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1. Can environment or allergy explain international variation in prevalence of wheeze in childhood?

Author

Weinmayr, G., Jaensch, A., Ruelius, A. -K., Forastiere, F., Strachan, D. P., Weiland, S. K., Buchele, G., Dentler, C., Rzehak, P., Priftanji, A., Shkurti, A., Simenati, J., Grabocka, E., Shyti, K., Agolli, S., Gurakuqi, A., Stein, R. T., de Pereira, M. U., Jones, M. H., Pitrez, P. M., Cooper, P. J., Chico, M., Chen, Y. Z., Zhong, N. S., Lai, C. K. W., Wong, G. W. K., Riikjarv, M. -A., Annus, T., Annesi-Maesano, I., Gotua, M., Rukhadze, M., Abramidze, T., Kvachadze, I., Karsanidze, L., Kiladze, M., Dolidze, N., Leupold, W., Keil, U., von Mutius, E., Arthur, P., Addo-Yobo, E., Gratziou, C., Priftis, K., Papadopoulou, A., Katsardis, C., Tsanakas, J., Hatziagorou, E., Kirvassilis, F., Clausen, M., Shah, J. R., Mathur, R. S., Khubchandani, R. P., Mantri, S., Di Domenicantonio, R., De Sario, M., Sammarro, S., Pistelli, Riccardo, Serra, M. G., Corbo, Giuseppe Maria, Perucci, C. A., Svabe, V., Sebre, D., Casno, G., Novikova, I., Bagrade, L., Brunekreef, B., Schram, D., Doekes, G., Jansen-van Vliet, P. H. N., Janssen, N. A. H., Aarts, F. J. H., de Meer, G., Crane, J., Wickens, K., Barry, D., Nystad, W., Bolle, R., Lund, E., Batlles Garrido, J., Rubi Ruiz, T., Bonillo Perales, A., Gonzalez Jimenez, Y., Aguirre Rodriguez, J., Momblan deCabo, J., Losilla Maldonado, A., Daza Torres, M., Garcia-Marcos, L., Martinez Torres, A., Guillen Perez, J. J., Pinana Lopez, A., Castejon Robles, S., Garcia Hernandez, G., Martinez Gimeno, A., Moro Rodriguez, A. L., Luna Paredes, C., Gonzalez Gil, I., Morales Suarez-Varela, M. M., Llopis Gonzalez, A., Escribano Montaner, A., Tallon Guerola, M., Braback, L., Kjellman, M., Nilsson, L., Mai, X. -M., Sandin, A., Saraclar, Y., Kuyucu, S., Tuncer, A., Sackesen, C., Sumbuloglu, V., Geyik, P., Kocabas, C., Kaur, B., El-Sharif, N., Nemery, B., Barghuthy, F., Abu Huij, S., Qlebo, M., van Hage, M., Ait-Khaled, N., Anderson, H. R., Flohr, C., Williams, John Harford, Asher, I., Ellwood, P., Stewart, A., Mitchell, E., Pearce, N., Beasley, R., Bjorksten, B., Foliaki, S., Mallol, J., Montefort, S., Odhiambo, J., and Robertson, C.

Subjects
International variation, medicine.medical_specialty, Allergy, Epidemiology, Settore MED/10 - MALATTIE DELL'APPARATO RESPIRATORIO, Environment, 030204 cardiovascular system & hematology, Global Health, medicine.disease_cause, Atopy, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Surveys and Questionnaires, Wheeze, Hypersensitivity, Prevalence, Humans, Medicine, Environmental risk factors, 030212 general & internal medicine, Risk factor, Child, Asthma, business.industry, Public health, Aeroallergen, medicine.disease, medicine.symptom, business, Demography
Abstract

