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Within the past three decades, there has been a rising trend for prevalences of asthma and allergic diseases worldwide, particularly from developed and industrializing countries. In Thailand, limited studies on epidemiology of atopic diseases have indicated relatively low prevalences of these conditions among the Thais. Recently, a standardized phase I questionnaire of the International Study of Asthma and Allergies in Childhood (ISAAC) has been developed to study and to compare geographical and temporal trend for prevalences of asthma, allergic rhinitis and eczema in children. The objectives of phase I ISAAC study in Thailand are to study prevalence of the three most common allergic diseases i.e. asthma, allergic rhinitis and eczema among Thai children of the two age groups (i.e., 6-7 and 13-14 years) living in the Bangkok metropolitan area and to collect basic epidemiologic data of these diseases among these children. The Thai translated version of phase I ISAAC questionnaires was administered to Thai children of the two age groups as above. Questionnaires were answered by parents of younger children, whereas, they were self-administered by 13-14 years old children. In addition, the validated international video questionnaires were used with older children. Fourteen primary schools and 13 secondary schools were randomly selected to cover the entire Bangkok metropolitan area. A total of 7341 questionnaires were eligible for the analysis (3628 from the younger age group and 3713 from the older age group). Data were entered and analysed by the Epi-Info program. The cumulative and 12 month period prevalences of the three conditions for all children were as follows; wheezing, 18.3 per cent, 12.7 per cent; rhinitis, 44.2 per cent, 38.7 per cent; and eczema, 15.4 per cent, 14.0 per cent, respectively. The period prevalence of wheezing for older children (13.6%) was higher than for younger children (11.7%). Prevalences of severe wheeze and exercise wheeze were more common among older children (4.0% and 15.7%). Both age groups reported high percentages for night cough (23.6% and 28.6%). A significantly large number of children from both groups reported symptoms of rhinitis with the majority indicating that symptoms were severe enough to limit their daily activities. Nevertheless, when confined only to those with eye symptoms, the prevalence decreased to 13.1 per cent. Eczema, in contrast to the other two conditions, occurred more frequently among younger children than among older children (period prevalence of 16% vs 9.1%). The rash was of a relatively mild nature since 77 per cent of children reporting symptoms indicated that the rash had cleared within the past 12 months. Allergic conditions are very common among children residing in Bangkok. Compared to the last survey in 1990, the period prevalence of wheezing has increased 4 fold, allergic rhinitis has increased nearly 3 fold whereas, eczema has remained stable. A large number of children in Bangkok are suffering from rhinitis symptoms. Results of this phase I ISAAC study indicate that allergic diseases are perhaps the most common childhood diseases in Thailand and could lead to a substantial economical loss for the country. There is an urgent need for an in-depth study to define epidemiological factors responsible for this increase.
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PMID:Prevalence of asthma, rhinitis and eczema in children from the Bangkok area using the ISAAC (International Study for Asthma and Allergy in Children) questionnaires. 962 8

This cross-sectional epidemiological study collected health data for 2,470 school children between 5 and 14 years of age (89% of eligible children) who had lived most of their lives in either one of two counties strongly impacted by industrial pollution (Bitterfeld and Hettstedt) or in a neighboring county without any sources of industrial pollution (Zerbst). The objective of the study was to examine whether regional differences--with respect to the occurrence of childhood respiratory diseases and symptoms or allergies--exist and, if such differences are found, whether they persist when we adjust for the effects of known risk factors such as medical and sociodemographic factors or factors related to the indoor environment. Controlling for medical, sociodemographic, and indoor factors, according to parental reports, children residing in Hettstedt have about a 50% increased lifetime prevalence for physician-diagnosed allergies, eczema, and bronchitis compared to children from Zerbst and about twice the number of respiratory symptoms such as wheeze, shortness of breath, and cough without cold. Sensitization to common aeroallergens according to skin prick tests [odds ratio (OR) = 1.38; 95% confidence interval (CI), 1.02-1.86] and specific IgE levels (OR = 1.75; CI, 1.31-2.33) was more common for children from Hettstedt than children from the nonpolluted county. Bitterfeld children, on the other hand, more often received a diagnosis of asthma and eczema than children residing in Zerbst and also showed slightly increased sensitization rates. In conclusion, industrial pollution related to mining and smelting operations in the county of Hettstedt were associated with a higher lifetime prevalence of respiratory disorders and an increased rate of allergic sensitization in children between the ages of 5 and 14 years. Further studies are needed to determine what role the high dust content of heavy metals plays in Hettstedt.
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PMID:Respiratory diseases and allergies in two polluted areas in East Germany. 987 17

