E von Mutius, FD Martinez, C Fritzsch, T Nicolai, G Roell and HH Thiemann
University Children's Hospital, Munich, Germany.

The German reunification offers a unique opportunity to study the impact of environmental factors on the development of childhood respiratory and allergic disorders in ethnically similar populations. We investigated the prevalence of asthma, hay fever, atopy, and bronchial hyperresponsiveness (BHR) in 9- to 11-year old children in West Germany (n = 5,030) and East Germany (n = 2,623). A self- administered questionnaire was distributed to the parents. Children underwent cold air challenge and allergy skin prick tests. Atopic sensitization was considerably more frequent in West German children than in their peers in East Germany (36.7% versus 18.2%; odds ratio [OR] = 2.6, p < 0.0001). The prevalence of current asthma and hay fever was significantly higher in West Germany when compared with that in East Germany (5.9% versus 3.9%; OR = 1.5, p < 0.0001 and 8.6% versus 2.7%; OR = 3.4, p < 0.0001, respectively). Bronchitis, however, was more prevalent in East Germany than in the western part of the country. The prevalence of BHR as assessed by cold air challenge was higher in West Germany compared with that in East Germany (8.3% versus 5.5%, OR = 1.6, p < 0.001). Logistic regression showed that the West German study area was no longer a significant independent determinant of asthma once sensitization to mites, cats, and pollen was taken into account. We conclude that sensitization to aeroallergens is strikingly more frequent in West Germany than in East Germany and this may explain the differences in the prevalence of asthma and hay fever between the two parts of the country.

This article has been cited by other articles:

				Z. E. K. Pogson, M. D. Antoniak, S. J. Pacey, S. A. Lewis, J. R. Britton, and A. W. Fogarty Does a Low Sodium Diet Improve Asthma Control?: A Randomized Controlled Trial Am. J. Respir. Crit. Care Med., July 15, 2008; 178(2): 132 - 138. [Abstract] [Full Text] [PDF]

				F. Palvo, E. C. Toledo, A. M. C. R. Menin, P. P. O. Jorge, M. F. Godoy, and D. Sole Risk Factors of Childhood Asthma in Sao Jose do Rio Preto, Sao Paulo, Brazil J Trop Pediatr, February 23, 2008; (2008) fmn007v1. [Abstract] [Full Text] [PDF]

				J Mallol, J A Castro-Rodriguez, E Cortez, V Aguirre, P Aguilar, and L Barrueto Heightened bronchial hyperresponsiveness in the absence of heightened atopy in children with current wheezing and low income status Thorax, February 1, 2008; 63(2): 167 - 171. [Abstract] [Full Text] [PDF]

				A. V. Fedulov, A. Leme, Z. Yang, M. Dahl, R. Lim, T. J. Mariani, and L. Kobzik Pulmonary Exposure to Particles during Pregnancy Causes Increased Neonatal Asthma Susceptibility Am. J. Respir. Cell Mol. Biol., January 1, 2008; 38(1): 57 - 67. [Abstract] [Full Text] [PDF]

				G. Weinmayr, S. K. Weiland, B. Bjorksten, B. Brunekreef, G. Buchele, W. O. C. Cookson, L. Garcia-Marcos, M. Gotua, C. Gratziou, M. van Hage, et al. Atopic Sensitization and the International Variation of Asthma Symptom Prevalence in Children Am. J. Respir. Crit. Care Med., September 15, 2007; 176(6): 565 - 574. [Abstract] [Full Text] [PDF]

				W. Eder, M. J. Ege, and E. von Mutius The asthma epidemic. N. Engl. J. Med., November 23, 2006; 355(21): 2226 - 2235. [Full Text] [PDF]

				Y.-L. Lee, T.-R. Hsiue, C.-H. Lee, H.-J. J. Su, and Y. Leon Guo Home exposures, parental atopy, and occurrence of asthma symptoms in adulthood in southern taiwan. Chest, February 1, 2006; 129(2): 300 - 308. [Abstract] [Full Text] [PDF]