Asthma prevalence in children varies substantially around the world, but the contribution of known risk factors to this international variation is uncertain. The International Study of Asthma and Allergies in Childhood (ISAAC) Phase Two studied 8-12 year old children in 30 centres worldwide with parent-completed symptom and risk factor questionnaires and aeroallergen skin prick testing. We used multilevel logistic regression modelling to investigate the effect of adjustment for individual and ecological risk factors on the between-centre variation in prevalence of recent wheeze. Adjustment for single individual-level risk factors changed the centre-level variation from a reduction of up to 8.4% (and 8.5% for atopy) to an increase of up to 6.8%. Modelling the 11 most influential environmental factors among all children simultaneously, the centre-level variation changed little overall (2.4% increase). Modelling only factors that decreased the variance, the 6 most influential factors (synthetic and feather quilt, mother's smoking, heating stoves, dampness and foam pillows) in combination resulted in a 21% reduction in variance. Ecological (centre-level) risk factors generally explained higher proportions of the variation than did individual risk factors. Single environmental factors and aeroallergen sensitisation measured at the individual (child) level did not explain much of the between-centre variation in wheeze prevalence.

Published
2018

2. Can environment or allergy explain international variation in prevalence of wheeze in childhood?

Author

Weinmayr G, Jaensch A, Ruelius A, Forastiere F, Strachan D, Weiland S, Buchele G, Dentler C, Rzehak P, Priftanji A, Shkurti A, Simenati J, Grabocka E, Shyti K, Agolli S, Gurakuqi A, Stein R, de Pereira M, Jones M, Pitrez P, Cooper P, Chico M, Chen Y, Zhong N, Lai C, Wong G, Riikjarv M, Annus T, Annesi-Maesano I, Gotua M, Rukhadze M, Abramidze T, Kvachadze I, Karsanidze L, Kiladze M, Dolidze N, Leupold W, Keil U, von Mutius E, Arthur P, Addo-Yobo E, Gratziou C, Priftis K, Papadopoulou A, Katsardis C, Tsanakas J, Hatziagorou E, Kirvassilis F, Clausen M, Shah J, Mathur R, Khubchandani R, Mantri S, Di Domenicantonio R, De Sario M, Sammarro S, Pistelli R, Serra M, Corbo G, Perucci C, Svabe V, Sebre D, Casno G, Novikova I, Bagrade L, Brunekreef B, Schram D, Doekes G, Jansen-van Vliet P, Janssen N, Aarts F, de Meer G, Crane J, Wickens K, Barry D, Nystad W, Bolle R, Lund E, Garrido J, Ruiz T, Perales A, Jimenez Y, Rodriguez J, de Cabo J, Maldonado A, Torres M, Garcia-Marcos L, Torres A, Perez J, Lopez A, Robles S, Hernandez G, Gimeno A, Rodriguez A, Paredes C, Gil I, Suarez-Varela M, Gonzalez A, Montaner A, Guerola M, Braback L, Kjellman M, Nilsson L, Mai X, Sandin A, Saraclar Y, Kuyucu S, Tuncer A, Sackesen C, Sumbuloglu V, Geyik P, Kocabas C, Kaur B, El-Sharif N, Nemery B, Barghuthy F, Abu Huij S, Qlebo M, van Hage M, Ait-Khaled N, Anderson H, Flohr C, Williams H, Asher I, Ellwood P, Stewart A, Mitchell E, Pearce N, Beasley R, Bjorksten B, Foliaki S, Mallol J, Montefort S, Odhiambo J, Robertson C, and ISAAC Phase Two Study Grp

