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Original Article
Prevalence estimates and risk factors for early childhood wheeze across Europe: the EuroPrevall birth cohort
  1. Anna Selby1,
  2. Alasdair Munro2,
  3. Kate E Grimshaw1,3,
  4. Victoria Cornelius4,
  5. Thomas Keil5,6,
  6. Linus Grabenhenrich7,8,
  7. Michael Clausen9,
  8. Ruta Dubakiene10,
  9. Alessandro Fiocchi11,
  10. Marek L Kowalski12,
  11. Nikolaos G Papadopoulos13,14,
  12. Marta Reche15,
  13. Sigurveig T Sigurdardottir16,
  14. Aline B Sprikkelman17,
  15. Paraskevi Xepapadaki13,
  16. E N Clare Mills18,
  17. Kirsten Beyer19,
  18. Graham Roberts1,20,21
  1. 1 Clinical and Experimental Sciences and Human Development and Health Academic Units, Faculty of Medicine, University of Southampton, Southampton, UK
  2. 2 Department of Paediatrics, Royal Hampshire County Hospital, Winchester, UK
  3. 3 Department of Nutrition and Dietetics, Southampton Children’s Hospital, Southampton, UK
  4. 4 Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London, UK
  5. 5 Institute of Social Medicine, Epidemiology and Health Economics, Charité University Medical Centre, Berlin, Germany
  6. 6 Institute for Clinical Epidemiology and Biometry, Julius-Maximilians-Universitat Wurzburg, Wurzburg, Germany
  7. 7 Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
  8. 8 Department for Dermatology, Venerology and Allergology, Charité University Medical Centre, Berlin, Germany
  9. 9 Children’s Hospital, Landspitali – The National University Hospital of Iceland, Reykjavik, Iceland
  10. 10 Faculty of Medicine, Vilnius University, Vilnius, Lithuania
  11. 11 Division of Allergy, Ospedale Pediatrico Bambino Gesu, Roma, Italy
  12. 12 Department of Immunology, Rheumatology and Allergy, Medical University of Lodz, Lodz, Poland
  13. 13 Allergy Unit, 2nd Paediatric Clinic, University of Athens, Athens, Greece
  14. 14 Centre for Paediatrics and Child Health, Institute of Human Development, University of Manchester, Manchester, UK
  15. 15 Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
  16. 16 Department of Immunology, Landspitali – The National University Hospital of Iceland, Reykjavik, Iceland
  17. 17 Department of Pediatric Pulmonology and Allergology, Beatrix Children’s Hospital, University Medical Center Groningen, Groningen, The Netherlands
  18. 18 Institute of Inflammation and Repair, Manchester Academic Health Science Centre, Manchester Institute of Biotechnology, University of Manchester, Manchester, UK
  19. 19 Department of Paediatric Pulmonology and Immunology, Charité University Medical Centre, Berlin, Germany
  20. 20 NIHR Southampton Respiratory Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
  21. 21 The David Hide Asthma and Allergy Research Centre, St Mary’s Hospital, Isle of Wight, UK
  1. Correspondence to Professor Graham Roberts, Paediatric Allergy and Respiratory Medicine, Southampton University Hospital NHS Foundation Trust, Southampton SO16 6YD, UK; g.c.roberts{at}


Background Preschool wheeze is an important problem worldwide. No comparative population-based studies covering different countries have previously been undertaken.

Objective To assess the prevalence of early childhood wheeze across Europe and evaluate risk factors focusing on food allergy, breast feeding and smoke exposure.

Methods Infants from nine countries were recruited into the EuroPrevall birth cohort. At 12 and 24 months, data on wheeze, allergic signs/symptoms, feeding, smoke exposure, infections and day care attendance were collected using questionnaires. Poisson regression was used to assess risk factors for wheeze.

Results 12 049 infants were recruited. Data from the second year of life were available in 8805 (73.1%). The prevalence of wheeze in the second year of life ranged from <2% in Lodz (Poland) and Vilnius (Lithuania) to 13.1% (95% CI 10.7% to 15.5%) in Southampton (UK) and 17.2% (95% CI 15.0% 19.5%) in Reykjavik (Iceland). In multivariable analysis, frequent lower respiratory tract infections in the first and second years of life (incidence rate ratio (IRR) 1.9 (95% CI 1.3 to 2.6) and 2.5 (95% CI 1.9 to3.4), respectively), postnatal maternal smoking (IRR 1.6, 95% CI 1.1 to 2.4), day care attendance (IRR 1.6, 95% CI 1.1 to 2.5) and male gender (IRR 1.3, 95% CI 1.0 to 1.7) were associated with wheeze. The strength of their association with wheeze differed between countries. Food allergy and breast feeding were not independently associated with wheeze.

Conclusion The prevalence of early childhood wheeze varied considerably across Europe. Lower respiratory tract infections, day care attendance, postnatal smoke exposure and male gender are important risk factors. Further research is needed to identify additional modifiable risk factors that may differ between countries.

  • asthma epidemiology
  • paediatric asthma

Statistics from


  • Contributors ENCM was coordinator of the EuroPrevall project; KB was principal investigator of the birth cohort study. ACS, GR, KEG and AM performed the statistical analyses; TK, LG and VC provided statistical and epidemiological advice. ACS and GR drafted the manuscript. All authors reviewed and approved the final manuscript.

  • Funding The EuroPrevall birth cohort study was conducted within the collaborative research initiative EuroPrevall, an integrated project funded by the European Commission under the 6th Framework Programme (FOOD-CT-2005-514000), and Integrated Approaches to Food Allergy and Allergy Risk Management, a 7th Framework Collaborative Project (FP7-KBBE-2012-6). The UK birth cohort and the analysis for this paper was funded by the UK Food Standards Agency (T07046 and FS305019).

  • Competing interests GR received grants from the EU FP6 Programme and UK Food Standards Agency during the conduct of the study; KEG has received educational grants from Nutrica and speaker fees from Nutrica and Abbott; TK has received grants from the EU FP7 Programme outside of the submitted work; STS received grants from Landspitali University Hospital Science Fund, GlaxoSmithKline and the Icelandic Student Innovation Fund during the conduct of the study and has received non-financial support from Novartis and Thermo Fisher outside of the submitted work; ENCM has received grants from the UK Biological and Biotechnological Sciences Research Council, DBV Technologies, Reacta Biotech Ltd, the Medical Research Council, Innovate and the North West Lung Centre Charity outside of the submitted work and is founding director of Reacta Biotech Ltd; KB has received funding for research activities from the European Union, German Research Foundation, Berliner Sparkasse, BEA-Stiftung, Food Allergy and Anaphylaxis Network, Food Allergy Initiative, Danone, Thermo Fisher and DST Diagnostics. Other authors have no competing interests to declare.

  • Ethics approval Ethics approval was obtained from the relevant ethics committee in each country involved in the study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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