Prevalence of childhood asthma and allergic diseases in Ankara, Turkey

Secondhand smoke exposure and ocular health: A systematic review

The toxicology of secondhand smoke (SHS), along with the harm of its exposure to human health, has been generally acknowledged; however, specific evidence is lacking on the association between SHS exposure and ocular health. In this systematic review (PROSPERO registration number: CRD42022247992), we included 55 original articles published by 12 May 2023, which dealt with SHS exposure and ocular disorders, such as eye irritation, conjunctivitis, dry eye diseases, uveitis, myopia, astigmatism, contact lens discomfort, age-related macular degeneration, glaucoma, and thyroid eye disease that addressed the ocular neurovascular structures of the macular, retinal nerve fiber layer, choroid, and corneal biomechanical parameters. We found compelling correlational evidence for eye irritation, conjunctivitis, and dry eye symptoms-supporting that SHS exposure was positively associated with inflammatory and allergic changes in the eyes. Yet, evidence about the associations between SHS exposure and other ocular disorders, structures, and parameters is still limited or controversial. Given the limitations of existing literature, more investigations with high quality and rigorous design are warranted to elucidate the potentially harmful effects of SHS exposure on ocular health.

Pet-Keeping in Relation to Asthma, Rhinitis, and Eczema Symptoms Among Adolescents in Kuwait: A Cross-Sectional Study

Background: Findings on the associations between household pet-keeping and allergic diseases, including asthma, rhinitis, and eczema, have been contradictory, with investigations reporting positive, negative, and null associations. This study sought to estimate the prevalence of pet-keeping among families in Kuwait and to assess the associations between pet-keeping and symptoms of allergic diseases among adolescents. Methods: Schoolchildren aged 11-14 years (n = 3,864) were enrolled in this cross-sectional study. The children's parents completed questionnaires regarding their child's environmental exposures, including pet-keeping in the past 12 months, and clinical history and symptoms of allergic diseases. Associations were assessed using Poisson regression with robust variance estimation, and adjusted prevalence ratios (aPRs) and their 95% confidence intervals (CIs) were estimated. Results: Pet-keeping in the past 12 months was reported by 42.8% of the participating families. Birds, cats, rabbits, fish, and dogs were kept by 28.3, 13.2, 7.8, 3.9, and 3.1% of all households, respectively. Current cat ownership was significantly associated with current wheezing (aPR 1.29, 95% CI 1.05-1.58), current rhinitis symptoms (aPR 1.18, 95% CI 1.02-1.36), and ever doctor-diagnosed eczema (aPR 1.25, 95% CI 1.03-1.50). Current rabbit-keeping was positively associated with multiple symptoms of asthma (e.g., study-defined current asthma: aPR 1.38, 95% CI 1.04-1.82) and eczema (e.g., severe eczema: aPR 1.94, 95% CI 1.02-3.71). Similarly, current bird-keeping was associated with study-defined current rhinitis (aPR 1.19, 95% CI 1.05-1.41) and current itchy rash (aPR 1.27, 95% CI 1.10-1.46). Conclusions: Household pet-keeping is very common and diverse in Kuwait and was found to be positively associated with symptoms of allergic diseases among adolescents. The findings of associations between rabbit-keeping and symptoms of asthma and eczema add to the existing literature and further highlight the importance of considering the pet type when assessing such associations.

Evaluation of co-existing diseases in children with familial Mediterranean fever

Familial Mediterranean fever (FMF) is A common periodic fever syndrome. The causative gene of the FMF is named Mediterranean Fever gene (MEFV). Increased inflammation in FMF may play a role as a trigger for the development of some diseases. The objective of the study is to evaluate the frequency of comorbid disorders in children followed up with diagnosis of FMF. Additionally, we aimed to assess the association between FMF and other inflammatory conditions in a large pediatric FMF cohort. A total of 686 FMF patients were included in the cross-sectional study. A questionnaire including questions about characteristics of fever episodes, presence of arthralgia, arthritis, abdominal pain, chest pain during and co-existence of any other disease diagnosed by a physician was filled out by face-to-face interviews with patients or their parents. Female-male ratio was 0.85. Median age at the time of study, age at disease onset and at the time of diagnosis were 12.9 (1.7-22.3), 3 (0.08-17), and 6 (0.75-17) years, respectively. In 130 (18.9%) FMF patients we detected co-existing inflammatory condition. The most common co-existing diseases were: juvenile idiopathic arthritis 42 (6.1%), asthma/reactive airway disease 29 (4.2%), Henoch-Schönlein purpura 20 (2.9%), uveitis 12 (1.7%) and inflammatory bowel disease 10 (1.4%). Except for asthma/reactive airway disease and inflammatory bowel disease, there was no significant difference regarding the type of MEFV gene mutation. We have reported increased frequencies of various inflammatory conditions and decreased frequency of asthma in patients with FMF.

In utero exposure to pets is associated with asthma and wheezing in Mexican American children

OBJECTIVE

To examine the associations of in utero and early life exposure to cats/dogs and birds with the risk of lifetime doctor-diagnosed asthma and other respiratory conditions in a sample of Mexican American (MA) children 4-18 years of age.

METHODS

This study is a population-based cross-sectional investigation of 1816 MA children. We conducted multiple logistic models examining the relationship of asthma and wheezing with exposures to cats/dogs and birds in utero, infancy and at the time of the survey adjusted for country of birth, family history of asthma/allergies, antibiotics use in infancy and other covariates.

RESULTS

In adjusted analyses, in utero exposure to cats/dogs and birds jointly was associated with increased odds of asthma (adjusted odds ratio (aOR): 2.89; 95% confidence interval (CI): 1.34-6.23), ever wheezing (aOR: 1.96; 95% CI: 1.11-3.46) and current exercise-induced wheezing (aOR: 3.16; 95% CI: 1.27-7.85) compared to children not exposed to these pets in utero. Children who were exposed to both cats/dogs and birds in utero had an elevated, albeit statistically non-significant, odds of current wheezing. Exposures in infancy and at the time of the survey to cats/dogs and birds were not associated with asthma or wheezing.