Published
2019

3. Can environment or allergy explain international variation in prevalence of wheeze in childhood?

Author

Weinmayr, G., Jaensch, A., Ruelius, A. -K., Forastiere, F., Strachan, D. P., Weiland, S. K., Buchele, G., Dentler, C., Rzehak, P., Priftanji, A., Shkurti, A., Simenati, J., Grabocka, E., Shyti, K., Agolli, S., Gurakuqi, A., Stein, R. T., de Pereira, M. U., Jones, M. H., Pitrez, P. M., Cooper, P. J., Chico, M., Chen, Y. Z., Zhong, N. S., Lai, C. K. W., Wong, G. W. K., Riikjarv, M. -A., Annus, T., Annesi-Maesano, I., Gotua, M., Rukhadze, M., Abramidze, T., Kvachadze, I., Karsanidze, L., Kiladze, M., Dolidze, N., Leupold, W., Keil, U., von Mutius, E., Arthur, P., Addo-Yobo, E., Gratziou, C., Priftis, K., Papadopoulou, A., Katsardis, C., Tsanakas, J., Hatziagorou, E., Kirvassilis, F., Clausen, M., Shah, J. R., Mathur, R. S., Khubchandani, R. P., Mantri, S., Di Domenicantonio, R., De Sario, M., Sammarro, S., Pistelli, R., Serra, M. G., Corbo, G., Perucci, C. A., Svabe, V., Sebre, D., Casno, G., Novikova, I., Bagrade, L., Brunekreef, B., Schram, D., Doekes, G., Jansen-van Vliet, P. H. N., Janssen, N. A. H., Aarts, F. J. H., de Meer, G., Crane, J., Wickens, K., Barry, D., Nystad, W., Bolle, R., Lund, E., Batlles Garrido, J., Rubi Ruiz, T., Bonillo Perales, A., Gonzalez Jimenez, Y., Aguirre Rodriguez, J., Momblan deCabo, J., Losilla Maldonado, A., Daza Torres, M., Garcia-Marcos, L., Martinez Torres, A., Guillen Perez, J. J., Pinana Lopez, A., Castejon Robles, S., Garcia Hernandez, G., Martinez Gimeno, A., Moro Rodriguez, A. L., Luna Paredes, C., Gonzalez Gil, I., Morales Suarez-Varela, M. M., Llopis Gonzalez, A., Escribano Montaner, A., Tallon Guerola, M., Braback, L., Kjellman, M., Nilsson, L., Mai, X. -M., Sandin, A., Saraclar, Y., Kuyucu, S., Tuncer, A., Sackesen, C., Sumbuloglu, V., Geyik, P., Kocabas, C., Kaur, B., El-Sharif, N., Nemery, B., Barghuthy, F., Abu Huij, S., Qlebo, M., van Hage, M., Ait-Khaled, N., Anderson, H. R., Flohr, C., Williams, H., Asher, I., Ellwood, P., Stewart, A., Mitchell, E., Pearce, N., Beasley, R., Bjorksten, B., Foliaki, S., Mallol, J., Montefort, S., Odhiambo, J., Robertson, C., Pistelli R. (ORCID:0000-0003-3776-2482), Corbo G. (ORCID:0000-0002-8104-4659), Williams H., Weinmayr, G., Jaensch, A., Ruelius, A. -K., Forastiere, F., Strachan, D. P., Weiland, S. K., Buchele, G., Dentler, C., Rzehak, P., Priftanji, A., Shkurti, A., Simenati, J., Grabocka, E., Shyti, K., Agolli, S., Gurakuqi, A., Stein, R. T., de Pereira, M. U., Jones, M. H., Pitrez, P. M., Cooper, P. J., Chico, M., Chen, Y. Z., Zhong, N. S., Lai, C. K. W., Wong, G. W. K., Riikjarv, M. -A., Annus, T., Annesi-Maesano, I., Gotua, M., Rukhadze, M., Abramidze, T., Kvachadze, I., Karsanidze, L., Kiladze, M., Dolidze, N., Leupold, W., Keil, U., von Mutius, E., Arthur, P., Addo-Yobo, E., Gratziou, C., Priftis, K., Papadopoulou, A., Katsardis, C., Tsanakas, J., Hatziagorou, E., Kirvassilis, F., Clausen, M., Shah, J. R., Mathur, R. S., Khubchandani, R. P., Mantri, S., Di Domenicantonio, R., De Sario, M., Sammarro, S., Pistelli, R., Serra, M. G., Corbo, G., Perucci, C. A., Svabe, V., Sebre, D., Casno, G., Novikova, I., Bagrade, L., Brunekreef, B., Schram, D., Doekes, G., Jansen-van Vliet, P. H. N., Janssen, N. A. H., Aarts, F. J. H., de Meer, G., Crane, J., Wickens, K., Barry, D., Nystad, W., Bolle, R., Lund, E., Batlles Garrido, J., Rubi Ruiz, T., Bonillo Perales, A., Gonzalez Jimenez, Y., Aguirre Rodriguez, J., Momblan deCabo, J., Losilla Maldonado, A., Daza Torres, M., Garcia-Marcos, L., Martinez Torres, A., Guillen Perez, J. J., Pinana Lopez, A., Castejon Robles, S., Garcia Hernandez, G., Martinez Gimeno, A., Moro Rodriguez, A. L., Luna Paredes, C., Gonzalez Gil, I., Morales Suarez-Varela, M. M., Llopis Gonzalez, A., Escribano Montaner, A., Tallon Guerola, M., Braback, L., Kjellman, M., Nilsson, L., Mai, X. -M., Sandin, A., Saraclar, Y., Kuyucu, S., Tuncer, A., Sackesen, C., Sumbuloglu, V., Geyik, P., Kocabas, C., Kaur, B., El-Sharif, N., Nemery, B., Barghuthy, F., Abu Huij, S., Qlebo, M., van Hage, M., Ait-Khaled, N., Anderson, H. R., Flohr, C., Williams, H., Asher, I., Ellwood, P., Stewart, A., Mitchell, E., Pearce, N., Beasley, R., Bjorksten, B., Foliaki, S., Mallol, J., Montefort, S., Odhiambo, J., Robertson, C., Pistelli R. (ORCID:0000-0003-3776-2482), Corbo G. (ORCID:0000-0002-8104-4659), and Williams H.

