Sensitization to inhaled allergens as a risk factor for asthma and allergic diseases in Chinese population

doi:10.1016/S0091-6749(97)70018-6

Journal of Allergy and Clinical Immunology

Volume 99, Issue 5, May 1997, Pages 594-599

https://doi.org/10.1016/S0091-6749(97)70018-6 Get rights and content

Abstract

Background: Allergen sensitization is associated with asthma and allergic disease in children, but such a relationship has not been confirmed in Chinese populations. Objective: The objective of this study was to evaluate the effects of allergen sensitization and family history of atopy on asthma and allergic disease in Chinese schoolchildren from three southeast Asian populations. Methods: Written questionnaires on respiratory and allergic symptoms were completed by parents of children of secondary-school age (age range 12 to 18 years) in Hong Kong (n = 1062), Kota Kinabalu in eastern Malaysia (n = 409), and San Bu in southern China (n = 737). A subsample of schoolchildren underwent skin prick testing to common inhalant allergens (Hong Kong 471 children, Kota Kinabalu 321, San Bu 647). Results: The prevalence of asthma and allergic disease in schoolchildren was highest in Hong Kong, intermediate in Kota Kinabalu, and lowest in San Bu. However, the overall rate of atopic sensitization was similar in the three populations (49% to 63%). House dust mite and cockroach were the two most common allergens causing sensitization and these gave rise to more than 95% of the positive skin test results in all three populations. By regression analysis, mite allergy was associated with rhinitis and asthma in all three populations, and a family history of asthma, rhinitis, or eczema was strongly associated with respective symptoms in the subjects. After adjusting for age, sex, atopic status, and family history of allergic disease, the place of residence remained a significant independent factor for asthma (odds ratio [OR] = 1.0 for Hong Kong, 0.57 for Kota Kinabalu, 0.15 for San Bu, p < 0.001), rhinitis (OR = 1.0 for Hong Kong, 0.59 for Kota Kinabalu, 0.15 for San Bu, p < 0.001), or eczema (OR = 1.0 for Hong Kong, 0.35 for Kota Kinabalu, 1.01 for San Bu, p < 0.001). Conclusion: Sensitization to indoor allergens was a significant risk factor for asthma and allergic disease, and familial clustering of disease was common in the region. However, the marked difference in disease prevalence in the three southeast Asian populations of Chinese schoolchildren cannot be explained by atopic sensitization and family history alone, and the place of residence was an independent risk factor for asthma and allergies, which suggests an important environmental role in disease pathogenesis. (J Allergy Clin Immunol 1997;99:594-8.)

Section snippets

METHODS

The details of the subject selection and methods used have been reported elsewhere.³ In brief, children of secondary-school age (age range 12 to 18 years) in Hong Kong, Kota Kinabalu in Malaysia, and San Bu in southern China were entered into the study between April and June 1992. They were randomly selected from all grades of schoolchildren attending one of the assigned schools by the local education authorities. Each participant was sent a questionnaire on respiratory and allergic symptoms in

RESULTS

Table I shows the distribution of asthma and allergic symptoms in the three study poplations. In general, the prevalence of asthma and allergic disease was highest in Hong Kong, intermediate in Kota Kinabalu, and lowest in San Bu. Despite the marked difference in prevalence, the atopy rates were similar across the three study populations and, in particular, there was little difference in the skin test positivity to house dust mite and cockroach, the two most common inhaled allergens causing

DISCUSSION

We evaluated the effects of allergen sensitization and family history of atopy on asthma and allergic disease in Chinese schoolchildren living in three southeast Asian cities. The important findings of the study were that (1) marked differences in the prevalence of asthma and allergic disease among the three cities were seen despite similar atopy rates, (2) sensitization to indoor allergens, particularly house dust mite, rather than outdoor allergens was strongly associated with disease

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Citation Excerpt :
The Isle of Wight birth cohort showed that allergic sensitization was associated with higher risks of asthma, rhinitis and eczema development at age 4 years.6 In Chinese schoolchildren from Hong Kong, Malaysia and China, indoor allergic sensitization was associated with higher risks of asthma and rhinitis development.7 However, these studies did not examine the longitudinal patterns of allergic sensitization trajectories.
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Early onset of eczema and early allergic sensitization were strongly associated. Early sensitization, especially to house dust mites, was associated with increased risks of developing wheeze and eczema, pointing to the importance of developing preventive perinatal interventions and effective therapeutics for sensitized toddlers.
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^☆: From the Departments of ^aMedicine and ^cChemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong; and ^bthe Department of Health, Hong Kong.

^☆☆: Reprint requests: Roland Leung, MD, Associate Professor, Department of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.

^★: 0091–6749/97 $5.00 + 0 1/1/79344

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Sensitization to inhaled allergens as a risk factor for asthma and allergic diseases in Chinese population☆,☆☆,★

Abstract

Section snippets

METHODS

RESULTS

DISCUSSION

Lancet

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

Lancet

Lancet

Variations in the prevalence of respiratory symptoms, self-reported asthma attacks, and use of asthma medication in the European Community Health Survey

Eur Respir J

Prevalence of asthma and atopy in two areas of West and East Germany

Am J Respir Crit Care Med

Asthma, allergy and atopy in three South-East Asian populations

Thorax

Asthma epidemiology in the Far East

Clin Exp Allergy

Linkage analysis of IL4 and other chromosome 5q31.1 markers and total serum immunoglobulin E concentrations

Science

Association between atopy and variants of the β-subunit of the high affinity immunoglobulin E receptor

Nature Genet

Exposure to house-dust mite allergen (Der p I) and the development of asthma in childhood: a prospective study

N Engl J Med

Sensitization and exposure to indoor allergens as risk factors for asthma among patients presenting to hospital

Am Rev Respir Dis

Mite and cat allergen levels in homes and severity of asthma

Am J Respir Crit Care Med