Atopic Sensitisation and the International Variation of Asthma Symptom Prevalence in Children.

Am J Respir Crit Care Med. 2007 Jun 15;
Weinmayr G, Weiland SK, Bjorksten B, Brunekreef B, Buchele G, Cookson WO, Garcia-Marcos L, Gotua M, Gratziou C, van Hage M, von Mutius E, Riikjarv MA, Rzehak P, Stein RT, Strachan DP, Tsanakas J, Wickens K, Wong GW.
Institute of Epidemiology, Ulm University, Ulm, Germany.

BACKGROUND: Atopic sensitisation has long been known to be related to asthma in children. We investigated its role in the large international variation in the prevalence of childhood asthma.

METHODS: Cross-sectional studies of random samples of 8-12-year-old children (n=1000 per centre) were carried out according to the standardised methodology of Phase Two of the International Study of Asthma and Allergy in Childhood (ISAAC). Thirty study centres in 22 countries worldwide participated and reflect a wide range of living conditions from rural Africa to urban Europe. Data were collected by parental questionnaires (n=54,439), skin prick tests (n=31,759) and measurements of allergen-specific IgE levels in serum (n=8,951). Economic development was assessed by gross national income per capita (GNI).

RESULTS: The prevalence of current wheeze (i.e. during the past year) ranged from 0.8% in Pichincha (Ecuador) to 25.6% in Uruguaiana (Brazil). The fraction of current wheeze attributable to atopic sensitisation ranged from 0% in Ankara (Turkey) to 93.8% in Guangzhou (China). There were no correlations between prevalence rates of current wheeze and atopic sensitisation, and only weak correlations of both with GNI. However, the fractions and prevalence rates of wheeze attributable to skin test reactivity correlated strongly with GNI (Spearman rank-order coefficient rho=0.50; p=0.006 and rho=0.74; p<0.0001, respectively). In addition, the strength of the association between current wheeze and skin test reactivity, assessed by odds ratios, increased with GNI (rho=0.47; p=0.01).

CONCLUSION: The link between atopic sensitisation and asthma symptoms in children differs strongly between populations and increases with economic development.

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