Prevalence and early‐life risk factors of school‐age allergic multimorbidity: The EuroPrevall‐iFAAM birth cohort

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Abstract

Background

Coexistence of childhood asthma, eczema and allergic rhinitis is higher than can be expected by chance, suggesting a common mechanism. Data on allergic multimorbidity from a pan‐European, population‐based birth cohort study have been lacking. This study compares the prevalence and early‐life risk factors of these diseases in European primary school children.

Methods

In the prospective multicentre observational EuroPrevall‐iFAAM birth cohort study, we used standardized questionnaires on sociodemographics, medical history, parental allergies and lifestyle, and environmental exposures at birth, 12 and 24 months. At primary school age, parents answered ISAAC‐based questions on current asthma, rhinitis and eczema. Allergic multimorbidity was defined as the coexistence of at least two of these.

Results

From 10,563 children recruited at birth in 8 study centres, we included data from 5,572 children (mean age 8.2 years; 51.8% boys). Prevalence estimates were as follows: asthma, 8.1%; allergic rhinitis, 13.3%; and eczema, 12.0%. Allergic multimorbidity was seen in 7.0% of the whole cohort, ranging from 1.2% (Athens, Greece) to 10.9% (Madrid, Spain). Risk factors for allergic multimorbidity, identified with AICc, included family‐allergy‐score, odds ratio (OR) 1.50 (95% CI 1.32–1.70) per standard deviation; early‐life allergy symptoms, OR 2.72 (2.34–3.16) for each symptom; and caesarean birth, OR 1.35 (1.04–1.76). Female gender, OR 0.72 (0.58–0.90); older siblings, OR 0.79 (0.63–0.99); and day care, OR 0.81 (0.63–1.06) were protective factors.

Conclusion

Allergic multimorbidity should be regarded as an important chronic childhood disease in Europe. Some of the associated early‐life factors are modifiable and may be considered for prevention strategies.

Abstract

Allergic multimorbidity (coexistence of asthma, eczema and allergic rhinitis) is common among European children at primary school age, with 7% of study participants affected. Protective factors identified in the study include female sex, having older siblings and attending day care. Risk factors include history of allergic diseases in first‐degree family members, early‐age symptoms and caesarean birth.

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Most cited references 40

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Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC Phases One and Three repeat multicountry cross-sectional surveys

M Innes Asher, Stephen Montefort, Bengt Björkstén … (2006)

Data for trends in prevalence of asthma, allergic rhinoconjunctivitis, and eczema over time are scarce. We repeated the International Study of Asthma and Allergies in Childhood (ISAAC) at least 5 years after Phase One, to examine changes in the prevalence of symptoms of these disorders. For the ISAAC Phase Three study, between 2002 and 2003, we did a cross-sectional questionnaire survey of 193,404 children aged 6-7 years from 66 centres in 37 countries, and 304,679 children aged 13-14 years from 106 centres in 56 countries, chosen from a random sample of schools in a defined geographical area. Phase Three was completed a mean of 7 years after Phase One. Most centres showed a change in prevalence of 1 or more SE for at least one disorder, with increases being twice as common as decreases, and increases being more common in the 6-7 year age-group than in the 13-14 year age-group, and at most levels of mean prevalence. An exception was asthma symptoms in the older age-group, in which decreases were more common at high prevalence. For both age-groups, more centres showed increases in all three disorders more often than showing decreases, but most centres had mixed changes. The rise in prevalence of symptoms in many centres is concerning, but the absence of increases in prevalence of asthma symptoms for centres with existing high prevalence in the older age-group is reassuring. The divergent trends in prevalence of symptoms of allergic diseases form the basis for further research into the causes of such disorders.

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Siblings, day-care attendance, and the risk of asthma and wheezing during childhood.

Thomas Ball, José A. Castro-Rodríguez, Kent Griffith … (2000)

Young children with older siblings and those who attend day care are at increased risk for infections, which in turn may protect against the development of allergic diseases, including asthma. However, the results of studies examining the relation between exposure to other children and the subsequent development of asthma have been conflicting. In a study involving 1035 children followed since birth as part of the Tucson Children's Respiratory Study, we determined the incidence of asthma (defined as at least one episode of asthma diagnosed by a physician when the child was 6 to 13 years old) and the prevalence of frequent wheezing (more than three wheezing episodes during the preceding year) in relation to the number of siblings at home and in relation to attendance at day care during infancy. The presence of one or more older siblings at home protected against the development of asthma (adjusted relative risk for each additional older sibling, 0.8; 95 percent confidence interval, 0.7 to 1.0; P=0.04), as did attendance at day care during the first six months of life (adjusted relative risk, 0.4; 95 percent confidence interval, 0.2 to 1.0; P=0.04). Children with more exposure to other children at home or at day care were more likely to have frequent wheezing at the age of 2 years than children with little or no exposure (adjusted relative risk, 1.4; 95 percent confidence interval, 1.1 to 1.8; P=0.01) but were less likely to have frequent wheezing from the age of 6 (adjusted relative risk, 0.8; 95 percent confidence interval, 0.6 to 1.0; P=0.03) through the age of 13 (adjusted relative risk, 0.3; 95 percent confidence interval, 0.2 to 0.5; P<0.001). Exposure of young children to older children at home or to other children at day care protects against the development of asthma and frequent wheezing later in childhood.