We determined the prevalence of asthma, rhinitis, and eczema among Brazilian children using the standardized protocol of the International Study on Asthma and Allergies in Childhood (ISAAC) to facilitate the comparison of our results with other studies using the ISAAC methodology. We conducted a cross-sectional study from June to October 1994 to determine the prevalence of asthma, rhinitis, and eczema in 5182 school children aged 7-8 years and 13-14 years residing in the Brazilian towns of Santa Maria and Itabira (iron-mining cities located in Minas Gerais). Parents completed questionnaires at their child's school in the presence of trained interviewers. The cumulative prevalence of doctor-diagnosed asthma was 4.6% for all ages with no significant difference between the age groups. In general, there was a higher prevalence of symptoms in the younger age group than the older. The prevalence of wheezing in the previous 12 months was 14.3% (7-8 years old) and 9.3% (13-14 years old) (p < 0.01), of chronic cough in the previous 12 months was 25.6% (7-8 years old) and 22.1% (13-14 years old) (p < 0.01), and of nighttime cough in the previous 12 months was 22.3% (7-8 years old) and 19.4% (13-14 years old) (p < 0.05). Overall the prevalences of asthma and wheezing symptoms in the previous 12 months were higher for boys than girls (5.2% vs. 3.9% for asthma, p < 0.01, and 13.2% vs. 10.6% for wheezing, p < 0.01, respectively). These results suggest that asthma-related respiratory illnesses affect a substantial part of the childhood population in Itabira and Santa Maria, Minas Gerais. Some factors such as male gender and younger age may be associated with an increase risk for chronic respiratory symptoms. Prevalences of asthma and allergic diseases in these Brazilian cities on the basis of self-reporting of symptoms and of one's medical history may more accurately portray the true prevalence of asthma than the use of medical records.
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PMID:Prevalence of asthma and other childhood allergies in Brazilian schoolchildren. 1060 23

In this paper, forty-three folk medicinal plants from Sile (Turkey) have been reported. Among them 35 species were wild and eight species were cultivated plants. The folk medicinal plants have been mostly used for the treatment of eczema, stomach and kidney ailments, asthma, cough, diabetes, and wounds.
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PMID:Turkish folk medicinal plants, part III: Sile (Istanbul). 1107 75

Despite the important contribution of traffic sources to urban air quality, relatively few studies have evaluated the effects of traffic-related air pollution on health, such as its influence on the development of asthma and other childhood respiratory diseases. We examined the relationship between traffic-related air pollution and the development of asthmatic/allergic symptoms and respiratory infections in a birth cohort (n approximately 4,000) study in The Netherlands. A validated model was used to assign outdoor concentrations of traffic-related air pollutants (nitrogen dioxide, particulate matter less than 2.5 micro m in aerodynamic diameter, and "soot") at the home of each subject of the cohort. Questionnaire-derived data on wheezing, dry nighttime cough, ear, nose, and throat infections, skin rash, and physician-diagnosed asthma, bronchitis, influenza, and eczema at 2 years of age were analyzed in relation to air pollutants. Adjusted odds ratios for wheezing, physician-diagnosed asthma, ear/nose/throat infections, and flu/serious colds indicated positive associations with air pollutants, some of which reached borderline statistical significance. No associations were observed for the other health outcomes analyzed. Sensitivity analyses generally supported these results and suggested somewhat stronger associations with traffic, for asthma that was diagnosed before 1 year of age. These findings are subject to confirmation at older ages, when asthma can be more readily diagnosed.
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PMID:Air pollution from traffic and the development of respiratory infections and asthmatic and allergic symptoms in children. 1237 53

This article summarizes clinical characteristics and identifies sensitizing allergens in 135 asthmatic children under 13 years of age in Kuwait, a desert environment with scant vegetation and weather conditions least associated with asthma. There were 84 males (M:F 1.65:1). Almost 70% were breast-fed (1-24 months), 59% had eczema, 52% allergic rhinitis, 78% of first-degree relatives had atopy, and 52% of parents were consanguinous. Cough was the presenting symptom in 92% and together with wheezing occurred in 76%. Most (91%) were < or = 5 years of age at diagnosis and 42% < 2 years. Mean duration of symptoms prior to diagnosis was 9.3+/-2 months (1 week-1 year). Viral upper respiratory tract infections, cigarette smoke, and exercise were the commonest triggers of symptoms (79%, 68%, 62%). Fumes of traditional Bokhour (incense) constituted a major indoor hazard. The most common sensitizing allergens were pollens of imported plants, molds, house dust mites, cockroaches, and peanuts. Management showed considerable under-treatment and included alternative medicines. In conclusion, childhood asthma in this desert environment starts at an early age, and is associated with high rate of atopy and high frequency of sensitization to aero- and food allergens. Asthmatic children are disadvantaged by delay in diagnosis, undertreatment, exposure to indoor cigarette smoke, and local traditions.
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PMID:Characteristics of asthmatic children in Kuwait. 1244 49

