Prevalence of bronchial asthma and allergic rhinitis in Istanbul school children

Evolving Trends in Pediatric Allergic Diseases: A Cross-Sectional Study Over 20 Years in the Central Black Sea Region of Turkey

Background: In the past two decades, the prevalence of asthma, eczema, and allergic rhinitis has increased among school-aged children in the Central Black Sea region of Turkey. This increase is consistent with national and international data, reflecting the impact and temporal changes of allergic diseases on the community. A similar increasing trend is also observed worldwide. This study aims to contribute to the development of health policies related to allergic diseases among Turkish children in the Central Black Sea region. Materials and Methods: This study compares the results of two cross-sectional surveys conducted in schools in and around Samsun, Turkey, between the years 2006 and 2022, examining changes in the prevalence of specific allergic diseases such as asthma, allergic rhinitis, and atopic eczema. Utilizing the Turkish translation of the International Study of Asthma and Allergies in Childhood protocol, the research encompassed a total of 1,310 and 3,219 children, respectively. Results: In the recent study conducted in 2022, the prevalence of asthma and allergic bronchitis diagnosed by physicians was found to be 10.5% and 4.6%, respectively. In addition, the prevalence of allergic rhinitis was determined to be 3.1% and the prevalence of atopic dermatitis was 2.5%. Moreover, previously unidentified rates of food allergy were determined to be 2.5%, and drug allergy was found to be 2.4%. Furthermore, a comparison with a cross-sectional study conducted in the same region 20 years ago revealed a statistically significant increase in the prevalence of physician-diagnosed asthma and allergic bronchitis (with P-values of 0.0375 and 0.0107, respectively). Discussion: The findings of this study suggest a similar trend of increasing prevalence of allergic diseases when compared with similar studies at national and global levels. Consistent with trends identified in the international literature, Turkey is also affected by the rising prevalence of allergic diseases.

Decreased frequency of allergy in juvenile idiopathic arthritis: Results of a case-control study

OBJECTIVES

To determine the frequency of Th2-mediated allergic diseases (AD) in mainly Th1-driven juvenile idiopathic arthritis (JIA) subtypes.

METHODS

Ninety-nine JIA patients and 128 control subjects were enrolled in a prospective case-control study. All subjects were assessed with standard allergy questionnaire, complete blood cell count, and total serum immunoglobulin (sIg) E. sIgs G, A, M, Juvenile Arthritis Disease Activity Score-27 (JADAS27), and serum acute phase reactants (sAPR) were obtained in JIA. In the presence of allergic symptoms, skin prick (SPT) and pulmonary function tests (PFT) were performed.

RESULTS

Despite similar allergy risk factors, the frequencies of asthma and allergic rhinitis were lower in JIA group (all p ≤ .02). Allergic patients with JIA performed lower FEV₁/FVC ratio, PEF, and FEF25-75 compared to the control group (all p ≤ .04). JADAS27 and sAPR were similar among JIA patients with and without AD. Two JIA patients were found to have hypogammaglobulinemia.

CONCLUSION

The frequencies of AD, asthma, and allergic rhinitis may decrease in Th1-mediated JIA subtypes although the coexistence does not appear to affect the severity of arthritis whereas allergic symptoms may resolve after immunosuppressive treatment. PFTs should be obtained periodically in JIA. JIA patients may have an underlying primary immunodeficiency (ID) or immunosuppressive drugs may cause secondary ID.KEY POINTSCompared to the population, the frequency of Th2-mediated allergic diseases is lower in oligoarthritis and RF-negative polyarthritis that are primarily driven by a Th1 activity.The coexistence of allergic diseases in juvenile idiopathic arthritis does not affect the severity of arthritis.Pulmonary function tests can be thought to be obtained periodically in juvenile idiopathic arthritis.Immunological workup should be considered in atypically or severely presented patients with juvenile idiopathic arthritis before the initiation of immunosuppressive therapy to differentiate primary and secondary immunodeficiency.

The prevalence of asthma and related symptoms in Middle East countries

OBJECTIVES

Asthma is a chronic inflammatory airway disease characterized by reversible airway constriction and airway hyperresponsiveness. Asthma is a worldwide problem and its prevalence varies among different parts of the world. There are insufficient data about the prevalence and risk factors of this disease in Middle East countries.

DATA SOURCE

The objective of this review article was to determine the prevalence of asthma in Middle East countries by searching EMBASE, Medline, Web of Science and Google Scholar for articles about asthma prevalence in children and adults in this region.

STUDY SELECTION

The prevalence of asthma in different countries and different cities of each country in the Middle East was reviewed in children and adults of both sexes. The possible risk factors for asthma in different areas were also reviewed from 1985 to 2012.

RESULTS

The highest asthma prevalence in children and adults was 35.4% in Tehran, Iran by ISAAC phase I and 15% in Kuwait by self-designed questionnaire and the lowest prevalence was 1% in Kermanshah, Iran by ISAAC and 2% in Tehran, Iran by ECRHS questionnaire, respectively. Most studies showed that the prevalence of this common disease declines with increasing age.

CONCLUSION

The data showed that the prevalence of asthma varies among different countries and even among different cities of the same country. The common risk factors for this disease were genetic predisposition, cigarette smoking, family history of asthma and allergic diseases.

Evaluation of pulmonary functions in preschool children born late-preterm

AIM

The aim of this study was to evaluate the pulmonary functions of preschool children born late-preterm.