CONCLUSIONS

In utero exposure to pets might be associated with an increased risk of asthma and respiratory conditions in a sample of non-affluent MA children.

Minimum prick test panel for adult patients with asthma and rhinitis in Ankara, Turkey

OBJECTIVE

Determination of the number and type of allergens needed to be tested in epidemiological studies is important in order to identify most of the sensitized subjects with a cost-effective approach. This study aimed to investigate the minimum skin prick test panel for the identification of at least 95% of the sensitized subjects with symptoms of asthma and/or allergic rhinitis (AR) in Ankara, Turkey.

METHODS

Skin prick test results of 7492 patients who were referred to our outpatient clinic with clinical symptoms of asthma and/or AR between 1991 and 2005 were evaluated retrospectively. Seven allergens were tested in all and 13 allergens in 4202 patients. The allergen group needed for detection of 95% of the sensitized subjects was determined for both the 7 and 13 allergen panels. The study protocol was approved by the local ethics committee of Hacettepe University.

RESULTS

The atopy prevalences in the whole study population and in 4202 patients tested with the 13 allergen panel were calculated as 32.2% and 42.6%, respectively. Three allergens (Phleum pratense, Dermatophagoides pteronyssinus and Artemisia vulgaris) within the 7 allergen panel were adequate for the identification of at least 95% of the sensitized subjects. Olea europae was added to the previous three allergens when the 13 allergen panel was applied.

CONCLUSION

Three to four allergens are sufficient for identification at least 95% of sensitized subjects with asthma and/or AR in Ankara, Turkey.

Exposure to cats and dogs, and symptoms of asthma, rhinoconjunctivitis, and eczema

BACKGROUND

Associations between exposure to cats and dogs and respiratory and allergic outcomes in children have been reported in affluent countries, but little is known about such associations in less-affluent countries.

METHODS

The International Study of Asthma and Allergies in Childhood, phase 3 was carried out in children aged 6-7 years and adolescents aged 13-14 years across the world. Questions about cats and dogs in the home were included in an additional questionnaire. Using logistic regression, we investigated the association between such exposures and symptoms of asthma, rhinoconjunctivitis, and eczema. Adjustments were made for sex, region of the world, language, gross national income per capita, and 10 other covariates.

RESULTS

Among children (6-7 years of age), cat exposure in the first year of life was associated with current symptoms of asthma, wheeze, rhinoconjunctivitis, and eczema, especially in less-affluent countries. Among adolescents (13-14 years of age), we found a positive association between exposure to cats or dogs and symptom prevalence in more-affluent and less-affluent countries. The global multivariate odds ratios for children with complete covariate data were 1.17 (95% confidence interval = 1.08-1.29) for current symptoms of asthma, 1.13 (1.05-1.23) for rhinoconjunctivitis, and 1.38 (1.26-1.52) for eczema. Smaller odds ratios were found for exposure to only dogs. Exposure to only cats was associated with eczema.

CONCLUSION

Early-life exposure to cats is a risk factor for symptoms of asthma, rhinoconjunctivitis, and eczema in 6- to 7-year-old children, especially in less-affluent countries. Current exposure to cats and dogs combined, and only to dogs, is a risk factor for symptom reporting by 13- to 14-year-old adolescents worldwide.

Asthma and allergic diseases in school children from 1992 to 2007 with incidence data

BACKGROUND

Information about change in the prevalence of asthma and allergic diseases and factors related with these diseases would be beneficial in decreasing the burden of these diseases.

OBJECTIVE

To assess (i) change in prevalence of asthma and allergic diseases; (ii) factors associated with asthma and wheeze; and (iii) incidence of asthma and wheeze.

METHODS

A questionnaire was administered to children aged 7-12 years in first five grades in the same primary school in 1992 (n: 1036), 1997 (n: 738), 2002 (n: 621), and 2007 (n: 422) and filled by the parents. A second survey in 2007 (n: 474, in eight grades) was conducted in the same schoolchildren, 6 months apart, to assess the incidence of asthma and wheeze and the associated factors.

RESULTS

Comparison of 1992, 1997, 2002, and 2007 surveys revealed that prevalence of asthma (8.3%, 9.8%, 6.4%, 3.3%, respectively), wheeze (11.9%, 13.3%, 6.4%, 3.1%, respectively), hay fever (15.4%, 14.1%, 7.2%, 3.1%, respectively), and eczema (4.0%, 4.3%, 1.8%, 1.2%, respectively) were significantly lower in 2002 and 2007 compared with that in 1992. Percentage of passive smoking decreased after 1992 (74.0%, 64.0%, 64.1%, and 65.5%, respectively). Incidence of asthma and wheeze in 2007 surveys were 0.9/100 and 1.1/100, respectively. After the adjustment for age and gender, infection in the past, family atopy, and presence of atopic disease (eczema or hay fever) were associated with asthma and wheeze. Maternal smoking and lack of breast feeding were associated with asthma. Male gender, pet ownership in the past, lack of health insurance coverage, snoring, and wood or coal used as fuel were associated with wheeze.

CONCLUSIONS

Decreased prevalence of asthma and allergic diseases in the last 10 years could be related to decreased rate of passive smoking. Lower socioeconomic status and lack of breast feeding could increase the risk of asthma in children.

Epidemiology and burden of rhinitis and rhinoconjunctivitis in 9- to 11-year-old children

BACKGROUND

Rhinoconjunctivitis (RC) is regarded as the most common chronic disease of childhood; however, the currently available epidemiological studies on prevalence, burden, and risk factors of RC are insufficient. This analysis aimed to investigate potential risk factors, symptom frequency, and burden of RC.

METHODS

Using the International Study of Asthma and Allergies in Childhood Phase II questionnaires, 6963 elementary school children aged 9-11 years were surveyed in five different city centers of Turkey. All participants were skin-prick tested with common aeroallergens.

