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Background - Cross‐sectional studies suggested that allergy prevalence in childhood is higher in boys compared to girls, but it remains unclear whether this inequality changes after puberty. We examined the sex‐specific prevalence of asthma and rhinitis as single and as multimorbid diseases before and after puberty onset in longitudinal cohort data. Methods - In six European population‐based birth cohorts of MeDALL, we assessed the outcomes: current rhinitis, current asthma, current allergic multimorbidity (ie, concurrent asthma and rhinitis), puberty status and allergic sensitization by specific serum antibodies (immunoglobulin E) against aero‐allergens. With generalized estimating equations, we analysed the effects of sex, age, puberty (yes/no) and possible confounders on the prevalence of asthma and rhinitis, and allergic multimorbidity in each cohort separately and performed individual participant data meta‐analysis. Findings - We included data from 19 013 participants from birth to age 14‐20 years. Current rhinitis only affected girls less often than boys before and after puberty onset: adjusted odds ratio for females vs males 0.79 (95%‐confidence interval 0.73‐0.86) and 0.86 (0.79‐0.94), respectively (sex‐puberty interaction P = .089). Similarly, for current asthma only, females were less often affected than boys both before and after puberty onset: 0.71, 0.63‐0.81 and 0.81, 0.64‐1.02, respectively (sex‐puberty interaction P = .327). The prevalence of allergic multimorbidity showed the strongest sex effect before puberty onset (female‐male‐OR 0.55, 0.46‐0.64) and a considerable shift towards a sex‐balanced prevalence after puberty onset (0.89, 0.74‐1.04); sex‐puberty interaction: P < .001. Interpretation - The male predominance in prevalence before puberty and the “sex‐shift” towards females after puberty onset were strongest in multimorbid patients who had asthma and rhinitis concurrently. European Union under the Health Cooperation Work Programme of the 7th Framework Programme. Grant Number: 261357

Background: While the prevalence of childhood wheeze continues to increase in many countries, decreasing trends have also been reported. This may be explained by increased use of asthma medication, which effectively suppresses wheeze symptoms. In this study we investigated trends in wheeze in Dutch school children between 1989 and 2005, and their association with medication use. Methods: In five repeated cross-sectional surveys between 1989 and 2005, parents of all 5- to 6-year-old and 8- to 11-year-old children eligible for a routine physical examination were asked to complete a questionnaire on their child's respiratory health. We identified all children for whom a questionnaire was completed in two successive surveys. Children were grouped according to birth year and classified into one out of four wheeze categories: "no wheeze," "discontinued wheeze," "continued wheeze," or "new-onset wheeze." Results: In total, 3,339 children, born in 1983 (N = 670), 1988 (N = 607), 1992 (N = 980), and 1995 (N = 1,082), participated twice. Over the study period, the proportion of children with "no wheeze" increased from 73.8% to 86.1% (P-trend 0.05 for all wheeze categories). Conclusion: An increasing trend of Dutch school children with " no wheeze," and decreasing trends of children with "discontinued" and "continued" wheeze between 1989 and 2005 could not be explained by (increased) medication use. This suggests that wheeze prevalence is not masked by medication use, but is truly declining. (C) 2014 Wiley Periodicals, Inc.

Background and Aim The burden of childhood asthma and its risk factors is an important but neglected public health challenge in Latin America. We investigated the association between allergic symptoms and dietary intake in children from this region. Methods As part of the International Study of Asthma and Allergies in Childhood (ISAAC) Phase III, questionnaire collected dietary intake was investigated in relation to risk of parental/child reported current wheeze (primary outcome) and rhino-conjunctivitis and eczema. Per-country adjusted logistic regressions were performed, and combined effect sizes were calculated with meta-analyses. Results 143,967 children from 11 countries had complete data. In children aged 6–7 years, current wheeze was negatively associated with higher fruit intake (adjusted odds ratio [aOR] 0.65; 95% CI 0.74, 0.97). Current rhino-conjunctivitis and eczema were statistically negatively associated with fruit intake (aOR 0.72; 95% CI 0.64, 0.82; and OR 0.64, 95% CI 0.56, 0.74, respectively). Vegetable intake was negatively associated with risk of symptoms in younger children, but these associations were attenuated in the 13–14 years old group. Fastfood/burger intake was positively associated with all three outcomes in the older children. Conclusion A higher intake of fruits and vegetables was associated with a lower prevalence of allergic symptoms in Latin American children. Conversely, intake of fastfood was positively associated with a higher prevalence of wheeze in adolescents. Improved dietary habits in children might help reduce the epidemic of allergic symptoms in Latin America. Food interventions in asthmatic children are needed to evaluate the possible public health impact of a better diet on respiratory health. Electronic supplementary material The online version of this article (doi:10.1007/s00408-017-0044-z) contains supplementary material, which is available to authorized users.