Abstract

Asthma prevalence in children varies substantially around the world, but the contribution of known risk factors to this international variation is uncertain. The International Study of Asthma and Allergies in Childhood (ISAAC) Phase Two studied 8–12 year old children in 30 centres worldwide with parent-completed symptom and risk factor questionnaires and aeroallergen skin prick testing. We used multilevel logistic regression modelling to investigate the effect of adjustment for individual and ecological risk factors on the between-centre variation in prevalence of recent wheeze. Adjustment for single individual-level risk factors changed the centre-level variation from a reduction of up to 8.4% (and 8.5% for atopy) to an increase of up to 6.8%. Modelling the 11 most influential environmental factors among all children simultaneously, the centre-level variation changed little overall (2.4% increase). Modelling only factors that decreased the variance, the 6 most influential factors (synthetic and feather quilt, mother’s smoking, heating stoves, dampness and foam pillows) in combination resulted in a 21% reduction in variance. Ecological (centre-level) risk factors generally explained higher proportions of the variation than did individual risk factors. Single environmental factors and aeroallergen sensitisation measured at the individual (child) level did not explain much of the between-centre variation in wheeze prevalence.

Published
2019

4. Overweight/obesity and respiratory and allergic disease in children: International study of asthma and allergies in childhood (ISAAC) phase two

Author

Weinmayr, G. Forastiere, F. Büchele, G. Jaensch, A. Strachan, D.P. Nagel, G. Weiland, S.K. Dentler, C. Rzehak, P. Priftanji, A. Shkurti, A. Simenati, J. Grabocka, E. Shyti, K. Agolli, S. Gurakuqi, A. Stein, R.T. De Pereira, M.U. Jones, M.H. Pitrez, P.M. Cooper, P.J. Chico, M. Chen, Y.Z. Zhong, N.S. Lai, C.K.W. Wong, G.W.K. Riikjärv, M.-A. Annus, T. Annesi-Maesano, I. Gotua, M. Rukhadze, M. Abramidze, T. Kvachadze, I. Karsanidze, L. Kiladze, M. Dolidze, N. Leupold, W. Keil, U. Von Mutius, E. Arthur, P. Addo-Yobo, E. Gratziou, C. Priftis, K. Papadopoulou, A. Katsardis, C. Tsanakas, J. Hatziagorou, E. Kirvassilis, F. Clausen, M. Shah, J.R. Mathur, R.S. Khubchandani, R.P. Mantri, S. Di Domenicantonio, R. De Sario, M. Sammarro, S. Pistelli, R. Serra, M.G. Corbo, G. Perucci, C.A. Svabe, V. Sebre, D. Casno, G. Novikova, I. Bagrade, L. Brunekreef, B. Schram, D. Doekes, G. Jansen-Van Vliet, P.H.N. Janssen, N.A.H. Aarts, F.J.H. De Meer, G. Crane, J. Wickens, K. Barry, D. Nystad, W. Bolle, R. Lund, E. Garrido, J.B. Ruiz, T.R. Perales, A.B. Jiménez, Y.G. Rodriguez, J.A. De Cabo, J.M. Maldonado, A.L. Torres, M.D. García-Marcos, L. Torres, A.M. Pérez, J.J.G. López, A.P. Robles, S.C. Hernandez, G.G. Gimeno, A.M. Rodríguez, A.L.M. Paredes, C.L. Gil, I.G. Suarez-Varela, M.M.M. González, A.L. Montaner, A.E. Guerola, M.T. Bråbäck, L. Sandin, A. Kjellman, M. Nilsson, L. Mai, X.-M. Saraçlar, Y. Tuncer, A. Saçkesen, C. Sumbulglu, V. Geyik, P. Kocabas, C. Kuyucu, S. Kaur, B. El-Sharif, N. Barghuthy, F. Abu Huij, S. Qlebo, M. Nemery, B. Aït-Khaled, N. Anderson, H.R. Pearce, N. Strachan, D.P. Flohr, C. Williams, H. Asher, M.I. Ellwood, P. Stewart, A. Mitchell, E. Beasley, R. Björkstén, B. Foliaki, S. Mallol, J. Montefort, S. Odhiambo, J. Robertson, C. ISAAC Phase Two Steering Group