RESULTS

The prevalence of ever rhinitis, physician-diagnosed rhinitis, current rhinitis, and current RC were 51.6, 31.0, 43.5, and 23.1%, respectively; 19.8% of children with RC symptoms were atopic to at least one allergen. Among students with RC symptoms, 42.2, 23.9, 35.8, and 28.2% reported moderate-severe interference of daily activities, at least 1 day of absence from school, visit to a health care professional, and any drug usage for rhinitis, respectively. Nasal decongestants and oral antihistamines were the most frequently used treatment. Approximately 70% of RC patients reported perennial symptoms and 42.8% were classified as mild to intermittent. Multivariate logistic regression analysis revealed family history of asthma and/or allergic rhinitis (odds ratio [OR] = 1.863; confidence interval, [CI] = 1.583-2.191; p < 0.001), living in a house with mold and dampness in the 1st year of life (OR = 1.651; CI = 1.356-2.01; p < 0.001), maternal smoking in pregnancy (OR = 1.425; CI = 1.089-1.864; p = 0.011), low monthly income (OR = 1.685; CI = 1.422-1.998; p = 0.001), current wheezing (OR = 2.543; CI = 2.151-3.006; p = 0.001), and current atopic eczema (OR = 2.503; CI = 1.96-3.196; p = 0.001) as significant risk factors for current RC.

CONCLUSION

Along with the high prevalence of RC in childhood, underdiagnosis and undertreatment of the disease are also frequent. The socioeconomic burden of the disease can be reduced by increasing awareness and proper diagnosis/treatment.

Prevalence of asthma and allergic diseases in primary school children in Edirne, Turkey, two surveys 10 years apart

To assess change in prevalence and risk factors of asthma and allergic diseases among primary school children in rural and urban parts of Edirne, Turkey, a series of cross-sectional studies were conducted in 1994 and 2004. A questionnaire was administered to the parents of primary school children aged 7-12, in urban and rural parts of Edirne, Turkey (5412 in 1994 and 5735 in 2004). Response rates in 1994 and 2004 were 84% and 82.5%, respectively. There were significant differences between the age distribution, urban habitation (1994: 70.1%, 2004: 75.8%, p < 0.001), passive smoking (1994: 74.7%, 2004: 60.0%, p < 0.001), and family atopy (1994: 12.7%, 2004: 18.2%, p < 0.001) between the two surveys. Current prevalence of asthma and wheeze increased in the 2004 when compared to 1994 in both rural and urban regions (current asthma for rural and urban regions, 5.2% and 5.8% in 1994; 8.6% and 12.1% in 2004, respectively). Female-to-male ratio of current asthma increased from 0.7 in 1994 to 0.9 in 2004. Comparison of the risk factors in the two surveys suggested urban habitation and factors other than family atopy, passive smoking and no breast feeding as possible contributors for the increasing asthma and wheeze. Prevalence of asthma and allergic diseases increased among school children in Edirne, Turkey from 1994 to 2004. Life style changes and urbanization could be related to this increasing trend.

Epidemiology of atopic dermatitis in primary schoolchildren in Turkey

The present study aimed to investigate the prevalence of atopic dermatitis in primary schoolchildren in Denizli, Turkey, and to determine the possible risk factors for atopic dermatitis in home environment. A self-administered questionnaire was handled to the parents of 2,100 children aged 7 to 15 years, from three randomized primary schools and 1,644 (78.9%) completed and returned the questionnaire. The questionnaire included the United Kingdom Working Party diagnostic criteria and asked about conditions that could affect the course of atopic dermatitis. The prevalence of atopic dermatitis and coexisting factors that may affect the course of the disease were evaluated in 1,644 children (825 girls and 819 boys). The prevalence of atopic dermatitis was detected as 4.9%. Passive smoking, heating systems either in the house or in the child's bedroom, and the number of people living in the house had no significant effect (p > 0.005). The difference in prevalence of atopic dermatitis between developed and developing countries is striking. The determination of the factors that have an influence in this issue will probably enable us to change the course and frequency of atopic dermatitis.

Prevalence and risk factors of allergies in Turkey: Results of a multicentric cross-sectional study in children

The Prevalence And Risk Factors of Allergies in Turkey (PARFAIT) study was planned to evaluate prevalence and risk factors of asthma and allergic diseases and also to find out which geographical variables and/or climatic conditions play a role determining the prevalence of allergic diseases in Turkish school children. Study was planned as cross-sectional questionnaire-based. About 25,843 questionnaires from 14 centers were appropriate for analysis. Parental history of allergy, having an atopic sibling and other atopic disease in index case was significant risk factors for all allergic diseases. Breast feeding decreased the risk of current asthma (OR: 0.92, CI: 0.86-0.99) and wheezing (OR: 0.93, CI: 0.87-0.99) but not allergic rhinitis and eczema. Respiratory infection in the past was an important risk factor for the occurrence of allergic diseases especially for asthma which was increased 4.53-fold. Children exposed to household smoke were significantly at higher risk of asthma, wheezing, and allergic rhinitis (OR: 1.20, CI: 1.08-1.33; OR: 1.21, CI: 1.09-1.34; and OR: 1.32, CI: 1.21-1.43, respectively). All allergic diseases were increased in those children living in areas which have altitude of below 1000 m and mean yearly atmospheric pressure above 1000 mb. The study has suggested that household and country-specific environmental factors are associated with asthma, wheezing, allergic rhinitis, and eczema risk during childhood in Turkey.

Is childhood asthma still underdiagnosed and undertreated in Istanbul?

BACKGROUND

Childhood asthma is reported to be underdiagnosed and undertreated worldwide. The purpose of the present study was to investigate the rate of underdiagnosis and undertreatment among children diagnosed with asthma in a tertiary reference center in Turkey.

METHODS

A questionnaire survey was carried out among the parents of 1134 patients diagnosed with asthma in a tertiary reference outpatient clinic.