MATERIAL AND METHODS

Children aged between 3-7 years who were born at 340/7-366/7 weeks' gestation represented the target sample. Patients with a diagnosis of congenital cardiac, pulmonary and/or muscle diseases were excluded. Respiratory symptoms were evaluated using the modified asthma predictive index and International Study of Asthma and Allergies in Childhood criteria for children aged under and over 6 years, respectively. Skin prick tests were performed. Age-matched healthy controls were chosen according to the criteria proposed by the American Thoracic Society. Lung functions were evaluated using impulse oscillometry study in both groups. Data were recorded in the SPSS program.

RESULTS

A total of 139 late-preterms and 75 healthy controls participated in the study. The mean gestational week of the late-preterms was 35.3±0.9 weeks. The main admission diagnosis to neonatal intensive care unit was respiratory distress. In the postdischarge period, 54.1% were hospitalized for pulmonary infections at least once, and 57.8% were passive smoking currently. Aeroallergen sensitivity was detected as 25.8% in the late-preterm group; 34.5% and 15.1% were diagnosed as having asthma and non-asthmatic atopy, respectively. Impulse oscillometry study parameters of R5, R10, and Z5 were higher and X10 and X15 were lower in late-preterms than in controls (p<0.05). Late-preterms with and without respiratory distress in the postnatal period revealed no statistical differences for any parameters.

CONCLUSIONS

Our findings suggest that presence of increased peripheral airway resistance in late-preterms as compared to term-born controls.

GIS-based Association Between PM10 and Allergic Diseases in Seoul: Implications for Health and Environmental Policy

Purpose

The role of PM10 in the development of allergic diseases remains controversial among epidemiological studies, partly due to the inability to control for spatial variations in large-scale risk factors. This study aims to investigate spatial correspondence between the level of PM10 and allergic diseases at the sub-district level in Seoul, Korea, in order to evaluate whether the impact of PM10 is observable and spatially varies across the subdistricts.

Methods

PM10 measurements at 25 monitoring stations in the city were interpolated to 424 sub-districts where annual inpatient and outpatient count data for 3 types of allergic diseases (atopic dermatitis, asthma, and allergic rhinitis) were collected. We estimated multiple ordinary least square regression models to examine the association of the PM10 level with each of the allergic diseases, controlling for various sub-district level covariates. Geographically weighted regression (GWR) models were conducted to evaluate how the impact of PM10 varies across the sub-districts.

Results

PM10 was found to be a significant predictor of atopic dermatitis patient count (P<0.01), with greater association when spatially interpolated at the sub-district level. No significant effect of PM10 was observed on allergic rhinitis and asthma when socioeconomic factors were controlled for. GWR models revealed spatial variation of PM10 effects on atopic dermatitis across the sub-districts in Seoul. The relationship of PM10 levels to atopic dermatitis patient counts is found to be significant only in the Gangbuk region (P<0.01), along with other covariates including average land value, poverty rate, level of education and apartment rate (P<0.01).

Conclusions

Our findings imply that PM10 effects on allergic diseases might not be consistent throughout Seoul. GIS-based spatial modeling techniques could play a role in evaluating spatial variation of air pollution impacts on allergic diseases at the sub-district level, which could provide valuable guidelines for environmental and public health policymakers.

Prevalence of asthma, local risk factors and agreement between written and video questionnaires among Turkish adolescents

BACKGROUND

There is currently no standard tool for the measurement of asthma in epidemiological studies. The objectives of this study were to determine the prevalence of asthma, to describe the potential local risk factors, and to assess the agreement between written and video questionnaires in 13- to 14-year-old schoolchildren.

METHODS

We performed a cross-sectional study involving 5427 adolescents in 26 schools. Prevalence of asthma symptoms were evaluated using the International Study of Asthma and Allergies in Childhood (ISAAC) written and video questionnaire. The adolescents were asked additional questions for risk factors of asthma.

RESULTS

The prevalence of lifetime wheeze, wheeze in the last 12 months and doctor-diagnosed asthma with written questionnaire were found as 13.5%, 6.3% and 11.2% respectively. Prevalence of lifetime wheeze, wheeze in the last 12 months, wheeze after exercise in the last 12 months, with video questionnaire were found as 9.6%, 5.5%, 11.9% and 1.9% respectively. The proportion of total agreement between the two questionnaires was high (0.77-0.81) with poor kappa value (0.25-0.50). In multivariate analysis, family history of atopy, stuffed toys and accompaniment of children to their parents after school hours in textile industry were found as risk factors for asthma. In addition kind of bird, such as canary was found as a risk factor.

CONCLUSION

Prevalence of asthma is moderate in Turkey. Agreement between the two questionnaires was high. Accompaniment of children to their parents in textile industry is a newly-described risk factor for asthma.

Risk factors affecting asthma prevalence in adolescents living in Istanbul, Turkey

BACKGROUND

Asthma is one of the most important diseases of childhood. The aim of this study was to evaluate the prevalence of asthma symptoms and risk factors affecting asthma.

METHODS

In a cross-sectional study design, 9991 children, aged 13-14 years in 61 primary schools in 32 districts of Istanbul were evaluated. Asthma prevalence among the children was assessed using the ISAAC protocol.

RESULTS

In our study, a total of 10,894 questionnaires were distributed to 13-14 years old children, and of these 9991 questionnaires were suitable for analysis with an overall response rate of 91.7%. The rates of wheeze ever, wheezing in last 12 months and lifetime doctor diagnosed asthma prevalence were 17.4%, 9.0%, and 11.8%, respectively. There were 4746 boys (47.9%) and 5166 girls (52.1%) with M/F ratio of 0.92. Atopic family history, fewer than three siblings living at home, tonsillectomy or adenoidectomy history, consumption of fermented foods, mixed pickles, margarine and meat were found to be associated with an increased asthma risk. Use of paracetamol in the last 12 months, consumption of fruit and animal fats acted as a protective factor against asthma. The Mediterranean-style diet was not associated with the prevalence of asthma.

