk for asthma in the SCG group remained significant in the multivariate logistic regression analysis when adjusted for age, sex and atopy, and further when adjusted for earlier episodes of wheezing and respiratory syncytial virus identification. However, after adjustment for blood eosinophilia, the significance was lost, albeit the risk for asthma remained low (OR 0.21; 95% CI 0.04-1.12). A sensitivity analysis, which was done by including the six drop-outs of the SCG group as unfavorable and the 12 drop-outs of other groups as favorable outcomes in the model, did not change the direction of the result (OR 0.70; 95% CI 0.26-1.89). CONCLUSIONS: An early SCG intervention in infants hospitalized for wheezing was associated with a lowered risk for early school-age asthma, especially in infants with evidence of atopy.     

Hospitalization for RSV bronchiolitis before 12 months of age and subsequent asthma, atopy and wheeze: A longitudinal birth cohort study

Several epidemiological studies have reported recurrent wheezing and asthma in children after respiratory syncytial virus (RSV) bronchiolitis in infancy. The relationship with allergic sensitization is less clear and recent evidence suggests an interaction between atopy and RSV infection in the development of asthma. Data from a large, population-based, birth-cohort (Avon Longitudinal Study of Parents and Children) were used to compare outcomes of children according to whether or not they had been admitted to hospital in the first 12 months with RSV-proven bronchiolitis. Outcomes considered were 12-month prevalence of wheeze at two ages (between 30-42 and 69-81 months), cumulative prevalence of doctor-diagnosed asthma at 91 months and skin prick test defined atopy at 7 yr. Multivariable logistic regression models were used to calculate odds ratios for outcomes adjusted for potential confounders. A total of 150 infants (1.1% of the cohort) were admitted to hospital within 12 months of birth with RSV bronchiolitis. The prevalence of wheezing was 28.1% in the RSV group and 13.1% in controls at 30-42 months and 22.6% vs. 9.6% at 69-81 months. The cumulative prevalence of asthma was 38.4% in the RSV group and 20.1% in controls at 91 months. Atopy was found in 14.6% of the RSV group and in 20.7% of controls at 7 yr. RSV bronchiolitis was associated with subsequent wheezing between 30-42 (Odds ratio [95% CI] 2.3 [1.3, 3.9]) and 69-81 months (OR 3.5 [1.8, 6.6]) and with the cumulative prevalence of asthma at 91 months (OR 2.5 [1.4, 4.3]) but not with atopy (OR 0.7 [0.2, 1.7]). In a population-based birth cohort, RSV bronchiolitis was associated with subsequent wheezing and asthma but not with the development of atopy by age 7 yr.     

Development of atopy and wheezing symptoms in relation to heredity and early pet keeping in a Swedish birth cohort

The role of pet keeping during infancy for the development of allergy and asthma is still controversial. The objective of this population-based birth cohort study was to assess the development of atopy and different wheezing phenotypes during the first 4 yr of life in relation to heredity and early pet keeping. The cohort comprised all 1228 infants living in a Swedish county who were born over a 1-yr period. The parents replied to repeated questionnaires and 817 of the children were skin prick tested both at 1 and 4 yr. Cat keeping during the first year of life was associated with an increased risk of a positive skin prick test to cat at 1 yr of age [odds ratio (OR) 2.2, 95% confidence interval (CI) 0.9-5.6], but neither with sensitivity nor clinical symptoms of allergy at 4 yr. Dog keeping during the first year of life was associated with an increased risk of early-onset transient wheezing, but only in children with parental asthma (adjusted OR 4.3, 95% CI 1.5-12.1). In contrast, early dog keeping had an inverse association with sensitivity to pollen allergen at 4 yr (adjusted OR 0.3, 95% CI 0.1-0.9) and late-onset wheezing (adjusted OR 0.4, 95% CI 0.2-1.0). Thus, pet keeping during the first year of life was not associated with an increased risk of atopy at 4 yr, although a positive SPT to cat was more common at 1 yr. Our findings may even suggest that dog keeping during the first year of life might provide some protection from pollen allergy and late-onset wheezing and increase the risk of early-onset transient wheezing in children with heredity for asthma.     

High body mass index, asthma and allergy in Swedish schoolchildren participating in the International Study of Asthma and Allergies in Childhood: Phase II

AIM: To assess the relationship between high body mass index (BMI) and asthma and atopic manifestations in 12-y-old children. METHODS: The relationship between high BMI and asthma symptoms was studied in 457 sixth-grade children, with (n = 161) and without (n = 296) current wheeze. High BMI was defined as > or = 75th percentile of gender-specific BMI reference values for Swedish children at 12 y of age; overweight as a subgroup of high BMI was defined as > or = 95th percentile. Children with a BMI < 75th percentile served as controls. Questionnaires were used to assess asthmatic and allergic symptoms, and bronchial hyperresponsiveness was assessed by hypertonic saline provocation tests. RESULTS: Current wheeze was associated with high BMI after adjustment for confounding factors (adjusted OR 1.7, 95% CI 1.0-2.5) and overweight had an even more pronounced effect (adjusted OR 1.9, 95% CI 1.0-3.6). In addition, asthma severity was associated with high BMI, as evaluated by the number of wheezing episodes during the previous 12 mo among the wheezing children (adjusted OR 2.0, 95% CI 1.0-4.0). There was also an association between high BMI and the presence of eczema in wheezing children (adjusted OR 2.2, 95% CI 1.0-4.6). However, high BMI was not significantly associated with hay fever, positive skin prick tests or bronchial hyperresponsiveness. CONCLUSION: The study confirms and extends a previously observed relationship between BMI and the presence of wheezing and asthma.     

