Longitudinal changes in atopy during a 4-year period: Relation to bronchial hyperresponsiveness and respiratory symptoms in a population sample of Australian schoolchildren

doi:10.1016/0091-6749(90)90223-Q

Journal of Allergy and Clinical Immunology

Volume 85, Issue 1, Part 1, January 1990, Pages 65-74

https://doi.org/10.1016/0091-6749(90)90223-Q Get rights and content

Abstract

A total of 380 schoolchildren living in Belmont, New South Wales, a coastal town where the predominant aeroallergens are house dust mites, were studied on three occasions at 2-year intervals. At each study, atopy was measured by skin prick tests to 13 allergens, bronchial responsiveness was measured by histamine inhalation test, and respiratory illness history was assessed by a self-administered questionnaire to parents. The age of the group was 8 to 10 years at enrollment. We found that skin wheals <4 mm were not associated with respiratory or allergic illness, and therefore, we defined atopy as the presence of a skin wheal of ≥4 mm. In the sample, 24% of the children were atopic at 8 to 10 years (early-onset atopy), and an additional 15% became atopic during the study (late-onset atopy). Both early- and late-onset atopy had a close association with hay fever. Late-onset atopy was strongly associated with inconsistent reporting of symptoms. Early-onset atopy was an important risk factor for bronchial hyperresponsiveness (BHR), diagnosed asthma, and continuing symptoms of wheeze, and was a particularly important risk factor for BHR with current wheeze in late childhood years. We conclude that atopy acquired at an early age is an important predictive factor for respiratory symptoms occurring with BHR and continuing into late childhood.

References (37)

RA Barbee et al.
Longitudinal changes in allergen skin test reactivity in a community population sample
J Allergy Clin Immunol
(1987)
LP Boulet et al.
Asthma and increases in nonallergic bronchial responsiveness from seasonal pollen exposure
J Allergy Clin Immunol
(1983)
CS Witt et al.
Positive allergy prick tests associated with bronchial histamine responsiveness in an unselected population
J Allergy Clin Immunol
(1986)
B Stenius
Skin and provocation tests with Dermotophagoides pteronyssinus in allergic rhinitis: comparison of prick and intracutaneous skin test methods and correlation with specific IgE
Allergy
(1973)
DH Bryant et al.
The correlation between skin tests, bronchial provocation tests, and the serum level of IgE specific for common allergens in patients with asthma
Clin Allergy
(1975)
FA Herbert et al.
RAST and skin test screening in the investigation of asthma
Ann Allergy
(1982)
S Krilis et al.
Analysis of allergen-specific IgE responses in 341 allergic patients: associations between allergens and between allergen groups and clinical diagnoses
Aust NZ J Med
(1985)
RC Godfrey et al.
The prevalence of immediate positive skin tests to Dermatophagoides pteronyssinus and grass pollen in schoolchildren
Clin Allergy
(1976)
AJ Woolcock et al.
Atopy and bronchial reactivity in Australian and Melanesian populations
Clin Allergy
(1978)
TMK Haahtella
The prevalence of allergic conditions and immediate skin test reactions among Finnish adolescents
Clin Allergy
(1979)

RA Barbee et al.

Immediate skin-test reactivity in a general population sample

Ann Intern Med

(1976)

LR Friedhoff et al.

A genetic-epidemiological study of human immune responsiveness to allergens in an industrial population. 1. Epidemiology of reported allergy and skin test positivity

Am J Med Genet

(1981)

M Chan-Yeung et al.

Immediate skin reactivity and its relationship to age, sex, smoking, and occupational exposure

Arch Environ Health

(1985)

G Hattevig et al.

The prevalence of allergy and IgE antibodies to inhalant allergens in Swedish schoolchildren

Acta Paediatr Scand

(1987)

A Barbato et al.

Modification of bronchial hyperreactivity during pollen season in children allergic to grass

Ann Allergy

(1987)

DW Cockcroft et al.

Allergen-induced increase in nonaliergic bronchial reactivity

Clin Allergy

(1977)

B Burrows et al.

Respiratory disorders and allergy skin-test reactions

Ann Intern Med

(1976)

KN McNicol et al.