Abstract

Background: Childhood obesity and asthma are increasing worldwide. A possible link between the two conditions has been postulated. Methods: Cross-sectional studies of stratified random samples of 8-12-year-old children (n=10 652) (16 centres in affluent and 8 centres in non-affluent countries) used the standardized methodology of ISAAC Phase Two. Respiratory and allergic symptoms were ascertained by parental questionnaires. Tests for allergic disease were performed. Height and weight were measured, and overweight and obesity were defined according to international definitions. Prevalence rates and prevalence odds ratios were calculated. Results: Overweight (odds ratio=1.14, 95%-confidence interval: 0.98; 1.33) and obesity (odds ratio=1.67, 95%-confidence interval: 1.25; 2.21) were related to wheeze. The relationship was stronger in affluent than in non-affluent centres. Similar results were found for cough and phlegm, rhinitis and eczema but the associations were mostly driven by children with wheeze. There was a clear association of overweight and obesity with airways obstruction (change in FEV1/FVC, 20.90, 95%-confidence interval: 21.33%; 20.47%, for overweight and 22.46%, 95%-confidence interval: 23.84%; 21.07%, for obesity) whereas the results for the other objective markers, including atopy, were null. Conclusions: Our data from a large international child population confirm that there is a strong relation of body mass index with wheeze especially in affluent countries. Moreover, body mass index is associated with an objective marker of airways obstruction (FEV1/FVC) but no other objective markers of respiratory and allergic disorders. © 2014 Weinmayr et al.

Published
2014

5. How well do questionnaires perform compared with physical examination in detecting flexural eczema? Findings from the International Study of Asthma and Allergies in Childhood (ISAAC) Phase Two

Author

Flohr, C., Weinmayr, G., Weiland, S. K., Addo-Yobo, E., Annesi-Maesano, Isabella, Björkstén, B., Bråbäck, L., Büchele, G., Chico, M., Cooper, P., Clausen, M., El Sharif, N., Martinez Gimeno, A., Mathur, R. S., von Mutius, E., Morales Suarez-Varela, M., Pearce, N., Svabe, V., Wong, G. W. K., Yu, M., Zhong, N. S., Williams, H. C., Renseigné, Non, Epidémiologie des maladies infectieuses et modélisation (ESIM), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Department of Geology, Ball State University, School of Biosciences [Cardiff], Cardiff University, Flohr C, G Weinmayr, M Clausen, El Sharif N, Martinez Gimeno A, RS Mathur, Mutius von E, Morales-Suarez Varela M, N Pearce, V Svabe, Wong GW, M Yu, SK Weiland, Zhong NS, Williams HC, Phase Deux Groupe d'étude ISAAC .G Büchele, Genuneit J, Kleiner A, G Nagel, Weinmayr G, Priftanji A, A Shkurti, Simenati J, E-Addo Yobo, E Grabocka, K Shyti, S Agolli, Gurakuqi A, RT Stein, de Pereira MU, MH Jones, PM Pitrez, Cooper PJ, YZ Chen, Annesi-Maesano I, C Lai, Wong G, MA Riikjärv, T Annus, M Gotua, M Rukhadze, T Abramidze, Kvachadze I, L Karsanidze, M Kiladze, B Bjorksten, N Dolidze, Leupold W, U Keil, von Mutius E, Arthur P, C Gratziou, C Priftis, Papadopoulou A, C Katsardis, Tsanakas J, L Bråbäck, E Hatziagorou, Kirvassilis F, JR Shah, RP Khubchandani, S Mantri, Forastière F, G Büchele, M Chico, and P Cooper

