Increase in chronic or recurrent rhinitis, rhinoconjunctivitis and eczema among schoolchildren in Greece: three surveys during 1991-2003

Diverging trends of respiratory allergies and eczema in Greek schoolchildren: Six surveys during 1991-2018

Background: The prevalence of childhood asthma, rhinoconjunctivitis, and eczema in the city of Patras, Greece, has been followed in four consecutive surveys since 1991. After a continuous rise in the prevalence of all three of these disorders, a plateau was reached for asthma between 2003 and 2008, whereas the prevalence of rhinoconjunctivitis and eczema continued to increase. Objective: To investigate these trends in the same population into the following decade. Methods: We repeated two methodologically identical cross-sectional parental questionnaire surveys in 2013 and 2018 among 8-9-year-old schoolchildren (N = 2554 and N = 2648, respectively). In 2018, spirometry and fractional exhaled nitric oxide (FeNO) measurements were also performed. Results: Current asthma (i.e., wheeze/asthma in the past 2 years) decreased from 6.9% in 2008 to 5.2% in 2013 and 4.3% in 2018 (p for trend < 0.001). The prevalence of lifetime ("ever had") rhinoconjunctivitis also declined (5.1% in 2008, 4.4% in 2013, 3.0% in 2018; p for trend < 0.001), whereas that of lifetime eczema increased (10.8%, 13.6%, and 16.1%, respectively; p for trend < 0.001). The relative risk of current asthma in children with ever-had rhinoconjundtivitis was 7.73 in 2008, 6.00 in 2013, and 6.69 in 2018, whereas the relative risk in those with ever-had eczema was 5.15, 2.80, and 2.22, respectively. Among children with asthma, those with rhinoconjunctivitis had lower forced expiratory volume in the first second of expiration and higher FeNO values than those with eczema. Conclusion: The prevalence of asthma and rhinoconjunctivitis declined during the past decade in Greek schoolchildren, whereas the prevalence of eczema continued to rise. Nevertheless, the relationship between rhinoconjunctivitis and asthma remained strong, whereas the association between eczema and asthma appears to have weakened.

Risk factors for readmission of children hospitalized with acute asthma attacks in South China

OBJECTIVE

Asthma seriously endangers the health of children. Re-hospitalization for childhood asthma consumes a large amount of medical and health resources. The present study aimed to assess the rates and risk factors for hospital readmission of children with acute asthma attacks in south China.

METHODS

We retrospectively enrolled 1702 acute asthma patients aged < 18 years from 1/1/2007 to 12/31/2015. Patients who were readmitted within one year after index hospital discharge were divided into a readmission group. Index hospitalization data were acquired from clinical records. Chi-square tests and multivariate logistic regression analyses were used to evaluate the risk factors.

RESULTS

There were 90 (5.29%) readmitted patients from 1702 acute asthma patients. Considering the large sample differences between readmitted and single-admitted patients, 123 single-admitted patients (1.5-fold as many as the readmitted group) were randomly selected. Further univariate Chi-square tests and multivariate logistic regression analyses showed that the predictors of readmission included eczema history (odds ratio (OR) 3.122, p = 0.003) and mycoplasma pneumoniae (MP) antibody immunoglobulin M(IgM) (OR 2.386, p = 0.037).

CONCLUSIONS

Among the children admitted to a hospital in south China with acute asthma attacks, 5.29% were readmitted within the following year. Patients with history of eczema and positive MP antibody IgM had significantly increased the chances of one-year readmission, underlining the importance of targeted long-term postdischarge follow-up of these children.

Sex-Related Allergic Rhinitis Prevalence Switch from Childhood to Adulthood: A Systematic Review and Meta-Analysis

BACKGROUND

A sex-related switch in the prevalence of asthma from childhood (male predominance) to adulthood (female predominance) has been described, but for allergic rhinitis this remains unclear. We aimed to examine sex- and age-group-specific differences in allergic rhinitis prevalence by systematically evaluating studies from across the globe.

METHODS

A systematic search of MEDLINE and Embase for population-based cross-sectional studies was performed regardless of the language of publication. The search was restricted to the present millennium (2000 to June 2014). Study quality was defined by the sampling method, response rate, sample size, and data collection method. To assess sex differences in the prevalence of self- or parent-reported symptoms of rhinitis, calculated pooled estimates of the male-female ratio (MFR) were obtained using random-effects model meta-analyses due to heterogeneity. A meta-regression analysis was also performed.

RESULTS

Out of 6,539 publications identified, 67 cross-sectional population-based studies (291,726 males and 301,781 females) were included in our meta-analysis. In children (<11 years of age) significantly more boys than girls had rhinitis symptoms (MFR 1.21, 95% CI 1.17-1.25), whereas in adolescents (11 to <18 years of age) males were significantly less often affected than females (MFR 0.90, 95% CI 0.85-0.95). No sex-specific prevalence difference was observed in adults (MFR 0.96, 95% CI 0.83-1.17). These findings were consistent in all continents except in Asia, where the male predominance remained beyond childhood.

