Published ahead of print on June 15, 2007, doi:10.1164/rccm.200607-994OC
© 2007 American Thoracic Society doi: 10.1164/rccm.200607-994OC
Atopic Sensitization and the International Variation of Asthma Symptom Prevalence in Children 1 Institute of Epidemiology, Ulm University, Ulm, Germany; 2 Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; 3 Institute for Risk Assessment Sciences, University of Utrecht, and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands; 4 Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, United Kingdom; 5 University of Murcia, Murcia, Spain; 6 Center of Allergy and Immunology, Tbilisi, Georgia; 7 Medical School, Athens University, Evgenidio Hospital, Athens, Greece; 8 Clinical Immunology and Allergy Unit, Department of Medicine, Karolinska Institutet and University Hospital, Stockholm, Sweden; 9 Dr. von Haunersches University Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; 10 Tallinn Children's Hospital, Tallinn, Estonia; 11 Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, RS, Brazil; 12 St. George's, University of London, London, United Kingdom; 13 Paediatric Respiratory Unit, Hippokration Hospital, Thessaloniki, Greece; 14 Wellington Asthma Research Group, Wellington School of Medicine and Health Sciences, Wellington, New Zealand; and 15 Department of Paediatrics, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, NT, Hong Kong, SAR China Correspondence and requests for reprints should be addressed to Dr. Gudrun Weinmayr, Ph.D., Institute of Epidemiology, Ulm University, Helmholtzstrasse 22, D-89075 Ulm, Germany. E-mail: gudrun.weinmayr{at}uni-ulm.de 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 Conclusions: The link between atopic sensitization and asthma symptoms in children differs strongly between populations and increases with economic development.
Key Words: wheeze • ISAAC Phase Two • IgE • population attributable risk • gross national income per capita
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