Subjects
Male, Allergy, medicine.medical_specialty, Eczema, Physical examination, Dermatology, Severity of Illness Index, Atopy, 030207 dermatology & venereal diseases, 03 medical and health sciences, MESH: Physical Examination, 0302 clinical medicine, Risk Factors, immune system diseases, MESH: Risk Factors, Germany, Surveys and Questionnaires, MESH: Child, MESH: Severity of Illness Index, Epidemiology, Prevalence, otorhinolaryngologic diseases, medicine, Humans, 030212 general & internal medicine, Child, skin and connective tissue diseases, Physical Examination, MESH: Germany, MESH: Prevalence, Asthma, Symptom prevalence, MESH: Humans, medicine.diagnostic_test, business.industry, MESH: Questionnaires, Atopic dermatitis, medicine.disease, MESH: Male, 3. Good health, Surgery, El Niño, MESH: Eczema, Family medicine, Female, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, MESH: Female
Abstract

International audience; BACKGROUND: Questionnaires are widely used in epidemiological studies to measure eczema symptom prevalence, but there are concerns regarding their accuracy if used as a diagnostic tool. OBJECTIVES: To compare the performance of a validated eczema symptom questionnaire and a standardized skin examination protocol employed in the second phase of the International Study of Asthma and Allergies in Childhood (ISAAC). METHODS: A total of 30,358 schoolchildren aged 8-12 years from 18 countries were examined for flexural eczema. Parents also completed an eczema symptom questionnaire. We compared prevalence estimates at the population level based on the questionnaire vs. physical examination. We also compared the skin examination and the ISAAC questionnaire in making a diagnosis of flexural eczema. RESULTS: The point prevalences for flexural eczema at centre level based on a single examination were lower than the questionnaire-based 12-month period prevalences (mean centre prevalence 3.9% vs. 9.4%). Correlation between prevalences of both outcome measures was high (r = 0.77, P < 0.001). At the individual level, questionnaire-derived symptoms of 'persistent flexural eczema in the past 12 months' missed < 10% of cases of flexural eczema detected on physical examination. However, between 33% and 100% of questionnaire-based symptoms of 'persistent flexural eczema in the past 12 months' were not confirmed on examination. CONCLUSIONS: ISAAC questionnaire-derived symptom prevalences are sufficiently precise for comparisons between populations. Where diagnostic precision at the individual level is important, questionnaires should be validated and potentially modified in those populations beforehand, or a standardized skin examination protocol should be used.

Published
2009

6. Effect of breastfeeding on asthma, lung function and bronchial hyperreactivity in ISAAC Phase II

Author

Weinmayr, G., Forastiere, F., Weiland, S. K., Rzehak, P., Abramidze, T., Annesi-Maesano, Isabella, Björkstén, B., Brunekreef, B., Büchele, G., Cookson, W. O. C., Von Mutius, E., Pistelli, R., Strachan, D. P., Renseigné, Non, Epidémiologie des maladies infectieuses et modélisation (ESIM), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), G Büchele, Garcia-Hernandez G, SK Weiland, Groupe d'étude ISAAC Phase II . Collaborateurs (149) Bjorksten B, B Brunekreef, W Cookson, Strachan D, E von Mutius, Kleiner A, G Nagel, P Rzehak, G Weinmayr, Priftanji A, A Shkurti, Simenati J, Grabocka E, Shyti K, S Agolli, Gurakuqi A, RT Stein, de Pereira MU, MH Jones, B Bjorksten, PM Pitrez, Cooper PJ, M Chico, Zhong NS, C Lei, Wong G, MA Riikjärv, T Annus, Annesi-Maesano I, M Gotua, YZ Chen, M Rukhadze, T Abramidze, Kvachadze I, L Karsanidze, M Kiladze, N Dolidze, W Leupold, U Keil, von Mutius E, Arthur P, Wang H, E-Addo Yobo, C Gratziou, C Priftis, Papadopoulou A, C Katsardis, Tsanakas J, E Hatziagorou, Kirvassilis F, M Clausen, JR Shah, W Nystad, RS Mathur, RP Khubchandani, S Mantri, Forastière F, Di Domenicantonio R, De Sario M, S Sammarro, R Pis, Y Saraclar, L Bråbäck, Batlles-Garrido J, and Çocuk Sağlığı ve Hastalıkları