RESULTS

Mean age of the patients was 4.9 years (range 1-17 years). Of these children 45.5% had recurrent asthma attacks (average 4.8 attacks per year) and 24.7% had only the symptom of vigorous fits of coughing. Although they had been symptomatic for 29.6 months, only 41.1% were diagnosed as having asthma before admission to the clinic. In this study group 61.3% had received some form of asthma treatment, but only 21.1% of all patients were treated according to the guidelines. The rate of treatment according to guidelines was lower in the children under 6 years of age than older children (18.8 vs 24.2%, respectively, P = 0.02).

CONCLUSIONS

Underdiagnosis and undertreatment of childhood asthma still seem to be a major problem in the management of childhood asthma, especially in preschool children, even after the recommendations of guidelines.

Current cat ownership may be associated with the lower prevalence of atopic dermatitis, allergic rhinitis, and Japanese cedar pollinosis in schoolchildren in Himeji, Japan

The aim of the study was to clarify the relationship between current pet ownership, passive smoking, and allergic diseases among the Japanese children. From 1995 to 2001, we distributed the Japanese edition of the questionnaire of the American Thoracic Society and the Division of Lung Diseases (ATS-DLD) to survey allergic diseases among 35,552 6-yr-old children at primary school in the city of Himeji, Japan. We analyzed the data by multiple logistic regression and calculated adjusted odds ratios for environmental factors, including passive smoking and pet (dog and/or cat) ownership. There were no significant relationships between the prevalence of asthma and current pet ownership and passive smoking. However, current cat ownership was related to a significantly lower prevalence of atopic dermatitis [adjusted odds ratio (aOR) 0.79, 95% confidence interval (CI) 0.67-0.93], allergic rhinitis (aOR: 0.71, 95% CI 0.57-0.89) and Japanese cedar pollinosis (aOR 0.57, 95% CI 0.44-0.75). Strikingly, passive smoking was also related to a significantly lower prevalence of allergic rhinitis (aOR 0.83, 95% CI 0.77-0.89) and Japanese cedar pollinosis (aOR 0.81, 95% CI 0.74-0.88). Current cat ownership was associated with a lower prevalence of atopic dermatitis, allergic rhinitis, and Japanese cedar pollinosis. In addition, passive smoking was also associated with a lower prevalence of allergic rhinitis and Japanese cedar pollinosis.

Evaluation of risk factors in patients diagnosed with bronchial asthma

Bronchial asthma is a public health problem with gradually increasing importance, affecting more than 100 million individuals worldwide and found independently of the level of development of the country. Factors related to lifestyle and the environment form the basis for the increase in the prevalence of the disease.

AIM

To evaluate our patients being followed-up with a diagnosis of bronchial asthma at the Allergy Clinic for risk factors and to determine their sociodemographic characteristics.

MATERIAL AND METHOD

The risk factors of 3025 patients followed-up with a diagnosis of bronchial asthma at the Allergy Clinic of the Ministry of Health, Ankara Diskapi Children's Diseases Training and Research Hospital between January 1995 and March 2000 were evaluated retrospectively.

RESULTS

A high percentage of our patients suffered from both asthma and allergic rhinitis and 45% of our asthmatic patients had allergic rhinitis while 93.5% of those with allergic rhinitis were also asthmatic. Asthma was more common in males and those born in the summer months. 57.6% of the patients had a history of atopy. Passive smoking was observed at a high rate and cigarette smoke was the most important factor increasing the symptoms. The symptoms increased during the winter. 92.8% of the patients lived in the city. The average Ig E level was high and 60.9% of the patients were atopic on the skin prick test.

RESULTS

Asthma seems to be an important health problem in our country. Recognizing the risk factors is important for the diagnosis and prevention of the disease.

[Prevalence of atopic dermatitis in schoolchildren from Cartagena (Spain) and relationship with sex and pollution]

BACKGROUND

Atopic dermatitis is favored by exogenous factors, such as air pollution interacting with a genetic predisposition.

OBJECTIVE

The aim of the present study was to evaluate the influence of sex and air pollution in the city of Cartagena on the prevalence of atopic dermatitis.

DESIGN AND METHODS

We performed a cross-sectional study using the ISAAC questionnaire in schoolchildren aged 13 and 14 years old from Cartagena (Murcia). The influence of sex and the schools' location in two distinct areas (polluted and unpolluted) on the prevalence of atopic dermatitis and its severity (described as being awakened by nocturnal itching) was analyzed.

RESULTS

The prevalence of atopic eczema was 6.3 %. Atopic eczema was severe in 19 % of the cases. Risk factors for atopic eczema were female sex (OR 2.19 95 % CI: 1.59-3. 02) and attending school in a polluted area (OR: 1.83, 95 % CI 1.01-1.87) but these factors were not associated with greater severity.

CONCLUSIONS

Air pollution is associated with a higher prevalence of atopic eczema and there is a trend that this eczema is more severe. The condition was more prevalent among girls.

Risk factors determining allergic airway diseases in Turkish subjects

With regard to changes in life-style after the 1980s, the reflection of environmental factors on the evolution of allergic airway disease (AAD) has not yet been analyzed in Turkey. In this trial, we aimed to determine the factors related to AAD in Turkish subjects. Patients diagnosed as having asthma and/or rhinitis with positive skin prick tests (SPTs) were accepted as members of the "atopic group" (n = 235). Subjects demonstrated to have negative SPTs and no clinical evidence of any atopic disorder were accepted as members of the "nonatopic control group" (n = 84). Data obtained from a questionnaire applied cross-sectionally to the study groups were compared for risk factor analysis. According to the results of univariate analysis, nonatopic controls were found to have been born in villages more frequently than those in the atopic group (14.3% vs. 4.7%, p = 0.02). Atopic group members had lived in apartments during childhood more frequently than nonatopic controls (53.6% vs. 38%, p = 0.04). A topic group members, particularly the asthmatics, had lower sibship size (< or = 1 sibling) (41.3% vs. 16.7%, p = 0.0003) and nonatopic subjects had higher sibship size (> or = 3 siblings) (73.8% vs. 43.4%, p < 0.0001). The rate of maternal atopy was higher in the atopic group (24.7% vs. 9.5%, p = 0.02). Place of birth, sibship size, and atopic status of the mother, but not house type, were found to be significant in the multivariate analysis. As a conclusion, rural life-style seems to have a protective effect on the development of atopy in Turkey. On the contrary, factors directly or indirectly related to urban life-style during early childhood were found to be associated with the allergic airway diseases.