				U. Gehring, S. Pattenden, H. Slachtova, T. Antova, C. Braun-Fahrlander, E. Fabianova, T. Fletcher, C. Galassi, G. Hoek, S. V. Kuzmin, et al. Parental education and children's respiratory and allergic symptoms in the Pollution and the Young (PATY) study Eur. Respir. J., January 1, 2006; 27(1): 95 - 107. [Abstract] [Full Text] [PDF]

				L. Braback, A. Hjern, and F. Rasmussen Social class in asthma and allergic rhinitis: a national cohort study over three decades Eur. Respir. J., December 1, 2005; 26(6): 1064 - 1068. [Abstract] [Full Text] [PDF]

				A. J. Ghio, C. A. Piantadosi, X. Wang, L. A. Dailey, J. D. Stonehuerner, M. C. Madden, F. Yang, K. G. Dolan, M. D. Garrick, and L. M. Garrick Divalent metal transporter-1 decreases metal-related injury in the lung Am J Physiol Lung Cell Mol Physiol, September 1, 2005; 289(3): L460 - L467. [Abstract] [Full Text] [PDF]

				H. M. Boezen, J. M. Vonk, S. C. van der Zee, J. Gerritsen, G. Hoek, B. Brunekreef, J. P. Schouten, and D. S. Postma Susceptibility to air pollution in elderly males and females Eur. Respir. J., June 1, 2005; 25(6): 1018 - 1024. [Abstract] [Full Text] [PDF]

				B-F Hwang, Y-L Lee, Y-C Lin, J J K Jaakkola, and Y L Guo Traffic related air pollution as a determinant of asthma among Taiwanese school children Thorax, June 1, 2005; 60(6): 467 - 473. [Abstract] [Full Text] [PDF]

				D. P. Ennis, J. P. Cassidy, and B. P. Mahon Acellular Pertussis Vaccine Protects against Exacerbation of Allergic Asthma Due to Bordetella pertussis in a Murine Model Clin. Vaccine Immunol., March 1, 2005; 12(3): 409 - 417. [Abstract] [Full Text] [PDF]

				R J Hancox, B J Milne, D R Taylor, J M Greene, J O Cowan, E M Flannery, G P Herbison, C R McLachlan, R Poulton, and M R Sears Relationship between socioeconomic status and asthma: a longitudinal cohort study Thorax, May 1, 2004; 59(5): 376 - 380. [Abstract] [Full Text] [PDF]

				S. J. McGeady Immunocompetence and Allergy Pediatrics, April 1, 2004; 113(4/S1): 1107 - 1113. [Abstract] [Full Text] [PDF]

				M. Kabesch and R. P. Lauener Why Old McDonald had a farm but no allergies: genes, environments, and the hygiene hypothesis J. Leukoc. Biol., March 1, 2004; 75(3): 383 - 387. [Full Text] [PDF]

				I. Hussain and J. Smith Evidence for the Transmissibility of Atopy: Hypothesis Chest, November 1, 2003; 124(5): 1968 - 1974. [Abstract] [Full Text] [PDF]

				J. Stevenson Relationship Between Behavior and Asthma in Children With Atopic Dermatitis Psychosom Med, November 1, 2003; 65(6): 971 - 975. [Abstract] [Full Text] [PDF]

				Y-L. Lee, C-K. Shaw, H-J. Su, J-S. Lai, Y-C. Ko, S-L. Huang, F-C. Sung, and Y.L. Guo Climate, traffic-related air pollutants and allergic rhinitis prevalence in middle-school children in Taiwan Eur. Respir. J., June 1, 2003; 21(6): 964 - 970. [Abstract] [Full Text] [PDF]

				G. Walzl, I. R. Humphreys, B. G. Marshall, L. Edwards, P. J. M. Openshaw, R. J. Shaw, and T. Hussell Prior Exposure to Live Mycobacterium bovis BCG Decreases Cryptococcus neoformans-Induced Lung Eosinophilia in a Gamma Interferon-Dependent Manner Infect. Immun., June 1, 2003; 71(6): 3384 - 3391. [Abstract] [Full Text] [PDF]