CONCLUSIONS

Lifetime doctor diagnosed asthma prevalence was found to be 11.8% in 13-14 year olds. History of tonsillectomy and/or adenoidectomy and consumption of fermented foods, mixed pickles, margarine and meat may increase the symptoms of asthma. Usage of paracetamol and consumption of animal fats may be investigated as a protective factor against asthma.

The prevalence of asthma diagnosis and symptoms is still increasing in early adolescents in Turkey

BACKGROUND

This study was performed to evaluate the time trends in prevalence of asthma and related factors in Denizli, Turkey.

METHODS

Two cross-sectional surveys were performed, 6 years apart (2002 and 2008) using the ISAAC protocol, in the 13-14 age groups and comparisons were made between the results.

RESULTS

Lifetime prevalence of wheeze, 12 month prevalence of wheeze, and the prevalence of wheeze after exercise in the previous 12 months were significantly increased respectively from 10.2% to 13.4% (POR = 1.37, 95%CI = 1.18-1.58, p < 0.001), from 5.0% to 6.2% (POR = 1.26, 95%CI = 1.02-1.55, p = 0.016) and from 9% to 10.2% (POR = 1.15, 95%CI = 0.98-1.35, p = 0.046) in 2008 study. Doctor diagnosed asthma prevalence also increased significantly from 2.1% to 12.9 (POR = 6.80, 95%CI = 5.22-8.85, p < 0.001). Prevalence of sleep disturbed by wheeze in the last 12 months; but, never woken with wheezing (POR = 1.62, 95%CI = 1.26-2.09, p = < 0.001) and less than one night per week (POR = 1.58, 95%CI = 1.06-2.36, p = 0.013) were significantly increased in 2008 study. Severe attacks of wheeze limiting speech in the last year was increased from 1.3% to 2.2% (POR = 1.67, 95%CI = 1.14-2.43, p = 0.004). The number of wheeze attacks in the previous 12 months was increased significantly for 4-to-12 attacks (POR = 1.54, 95%CI = 1.03-2.32, p = 0.02) in 2008 study. However, prevalence of waking with cough in the last 12 months did not change. While history of family atopy and domestic animal at home were found as significant risk factors for asthma in 2002 study, male gender, history of family atopy and stuffed toys were found significant in 2008.

CONCLUSIONS

The prevalence of asthma symptoms were increased in Denizli. History of family atopy, male gender and stuffed toys were important risk factors for asthma in 2008.

Effects of dietary habits and risk factors on allergic rhinitis prevalence among Turkish adolescents

BACKGROUND

Allergic rhinitis (AR) is a global health problem affecting many people from childhood to adulthood. The aim of this study was to evaluate the prevalence of AR and related symptoms, and to assess the risk factors, dietary habits and the Mediterranean diet affecting AR.

METHODS

In a cross-sectional study design, 9991 children, aged 13-14 years in 61 primary schools in 32 districts of Istanbul were evaluated. The prevalence of AR symptoms among the children was evaluated using the ISAAC protocol.

RESULTS

In our study, total of 10,984 questionnaires were distributed to 13-14yr-old schoolchildren to 61 schools in 32 district of Istanbul and 9991 questionnaires were suitable for analysis with an overall response of 91.7%. The rates of lifetime rhinitis, rhinitis in last 12 months and lifetime doctor diagnosed AR prevalence were 53.5%, 38.3% and 4.5%, respectively. The variation among districts in the prevalence of doctor diagnosed AR was very high. The highest prevalence was about 10 times higher than in the district with the lowest prevalence (range: 1.4-14.5) of Istanbul. A family history of atopy, mother with a university degree, presence of cat at home during last 12 months and adenoidectomy were significant for increased doctor diagnosed AR risk. Additionally, although fish and other sea foods, fermented drinks made from millets and various seeds, animal fats and butter were independent risk factors for doctor diagnosed AR, fish oil and hamburger were protective foods for doctor diagnosed AR. The MD was not associated with the prevalence of doctor diagnosed AR.

CONCLUSIONS

This study shows that that there are wide variations for the prevalence of AR related symptoms in 13-14yr-old schoolchildren among districts of Istanbul in Turkey. Socio-economical, environmental factors, some dietary habits, but not Mediterranean diet may affect the prevalence of AR.

Rising trend of allergic rhinitis prevalence among Turkish schoolchildren

OBJECTIVES

To assess the time trends and possible risk factors associated with allergic rhinitis symptoms in schoolchildren from Denizli, Turkey.

METHOD

Two identical cross-sectional surveys were performed in the 13- to 14-yr age group at intervals of six years using ISAAC questionnaire. Possible risk factors were also asked and the children completed questionnaires by self.

RESULTS

A total of 4078 children (response rate 75%) in the 2008 and 3004 children (response rate, 93.8%) in 2002 were included. The lifetime prevalence of rhinitis, 12-month prevalence of rhinitis, prevalence of associated itchy eye in the previous 12 months and doctor diagnosed allergic rhinitis prevalence were increased from 34.2% to 49.4% (POR=1.87, 95% CI=47.8-50.9 and p ≤ 0.001), from 23.5.0% to 32.9% (POR=1.59, 95% CI=31.4-34.3 and p ≤ 0.001), from 9.6% to 14.9% (POR=1.64, 95% CI=13.8-16.0 and p ≤ 0.001), and from 4.3% to 7% (POR=1.67, 95% CI=6.2-7.8 and p ≤ 0.001) respectively. Severe interference with daily activity in the previous 12 months did not change. In multivariate analysis, history of family atopy, stuffed toys, high annual family income, presence of allergy in mother, father and accompaniment of children to their parents after school hours in textile industry were found as risk factors in 2008 study.