Spectrum of asthma in children. II. Allergic components

Br Med J

(1973)

Cited by (240)

A national cross-sectional study of exposure to outdoor nitrogen dioxide and aeroallergen sensitization in Australian children aged 7–11 years
2021, Environmental Pollution
The prevalence of allergic diseases in Australian children is high, but few studies have assessed the potential role of outdoor air pollution in allergic sensitization. We investigated the association between outdoor air pollution and the prevalence of aeroallergen sensitization in a national cross-sectional study of Australian children aged 7–11 years. Children were recruited from 55 participating schools in 12 Australian cities during 2007–2008. Parents completed a detailed (70-item) questionnaire. Outdoor nitrogen dioxide (NO₂), as a proxy for exposure to traffic-related emissions, was estimated using measurements from regulatory monitors near each school and a national land-use regression (LUR) model. Three averaging periods were assessed, using information on duration of residence at the address, including lifetime, previous (lifetime, excluding the last year), and recent (the last year only). The LUR model was used as an additional source of recent exposure estimates at school and home addresses. Skin prick tests (SPTs) were performed to measure sensitization to eight common aeroallergens. Multilevel logistic regression estimated the association between NO₂ and sensitization (by individual allergens, indoor and outdoor allergens, and all allergens combined), after adjustment for individual- and area-level covariates. In total, 2226 children had a completed questionnaire and SPT. The prevalence of sensitization to any allergen was 44.4%. Sensitization to house dust mites (HDMs) was the most common (36.1%), while sensitization to Aspergillus was the least common (3.4%). Measured mean (±s.d.) NO₂ exposure was between 9 (±2.9) ppb and 9.5 (±3.2) ppb, depending on the averaging period. An IQR (4 ppb) increase in measured previous NO₂ exposure was associated with greater odds of sensitization to HDMs (OR: 1.21, 95% CI: 1.01–1.43, P = 0.035). We found evidence of an association between relatively low outdoor NO₂ concentrations and sensitization to HDMs, but not other aeroallergens, in Australian children aged 7–11 years.
Managing Chronic Cough as a Symptom in Children and Management Algorithms: CHEST Guideline and Expert Panel Report
2020, Chest
Cough is one of the most common presenting symptoms to general practitioners. The objective of this article is to collate the pediatric components of the CHEST chronic cough guidelines that have recently updated the 2006 guidelines to assist general and specialist medical practitioners in the evaluation and management of children who present with chronic cough.
We reviewed all current CHEST Expert Cough Panel’s statements and extracted recommendations and suggestions relating to children aged ≤ 14 years with chronic cough (> 4 weeks duration). Additionally, we undertook systematic reviews to update other sections we considered relevant and important.
The eight recent CHEST guidelines relevant to children, based on systematic reviews, reported some high-quality evidence in the management of chronic cough in children (eg, use of algorithms and management of wet/productive cough using appropriate antibiotics). However, much evidence is still inadequate, particularly in the management of non-specific cough in the community.
The recommendations and suggestions related to the management of chronic cough in the pediatric age group have been based upon high-quality systematic reviews and are summarized in this article. Compared to the 2006 Cough Guidelines, there is now high-quality evidence for some aspects of the management of chronic cough in children. However, further studies particularly in primary health care are required.
Meta-analysis of the comorbidity rate of allergic rhinitis and asthma in Chinese children
2018, International Journal of Pediatric Otorhinolaryngology
Allergic rhinitis (AR) and asthma often occur concomitantly and are the two most common inflammatory conditions of the airways in children. Large-scale studies investigating the comorbidity of asthma and AR in children are rare. So, we performed a meta-analysis to describe the comorbidity rate of asthma and AR in Chinese children.
We retrieved related studies from Pubmed, Science, Springer, Elsevier, Embase, BMJ, and four Chinese biomedical databases, including Wanfang Data, VIP, CBM, and CNKI. From these individual studies, the comorbidity rate of asthma and AR in Chinese children was extracted and pooled to generate summary effect estimates in R version 3.2.3.
The meta-analysis included 25 cross-sectional studies. The results indicated that in China, the incidence of asthma in children with AR is 35.01% (95% CI: 32.32%–37.70%) and the incidence of AR in children with asthma is 54.93% (95% CI: 53.05%–56.80%).
The comorbidity of AR and asthma is high in Chinese children. Statistically, the prevalence of AR was higher in children with asthma, as opposed to the prevalence of asthma in children with AR. The comorbidity rate of AR and asthma signifies the importance of improving the recognition and treatment under both conditions by respiratory physicians and otolaryngologists.
Natural history of skin prick test reactivity: A 20-year prospective study of a random population sample of children and adolescents
2017, Annals of Allergy, Asthma and Immunology
Citation Excerpt :
However, our knowledge of changes over time in reactivity and the clinical implications of sensitization to the different groups of aeroallergens (ie, pollen, fur, house dust mites, and mold) remains limited. The few longitudinal studies completed have mostly observed the study population for a period of 2 to 8 years and found that sensitization is developed through childhood and puberty12,13 and lost in late adulthood.14 The aim of the present study was, therefore, to examine the change in SPT reactivity in a random population sample of children and adolescents during a 20-year period.