The aim of this study was to determine the prevalence of wheeze, eczema and rhinitis in 6-7 year old schoolchildren in Louth and Meath and assess their risk factors. The ISAAC (International Study for Asthma and Allergies in Childhood) questionnaire was used. The response rate was 64.1% (n = 1899). The prevalence rates for wheeze, eczema and rhinitis were 17.4%, 11.2% and 20.2% respectively, with 2.4% of children reported to be suffering from all 3 conditions. The main risk factors for wheeze were male sex and smoking in the home. Ninety-five (28.7%) children with wheeze had no diagnosis of asthma. Of these children 36 (37.9%) had wheeze with exercise, 55 (59.9%) had a dry cough not associated with a cold or flu and 13 (13.7%) reported more than 4 attacks of wheeze in the last year. This study suggests underdiagnosis and undertreatment of atopic illness in this age group. It also suggests decreasing exposure to passive smoking and early recognition and treatment will improve quality of life for many children.
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PMID:Wheeze, eczema and rhinitis in 6-7 year old Irish schoolchildren. 1279 69

The role of inhaled corticosteroids in the treatment of recurrent or persistent wheeze in infancy remains unclear. We evaluated the effect of 3 months of treatment with inhaled fluticasone propionate, 200 microg daily (FP200), on lung function and symptom scores in wheezy infants. Moreover, we evaluated whether infants with atopy and/or eczema respond better to FP200 as compared with non-atopic infants. Forced expiratory flow (Vmax(FRC)) was measured at baseline and after treatment. Sixty-five infants were randomized to receive FP200 or placebo, and 62 infants (mean age, 11.3 months) completed the study. Mean Vmax(FRC), expressed as a Z score, was significantly below normal at baseline and after treatment in both groups. The change from baseline of Vmax(FRC) was not different between the two treatment arms. After 6 weeks of treatment, and not after 13 weeks, the FP200 group had a significantly higher percentage of symptom-free days and a significant reduction in mean daily cough score compared with placebo. Separate analysis of treatment effect in infants with atopy or eczema showed no effect modification. We conclude that in wheezy infants, after 3 months of treatment with fluticasone, there was no improvement in lung function and no reduction in respiratory symptoms compared with placebo.
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PMID:Efficacy of fluticasone propionate on lung function and symptoms in wheezy infants. 1618 14

In utero programming of atopic manifestations has been suggested. We investigated the association between oral contraceptive (OC) use before, and complications during pregnancy (CDP) and asthma, along with other atopic manifestations. The study is based on neonates from Kingston and St Andrew, a geographic subcohort from the Jamaican Perinatal Morbidity, Mortality Survey conducted in 1986-1987. Information on OC use and CDP was extracted from maternal interviews and medical records. In a follow up in 1997-1998, via interviews with mothers, trained nurses collected information on asthma/wheezing, coughing, eczema, and hay fever. Data, specific to this paper, from birth and 11-12 yr of age was available for a total of 1040 of the 1720 members of the geographic subcohort. Using logistic regression, controlling for confounders, we estimated adjusted odds ratio (aOR) and corresponding 95% confidence intervals (CI). For asthma or wheezing, and coughing, aOR for OC use were 1.81 (95% CI: 1.25-2.61), and 2.72 (95% CI: 1.41-5.24), respectively. CDP was only shown to be a significant risk factor for hay fever. Additionally, a higher number of older siblings were protective for hay fever. The results suggest that asthma in childhood may be programmed in utero.
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PMID:Are oral contraceptive use and pregnancy complications risk factors for atopic disorders among offspring? 1561 Mar 61

Respiratory syncytial virus (RSV) infection is the most common cause of bronchiolitis in infants and an important risk factor for the development of recurrent wheezing and asthma. Cysteinyl leukotrienes were implicated in the pathophysiology of these diseases, and are being targeted for their diagnosis and therapy. We measured urinary leukotriene E4 (LTE4) in infants with RSV bronchiolitis in comparison with controls without respiratory infection, and investigated whether medical and family history, age, and passive exposure to tobacco smoke are related to urinary leukotriene excretion. We studied 33 infants with bronchiolitis and 25 controls, 1-12 months of age. Demographic and historical data were obtained from informed-consent forms and questionnaires completed by the parents. RSV was detected in nasal secretions by enzyme-linked immunoassay. Urine samples were collected on day of admission and were analyzed for LTE4 with an enzyme-linked immunoassay. Urinary LTE4 was 8-fold higher in infants with bronchiolitis than in controls. Leukotriene excretion was significantly higher in infected infants <6 months of age with a medical history of eczema or dry cough and/or family history of asthma. Multivariate analysis revealed that eczema and dry cough are independently associated with high LTE4 excretion during bronchiolitis. Exposure to tobacco smoke did not affect urinary LTE4. Our study shows that leukotriene synthesis during bronchiolitis is particularly elevated in younger infants with an atopic/asthmatic background. Urinary LTE4 may become a valuable, noninvasive marker for the identification of patients who will benefit most from therapy with leukotriene modifiers for management of bronchiolitis.
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PMID:Leukotriene synthesis during respiratory syncytial virus bronchiolitis: influence of age and atopy. 1610 56


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