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Comorbidity of eczema, rhinitis, and asthma in IgE-sensitised and non-IgE-sensitised children in MeDALL: a population-based cohort study.

Mariona Pinart, Marta Benet, Isabella Annesi-Maesano … (2014)

Eczema, rhinitis, and asthma often coexist (comorbidity) in children, but the proportion of comorbidity not attributable to either chance or the role of IgE sensitisation is unknown. We assessed these factors in children aged 4-8 years. In this prospective cohort study, we assessed children from 12 ongoing European birth cohort studies participating in MeDALL (Mechanisms of the Development of ALLergy). We recorded current eczema, rhinitis, and asthma from questionnaires and serum-specific IgE to six allergens. Comorbidity of eczema, rhinitis, and asthma was defined as coexistence of two or three diseases in the same child. We estimated relative and absolute excess comorbidity by comparing observed and expected occurrence of diseases at 4 years and 8 years. We did a longitudinal analysis using log-linear models of the relation between disease at age 4 years and comorbidity at age 8 years. We assessed 16 147 children aged 4 years and 11 080 aged 8 years in cross-sectional analyses. The absolute excess of any comorbidity was 1·6% for children aged 4 years and 2·2% for children aged 8 years; 44% of the observed comorbidity at age 4 years and 50·0% at age 8 years was not a result of chance. Children with comorbidities at 4 years had an increased risk of having comorbidity at 8 years. The relative risk of any cormorbidity at age 8 years ranged from 36·2 (95% CI 26·8-48·8) for children with rhinitis and eczema at age 4 years to 63·5 (95% CI 51·7-78·1) for children with asthma, rhinitis, and eczema at age 4 years. We did longitudinal assessment of 10 107 children with data at both ages. Children with comorbidities at 4 years without IgE sensitisation had higher relative risks of comorbidity at 8 years than did children who were sensitised to IgE. For children without comorbidity at age 4 years, 38% of the comorbidity at age 8 years was attributable to the presence of IgE sensitisation at age 4 years. Coexistence of eczema, rhinitis, and asthma in the same child is more common than expected by chance alone-both in the presence and absence of IgE sensitisation-suggesting that these diseases share causal mechanisms. Although IgE sensitisation is independently associated with excess comorbidity of eczema, rhinitis, and asthma, its presence accounted only for 38% of comorbidity, suggesting that IgE sensitisation can no longer be considered the dominant causal mechanism of comorbidity for these diseases. Copyright © 2014 Elsevier Ltd. All rights reserved.

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Author and article information

Contributors

Sigurveig T. Sigurdardottir:

ORCID: https://orcid.org/0000-0002-6275-0910

veiga@landspitali.is , jonasson@hi.is

Kristjan Jonasson:

ORCID: https://orcid.org/0000-0002-9066-3128

jonasson@hi.is

Journal

Journal ID (nlm-ta): Allergy

Journal ID (iso-abbrev): Allergy

Journal ID (doi): 10.1111/(ISSN)1398-9995

Journal ID (publisher-id): ALL

Title: Allergy

Publisher: John Wiley and Sons Inc. (Hoboken )

ISSN (Print): 0105-4538

ISSN (Electronic): 1398-9995

Publication date (Electronic): 08 June 2021

Publication date (Print): September 2021

Volume: 76

Issue: 9 ( doiID: 10.1111/all.v76.9 )

Pages: 2855-2865

Affiliations

[ ¹ ] Landspitali University Hospital Reykjavik Iceland

[ ² ] Faculty of Medicine University of Iceland Reykjavik Iceland

[ ³ ] Department of Computer Science University of Iceland Reykjavík Iceland

[ ⁴ ] Children's Hospital Reykjavik Reykjavik Iceland

[ ⁵ ] Department of Allergy Landspitali University Hospital Reykjavik Iceland

[ ⁶ ] Children’s Hospital Landspitali University Hospital Reykjavik Iceland

[ ⁷ ] Human Development and Health & Clinical and Experimental Sciences Faculty of Medicine University of Southampton UK

[ ⁸ ] NIHR Southampton Biomedical Research Centre University Hospital Southampton NHS Foundation Trust Southampton UK

[ ⁹ ] The David Hide Asthma and Allergy Research Centre St Mary’s Hospital Isle of Wight UK

[ ¹⁰ ] Dietetic Department Salford Royal NHS Foundation Trust UK

[ ¹¹ ] Clinical and Experimental Sciences Faculty of Medicine University of Southampton UK

[ ¹² ] Division of Infection, Immunity and Respiratory Medicine School of Biological Sciences Manchester Institute of Biotechnology University of Manchester Manchester UK

[ ¹³ ] Allergy Department 2nd Pediatric Clinic National and Kapodistrian University of Athens Athens Greece