CONCLUSIONS

The male predominance of rhinitis prevalence in childhood changed towards a female predominance in adolescence across the globe, except in Asia. Longitudinal studies are needed to confirm these cross-sectional data and examine possible determinants and underlying mechanisms.

Modifiable exposures to air pollutants related to asthma phenotypes in the first year of life in children of the EDEN mother-child cohort study

Background

Studies have shown diverse strength of evidence for the associations between air pollutants and childhood asthma, but these associations have scarcely been documented in the early life. The purpose of this study was to evaluate the impacts of various air pollutants on the development of asthma phenotypes in the first year of life.

Methods

Adjusted odds ratios were estimated to assess the relationships between exposures to air pollutants and single and multi-dimensional asthma phenotypes in the first year of life in children of the EDEN mother-child cohort study (n = 1,765 mother-child pairs). The Generalized Estimating Equation (GEE) model was used to determine the associations between prenatal maternal smoking and in utero exposure to traffic-related air pollution and asthma phenotypes (data were collected when children were at birth, and at 4, 8 and 12 months of age). Adjusted Population Attributable Risk (aPAR) was estimated to measure the impacts of air pollutants on health outcomes.

Results

In the first year of life, both single and multi-dimensional asthma phenotypes were positively related to heavy parental smoking, traffic-related air pollution and dampness, but negatively associated with contact with cats and domestic wood heating. Adjusted odds ratios (aORs) for traffic-related air pollution were the highest [1.71 (95% Confidence Interval (CI): 1.08-2.72) for ever doctor-diagnosed asthma, 1.44 (95% CI: 1.05-1.99) for bronchiolitis with wheezing, 2.01 (95% CI: 1.23-3.30) for doctor-diagnosed asthma with a history of bronchiolitis]. The aPARs based on these aORs were 13.52%, 9.39%, and 17.78%, respectively. Results persisted for prenatal maternal smoking and in utero exposure to traffic-related air pollution, although statistically significant associations were observed only with the asthma phenotype of ever bronchiolitis.

Conclusions

After adjusting for potential confounders, traffic-related air pollution in utero life and in the first year of life, had a greater impact on the development of asthma phenotypes compared to other factors.

Investigating international time trends in the incidence and prevalence of atopic eczema 1990-2010: a systematic review of epidemiological studies

The prevalence of atopic eczema has been found to have increased greatly in some parts of the world. Building on a systematic review of global disease trends in asthma, our objective was to study trends in incidence and prevalence of atopic eczema. Disease trends are important for health service planning and for generating hypotheses regarding the aetiology of chronic disorders. We conducted a systematic search for high quality reports of cohort, repeated cross-sectional and routine healthcare database-based studies in seven electronic databases. Studies were required to report on at least two measures of the incidence and/or prevalence of atopic eczema between 1990 and 2010 and needed to use comparable methods at all assessment points. We retrieved 2,464 citations, from which we included 69 reports. Assessing global trends was complicated by the use of a range of outcome measures across studies and possible changes in diagnostic criteria over time. Notwithstanding these difficulties, there was evidence suggesting that the prevalence of atopic eczema was increasing in Africa, eastern Asia, western Europe and parts of northern Europe (i.e. the UK). No clear trends were identified in other regions. There was inadequate study coverage worldwide, particularly for repeated measures of atopic eczema incidence. Further epidemiological work is needed to investigate trends in what is now one of the most common long-term disorders globally. A range of relevant measures of incidence and prevalence, careful use of definitions and description of diagnostic criteria, improved study design, more comprehensive reporting and appropriate interpretation of these data are all essential to ensure that this important field of epidemiological enquiry progresses in a scientifically robust manner.

Comparison in asthma and allergy prevalence in the two major cities in Greece: the ISAAC phase II survey

BACKGROUND

Variability in the prevalence of allergic diseases has been detected not only between different countries, but also between cities with similar national and different socio-economic or climatic characteristics. The aim of this study was to determine the prevalence of childhood asthma and allergies and which factors are associated with them, in the two largest Greek cities, Athens and Thessaloniki.

METHODS

Two thousand and twenty-three Greek 9-10-year-old schoolchildren from Athens (Central Greece) and Thessaloniki (North Greece, more humid), were included in ISAAC-II study. All participants followed the ISAAC-II protocol by questionnaire, skin prick testing and flexural dermatitis examination.

RESULTS

Compared with Athens, the prevalence of current wheezing (8.4% vs. 5.7%, p=0.002), lifetime asthma (11.5% vs. 7.7%, p=0.004), atopic current asthma (3.2% vs. 1.6%, p=0.02), allergic rhinitis (8.2% vs. 5.2%, p=0.007), and hay fever (21.7% vs. 12.5%, p<0.001) were higher in Thessaloniki. The overall sensitisation rate was also higher in Thessaloniki than in Athens (25.2% vs. 16%, p<0.001) with more prevalent sensitising due to the perennial allergens (D. pteronyssinus, D. farinae, Alternaria tenuis) and cat dander. Perennial allergens sensitisation was a risk factor for current asthma in both cities.