				P. M. Kaan and R. G. Hegele Interaction between Respiratory Syncytial Virus and Particulate Matter in Guinea Pig Alveolar Macrophages Am. J. Respir. Cell Mol. Biol., June 1, 2003; 28(6): 697 - 704. [Abstract] [Full Text] [PDF]

				K. A. Pacheco, C. McCammon, A. H. Liu, P. S. Thorne, M. E. O'Neill, J. Martyny, L. S. Newman, R. F. Hamman, and C. S. Rose Airborne Endotoxin Predicts Symptoms in Non-Mouse-sensitized Technicians and Research Scientists Exposed to Laboratory Mice Am. J. Respir. Crit. Care Med., April 1, 2003; 167(7): 983 - 990. [Abstract] [Full Text] [PDF]

				M Rudwaleit, B Andermann, R Alten, H Sorensen, J Listing, A Zink, J Sieper, and J Braun Atopic disorders in ankylosing spondylitis and rheumatoid arthritis Ann Rheum Dis, November 1, 2002; 61(11): 968 - 974. [Abstract] [Full Text] [PDF]

				G.S. Leonardi, D. Houthuijs, B. Nikiforov, J. Volf, P. Rudnai, J. Zejda, E. Gurzau, E. Fabianova, T. Fletcher, and B. Brunekreef Respiratory symptoms, bronchitis and asthma in children of Central and Eastern Europe Eur. Respir. J., October 1, 2002; 20(4): 890 - 898. [Abstract] [Full Text] [PDF]

				J.-F. Bach The Effect of Infections on Susceptibility to Autoimmune and Allergic Diseases N. Engl. J. Med., September 19, 2002; 347(12): 911 - 920. [Full Text] [PDF]

				M. N. Hylkema, W. Timens, M. Luinge, N. van der Werf, and M. O. Hoekstra The Effect of Bacillus Calmette-Guerin Immunization Depends on the Genetic Predisposition to Th2-Type Responsiveness Am. J. Respir. Cell Mol. Biol., August 1, 2002; 27(2): 244 - 249. [Abstract] [Full Text] [PDF]

				A Sherriff, J Golding, and The Alspac Study Team Factors associated with different hygiene practices in the homes of 15 month old infants Arch. Dis. Child., July 1, 2002; 87(1): 30 - 35. [Abstract] [Full Text] [PDF]

				N. El-Sharif, Z. Abdeen, R. Qasrawi, G. Moens, and B. Nemery Asthma prevalence in children living in villages, cities and refugee camps in Palestine Eur. Respir. J., June 1, 2002; 19(6): 1026 - 1034. [Abstract] [Full Text] [PDF]

				J. Heinrich, B. Hoelscher, C. Frye, I. Meyer, M. Wjst, and H-E. Wichmann Trends in prevalence of atopic diseases and allergic sensitization in children in Eastern Germany Eur. Respir. J., June 1, 2002; 19(6): 1040 - 1046. [Abstract] [Full Text] [PDF]

				S. D Message and S. L Johnston Viruses in asthma: The role of viruses in childhood respiratory infections Br. Med. Bull., March 1, 2002; 61(1): 29 - 43. [Abstract] [Full Text] [PDF]

				G.W.K. Wong, S.T. Li, D.S.C. Hui, T.F. Fok, N.S. Zhong, Y.Z. Chen, and C.K.W. Lai Individual allergens as risk factors for asthma and bronchial hyperresponsiveness in Chinese children Eur. Respir. J., February 1, 2002; 19(2): 288 - 293. [Abstract] [Full Text] [PDF]

				J Grigg The health effects of fossil fuel derived particles Arch. Dis. Child., February 1, 2002; 86(2): 79 - 83. [Abstract] [Full Text] [PDF]

				E. von Mutius Infection: friend or foe in the development of atopy and asthma? The epidemiological evidence Eur. Respir. J., November 1, 2001; 18(5): 872 - 881. [Abstract] [Full Text] [PDF]

				G Koeppen-Schomerus, J Stevenson, and R Plomin Genes and environment in asthma: a study of 4 year old twins Arch. Dis. Child., November 1, 2001; 85(5): 398 - 400. [Abstract] [Full Text] [PDF]