CONCLUSION

The prevalence of allergic rhinitis increased significantly in 2008. Family history of atopy, stuffed toys, high annual family income and accompaniment of children to their parents in textile industry were found as risk factors for doctor diagnosed allergic rhinitis.

Impact of parental smoking on childhood asthma

OBJECTIVE

To evaluate the exposure to environmental tobacco smoke (ETS) of the childhood population in this community and its relationship with asthma symptoms.

METHODS

A cross-sectional study was conducted using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire on children and adolescents in this community. The symptoms "wheezing ever", "current asthma", "severe asthma", and "exercise-induced asthma" were defined by this questionnaire. Parental smoking was classified into four mutually exclusive categories: 1) no parent smokes; 2) only the mother smokes; 3) only the father smokes; and 4) both parents smoke. The odds ratio of the prevalence of asthma symptoms according to ETS exposure was calculated using logistic regression.

RESULTS

A total of 10,314 children and 10,453 adolescents were included. Over 51% of the children and adolescents were exposed to ETS at home. ETS is associated with a higher prevalence of asthma symptoms, particularly if the mother or both parents smoke.

CONCLUSION

The prevalence of ETS is still high in this community, although there has been a decreasing tendency in the last 15 years. ETS is associated with higher prevalence of asthma.

The burden of allergic rhinitis and asthma

Asthma and allergic rhinitis are common health problems that cause major illness and disability worldwide. The prevalence of allergic rhinitis is estimated to range from 10% to 20% in the USA and Europe. Multiple factors contribute to the wide range of reported prevalence rates. These include type of prevalence rate reported (current or cumulative), study selection criteria, age of participants, differences in survey methods, varied geographic locations and socioeconomic status, any of which are significant enough to confound direct comparison between studies. There is no standard set of diagnostic criteria for allergic rhinitis. In most studies, the criteria for diagnosis are based on the subject's reporting, solely by questionnaire and rarely confirmed by skin testing. In addition, most studies focus on hay fever, leaving perennial allergic rhinitis underestimated. Sinus imaging is generally not performed and, therefore, rhinosinusitis not differentiated. Some investigators report 'current' prevalence while others report 'cumulative' or 'lifetime' prevalence. Epidemiologic studies have consistently shown that asthma and rhinitis often coexist in the same patients. The prevalence of asthma is <2% in subjects without rhinitis while it varies from 10% to 40% in patients with rhinitis. Furthermore, the majority of patients with asthma experience rhinitis, which is a factor in the risk for asthma. Despite recognition that allergic rhinitis and asthma are global health problems, there are insufficient epidemiologic data and more data are needed with regard to their etiologic risk factors and natural history. This aim of this review is to enable the reader to discuss prevalence, risk factors and prognosis of allergic rhinitis and asthma.

Prevalence and diversity of allergic rhinitis in regions of the world beyond Europe and North America

BACKGROUND

There is comparatively little information in the public domain on the diversity in prevalence and triggers/factors associated with allergic rhinitis (AR) or allergic rhinoconjunctivitis (AR/C) in countries beyond western-Europe and North America.

OBJECTIVE

To review the prevalence and the sensitizing agents/triggers and factors associated with AR/C in several countries in Africa, the Asia-Pacific region, Australia, Eastern Europe, Latin America, Middle East and Turkey.

METHODS

Articles published in English in peer-reviewed journals were assessed and selected for further review, following an extensive literature search using the Medline database.

RESULTS

This review demonstrated that prevalence of AR and AR/C in these regions has predominantly been investigated in children; with studies indicating wide inter- and intra-regional variations ranging from 2.9% AR and 3.8% AR/C in 10-18-years-old children from one region in Turkey to 54.1% AR and 39.2% AR/C in 13-14-years-old children in one region in Nigeria. Moreover, the prevalence of AR and AR/C has increased markedly over the last decade particularly in some of the more affluent African countries, China-Taiwan and several Middle East countries, likely as a consequence of improved living standards leading to increased exposure to multiple traditional and non-traditional sensitizing agents and risk factors similar to those noted in western-Europe and North America.

CONCLUSIONS AND CLINICAL RELEVANCE

Our findings suggest that the greater diversity in prevalence of AR or AR/C in populations in these regions is in contrast to the lower diversity of AR or AR/C in the 'western populations (USA and Europe), which tend to be more uniform. This review provides a comprehensive database of the important allergens and triggers which are likely to influence the prevalence of allergic rhinitis in these diverse regions, where the prevalence of allergic rhinitis is increasing and its adverse impact on the quality of life of affected individuals is increasingly recognised.

Effects of curcumin on lung histopathology and fungal burden in a mouse model of chronic asthma and oropharyngeal candidiasis

BACKGROUND AND AIMS

Oropharyngeal candidiasis (OPC) is one of the most common local side effects of current therapy in chronic asthma. New therapeutic options with fewer side effects and reverse chronic changes are needed. Curcumin, as a promising antiinflammatory and antifungal agent, could be a candidate of alternative therapy in asthma. This study aimed to determine the efficacy of orally administrated curcumin on lung histopathology, serum nitric oxide levels and fungal burden in a murine model of asthma and OPC.