We sought to examine the relationship globally between UVR dose exposure and current eczema prevalences. ISAAC Phase Three provided data on eczema prevalence for 13- to 14-year-olds in 214 centers in 87 countries and for 6- to 7-year-olds in 132 centers in 57 countries. Linear and nonlinear associations between (natural log transformed) eczema prevalence and the mean, maximum, minimum, standard deviation, and range of monthly UV dose exposures were assessed using linear mixed-effects regression models. For the 13- to 14-year-olds, the country-level eczema prevalence was positively and linearly associated with country-level monthly mean (prevalence ratio = 1.31 [95% confidence interval = 1.05-1.63] per kJ/m2) and minimum (1.25 [1.06-1.47] per kJ/m2) UVR dose exposure. Linear and nonlinear associations were also observed for other metrics of UV. Results were similar in trend, but nonsignificant, for the fewer centers with 6- to 7-year-olds (e.g., 1.24 [0.96-1.59] per kJ/m2 for country-level monthly mean UVR). No consistent within-country associations were observed (e.g., 1.05 [0.89-1.23] and 0.92 [0.71-1.18] per kJ/m2 for center-level monthly mean UVR for the 13- to 14- and 6- to 7-year-olds, respectively). These ecological results support a role for UVR exposure in explaining some of the variation in global childhood eczema prevalence. This work was supported by a Marie Skłodowska-Curie Individual Fellowship (H2020-MSCA-IF-2015; proposal number 704268)

Whether exposure to outdoor air pollution increases the prevalence of rhinoconjunctivitis in children is unclear. Using data from Phase Three of the International Study of Asthma and Allergies in childhood (ISAAC), we investigated associations of rhinoconjunctivitis prevalence in adolescents with model-based estimates of ozone, and satellite-based estimates of fine (diameter

Summary Background Eczema, rhinitis, and asthma often coexist (comorbidity) in children, but the proportion of comorbidity not attributable to either chance or the role of IgE sensitisation is unknown. We assessed these factors in children aged 4–8 years. Methods In this prospective cohort study, we assessed children from 12 ongoing European birth cohort studies participating in MeDALL (Mechanisms of the Development of ALLergy). We recorded current eczema, rhinitis, and asthma from questionnaires and serum-specific IgE to six allergens. Comorbidity of eczema, rhinitis, and asthma was defined as coexistence of two or three diseases in the same child. We estimated relative and absolute excess comorbidity by comparing observed and expected occurrence of diseases at 4 years and 8 years. We did a longitudinal analysis using log-linear models of the relation between disease at age 4 years and comorbidity at age 8 years. Findings We assessed 16 147 children aged 4 years and 11 080 aged 8 years in cross-sectional analyses. The absolute excess of any comorbidity was 1·6% for children aged 4 years and 2·2% for children aged 8 years; 44% of the observed comorbidity at age 4 years and 50·0% at age 8 years was not a result of chance. Children with comorbidities at 4 years had an increased risk of having comorbidity at 8 years. The relative risk of any cormorbidity at age 8 years ranged from 36·2 (95% CI 26·8–48·8) for children with rhinitis and eczema at age 4 years to 63·5 (95% CI 51·7–78·1) for children with asthma, rhinitis, and eczema at age 4 years. We did longitudinal assessment of 10 107 children with data at both ages. Children with comorbidities at 4 years without IgE sensitisation had higher relative risks of comorbidity at 8 years than did children who were sensitised to IgE. For children without comorbidity at age 4 years, 38% of the comorbidity at age 8 years was attributable to the presence of IgE sensitisation at age 4 years. Interpretation Coexistence of eczema, rhinitis, and asthma in the same child is more common than expected by chance alone—both in the presence and absence of IgE sensitisation—suggesting that these diseases share causal mechanisms. Although IgE sensitisation is independently associated with excess comorbidity of eczema, rhinitis, and asthma, its presence accounted only for 38% of comorbidity, suggesting that IgE sensitisation can no longer be considered the dominant causal mechanism of comorbidity for these diseases. Funding EU Seventh Framework Programme.

