Published ahead of print on June 15, 2007, doi:10.1164/rccm.200607-994OC Am. J. Respir. Crit. Care Med., Volume 176, Number 6, September 2007, 565-574 A more recent version of this article appeared on September 15, 2007
Submitted on July 21, 2006 Atopic Sensitisation and the International Variation of Asthma Symptom Prevalence in ChildrenGudrun Weinmayr1*,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, 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, University of Tbilisi, Tbilisi, Georgia, 7 Medical School, Athens University, Evgenido 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 (PUCRS), Porto Alegre, 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, 15 Department of Paediatrics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China * To whom correspondence should be addressed. E-mail: gudrun.weinmayr{at}uni-ulm.de.
Background: Atopic sensitisation has long been known to be related to asthma in children. We investigated its role in the large international variation in the prevalence of childhood asthma.
Methods: Cross-sectional studies of random samples of 8-12-year-old children (n=1000 per centre) were carried out according to the standardised methodology of Phase Two of the International Study of Asthma and Allergy in Childhood (ISAAC). Thirty study centres 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).
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 sensitisation ranged from 0% in Ankara (Turkey) to 93.8% in Guangzhou (China). There were no correlations between prevalence rates of current wheeze and atopic sensitisation, 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 Key words: wheeze, ISAAC Phase Two, IgE, attributable risk, GNI
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=0.50; p=0.006 and 