METHODS

Thirty five BALB/c mice were divided into five groups: I, II, III, IV (placebo) and V (control). All groups except the control were sensitized and challenged with ovalbumin. OPC model was established after the model of chronic asthma. Lung histology, serum nitric oxide levels and fungal burden were evaluated after 5 days of treatment with curcumin, dexamethasone, curcumin-dexamethasone combination and placebo. Evaluation of lung histology included subepithelial smooth muscle and epithelial thickness and number of goblet and mast cells by using light microscopy.

RESULTS

All histological parameters improved in curcumin group similar to dexamethasone group. Curcumin and dexamethasone-curcumin combination were also as effective as dexamethasone on decreasing nitric oxide levels. Oral fungal burden was significantly lower in curcumin-treated group than dexamethasone.

CONCLUSIONS

In our study we demonstrated that curcumin administration alleviates the pathological changes in asthma and decreases the fungal burden. Curcumin may have a potential effect on treating chronic asthma and decreasing the frequency of the OPC.

Pediatric allergy and immunology in Turkey

Allergic diseases constitute a significant health problem in Turkey. According to a recent multicenter study, which used the ISAAC questionnaire, the mean prevalence of wheezing, rhinoconjunctivitis, and eczema in 10-yr-old school children during the past year was 15.8%, 23.5%, and 8.1%, respectively. A healthcare level system, regulated by Ministry of Health, is available in Turkey. Pediatric allergists and pediatric immunologists provide patient care at the tertiary level. Currently, 48 centers deliver care for allergic and immunologic diseases in children. There are 136 pediatric and 61 adult allergists/immunologists. Although the number of allergy/clinical immunology specialists is limited, these centers are capable of delivering many of the procedures required for the proper management and diagnosis of allergy/immunology. Pediatric allergy and/or immunology is a subspecialty lasting 3 yr and follows a 4-yr pediatric specialist training. Fellow training involves gaining knowledge in basic and clinical allergy and immunology as well as the performance and interpretation of laboratory procedures in the field of allergy and clinical immunology. The Turkish National Society of Allergy and Clinical Immunology (TNSACI) was officially established in 1989 and currently has 356 members. The society organizes a national congress annually and winter schools for fellowship training as well as training courses for patients and their relatives. TNSACI also has a strong representation in European Academy of Allergy and Clinical Immunology (EAACI) and European Society for Immunodeficiencies (ESID) through its participation in the executive committee, consensus reports, and initiatives in the diagnosis of allergic and immunologic diseases of children. The 30th Congress of the EAACI is also due to be held in Istanbul, Turkey, between June 11 and 15, 2011.

The prevalences of allergic diseases in rural and urban areas are similar

BACKGROUND

In this study, we aimed to detect the influence of environmental and socioeconomic factors for asthma, allergic rhinitis, and eczema among children aged 6-18 years.

METHOD

Two each of schools located in urban and in rural areas were included in the study. Children in these schools were asked to respond to 32 questions in total, including demographic and socioeconomic features and the questions of the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire form.

RESULTS

The average age of children included in the study was 11.5 ± 3.3 years, and the ratio of boys (55.4%) to girls (44.6%) was 1.2/1. The prevalence of asthma was found as 11.5%, allergic rhinitis as 22.1%, and eczema as 10.7%. Asthma (21.9%), allergic rhinitis (44.3%) and eczema (19.8%) were more frequent in cases which had family history of atopy (p < 0.001). Although there were differences between regions regarding income and educational levels, number of persons in the household, duration of breast feeding, and dietary habits, these variants were found inconclusive for the development of asthma. The risk of progression to asthma and atopic diseases decreased as age increased and the educational level of the father increased.

CONCLUSION

According to our results, atopic diseases can be considered frequent in Konya, history of atopy in the family is the most predictive factor and the effects of rural or urban factors are not obvious in atopic disease development.

Risk factors for asthma and other allergic diseases in seasonal rhinitis

BACKGROUND

Rhinitis and asthma are common comorbidities. The aim of this study was to determine the risk factors for asthma and other allergic diseases in seasonal rhinitis (SR) patients.

METHODS

Records of 922 patients diagnosed as SR between 1991 and 2005 were evaluated retrospectively. Patients were grouped according to the results of our standard skin prick tests as follows: I-No sensitization: no sensitization to any allergen; II-Mono-pollen sensitization: sensitization to only one pollen allergen; III-Poly-pollen sensitization: sensitization to more than one pollen allergen; IV-Mite sensitization: sensitization to mite with or without any other allergen sensitization.

RESULTS

The mean age of the patients was 29.5 +/- 9.6 and 587 patients (63.2%) were females. Age at onset of SR was median 21 years (16-29 years). Of the 922 patients, 99 had no sensitization, 335 had poly-pollen sensitization, 346 had mono-pollen sensitization, and 142 had mite sensitization. The most prevalent allergens were P. pratense (85.3%) and O. europae (31.5%). No sensitization group as compared to poly-pollen sensitization group had significantly higher prevalence of asthma as a single accompanying disease (14.1%, p < 0.05). Mono-pollen sensitization was significantly associated with lower risk of any accompanying allergic disease (OR: 0.7, 95% CI 0,5-0,9) while no sensitization group (OR: 2.8, 95% CI 1.3-5.9) and mite sensitization were associated with asthma (OR: 2.3, 95% CI 1.2-4.4).

CONCLUSION

SR is a condition that presents with different phenotypes. The group with no sensitization and mite sensitization has the highest prevalence of asthma while SR patients with mono-pollen sensitization are unlikely to have an accompanying allergic disease, including asthma.

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.