Cultural adaptation is associated with atopy and wheezing among children of Turkish origin living in Germany

BACKGROUND

Turkish children have been found to suffer less from atopic diseases than their German peers. The underlying causes are unknown.

OBJECTIVE

To evaluate rates of sensitization and atopic disease among children in Germany with German or Turkish ethnicity and different degrees of cultural adaptation.

METHODS

This was a cross-sectional study. The setting was screening for school eligibility in an inner-city district of Berlin/Germany. The participants were preschool children born in Germany with double German or double Turkish parental citizenship. Cultural adaptation of Turkish children was assessed by the language parents used to communicate with their child: only Turkish (n = 60, group A); Turkish and German (n = 269, group B); and only German (n = 103, group C). Group D contained children from German parents (n = 383). The main outcome measures were specific sensitization to common aeroallergens (CAP-System, Pharmacia Phadiatop >or= 0.35 kU/L), and lifetime and 1-year prevalences of allergic disease symptoms (ISAAC questionnaire in German and Turkish, Mantel-Haenszel test for trend).

RESULTS

Sensitization rates for groups A, B, C and D were 8.0%, 6.8%, 18.9% and 18.3%, respectively (P = 0.004). The corresponding prevalence rates for wheeze ever were 6.7%, 9.3%, 12.6% and 21.3% (P < 0.001), wheeze in the past year 3.3%, 3.7%, 9.7% and 10.2% (P = 0.001), itchy rash ever 3.3%, 6.3%, 8.7% and 13.7% (P < 0.001), itchy rash in the past year 1.7%, 3.7%, 4.9% and 9.5% (P < 0.001), respectively. No significant differences were found for hay fever symptoms.

CONCLUSIONS

Higher cultural adaptation is correlated with higher rates of allergic sensitization and disease among children of Turkish origin living in Berlin. This correlation suggests that environmental rather than genetic differences are responsible for the differences observed.

Doppler echocardiographic evaluation of pulmonary arterial pressure in children with allergic rhinitis

In children, persistent upper airway obstruction may lead to increased pulmonary arterial pressure (PAP). Allergic rhinitis (AR) is one of the frequent cause of persisting upper airway obstruction by nasal blockage in childhood. Regular use of nasal topical corticosteroids are effective in reducing nasal blockage and obstruction. However, whether symptomatic children with AR have increased PAP and curative effect of topical steroids are not known. The aims of this study were to clarify whether children having active symptoms of AR have increased PAP and to investigate the curative effect of reducing nasal obstruction by topical corticosteroids. Twenty-three children, aged between 5 and 16, diagnosed as AR, consisted of 17 seasonal AR (SAR) and seven perennial AR (PAR), were included in the study. Nineteen age and sex matched healthy children were received as controls. PAP was measured by using Doppler echocardiography in all subjects and symptom scores of AR were recorded in rhinitis group. After first evaluation, nasal steroid, budesonid, was given to rhinitis group for three months. Mean systolic PAP was 33.4+/-3.1 for children with AR mmHg and 23.6+/-4.3 mmHg for the control group. The difference was statistically significant (P<0.05). Mean systolic PAP of children with PAR was significantly higher than children with SAR (P<0.05). In rhinitis group, mean PAP decreased significantly after relief of upper airway obstruction by nasal corticosteroid therapy to normal level of 24.9+/-3.6 mmHg (P<0.05). Our results showed that children with AR may have significantly higher PAP than healthy subjects and decreased to normal levels after relieving nasal blockage by nasal corticosteroids. Nevertheless, Doppler echocardiography is a safe, non-invasive and practical tool for cardiac investigation of children with AR. Therefore, in symptomatic period, evaluation of PAP of children with AR by using Doppler echocardiography may be useful in the planning and following of their therapy.

Prevalence of bronchial asthma and allergic rhinitis in Istanbul school children

The aim of this study was to determine the prevalence of asthma, allergic rhinitis and their related symptoms in Istanbul and to investigate the effect of socioeconomic status on the prevalence of asthma and allergic rhinitis and whether there are differences between the prevalence of childhood asthma in the same and different regions as found in previous studies and our own. The study period was the 1996-1997 school year in three primary schools in Istanbul. For proportional representation of high, middle, and low socioeconomic levels, the schools were selected from three different regions of Istanbul. A translated version of the International Study of Asthma and Allergies in Childhood (ISAAC) was used. The questionnaire was distributed to the parents of 2600 students aged 6-15 years. All of the 2276 children whose parents responded were included in the survey. The overall cumulative and current prevalences of wheezing were 13.7 and 7.2% respectively and the overall cumulative prevalence of allergic rhinitis was 17.6%. There was no statistically significant difference between asthmatics and non-asthmatics by sex, socioeconomic status and passive smoking. Family history of atopy was found to be significantly higher in asthmatics. Although there are differences in the results of studies concerning the prevalence of asthma and allergic rhinitis not only between different countries but also between different regions of the same city, by using a standardized international method, the actual values may be obtained.

Systematic review: Exposure to pets and risk of asthma and asthma-like symptoms

BACKGROUND

Studies of exposure to pets and risk of asthma have yielded conflicting results.

OBJECTIVES

We performed a systematic review to synthesize the evidence of the effect of exposure to pets in the home on the risk of asthma and asthma-related symptoms. We also assessed differences between the studies as sources of heterogeneity of the results.