Indoor environment,atopy and the risk of asthma in children in New Zealand

The objective of this study was to examine the relationship between the indoor environment, atopy and asthma in 7–9-year-old children. Cases and controls were randomly selected from children who participated in the International Study of Asthma and Allergies in Childhood (ISAAC) in Wellington, New Zealand. Cases were children with a previous diagnosis of asthma and current medication use (n = 233) and controls were children with no history of wheezing and no diagnosis of asthma (n = 241). Information was recorded about the indoor environment during the first year of life and currently. Dust was sampled from floors and beds and Der p 1 and Fel d 1 measured using enzyme-linked immunosorbent assays. Skin-prick tests were performed with eight common allergens. Sensitization to Dermatophagoides farinae (OR = 3.19; 95% CI 1.74–5.84), Dermatophagoides pteronyssinus (OR = 2.06; 95% CI 1.16–3.65) and cat (OR = 3.89; 95% CI 1.06–14.30) were independently associated with current asthma. The use of a sheepskin in the first year of life (OR = 1.91; 95% CI 1.11–3.33) was also independently associated with current asthma but current Der p 1 levels showed no association with current asthma. Exposures in early life may be more important than current exposures in determining asthma at age 7–9 years. Prospective studies are needed in New Zealand to determine the relative importance of early life exposures to Der p 1 and other risk factors for asthma.     

Rhinitis in 10-year-old children and early life risk factors for its development

Aim: To study the prevalence, characteristics of and risk factors for childhood rhinitis. Methods: In a whole population birth cohort study (n = 1456) the prevalence and characteristics of rhinitis among 10-y-old children were examined. At this age 1373 children (94%) completed standardized questionnaires, 1043 (72%) skin-prick testing, 953 (65%) serum inhalant immunoglobulin E antibody screening and 784 (54%) methacholine bronchial challenges. Results: At the age of 10 y the prevalence of hayfever ever was 18.6% and current nasal symptoms (rhinitis) 22.6%. Rhinitis at 10 y was largely seasonal and associated with low morbidity, although 62.7% of cases required pharmacological treatment. Atopy (positive skin test) and other allergic states were associated with rhinitis (p 3 0.001). Wheeze or diagnosed asthma was higher with coexistent rhinitis. Among wheezing children physician-diagnosed asthma (p 3 0.024) and inhaled corticosteroid use (p 3 0.001) were greater with the presence of rhinitis. Significant bronchial hyperresponsiveness (methacholine concentration giving a 20% fall in forced expiratory volume in 1 s 34.0 mg ml 31 ) was greater if rhinitis was present even when the child did not wheeze (p 3 0.001). Risk factor analysis for rhinitis identified the independent significance for atopy (p 3 0.001) and eczema ( p = 0.009) at the age of 4 y plus paternal rhinitis (p 3 0.001), maternal rhinitis ( p = 0.033) and maternal food allergy ( p = 0.016). Conclusion: Rhinitis is common at the age of 10 y, with strong associations with atopy, wheezing, asthma and bronchial hyperresponsiveness. An inherited predisposition towards atopy appears to predominate over environment in the aetiology of this state.     

Prevalence of asthma and allergic diseases in primary school children in Ankara, Turkey: Two cross‐sectional studies, five years apart

The prevalence of allergic diseases is reported to have increased worldwide. Two questionnaire surveys, five years apart, were conducted to evaluate the trend of prevalence rates and possible risk factors among primary school children in Ankara, Turkey. A previous survey in 1992 revealed the lifetime prevalences of asthma, wheezing, allergic rhinitis and atopic dermatitis were 17.4%, 23.3%, 28% and 6.1%, and the prevalences for the preceding 12 months were 8.3%, 11.9%, 15.4% and 4%, respectively. The survey was repeated with the same questionnaire in the same age group (6–13 years) of the same school in May 1997. The parents of 358 boys and 380 girls completed the questionnaire. The lifetime and last 12 months' prevalences of asthma, wheezing, rhinitis and atopic dermatitis were 16.8%, 22.5%, 18.7%, 6.5%, and 9.8%, 13.3%, 14.1%, 4.3%, respectively. There was a significant change only for the lifetime prevalence of rhinitis (p < 0.001). The rate of indoor smoking had declined from 73.9% to 64%, and pet ownership had risen from 7.9% to 22.9% (p < 0.001 for both). Atopic family history was the most prominent risk factor for all types of allergic disorders. Male gender was a significant risk factor for current asthma and wheezing [odds ratio (OR) = 1.80 and 1.59; 95% confidence intervals (CI) = 1.09–2.98 and 1.01–2.48, respectively], and passive smoking affected the occurrence of allergic rhinitis (OR = 1.84; CI = 1.13–3.00). The prevalence rates of allergic diseases among primary school children in Ankara stabilized during a 5‐year period for all diseases other than allergic rhinitis. However, there are changing behavior patterns, i.e. indoor smoking and keeping pet animals, which that may have affected these rates.     