Prevalence of Asthma and Wheeze in Relation to Passive Smoking in Japanese Children

PURPOSE

Evidence remains inconclusive as to whether environmental tobacco smoke is a risk factor for allergic disorders in childhood. The present large-scale cross-sectional study examined the relationship between passive smoking at home and the prevalence of allergic disorders in Japanese schoolchildren.

METHODS

Study subjects were 23,044 children aged 6 to 15 years in Okinawa. Outcomes were based on diagnostic criteria from the International Study of Asthma and Allergies in Childhood. Adjustment was made for sex, age, region of residence, number of siblings, paternal and maternal history of asthma, atopic eczema, or allergic rhinitis, as well as paternal and maternal educational level.

RESULTS

The prevalence of wheeze, asthma, atopic eczema, and allergic rhinoconjunctivitis in the previous 12 months was 10.7%, 7.6%, 6.8%, and 7.7%, respectively. Current heavy passive smoking and 7.0 or more pack-years of smoking in the household were independently related to an increased prevalence of wheeze and asthma, especially in children 6 to 10 years of age and children with a positive parental allergic history. There was no dose-response relationship between pack-years of smoking in the household and atopic eczema or allergic rhinoconjunctivitis.

CONCLUSIONS

Our findings suggested that environmental tobacco smoke might be associated with an increased prevalence of wheeze and asthma in Japanese children.

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.

Prevalence and risk factors for allergic rhinitis in primary school children

OBJECTIVE

Allergic rhinitis is a common chronic illness of childhood. The aim of the study was to evaluate the prevalence and risk factors of allergic rhinitis in 6-12-year-old schoolchildren in Istanbul.

METHODS

A total of 2500 children aged between 6 and 12 years in randomly selected six primary schools of Istanbul were surveyed by using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire between April and May 2004.

RESULTS

Of them 2387 (1185 M/1202 F) questionnaires were appropriately completed by the parents with an overall response of 95.4%. The prevalence of physician-diagnosed allergic rhinitis was 7.9% (n=189). A family history of atopy (aOR=1.30, 95% CI=1.00-1.68), frequent respiratory tract infection (aOR=1.36, 95% CI=1.08-1.70) and sinusitis (aOR=2.29, 95% CI=1.64-3.19), antibiotic use in the first year of life (aOR=1.26, 95% CI=1.01-1.57), cat at home in the first year of life (aOR=2.21, 95% CI=1.36-3.61), dampness at home (aOR=1.31, 95% CI=1.04-1.65) and perianal redness (aOR=1.26, 95% CI=1.01-1.57) were significant for increased risk for allergic rhinitis. Frequent consumption of fruits and vegetables were inversely, and frequent consumption of lollipops and candies were positively associated with allergic rhinitis symptoms.

CONCLUSION

Our study reconfirmed that family history of atopy, frequent respiratory tract infections, antibiotics given in the first year of life, cat at home in the first year of life, dampness at home, perianal redness and dietary habits are important independent risk factors for AR. Researchers worldwide should be focused to these factors and try to develop policies for early intervention, primary and secondary preventions for allergic diseases.

Frequency of allergic diseases following measles

OBJECTIVE

Viral and bacterial infections in childhood decrease the likelihood of allergic diseases in later life. The frequency of allergic diseases in patients with a history of measles has been reported to be low but some studies still suggest that measles can increase the frequency of allergic diseases. The aim of this study was to investigate the frequency of allergic diseases following measles in childhood.

METHODS

Fifty-two children hospitalized in our clinic with measles were compared with 51 children without measles. Allergic diseases were investigated in both groups by using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. In all children, allergy skin tests were performed with the four most common allergens.

RESULTS

Sensitivity to Dermatophagoides pteronyssinus was less frequent in children with measles than in those without (p < 0.05). A history of nebulized salbutamol use in the emergency room in the previous 12 months was also less frequent in the measles group (p < 0.05). Inhaled corticosteroid use was more common in the group without measles (p < 0.05).

CONCLUSION

The results of this study indicate that findings of allergic disease are less frequent in children with a history of measles. These children were less sensitive to D. pteronyssinus.

Seasonal rhinitis, clinical characteristics and risk factors for asthma

BACKGROUND

The aim was to determine the clinical characteristics of patients with seasonal rhinitis (SR) and to disclose differences in the treatment of SR between an adult allergy clinic and other clinics over time.

METHODS

A retrospective study was conducted based on clinical records of 774 out of 955 patients diagnosed with SR in an adult allergy clinic between 1 January 1991 and 31 December 2003.

RESULTS

The mean age of the patients was 29.1 +/- 9.29 years and 62.7% were female. The most common major complaints of the patients were nasal symptoms in 82.3%. The mean duration of the disease was 6.76 +/- 6.8 years. The patients were symptomatic with a mean of 3.5 +/- 1.7 months a year, mostly during the period between April and July. Skin prick tests were positive in 685 patients (90.3%), where the most common sensitivity was against timothy grass (85.1%). The most common accompanying allergic diseases were food hypersensitivity in 14%, bronchial asthma in 13.4%, and drug allergy and/or intolerance in 9.6%. Although the use of specific immunotherapy and short-acting sedative antihistamines decreased over time, the use of nasal steroids and long-acting nonsedative antihistamines tended to increase before admission to our clinic. Older age (OR: 1.77, 95% CI: 1.06-2.94), presence of familial atopy (OR: 1.72, 95% CI: 1.04-2.85), respiratory symptoms (OR: 2.10, 95% CI: 1.75-2.50), ocular symptoms (OR: 0.77, 95% CI: 0.61-0.98) and metal allergy (OR: 0.25, 95% CI: 0.07-0.89) were associated with the development of asthma in patients with SR.