Subjects
Male, Pediatrics, Time Factors, MESH: Asthma, MESH: Respiratory Sounds, Respiratory System, Breastfeeding, MESH: Logistic Models, MESH: Respiratory Function Tests, Atopy, MESH: Conjunctivitis, 0302 clinical medicine, Risk Factors, MESH: Risk Factors, Surveys and Questionnaires, MESH: Child, 030212 general & internal medicine, Child, MESH: Rhinitis, Respiratory Function Tests, 3. Good health, Breast Feeding, MESH: Breast Feeding, Female, Bronchial Hyperreactivity, medicine.symptom, Pulmonary and Respiratory Medicine, medicine.medical_specialty, MESH: Socioeconomic Factors, MESH: Allergens, MESH: Hypersensitivity, 03 medical and health sciences, MESH: Cross-Sectional Studies, MESH: Skin Tests, Wheeze, medicine, Humans, MESH: Prevalence, Respiratory Sounds, Retrospective Studies, Asthma, MESH: Humans, MESH: Rhinitis, Allergic, Perennial, business.industry, MESH: Questionnaires, MESH: Time Factors, MESH: Bronchial Hyperreactivity, MESH: Rhinitis, Allergic, Seasonal, MESH: Retrospective Studies, Odds ratio, medicine.disease, Confidence interval, MESH: Male, Logistic Models, Socioeconomic Factors, 030228 respiratory system, El Niño, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, Breast feeding, MESH: Seasons, MESH: Female, MESH: Models, Statistical
Abstract

International audience; The association between breastfeeding and wheezing, lung function and atopy was evaluated in the International Study of Asthma and Allergy in Childhood (ISAAC) Phase II. Cross-sectional studies were performed in 27 centres in 20 countries. Information on disease and exposure factors was collected by parental questionnaires. Data from 54,000 randomly selected school children (aged 8-12 yrs, 31,759 with skin prick testing) and a stratified subsample (n = 4,888) were used for testing the correlation of breastfeeding with bronchial hyperreactivity and lung function. Random effect models for meta-analysis were applied to calculate combined odds ratios (ORs). Any breastfeeding was associated with less wheeze both in affluent (adjusted OR (OR(adj)) 0.87, 95% confidence interval (CI) 0.78-0.97) and nonaffluent countries (OR(adj) 0.80, 95% CI 0.68-0.94). Further analyses revealed that this was true only for nonatopic wheeze in nonaffluent countries (OR(adj) 0.69, 95% CI 0.53-0.90). Breastfeeding was not associated with atopic wheeze and objective measures of allergy in both affluent and nonaffluent countries. In contrast, breastfeeding was associated with higher predicted forced expiratory volume in one second in affluent countries only (mean ratio 1.11, 95% CI 1.02-1.20). Breastfeeding is associated with protection against nonatopic wheeze, which becomes particularly evident in nonaffluent countries. Overall, breastfeeding was not related to any measure of allergy. These findings may explain some of the controversy regarding breastfeeding, since the direction of the association with breastfeeding depends on the predominating wheeze phenotype (e.g. atopic, nonatopic).