Allergic reactions to airborne allergens may have important consequences for affected individuals and are believed to be unstable through life, although evidence from longitudinal studies is limited.
To assess changes in skin prick reactivity during 20 years in a random population sample of children and adolescents in relation to symptoms of rhinitis.
A total of 983 individuals, aged 7 to 17 years, were randomly selected in 1986 and invited to 4 examinations during a 20-year period. During each examination, a skin prick test was performed using common local aeroallergens (ie, birch, grass, mugwort, horse, dog, cat, house dust mite [Dermatophagoides pteronyssinus and Dermatophagoides farinae] and 2 molds [Alternaria iridis and Cladosporium herbarum]).
The prevalence of allergy to any tested allergen peaked at the ages of 13 to 23 years. Rates of sensitization were variable. In the group of individuals tested more than once (n = 592), 16% developed sensitization during the study period and 9% became desensitized. In the group of individuals tested at all 4 examinations (n = 148), 34% developed sensitization and 22% became desensitized. In the group who developed sensitization, 55% had rhinitis, 17% had asthma, and 70% had eczema. In the group who became desensitized, 30% had rhinitis, 10% had asthma, and 50% had eczema.
This 20-year prospective study found that sensitization is common, but its prevalence in individuals is also variable over time. Furthermore, through puberty and early adulthood a large number of individuals develop sensitization and a smaller number become desensitized. In addition, we found that symptoms of rhinitis rarely preceded sensitization.
Latent class analysis reveals clinically relevant atopy phenotypes in 2 birth cohorts
2017, Journal of Allergy and Clinical Immunology
Phenotypes of childhood-onset asthma are characterized by distinct trajectories and functional features. For atopy, definition of phenotypes during childhood is less clear.
We sought to define phenotypes of atopic sensitization over the first 6 years of life using a latent class analysis (LCA) integrating 3 dimensions of atopy: allergen specificity, time course, and levels of specific IgE (sIgE).
Phenotypes were defined by means of LCA in 680 children of the Multizentrische Allergiestudie (MAS) and 766 children of the Protection against allergy: Study in Rural Environments (PASTURE) birth cohorts and compared with classical nondisjunctive definitions of seasonal, perennial, and food sensitization with respect to atopic diseases and lung function. Cytokine levels were measured in the PASTURE cohort.
The LCA classified predominantly by type and multiplicity of sensitization (food vs inhalant), allergen combinations, and sIgE levels. Latent classes were related to atopic disease manifestations with higher sensitivity and specificity than the classical definitions. LCA detected consistently in both cohorts a distinct group of children with severe atopy characterized by high seasonal sIgE levels and a strong propensity for asthma; hay fever; eczema; and impaired lung function, also in children without an established asthma diagnosis. Severe atopy was associated with an increased IL-5/IFN-γ ratio. A path analysis among sensitized children revealed that among all features of severe atopy, only excessive sIgE production early in life affected asthma risk.
LCA revealed a set of benign, symptomatic, and severe atopy phenotypes. The severe phenotype emerged as a latent condition with signs of a dysbalanced immune response. It determined high asthma risk through excessive sIgE production and directly affected impaired lung function.
Increase in Allergic Sensitization in Schoolchildren: Two Cohorts Compared 10 Years Apart
2017, Journal of Allergy and Clinical Immunology: In Practice
Citation Excerpt :
In Australia, the 4-year incidence was 15%,16 while a lower incidence was reported from Isle of Wight, 14%, over 6 years.15 However, completely accurate comparisons are difficult because the ages under study and the studied allergens differ somewhat.15,16 Interestingly, in our study area, the incidence of allergic sensitization from age 7 to 8 years to age 11 to 12 years had increased significantly from 14% to 18% over 10 years.
Time trends of incidence of allergic sensitization are unknown and recent trends of prevalence and risk factors are lacking.
To estimate the incidence, prevalence, remission, risk factors, and time trends for allergic sensitization among schoolchildren followed from age 7 to 8 years to age 11 to 12 years.
In 2006, all children in grades 1 and 2 aged 7 to 8 years in 2 municipalities in northern Sweden were invited to a questionnaire survey and to skin prick testing to 10 common airborne allergens. The cohort was reexamined in 2010, with additional blood sampling for specific IgE. Participation rates were 90% (n = 1700) at age 7 to 8 years and 85% (n = 1657) at age 11 to 12 years. The results were compared with a cohort examined by identical methods 10 years earlier.
The prevalence of positive skin prick test result to any allergen increased from 30% at age 7 to 8 years to 41% at age 11 to 12 years (P < .001). The cumulative 4-year incidence was 18%, while remission was low. Sensitization to pollen and furred animals was most common. A family history of allergy was significantly associated with incident sensitization, whereas the presence of furred animals at home was negatively associated. The prevalence at age 7 to 8 years and at age 11 to 12 years and the 4-year incidence were all significantly higher compared with the cohort examined 10 years earlier.
The prevalence of allergic sensitization increased by age as a consequence of a high incidence and a low remission. The trends of increasing incidence and prevalence among schoolchildren imply future increases in the prevalence of allergic diseases.