CONCLUSION

SR lasts approximately 3.5 months and the main cause in Ankara, Turkey is grass pollen sensitivity. Patients with any other allergic conditions make up 39.8% of the patients. SR patients are referred to allergy clinics quite late, which might be due to SR not being considered as a serious disease.

The prevalence, severity and seasonal variations of asthma, rhinitis and eczema in Taiwanese schoolchildren

The prevalence of asthma is increasing in Taiwan but data remain limited. The aim of this study was to determine the prevalence, severity, demographic and seasonal variations of asthma, rhinitis, and eczema in Taiwan. Using a one-stage stratified cluster random sampling, first grade (aged 6-8) and eighth grade (aged 13-15) students from Taoyuan, northern Taiwan, were invited to participate in this survey. The results showed a total of 6190 students, 3079 aged 6-8 and 3111 aged 13-15, completed this survey. In general, children aged 6-8 had significantly higher prevalence rates of diagnosed asthma, rhinitis, and eczema than children aged 13-15 (12.2%, 29.8%, and 10.2% vs. 9.6%, 18.3%, and 4.7%, respectively). Similarly, children aged 6-8 had significantly higher proportions of allergic symptoms, except for exercise-induced wheezing (5.8% vs. 17.8%, p < 0.0001). Among those with allergic disorders, children aged 6-8 presented a greater severity of wheezing attacks in the last 12 months. As regards gender, boys aged 6-8 had a significantly higher proportion of asthma or rhinitis symptoms than girls aged 6-8 but not in children aged 13-15. In children aged 6-8, asthma and rhinitis peaked in winter, especially in December. However, children aged 13-15 had two peaks (winter and summer) for asthma or rhinitis.

Socioeconomic risk factors for asthma in Chilean young adults

OBJECTIVES

We studied the association between socioeconomic status (SES) and asthma symptoms, severity of asthma, atopy, and bronchial hyperresponsiveness (BHR) to methacholine.

METHODS

We studied 1232 men and women born between 1974 and 1978 in a semirural area of Chile. We assessed asthma symptoms with a standardized questionnaire, atopy with a skin-prick test to 8 allergens, and BHR to methacholine with the tidal breathing method. SES was derived from several indicators: education, occupation, completion of a welfare form, belongings, housing, number of siblings, and overcrowding.

RESULTS

Those with fewer belongings had more asthma symptoms. Those who had higher education and those who owned cars had fewer asthma symptoms and BHR. Overcrowding was negatively related to atopy, atopy with asthma symptoms, and BHR. Higher education and noncompletion of a welfare form were risk factors for atopy.

CONCLUSION

The strength and direction of the association between asthma and SES depended on what definition of asthma was analyzed. Asthma symptoms were more common among poor people. There was some support for the hygiene hypothesis, as overcrowding was associated with less wheezing with atopy, less atopy, and less BHR.

Food hypersensitivity in patients with seasonal rhinitis in Ankara

BACKGROUND

Food hypersensitivity (FH) affects 1-2 % of the adult population and is more common in atopic individuals. The aim of this study was to determine the frequency of FH and risk factors for its development in patients with seasonal rhinitis (SR) in our allergy clinic.

METHODS

We performed a retrospective study based on the medical records of 774 patients out of 955 patients diagnosed with SR in an adult allergy clinic between 1 January 1991 and 31 December 2003.

RESULTS

The mean age of the patients was 29.1 +/- 9.29 and 62.7 % were females. The most common major complaints were due to nasal symptoms in 82.3 %. The mean duration of SR was 6.8 +/- 6.8 years. Patients were symptomatic for a mean of 3.5 +/- 1.7 months per year. Skin prick tests (SPT) with common aeroallergens were positive in 685 patients (90.3 %), and the most common sensitivity was against timothy (85.1 %). The most common accompanying allergic disease was FH in 14 %. FH according to history and the results of SPT performed with food allergens were discordant. The most common clinical manifestations of FH were oral allergy (49.1 %) and cutaneous symptoms (38.9 %). Risk factors for the development of FH in patients with SR were dermatological symptoms, rhinitis duration > 5 years, symptom duration > 3 months per year, SPT reactivity to Artemisia vulgaris, tree pollen allergens (Corylus avellena, Betula verrucosa), and bee allergy.

CONCLUSION

FH was the most common (14 %) accompanying allergic disease in patients with SR. SPT with food allergens have limited diagnostic value for food allergy and/or intolerance. Risk factors for developing FH in patients with SR in Turkey were dermatological symptoms, duration of rhinitis > 5 years, duration of rhinitis symptoms > 3 months per year, and SPT reactivity to Corylus avellena.

The effect of BCG vaccine at birth on the development of atopy or allergic disease in young children

BACKGROUND

Exposure to infectious diseases may reduce the development of asthma or allergy. In particular, the role of the BCG vaccine in modulating asthma or allergy has been a source of speculation.

OBJECTIVE

To study newborns from 3 international sites to evaluate the prospective effect of BCG vaccine on allergic diseases or atopic development.

METHODS

Infants were enrolled from newborn and well-infant clinics in Thailand, Argentina, and Turkey. The standard BCG vaccine for each country was given at birth. Parents who consented to have their infant included in the protocol completed an allergy family questionnaire. Infants underwent a standard purified protein derivative (PPD) test at 9 to 12 months of age, and the reaction size was measured. At the age of 2 years, the children returned to be studied. Allergy skin tests to common allergens appropriate to location and age were performed, and the parents completed the International Study of Allergy and Asthma in Childhood questionnaire. The PPD reaction size was compared with the presence of atopy and allergy questionnaire responses.