The aim of the present study was to establish the differences in dyspnoea perception between children with undiagnosed and diagnosed asthma. A cross-sectional community-based study was performed, which included a parental questionnaire on the child's respiratory health and testing of airway reversibility and bronchial hyperresponsiveness (BHR). "Diagnosed asthma" was defined by a physician's diagnosis of asthma. "Undiagnosed asthma" was defined by the presence of asthma symptoms combined with either airway reversibility or BHR without a physician's diagnosis of asthma. Only children with a positive BHR test were selected for further analysis. Perception of dyspnoea was assessed using the Borg scale and the visual analogue scale (VAS), plotted against the percentage fall in forced expiratory volume in one second and expressed as the slope of the regression line. Of the initial 1,758 participating children, 70 had undiagnosed asthma and 38 had diagnosed asthma. The Borg and VAS slopes in children with undiagnosed asthma were less steep than those of children with diagnosed asthma (Borg: 0.07 and 0.14, respectively; VAS: 0.06 and 0.11, respectively). Among children with bronchial hyperresponsiveness, those without a parent's report of physician's diagnosis of asthma had a worse perception of dyspnoea than children with diagnosed asthma.

Background: Asthma and excessive body weight frequently coexist, whereas the exact relationship between the 2 diseases is unknown.Objective: To study whether asthma combined with excessive body weight has a greater effect on quality of life in children than the separate effects of asthma or excessive body weight alone. Methods: In a cross-sectional design, 1758 school children (age 7-10 years) participated: 4 study groups were composed of children with asthma and with/without excessive body weight, and healthy controls with/without excessive body weight. Diagnosis of asthma was defined by either a doctor's diagnosis or by core questions of the International Study of Asthma and Allergies in Childhood questionnaire in combination with either reversible airway obstruction or bronchial hyperresponsiveness. Excessive body weight was defined by using international cutoff points for body mass index. Quality of life was evaluated by the Pediatric Asthma Quality of Life Questionnaire.Results: For all domains of quality of life, children with both asthma and excessive body weight had lower scores than children with either asthma alone or excessive body weight alone. Compared with healthy controls, the score was 25% lower in children with asthma and excessive body weight, 14% lower in children with asthma and normal weight, and only 1% lower in overweight controls.Conclusion: Excessive body weight is associated with an additional decrease in quality of life in children with asthma. Clinical implications: Clinicians should be aware of the interaction between asthma and excessive body weight and the effect on quality of life and should give extra attention to children with both conditions.

To establish whether asthma affects physical activity levels in children (aged 7-10 years) we evaluated physical activity levels in children with undiagnosed asthma (UDA), diagnosed asthma (DA), and healthy controls (HCs). A cross-sectional community-based study was performed which included a parental questionnaire on their child's respiratory health, and testing of airway reversibility and bronchial hyperresponsiveness (BHR). DA was defined as the parents' confirmation of a physician's diagnosis of asthma in the past 12 months. UDA was defined by asthma symptoms combined with airway reversibility or BHR in children without a physician's diagnosis of asthma. Physical activity was measured during 5 days with an accelerometer and a diary, and with the habitual activity estimation scale which reviews the physical activity during the past 2 weeks. The final study population comprised 1,614 children of whom 81 (5%) had DA, 130 (8%) UDA, and 202 HCs. Baseline FEV(1) % was lowest in children with UDA (UDA FEV(1) 94% predicted, DA FEV(1) 98% predicted, HCs FEV(1) 100% predicted). Using the three methods, no differences were found in the physical activity between children with UDA, DA, and HCs. Childhood asthma does not appear to be associated with a decreased level of daily physical activity in our study population.