CONCLUSION

A higher prevalence of asthma symptoms, allergic rhinitis, and sensitisation rate was detected in Greek schoolchildren living in Thessaloniki compared to those in Athens. Allergy to mites and mould was more prevalent in Thessaloniki. The more humid weather of Thessaloniki may be implicated.

Quantitative assessments of indoor air pollution and respiratory health in a population-based sample of French dwellings

BACKGROUND

Various volatile organic compounds (VOCs) have been related to respiratory health effects, but have generally been assessed individually without taking into account the fact that such pollutants are highly correlated to one other.

AIMS

We investigated the effects of exposure to various VOC, and considered their combined effect on adult asthma and rhinitis.

METHOD

A national cross-sectional representative survey conducted by the Indoor Air Quality Observatory objectively assessed 20 VOCs in 490 main dwellings in France. A standardized questionnaire determined the prevalence of asthma and rhinitis among 1012 inhabitants of the dwellings (≥ 15 years). Marginal models for binary outcome were used to relate VOCs exposure to asthma and rhinitis, controlling for potential confounders. A global score representing the number of VOCs in each dwelling with an elevated concentration (using the 3(rd) quartile value of the distribution as a threshold value) was then derived as a measure of the combined effect of VOCs. Specific scores were built using a similar approach, grouping VOCs by family.

RESULTS

Asthma (8.6%) was significantly associated with N-undecane and 1,2,4-trimethylbenzene and rhinitis (38.3%) with ethylbenzene, trichloroethylene, m/p- and o-xylene. The global VOC score was associated with a significant risk of asthma and rhinitis (odds ratio (OR) of 1.40 and 1.22, respectively, for 5 additional VOCs with high exposure level). Both specific scores for aromatic hydrocarbons and aliphatic hydrocarbons were associated with a significantly risk of asthma (OR=1.12; 95% confidence interval (CI): 1.01-1.24 and OR=1.41; 95% CI=1.03-1.93, respectively). The specific VOC score for halogenated hydrocarbons was associated with a significant risk of rhinitis (OR=1.28; 95% CI: 1.07-1.54).

CONCLUSION

We have shown that high concentrations of VOCs in homes were associated with an increasing prevalence of asthma and rhinitis in adults.

Prevalence of childhood asthma and allergies in Serbia and Montenegro

BACKGROUND

This is the first multi-center epidemiological study on the prevalence of childhood asthma in Serbia and Montenegro. The International Study of Asthma and Allergies in Childhood (ISAAC) phase 3 is a large epidemiological multinational and multicentric study on the prevalence of asthma, allergic rhinitis and eczema in children.

METHODS

The 12-month period prevalence of asthma, allergic rhinitis and eczema was calculated using an ISAAC phase 3 questionnaire for two age groups: 6-7 years old and 13-14 years old.

RESULTS

In the 13 485 children from five study centers who responded to the questionnaire, the prevalence for childhood asthma ranged from 2.5% to 9.8%, for allergic rhinoconjunctivitis (hay fever) from 4.6% to 21%, and for eczema from 8.2% to 17.2%. The prevalence of current wheezing was high in both age groups (16.5% and 12.4% respectively).

CONCLUSIONS

The prevalence of asthma is higher in 6-7 years old school children in the urban and largest cities of Belgrade and Nis, and in 13-14 years old children in Podgorica. The prevalence of asthma, allergic rhinitis and eczema in the school children of Serbia and Montenegro seems similar to that of other countries in Central and South-Eastern Europe.

The natural history of allergic rhinitis in childhood

The distinction between 'seasonal' and 'perennial' allergic rhinitis (AR) is not always adequate. The 'Allergic Rhinitis and its Impact on Asthma' (ARIA) work group suggested a new classification for AR based on severity and duration of symptoms. Our primary aim was to describe the natural history and burden of AR according to the new ARIA criteria in a population-based birth cohort study of children up to 13 yr. We defined symptoms as 'severe' (impairment of daily activities) or 'mild' (no impairment) and 'persistent' (duration > 1 month) or 'intermittent' (<or=1 month) using annual questionnaires. Serum immunoglobulin E to five common aero-allergens was determined at six time points. We analyzed complete follow-up data from 467 children (54% boys). The 12-month prevalence of AR quadrupled from 6% (at age 3 yr) to 24% (at age 13 yr) in children with non-allergic parents and more than tripled from 13% (3 yr) to 44% (13 yr) in children with at least one allergic parent. Half or more of the children with AR had 'severe persistent' symptoms. At age 13, these children were significantly more often sensitized than those with 'mild persistent' disease: 91% vs. 70% (p = 0.015). Sensitization to aero-allergens (adjusted OR 18.9; 95%CI 9.3-38.4) and having 2 parents with allergy (3.1; 1.1-9.3) were significantly associated with AR. According to the ARIA criteria, the impact of AR seems to be substantial; the vast majority of affected children suffered persistently for periods of 2 months or more annually, and most of the children with persistent AR were impaired in their daily activities.