Prevalence and correlates of paediatric asthma and wheezing in a largely rural USA population

OBJECTIVE: The prevalence of asthma among children has been increasing in the United States and it is estimated that there are approximately 5 million children with asthma. This cross-sectional survey sought to estimate the prevalence of asthma and asthma symptoms and potential risk factors among children aged 16 and younger, in a largely rural population in the USA. METHODS: This study was a telephone survey of 1500 households in the South Plains/Panhandle region of Texas. Parents of children were interviewed with a response rate of 64%. Having been diagnosed with asthma by a physician and a report of wheezing in the last 12 months were used as dependent variables in multivariate logistic regressions with several sociodemographic and environmental factors as potential confounders. RESULTS: The age-adjusted prevalence of asthma and wheezing among children were approximately 15 and 18%, respectively. The prevalence of asthma was highest (20%) among children aged 11-16 (P < 0.001). Living in urban areas was associated significantly with asthma and wheezing. Non-Hispanic blacks reported significantly increased odds of asthma in their children (adjusted odds ratio (OR) = 2.04, 95%CI 1.02-4.08), whereas Mexican-Americans reported significantly reduced odds of asthma (adjusted OR = 0.48, 95%CI 0.29-0.78) and wheezing (adjusted OR = 0.58, 95%CI 0.37-0.89) in their children. The odds of asthma (adjusted OR = 1.78, 95%CI 1.09-2.92) and wheezing (adjusted OR = 2.45, 95%CI 1.52-3.95) was highest among children in the highest body mass index quartile. No significant association with pet ownership and exposure to second-hand smoke with asthma and wheezing was observed in this study. CONCLUSION: Urban residence, non-Hispanic black and Mexican-American race/ethnicity, and being overweight were significantly associated with the increased risk of asthma and/or wheezing.     

A different pattern of risk factors for atopic and non-atopic wheezing in 9–12-year-old children

Few epidemiological studies have compared the risk factors of asthma or wheezing between atopic and non-atopic children. The objective of this study was to determine if there are specific risk factors for current wheezing related to atopic status in schoolchildren. Schoolchildren 9-12 yr of age from three Spanish cities (n = 2720) were subject to a cross-sectional study of asthma risk factors (by questionnaire) and atopy (by skin prick test) according to the ISAAC phase-II protocol. Risk factors for current wheezing (in the last 12 months) as reported by parents were investigated among the atopic (positive prick test to at least one allergen) and the non-atopic (negative prick test) children. The prevalence of current wheezing was 13.1% in the whole group, 22.1% in the atopic group and 7.8% in the non-atopic group. However, only 62.4% of children with current wheezing were atopic. Male gender and asthma in the mother and/or the father were both significant and independent risk factors for current atopic wheezing, whereas maternal smoking in the first year of the child's life and mould stains on the household walls were for current non-atopic wheezing. In summary, this study shows that atopic and current non-atopic wheezing children in Spain do not share identical environmental and family risk factors.     

The introduction of solids in relation to asthma and eczema.

BACKGROUND: Despite scarce scientific evidence, current feeding guidelines recommend delayed introduction of solids for the prevention of asthma and allergy. AIMS: To explore whether late introduction of solids is protective against the development of asthma, eczema, and atopy. METHODS: A total of 642 children were recruited before birth and followed to the age of 5(1/2) years. Main outcome measures were: doctor's diagnosis of eczema ever, atopy according to skin prick test results against inhalant allergens, preschool wheezing, transient wheezing, all defined at age 5-5(1/2) years. Introduction of solids as main exposure measure was assessed retrospectively at age 1 year. RESULTS: There was no evidence for a protective effect of late introduction of solids for the development of preschool wheezing, transient wheezing, atopy, or eczema. On the contrary, there was a statistically significant increased risk of eczema in relation to late introduction of egg (aOR 1.6, 95% CI 1.1 to 2.4) and milk (aOR 1.7, 95% CI 1.1 to 2.5). Late introduction of egg was furthermore associated with a non-significant increased risk of preschool wheezing (aOR 1.5, 95% CI 0.92 to 2.4). There was no statistical evidence of feeding practices playing a different role in the development of asthma and eczema after stratification for parental asthma and atopy status. CONCLUSIONS: Results do not support the recommendations given by present feeding guidelines stating that a delayed introduction of solids is protective against the development of asthma and allergy.