				C. Frye, J. Heinrich, M. Wjst, and H-E. Wichmann Increasing prevalence of bronchial hyperresponsiveness in three selected areas in East Germany Eur. Respir. J., September 1, 2001; 18(3): 451 - 458. [Abstract] [Full Text] [PDF]

				M E Penny, S Murad, S S Madrid, T S Herrera, A Pineiro, D E Caceres, and C F Lanata Respiratory symptoms, asthma, exercise test spirometry, and atopy in schoolchildren from a Lima shanty town Thorax, August 1, 2001; 56(8): 607 - 612. [Abstract] [Full Text] [PDF]

				S. Baldacci, E. Omenaas, and M.P. Oryszczyn Allergy markers in respiratory epidemiology Eur. Respir. J., April 1, 2001; 17(4): 773 - 790. [Abstract] [Full Text] [PDF]

				M.H. Wieringa, P.A. Vermeire, H.P. Van Bever, V.J. Nelen, and J.J. Weyler Higher occurrence of asthma-related symptoms in an urban than a suburban area in adults, but not in children Eur. Respir. J., March 1, 2001; 17(3): 422 - 427. [Abstract] [Full Text] [PDF]

				B. Niggemann, S. Illi, C. Madloch, K. Volkel, S. Lau, R. Bergmann, E. von Mutius, U. Wahn, and MAS-Study Group Histamine challenges discriminate between symptomatic and asymptomatic children Eur. Respir. J., February 1, 2001; 17(2): 246 - 253. [Abstract] [Full Text] [PDF]

				A. W Stewart, E. A Mitchell, N. Pearce, D. P Strachan, and S. K Weiland The relationship of per capita gross national product to the prevalence of symptoms of asthma and other atopic diseases in children (ISAAC) Int. J. Epidemiol., February 1, 2001; 30(1): 173 - 179. [Abstract] [Full Text] [PDF]

				G. B Marks Commentary: Geographical heterogeneity of asthma Int. J. Epidemiol., February 1, 2001; 30(1): 179 - 180. [Full Text] [PDF]

				A.B. Kay Allergy and Allergic Diseases- First of Two Parts N. Engl. J. Med., January 4, 2001; 344(1): 30 - 37. [Full Text] [PDF]

				D. Jeffs, R. Grainger, and P. Powell Is childhood allergy more common amongst an island population? The Journal of the Royal Society for the Promotion of Health, December 1, 2000; 120(4): 236 - 241. [Abstract] [PDF]

				S. Wenzel Proceedings of the ATS Workshop on Refractory Asthma . Current Understanding, Recommendations, and Unanswered Questions Am. J. Respir. Crit. Care Med., December 1, 2000; 162(6): 2341 - 2351. [Full Text]

				W. W. Busse A 47-Year-Old Woman With Severe Asthma JAMA, November 1, 2000; 284(17): 2225 - 2233. [Full Text] [PDF]

				M. Shima and M. Adachi Effect of outdoor and indoor nitrogen dioxide on respiratory symptoms in schoolchildren Int. J. Epidemiol., October 1, 2000; 29(5): 862 - 870. [Abstract] [Full Text] [PDF]

				M. K. SELGRADE, A. L. LAMBERT, M. D. W. WARD, and M. I. GILMOUR Animal Models to Assess the Effects of Air Pollutants on Allergic Lung Disease Ann. N.Y. Acad. Sci., September 1, 2000; 919(1): 230 - 238. [Abstract] [Full Text] [PDF]

				J. L. L. KIMPEN Viral Infections and Childhood Asthma Am. J. Respir. Crit. Care Med., September 1, 2000; 162(3): S108 - 112. [Full Text] [PDF]

				T. A. E. PLATTS-MILLS, K. BLUMENTHAL, M. PERZANOWSKI, and J. A. WOODFOLK Determinants of Clinical Allergic Disease . The Relevance of Indoor Allergens to the Increase in Asthma Am. J. Respir. Crit. Care Med., September 1, 2000; 162(3): S128 - 133. [Full Text] [PDF]