METHODS

We conducted a MEDLINE search (until the end of 1999) using the following boolean search command: (asthma[all] OR wheez*[all]) AND (domestic animal*[all] OR pets[all]). The outcome was limited to either diagnosis of asthma or the symptom of wheezing. The exposure of interest was domestic animals in the home. Appropriate temporal relationship was defined as present in studies with either pet keeping within the first 2 years of life, in the past, or exposure to pets preceding the outcome.

RESULTS

Thirty-two of the 217 retrieved articles fulfilled the eligibility criteria. Inappropriate time sequence of the exposure and outcome information was an important source of heterogeneity and an indication of potential selection bias. Therefore we analyzed studies focusing on early exposure or ensuring appropriate temporal sequence. The pooled risk estimates for both asthma (fixed-effects odds ratio, 1.11; 95% CI, 0.98-1.25; heterogeneity, P =.04; random-effects odds ratio, 1.09; 95% CI, 0.89-1.34) and wheezing (fixed-effects odds ratio, 1.19; 95% CI, 1.05-1.35; heterogeneity, P =.03; random-effects odds ratio, 1.17; 95% CI, 0.95-1.44) indicated a small effect, which was limited to studies with a median study population age of over 6 years (fixed-effects odds ratio, 1.19; 95% CI, 1.02-1.40; heterogeneity, P =.04; random-effects odds ratio, 1.15; 95% CI, 0.86-1.56; fixed-effects odds ratio, 1.29; 95% CI, 1.12-1.48; heterogeneity, P =.31). In younger children the harmful effect disappeared for wheezing (odds ratio, 0.80; 95% CI, 0.59-1.08; P =.38).

CONCLUSION

Exposure to pets appears to increase the risk of asthma and wheezing in older children. The observed lower risk among exposed than among unexposed young children is consistent with a protective effect in this age group but could also be explained by selection bias.

Prevalence of asthma and allergic diseases in primary school children in Ankara, Turkey: two cross-sectional studies, five years apart

The prevalence of allergic diseases is reported to have increased worldwide. Two questionnaire surveys, five years apart, were conducted to evaluate the trend of prevalence rates and possible risk factors among primary school children in Ankara, Turkey. A previous survey in 1992 revealed the lifetime prevalences of asthma, wheezing, allergic rhinitis and atopic dermatitis were 17.4%, 23.3%, 28% and 6.1%, and the prevalences for the last 12 months were 8.3%, 11.9%, 15.4% and 4%, respectively. The survey was repeated with the same questionnaire in the same age group (6-13 years) of the same school in May 1997. The parents of 358 boys and 380 girls completed the questionnaire. The lifetime and last 12 months' prevalences of asthma, wheezing, rhinitis and atopic dermatitis were 16.8%, 22.5%, 18.7%, 6.5%, and 9.8%, 13.3%, 14.1%, 4.3%, respectively. There was a significant change only for the lifetime prevalence of rhinitis (p < 0.001). The rate of indoor smoking had declined from 73.9% to 64%, and pet ownership had risen from 7.9% to 22.9% (p < 0.001 for both). Atopic family history was the most prominent risk factor for all types of allergic disorders. Male gender was a significant risk factor for current asthma and wheezing [odds ratio (OR) = 1.80 and 1.59; 95% confidence intervals (CI) = 1.09-2.98 and 1.01-2.48, respectively], and passive smoking affected the occurrence of allergic rhinitis (OR = 1.84; CI = 1.13-3.00). The prevalence rates of allergic diseases among primary school children in Ankara stabilized during a 5-year period for all diseases other than allergic rhinitis. However, there are changing behavior patterns, i.e. indoor smoking and keeping pet animals, which that may have affected these rates.

Socioeconomic risk factors in the prevalence of asthma and other atopic diseases in children 6 to 7 years old in Valencia Spain

A cross-sectional survey of a cohort study was carried out between June and December 1994 in Valencia, Spain (population in 1994: 764,293 inhabitants). Two hundred sixty public and private schools randomly selected from the total of schools in Valencia were invited to participate; 3948 children aged 6-7 years cooperated in our study after informed consent was obtained from parents and school director. The survey in Valencia is part of the International Study of Asthma and Allergy in Childhood (ISAAC). Prevalences for asthma, rhinitis and atopic dermatitis were determined and contrasted with socioeconomic status (SES) among children. No statistically significant associations were established between the prevalences of asthma, rhinitis and atopic dermatitis, and SES. However, atopic dermatitis was found to be common among upper class children (21.5 per 100 children). Likewise, significant associations were observed between the severity of atopy (2 or 3 atopic manifestations) and SES (p = 0.000), being greater for lower strata (4.5 per 100 children); for the three SES level significant differences were established (p = 0.008) regarding passive exposure to tobacco smoke in the home.

Insights into asthma prevalence in Oregon

Asthma is one of the most common chronic diseases. The prevalence of asthma appears to be increasing. National data have suggested that Oregon's asthma mortality rate has been twice as high as the national average. The prevalence and impact of asthma are not systematically assessed or tracked within Oregon. We estimated the current asthma prevalence and mortality using data from statewide hospital discharge data, the 1995 Behavioral Risk Factor Surveillance Survey, and school registration data from the Portland area. A conservative estimate of Oregon's current asthma prevalence is 6-7% and lifetime asthma prevalence is estimated at 6-11% for both adults and children. It appears that current asthma prevalence increases during adolescence. The Willamette Valley, an area known for high pollen counts, does not have a higher rate of hospital discharges per capita than other areas within the state. Oregon's apparent higher asthma mortality may be the result of the Oregon State Health Division's aggressive policies toward accurate reporting on death certificates. Oregon's age distribution may also contribute to the apparent higher asthma mortality rate.