View all citing articles on Scopus

^☆: Supported by the Asthma Foundation of New South Wales and National Health and Medical Research Council of Australia.

^∗: Senior Research Assistant.

^∗∗: Professor of Respiratory Medicine.

View full text

Original articleLongitudinal changes in atopy during a 4-year period: Relation to bronchial hyperresponsiveness and respiratory symptoms in a population sample of Australian schoolchildren☆

Abstract

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

Skin and provocation tests with Dermotophagoides pteronyssinus in allergic rhinitis: comparison of prick and intracutaneous skin test methods and correlation with specific IgE

Allergy

The correlation between skin tests, bronchial provocation tests, and the serum level of IgE specific for common allergens in patients with asthma

Clin Allergy

RAST and skin test screening in the investigation of asthma

Ann Allergy

Analysis of allergen-specific IgE responses in 341 allergic patients: associations between allergens and between allergen groups and clinical diagnoses

Aust NZ J Med

The prevalence of immediate positive skin tests to Dermatophagoides pteronyssinus and grass pollen in schoolchildren

Clin Allergy

Atopy and bronchial reactivity in Australian and Melanesian populations

Clin Allergy

The prevalence of allergic conditions and immediate skin test reactions among Finnish adolescents

Clin Allergy

Immediate skin-test reactivity in a general population sample

Ann Intern Med

A genetic-epidemiological study of human immune responsiveness to allergens in an industrial population. 1. Epidemiology of reported allergy and skin test positivity

Am J Med Genet

Immediate skin reactivity and its relationship to age, sex, smoking, and occupational exposure

Arch Environ Health

The prevalence of allergy and IgE antibodies to inhalant allergens in Swedish schoolchildren

Acta Paediatr Scand

Modification of bronchial hyperreactivity during pollen season in children allergic to grass

Ann Allergy

Allergen-induced increase in nonaliergic bronchial reactivity

Clin Allergy

Respiratory disorders and allergy skin-test reactions

Ann Intern Med

Spectrum of asthma in children. II. Allergic components

Br Med J

Original article
Longitudinal changes in atopy during a 4-year period: Relation to bronchial hyperresponsiveness and respiratory symptoms in a population sample of Australian schoolchildren☆