				P. J. M. OPENSHAW and C. HEWITT Protective and Harmful Effects of Viral Infections in Childhood on Wheezing Disorders and Asthma Am. J. Respir. Crit. Care Med., August 1, 2000; 162(2): S40 - 43. [Full Text] [PDF]

				P. ERNST and Y. CORMIER Relative Scarcity of Asthma and Atopy among Rural Adolescents Raised on a Farm Am. J. Respir. Crit. Care Med., May 1, 2000; 161(5): 1563 - 1566. [Abstract] [Full Text]

				N. Pearce, J. Douwes, and R. Beasley Is allergen exposure the major primary cause of asthma? Thorax, May 1, 2000; 55(5): 424 - 431. [Abstract] [Full Text]

				M. R Becklake and F. Kauffmann Gender differences in airway behaviour over the human life span Thorax, December 1, 1999; 54(12): 1119 - 1138. [Full Text]

				P. J HELMS and G. CHRISTIE Prospects for preventing asthma Arch. Dis. Child., May 1, 1999; 80(5): 401 - 404. [Full Text]

				H. Y. Wang, C. P. Shelburne, J. Zamorano, A. E. Kelly, J. J. Ryan, and A. D. Keegan Cutting Edge: Effects of an Allergy-Associated Mutation in the Human IL-4R{alpha} (Q576R) on Human IL-4-Induced Signal Transduction J. Immunol., April 15, 1999; 162(8): 4385 - 4389. [Abstract] [Full Text] [PDF]

				E. ZEMP, S. ELSASSER, C. SCHINDLER, N. KUNZLI, A. P. PERRUCHOUD, G. DOMENIGHETTI, T. MEDICI, U. ACKERMANN-LIEBRICH, P. LEUENBERGER, C. MONN, et al. Long-Term Ambient Air Pollution and Respiratory Symptoms in Adults (SAPALDIA Study) Am. J. Respir. Crit. Care Med., April 1, 1999; 159(4): 1257 - 1266. [Abstract] [Full Text] [PDF]

				N. Pearce, J. Pekkanen, and R. Beasley How much asthma is really attributable to atopy? Thorax, March 1, 1999; 54(3): 268 - 272. [Full Text]

				T Nicolai, S Illi, and E von Mutius Effect of dampness at home in childhood on bronchial hyperreactivity in adolescence Thorax, December 1, 1998; 53(12): 1035 - 1040. [Abstract] [Full Text]

				P CULLINAN Asthma in African cities Thorax, November 1, 1998; 53(11): 909 - 910. [Full Text]

				I S. Farooqi and J. M Hopkin Early childhood infection and atopic disorder Thorax, November 1, 1998; 53(11): 927 - 932. [Abstract] [Full Text]

				C. I. M. PANHUYSEN, E. R. BLEECKER, G. H. KOETER, D. A. MEYERS, and D. S. POSTMA Characterization of Obstructive Airway Disease in Family Members of Probands with Asthma . An Algorithm for the Diagnosis of Asthma Am. J. Respir. Crit. Care Med., June 1, 1998; 157(6): 1734 - 1742. [Abstract] [Full Text] [PDF]

				J S H GASTON Will the increasing prevalence of atopy have a favourable impact on rheumatoid arthritis? Ann Rheum Dis, May 1, 1998; 57(5): 265 - 267. [Full Text]

				M. Kemeny and M. Peakman Recent advances: Immunology BMJ, February 14, 1998; 316(7131): 600 - 603. [Full Text]

				E. von Mutius, S. Illi, T. Nicolai, and F. D Martinez Relation of indoor heating with asthma, allergic sensitisation, and bronchial responsiveness: survey of children in South Bavaria BMJ, June 8, 1996; 312(7044): 1448 - 1450. [Abstract] [Full Text]

				P D Phelan Asthma in children: epidemiology BMJ, June 18, 1994; 308(6944): 1584 - 1585. [Full Text]

				P Cullinan and A J N Taylor Asthma in children: environmental factors BMJ, June 18, 1994; 308(6944): 1585 - 1586. [Full Text]