Prevalence of allergic rhinitis and atopic dermatitis among children in four regions of Finland

The primary aim of the study was to evaluate the prevalences of allergic rhinitis and atopic dermatitis and their regional differences among Finnish children. The secondary objective was to determine whether the responses to the questions used are affected by the pollen season if asked during such a season. In 1994-5, the self-reported prevalence of allergic symptoms in four regions of Finland was studied among 11,607 schoolchildren aged 13-14 years, as part of the International Study of Asthma and Allergies in Childhood (ISAAC). The prevalence of rhinoconjunctivitis during the preceding year was 16% in eastern Finland (Kuopio County, n=2821), 23% in southern Finland (Helsinki area, n=2771), 15% in southwestern Finland (Turku and Pori County, n=2983), and 16% in northern Finland (Lapland, n=3032). The respective prevalences of flexural dermatitis were 15%, 19%, 16%, and 18%. The surveys were performed in winter, except in the Helsinki area where the survey was carried out mainly in the spring pollen season. Among the children studied in autumn in Helsinki, the prevalence of rhinoconjunctivitis was 19% and that of flexural dermatitis 17%. In multivariate analysis, flexural dermatitis was slightly more common in Lapland than in all other areas. In contrast, no significant differences were found in rhinoconjunctivitis. The prevalences of both disorders were twice as high in girls as in boys. In conclusion, regional differences in the prevalence of allergic rhinitis and atopic dermatitis were small in our country, and the prevalence figures were rather similar to those reported from other European countries. Almost half of the children had suffered from at least one atopic disorder, and over one-third had had symptoms in the past year. A clear season-of-response effect was observed; the prevalence of rhinoconjunctivitis was 25% when studied during the pollen seasons in the Helsinki area.

Prevalence of childhood allergic diseases in Adana, Southern Turkey

A study to determine the prevalence of childhood asthma and other allergic diseases was done in Adana, during the period between January 1993 and January 1994. The study has been carried out on 2334 children (48.5% boys). Asthma and the other allergic diseases were recognized in 23.6% of the children. The prevalence of asthma, rhinoconjunctivitis, wheezing, and atopic dermatitis were found to be 12.9, 8.8, 8.4, and 5.0%, respectively. The symptoms of respiratory allergic diseases (asthma, rhinoconjunctivitis, wheezing) seemed to be significantly associated with the environmental factors. In conclusion, asthma and other allergic diseases constituted a major health problem for school children in Adana.

School absence and treatment in school children with respiratory symptoms in The Netherlands: data from the Child Health Monitoring System

STUDY OBJECTIVE

To assess the prevalence of respiratory problems, and the relation of these problems with school attendance, medicine use, and medical treatment.

DESIGN

The Child Health Monitoring System.

SETTING

Nineteen public health services across the Netherlands.

PARTICIPANTS

5186 school children aged 4-15 years, who were eligible for a routine health assessment in the 1991/1992 school year.

MAIN RESULTS

Respiratory symptoms were present in 12% of the children. Recent symptoms suggestive of asthma (wheezing or episodes of shortness of breath with wheezing in the past 12 months, or chronic cough, or a combination of these) were reported for 8%. These symptoms were most frequent in the younger children, and in children at school in towns with less than 20,000 inhabitants. Of the children with recent symptoms suggestive of asthma, 37% reported school absence for at least one week during the past 12 months, compared with 16% in children without respiratory symptoms. School absence because of respiratory illness was reported for 22%, and medicine use for respiratory problems for 38% of the children with recent symptoms suggestive of asthma. Of these children, 21% were receiving medical treatment, compared with 15% of the asymptomatic children.

CONCLUSIONS

Respiratory symptoms are a common health problem in children, and they are an important cause of school absence and medicine use. However, the percentage of children receiving medical treatment seemed quite low, indicating that proper diagnosis and treatment are probably still a problem.

Prevalence of asthma symptoms in school children in Ankara, Turkey

The aim of this study was to determine the prevalence of symptoms suggestive of asthma in children aged 7-14 years in Ankara, Turkey. For this purpose, the recently developed ISAAC (International Study for Asthma and Allergies in Childhood) questionnaire supplemented with six additional questions was issued to parents of 3154 primary school children from 12 schools. A separate page with questions regarding risk factors was also added to the questionnaire. The response rate was 88.3%. The cumulative and 12-month prevalence of wheezing were 14.4 and 4.7% respectively. The prevalence of physician-diagnosed asthma was 8.1%. A family history of atopy was found to be the strongest risk factor for having ever had wheezing (odds ratio (OR) = 2.89, 95% confidence interval (CI) = 2.32-3.60), wheezing in the past 12 months (OR = 3.21, CI = 2.21-4.67), and severe attack (OR = 2.41, CI = 1.36-4.25). Passive smoking was a risk only for having ever had wheezing (OR = 1.33, CI = 1.03-1.76). Increasing age was associated with a lower risk of current wheezing (OR = 0.85, CI = 0.81-0.90) and severe attack (OR = 0.77, CI = 0.67-0.88). Gender, socio-economic level and pet ownership did not appear to be risk factors for asthma-related symptoms. This study, the first epidemiological survey in Ankara, Turkey, using the ISAAC protocol, clearly shows that symptoms suggestive of asthma, albeit lower than in most European countries, are quite common and constitute a major health problem in Turkey.

Health effects of passive smoking. 3. Parental smoking and prevalence of respiratory symptoms and asthma in school age children

BACKGROUND

A systematic quantitative review of the evidence relating parental smoking to the prevalence of asthma and respiratory symptoms was conducted amongst school age children.

METHODS

Sixty relevant studies were identified after consideration of 1593 articles selected by electronic search of the Embase and Medline databases using keywords relevant to passive smoking in children. The search was completed in April 1997 and identified 25 studies of asthma, 41 of wheeze, 34 of chronic cough, seven of chronic phlegm and six of breathlessness which were included in a quantitative overview.