RESULTS

A total of 1,704 infants were studied. Statistical significance was found between a negative PPD response vs any positive PPD response and the risk of having an allergic history at the age of 2 years in Turkey (relative risk, 2.11; 95% confidence interval, 1.25-3.55; P = .005) and Thailand (relative risk, 2.16; 95% confidence interval, 1.18-3.94; P = .02) but not Argentina (relative risk, 1.09; 95% confidence interval, 0.70-1.68; P = .70).

CONCLUSIONS

This study further supports the role of infectious agents in modulating asthma and allergy development.

The economic burden of allergic rhinitis: a critical evaluation of the literature

Although a large number of economic analyses of allergic rhinitis have been published, there are relatively few empirically based studies, particularly outside the US. The majority of these analyses can be classified as burden-of-illness studies. Most estimates of the annual cost of allergic rhinitis range from dollars US 2-5 billion (2003 values). The wide range of estimates can be attributed to differences in identifying patients with allergic rhinitis, differences in cost assignment, limitations associated with available data and difficulties in assigning indirect costs (associated with reduced productivity) of allergic rhinitis. Approximately one-third of burden-of-illness studies include direct and indirect costs of allergic rhinitis, about one-third focus on direct costs only, and the remaining one-third focus exclusively on indirect costs due to reduced productivity. Indirect costs attributable to allergic rhinitis were higher in studies only estimating indirect costs (dollars US 5.5-9.7 billion) than in those estimating both direct and indirect costs (dollars US 1.7-4.3 billion). Although there are many economic evaluations of allergic rhinitis treatments in the published medical literature, very few represent formal cost-effectiveness evaluations that compare the incremental costs and benefits of alternative treatment strategies. Those that are incremental cost-effectiveness analyses have several limitations, including small samples, short study periods and the lack of a standardized measure of effectiveness. To date, the medical literature is lacking a comprehensive economic evaluation of general treatment strategies for allergic rhinitis. In undertaking such an analysis, serious consideration must be given to the study population of interest, the choice of appropriate comparators, the perspective from which the analysis is conducted, the target audience, the changing healthcare marketplace and the selection of a measure of effectiveness that incorporates both positive and negative aspects of treatments for allergic rhinitis. Future work would benefit from the development of a consensus on a summary measure of effectiveness that could be used in cost-effectiveness analyses of therapies for allergic rhinitis as well as additional empirical work to measure the association between severity of disease and its impact on worker productivity.

Family history as a predictor of asthma risk

Asthma, one of the most important chronic diseases of children, disproportionately affects minority and low-income children. Many environmental risk factors for asthma have been identified, including animal, mite, and other allergens; cigarette smoke; and air pollutants. Genetics also play an important causative role, as indicated by familial aggregation and the identification of candidate genes and chromosomal regions linked to asthma risk. Using a positive family history of asthma to identify children at increased risk could provide a basis for targeted prevention efforts, aimed at reducing exposure to environmental risk factors. To assess the predictive value of family history as an indicator of risk for childhood asthma, we reviewed population-based studies that evaluated family history of asthma and atopic disease in children with asthma. Our search identified 33 studies from all geographic regions of the world for review. The studies varied in definitions of positive family history and asthma phenotype and used study populations with asthma prevalence ranging from 2% to 26%. Nevertheless, family history of asthma in one or more first-degree relatives was consistently identified as a risk factor for asthma. In ten studies, sensitivity and predictive value of a positive family history of asthma could be calculated: sensitivity ranged from 4% to 43%, positive predictive value from 11% to 37%, and negative predictive value from 86% to 97%. Although a positive family history predicts an increased risk of asthma, it identifies a minority of children at risk. Positive family history may have utility in targeting some individual prevention efforts, but the low positive predictive value limits its value as a means to direct environmental remediation efforts.

Geographical variations of asthma and asthma symptoms among schoolchildren aged 5 to 8 years and 12 to 15 years in Palestine: the International Study of Asthma and Allergies in Childhood (ISAAC)

BACKGROUND

Many studies demonstrated the existence of geographic differences, within and between countries, in the prevalence of asthma, rhinitis, and eczema. However, in Palestine, there are no comprehensive Palestinian data to compare with those from other regional and international centers.

OBJECTIVE

To describe the prevalence of asthma and asthma symptoms in schoolchildren in two districts (Ramallah and North Gaza) in Palestine.

METHODS

After a two-stage stratified systematic sampling, approximately 14,500 schoolchildren, from the first and second grades of elementary school (ages 5 to 8 years) and eighth and ninth school grades (ages 12 to 15 years), were invited to participate in a survey using International Study of Asthma and Allergies in Childhood phase III questionnaires and protocols.

RESULTS

In general, younger children were reported to have a higher 12-month wheezing prevalence rate than older children (9.6 and 7.2%, respectively), and more physician-diagnosed asthma (8.4 and 5.9%, respectively). However, nocturnal cough and exercise-related wheezing were higher in the older age group compared with younger children. Younger children living in North Gaza district showed slightly higher prevalence rates for asthma and asthma symptoms, but older children had higher rates in Ramallah district. After adjustment using logistic regression analysis, male sex, living in inland areas, and younger age were shown to predict 12-month wheezing and physician-diagnosed asthma.

CONCLUSIONS

Palestinian children have asthma symptoms rates that are similar to several countries in the Mediterranean region such as Spain and Turkey, but still lower than other Middle East countries such as Saudi Arabia and Israel.