Published
2009

7. Atopic sensitization and the international variation of asthma symptom prevalence in children

Author

Riccardo Di Domenicantonio, Elpis Hatziagorou, Luis Garcia-Marcos, Erika Von Mutius, Lennart Nilsson, RENATO STEIN, Francesco Forastiere, Neil Pearce, Hywel Williams, Maia Gotua, Antonio Martínez-Gimeno, Philippa Ellwood, Lennart Bråbäck, Javier Mallol, Bert Brunekreef, Richard Beasley, Gary Wong, Marianne Van Hage, Raju Khubchandani, Manuela De Sario, Institute of Epidemiology, Universität Ulm - Ulm University [Ulm, Allemagne], Institute of Environmental Medicine, Karolinska Institutet [Stockholm], Division of Occupational and Environmental Health, Institute for Risk Assessment (IRAS), Utrecht University [Utrecht], Pediatric Pulmonology and Allergy, Virgen de la Arrixaca University Children's Hospital, Asthma and Allergy Department, University Children's Hospital-Ludwig-Maximilians University [Munich] (LMU), Epidémiologie des maladies infectieuses et modélisation (ESIM), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), SK Weiland, von Mutius E, MA Riikjärv, P Rzehak, RT Stein, DP Strachan, Tsanakas J, K Wickens, Wong GW, Phase Deux Groupe d'étude ISAAC . Collaborateurs (158) Bjorksten B, W Cookson, B Bjorksten, D Strachan, Dentler C, Kleiner A, G Weinmayr, Priftanji A, A Shkurti, Simenati J, Grabocka E, Shyti K, S Agolli, B Brunekreef, Gurakuqi A, Urrutia de Pereira M, MH Jones, PM Pitrez, Cooper PJ, M Chico, YZ Chen, Zhong NS, C Lai, Wong G, G Büchele, T Annus, Annesi-Maesano I, M Rukhadze, T Abramidze, Kvachadze I, L Karsanidze, M Kiladze, N Dolidze, W Leupold, U Keil, WO Cookson, S Weiland, P Arthur, Addo- E Yobo, C Priftis, Papadopoulou A, C Katsardis, E Hatziagorou, Kirvassillis F, M Claus, Marcos-Garcia L, M Gotua, C Gratziou, M Hage van, and University Children's Hospital-Ludwig Maximilians University

Subjects
Hypersensitivity, Immediate, Rural Population, Allergy, Pediatrics, Urban Population, MESH: Asthma, MESH: Antibodies, Anti-Idiotypic, Critical Care and Intensive Care Medicine, Global Health, Atopy, 0302 clinical medicine, MESH: Rural Population, Risk Factors, MESH: Risk Factors, MESH: Child, Odds Ratio, Prevalence, 030212 general & internal medicine, Child, MESH: Immunoglobulin E, Prognosis, 3. Good health, Antibodies, Anti-Idiotypic, MESH: Urban Population, medicine.symptom, MESH: Hypersensitivity, Immediate, Pulmonary and Respiratory Medicine, medicine.medical_specialty, MESH: Socioeconomic Factors, MESH: Prognosis, 03 medical and health sciences, MESH: Cross-Sectional Studies, Wheeze, Environmental health, Intensive care, medicine, Humans, Risk factor, MESH: Prevalence, Asthma, MESH: Humans, business.industry, Immunoglobulin E, medicine.disease, MESH: Odds Ratio, Cross-Sectional Studies, 030228 respiratory system, El Niño, Socioeconomic Factors, Attributable risk, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, MESH: World Health
Abstract

International audience; RATIONALE: Atopic sensitization has long been known to be related to asthma in children, but its role in determining asthma prevalence remains to be elucidated further. OBJECTIVES: To investigate the role of atopic sensitization in the large international variation in the prevalence of childhood asthma. METHODS: Cross-sectional studies of random samples of 8- to 12-year-old children (n = 1,000 per center) were performed according to the standardized methodology of Phase Two of the International Study of Asthma and Allergy in Childhood (ISAAC). Thirty study centers 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). MEASUREMENTS AND MAIN 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 sensitization ranged from 0% in Ankara (Turkey) to 93.8% in Guangzhou (China). There were no correlations between prevalence rates of current wheeze and atopic sensitization, 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). CONCLUSIONS: The link between atopic sensitization and asthma symptoms in children differs strongly between populations and increases with economic development.

Published
2007

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