Background: While the prevalence of childhood wheeze continues to increase in many countries, decreasing trends have also been reported. This may be explained by increased use of asthma medication, which effectively suppresses wheeze symptoms. In this study we investigated trends in wheeze in Dutch school children between 1989 and 2005, and their association with medication use. Methods: In five repeated cross-sectional surveys between 1989 and 2005, parents of all 5- to 6-year-old and 8- to 11-year-old children eligible for a routine physical examination were asked to complete a questionnaire on their child's respiratory health. We identified all children for whom a questionnaire was completed in two successive surveys. Children were grouped according to birth year and classified into one out of four wheeze categories: "no wheeze," "discontinued wheeze," "continued wheeze," or "new-onset wheeze." Results: In total, 3,339 children, born in 1983 (N = 670), 1988 (N = 607), 1992 (N = 980), and 1995 (N = 1,082), participated twice. Over the study period, the proportion of children with "no wheeze" increased from 73.8% to 86.1% (P-trend 0.05 for all wheeze categories). Conclusion: An increasing trend of Dutch school children with " no wheeze," and decreasing trends of children with "discontinued" and "continued" wheeze between 1989 and 2005 could not be explained by (increased) medication use. This suggests that wheeze prevalence is not masked by medication use, but is truly declining. (C) 2014 Wiley Periodicals, Inc.

Background: \ud The high prevalence of children's asthma symptoms, worldwide, is unexplained. We examined the relation between maternal pre-pregnancy weight and body mass index (BMI), and asthma symptoms in adolescents. \ud \ud Methods: \ud Data from 6945 adolescents born within the Northern Finland Birth Cohort 1986 were used. Prospective antenatal and birth outcome data, including maternal pre-pregnancy weight and BMI, and asthma symptoms in adolescent offspring at age 15–16 years, were employed. Logistic regression analyses were performed to examine the associations between relevant prenatal factors and asthma symptoms during adolescence. \ud \ud Results: \ud Current wheeze (within the past year) was reported by 10.6% of adolescents, and physician-diagnosed asthma by 6.0%. High maternal pre-pregnancy BMI was a significant predictor of wheeze in the adolescents (increase per kilogram per square metre unit; 2.7%, 95% CI 0.9 to 4.4 for ever wheeze; 3.5%, 95% CI 1.3 to 5.8 for current wheeze), and adjusting for potential confounders further increased the risk (2.8%, 95% CI 0.5 to 5.1; 4.7%, 95% CI 1.9 to 7.7, respectively). High maternal pre-pregnancy weight, in the top tertile, also significantly increased the odds of current wheeze in the adolescent by 20% (95% CI 4 to 39), and adjusting for potential confounders further increased the risk (OR=1.52, 95% CI 1.19 to 1.95). Results were similar for current asthma. Furthermore, these significant associations were observed only among adolescents without parental history of atopy but not among those with parental history of atopy. \ud \ud Conclusions: \ud The association demonstrated here between maternal pre-pregnancy overweight and obesity, and asthma symptoms in adolescents suggests that increase in asthma may be partly related to the rapid rise in obesity in recent years.

This study describes the impact of undiagnosed and diagnosed asthma on quality of life in schoolchildren aged 7-10 years and their caregivers in a cross-sectional community-based study. Diagnosed asthma was defined as the parents' confirmation of a physician's diagnosis of asthma. Undiagnosed asthma was defined by asthma symptoms combined with airway reversibility or bronchial hyperresponsiveness. Quality of life was evaluated in all children with asthma and a sample of healthy controls by the Pediatric Asthma Quality of Life Questionnaire, and by the Paediatric Asthma Caregiver's Quality of Life Questionnaire. We studied the impact of breathing problems on school absence. Compared with healthy controls, quality of life scores among children and their caregivers were lower if the child had asthma ( P