RESULTS

The pooled odds ratios for either parent smoking were 1.21 (95% CI 1.10 to 1.34) for asthma, 1.24 (95% CI 1.17 to 1.31) for wheeze, 1.40 (95% CI 1.27 to 1.53) for cough, 1.35 (95% CI 1.13 to 1.62) for phlegm, and 1.31 (95% CI 1.08 to 1.59) for breathlessness. Adjustment for confounding had little effect. Evidence of heterogeneity between studies appeared largely explicable by publication bias with a superfluity of small studies with large odds ratios. However, excluding these had little effect on the pooled odds ratios. The prevalence of all symptoms increased with the number of parents who smoked. While maternal smoking had a greater effect than paternal smoking, the effect of father only was clearly significant.

CONCLUSIONS

The relationship between parental smoking and respiratory symptoms seems very likely to be causal given statistical significance, robustness to adjustment for confounding factors, consistency of the findings in different countries, and evidence of dose response. The raised risk in households where the father, but not the mother, smoked argues for a postnatal effect.

The prevalence of self-reported asthma and respiratory symptoms in Ankara, Turkey

The prevalence of self-reported asthma was studied in a group of Turkish adults using the European Community Respiratory Health Survey (ECRHS) questionnaire distributed during 1994 local elections in Ankara, Turkey. A total of 2020 questionnaires were issued and 1820(90%) were returned. The mean age of the subjects was 34.5 +/- 10.2 years. The prevalence of wheezing at any time in the past was 39.1% which is much higher than has been reported in the literature. However, only 21.7% of the study population had wheezing in the year preceding the survey and 2.9% of them had severe asthma attacks. The prevlaences of nocturnal wheeze, nocturnal cough and morning tightness were higher in females (P = 0.05 for each). The results of this study showed a high rate of reported symptoms but a low rate of diagnosis and treatment of asthma among the adult population in Ankara.

Prevalence of childhood asthma in Istanbul, Turkey

In order to determine the asthma prevalence in 6-12-year-old schoolchildren in Istanbul, we issued 2350 questionnaires, according to ISAAC criteria, in six randomly selected city primary schools to be completed at home by parents. A total of 2232 of the questionnaires were completed, an overall response rate of 94.9%, and 2216 questionnaires were taken into consideration. The prevalence of asthma was found to be 9.8% and wheezing 15.1%. To investigate the effect of socioeconomic status on the prevalence of asthma, we evaluated the heating system at home, the place of residence, the educational levels of the mother and father, the number of people living in the house, the sharing of bedrooms, and the annual family income. In conclusion, the prevalence of childhood asthma was not affected by any of these factors. Atopic family history, food allergy, eczema, and frequent otitis media and sinusitis attacks were evaluated and found to be significant in asthma prevalence.

The prevalence of allergic diseases in primary school children in Edirne, Turkey

BACKGROUND

Allergic diseases present a major health burden for children as shown by the rising morbidity and increased mortality from asthma. Information on the prevalences of allergic disorders and contributing factors as well will help to establish feasible measures to change this trend, and more efficient assignment of the limited health resources.

OBJECTIVE

To assess the prevalences of asthma and other allergic diseases and the contribution of various risk factors in primary school children in Edirne, Turkey.

METHODS

Children aged 7 to 12 in primary schools in the municipality and 24 villages of Edirne were surveyed via a questionnaire completed by the parents. The cumulative (lifetime) and current (last 12 months) prevalences of allergic diseases and the presence of passive smoking, atopic family history, animal contact and breast-feeding in infancy were determined.

RESULTS

A total of 5412 children (70.1% from the metropolitan and 29.9% from the rural area) were enrolled. The cumulative and current prevalences of all allergic diseases were 24.6% and 9.9% respectively. The cumulative (lifetime) prevalences of bronchial asthma, wheezing, allergic rhinitis and atopic dermatitis were 16.4%, 18.9%, 12.3% and 2.2%, and the current (last 12 months) prevalences were 5.6%, 5.8%, 4.5% and 0.9% respectively. Three-fourths of the children were exposed to tobacco smoke at home. Atopic heredity appeared the most prominent risk factor for any allergic disorder. Neither age, breast-feeding nor place of habitation affected the occurrence of allergic disorders. Animal contact was a significant risk factor for asthma and wheezing (adjusted odd ratios (OR) and 95% confidence intervals (CI) for current prevalences are 1.38 (CI = 1.04-1.83) and 1.35 (CI = 1.02-1.78) respectively), exposure to indoor tobacco smoke for wheezing (OR = 1.52, CI = 1.10-2.09), and male gender for asthma (OR = 1.50, CI = 1.16-1.93). Current prevalences for all allergic diseases were significantly lower than those previously reported in Ankara, Turkey.

CONCLUSIONS

Allergic diseases are a major health burden for primary school children in Edirne, Turkey. Although atopic heredity appears to be the foremost important risk factor, reduction of exposure to indoor tobacco smoke and animal contact, especially for those with atopic family history, are important preventive measures. The impact of environmental exposures on distinguishing prevalences of allergic diseases in Ankara and Edirne should be further investigated.

One airway, one disease

The prevalence of asthma and allergic rhinitis is increasing in the general population, and a high proportion of new patients have coexisting upper and lower airway disease. Estimates show that 60 to 78% of patients who have asthma have coexisting allergic rhinitis. During the past decade, our understanding of asthma and allergic rhinitis has evolved. The historic perspective of these allergen-induced disorders as distinct and separate entities is being displaced by current thinking that they are described better as a continuum of inflammation involving one common airway. Therefore, traditional therapies originally indicated for allergic rhinitis and asthma are being reassessed to explore their potential utility in both upper and lower airway diseases. Recently, there has been a renewed interest in the role that histamines play in lower airway disease, and interest is increasing in the theory that leukotrienes, which are far more potent inflammatory mediators than histamines, play a role in upper airway disease. Given the pivotal role that leukotrienes play as potent inflammatory mediators in the pathophysiologic state of inflammation of both airways, leukotriene receptor antagonists recently have emerged as important therapeutic advances that have potential clinical utility in both asthma and allergic rhinitis.