[ ¹⁴ ] Division of Infection, Immunity & Respiratory Medicine University of Manchester Manchester UK

[ ¹⁵ ] Department of Allergy La Paz University Hospital IdiPAZ Madrid Spain

[ ¹⁶ ] Department of Pediatric Pulmonology and Pediatric Allergology University Medical Center Groningen University of Groningen The Netherlands

[ ¹⁷ ] Department of Pediatric Pulmonology and Pediatric Allergology Emma Children's Hospital Amsterdam UMC University of Amsterdam Amsterdam The Netherlands

[ ¹⁸ ] Department of Immunology, Allergy and Rheumatology Medical University of Lodz Lodz Poland

[ ¹⁹ ] Medical Faculty Clinic of Chest Diseases, Allergology and Immunology Vilnius University Vilnius Lithuania

[ ²⁰ ] Faculty of Medicine Clinic of Children’s Diseases Vilnius University Vilnius Lithuania

[ ²¹ ] Department of Paediatric Pneumology and Immunology Charité – Universitätsmedizin Berlin Berlin Germany

[ ²² ] Epidemiology Unit German Rheumatism Research Centre Berlin Germany

[ ²³ ] Institute of Social Medicine, Epidemiology and Health Economics Charité – Universitätsmedizin Berlin Berlin Germany

[ ²⁴ ] Centre for Health Informatics School of Health Sciences The University of Manchester Manchester UK

[ ²⁵ ] Allergy Department Hospital Clinico San Carlos Universidad Complutense IdISSC ARADyAl Madrid Spain

[ ²⁶ ] Departments of Experimental Immunology and of Otorhinolaryngology Amsterdam University Medical Centers Amsterdam The Netherlands

[ ²⁷ ] Institute of Inflammation and Repair University of Manchester Manchester UK

[ ²⁸ ] Department for Infectious Disease Epidemiology Robert Koch‐Institut Berlin Germany

[ ²⁹ ] Institute of Clinical Epidemiology and Biometry University of Würzburg Würzburg Germany

[ ³⁰ ] State Institute of Health Bavarian Health and Food Safety Authority Bad Kissingen Germany

Author notes

[*] [* ] Correspondence

Sigurveig T. Sigurdardottir, Landspitali University Hospital, Reykjavik. Iceland.

Email: veiga@ 123456landspitali.is

Kristjan Jonasson, School of Engineering and Natural Sciences, University of Iceland, Reykjavík, Iceland.

Email: jonasson@ 123456hi.is

Author information

Sigurveig T. Sigurdardottir https://orcid.org/0000-0002-6275-0910

Kristjan Jonasson https://orcid.org/0000-0002-9066-3128

Graham Roberts https://orcid.org/0000-0003-2252-1248

Nikolaos G. Papadopoulos https://orcid.org/0000-0002-4448-3468

Paraskevi Xepapadaki https://orcid.org/0000-0001-9204-1923

Marek L. Kowalski https://orcid.org/0000-0002-8442-2774

Linus Grabenhenrich https://orcid.org/0000-0002-9300-6625

Thomas Keil https://orcid.org/0000-0002-9108-3360

Article

Publisher ID: ALL14857

DOI: 10.1111/all.14857

PMC ID: 8453757

PubMed ID: 33934363

SO-VID: 9a9fb356-1e49-4fdd-9a07-54bb3363ab20

License:

This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

History

Date revision received : 04 February 2021

Date received : 17 November 2020

Date accepted : 22 February 2021

Page count

Figures: 5, Tables: 2, Pages: 11, Words: 8284

Funding

Funded by: Landspitali University Hospital Science Fund, Iceland

Funded by: Nutricia Advanced Medical Nutrition, The Netherlands

Funded by: MSD Lithuania

Funded by: Teva, The Netherlands

Funded by: AstraZeneca, The Netherlands

Funded by: Food Standards Agency UK

Funded by: GlaxoSmithKline Iceland

Funded by: Grida Lithuania

Funded by: GlaxoSmithKline, The Netherlands

Funded by: Seventh Framework Programme , doi 10.13039/100011199;

Award ID: FP7‐KBBE‐2012‐6

Award ID: 312147

Funded by: Sixth Framework Programme , doi 10.13039/501100004965;

Award ID: FOOD‐CT‐2005‐514000

Funded by: Ministry of Science and Higher education, Poland

Custom metadata

source-schema-version-number 2.0

cover-date September 2021

details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:6.0.7 mode:remove_FC converted:21.09.2021

ScienceOpen disciplines: Immunology

Keywords: allergic multimorbidity,allergic rhinitis,asthma,children,eczema

Data availability:

ScienceOpen disciplines: Immunology

Keywords: allergic multimorbidity, allergic rhinitis, asthma, children, eczema

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Prevalence and early‐life risk factors of school‐age allergic multimorbidity: The EuroPrevall‐iFAAM birth cohort

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Most cited references 40

Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC Phases One and Three repeat multicountry cross-sectional surveys

Siblings, day-care attendance, and the risk of asthma and wheezing during childhood.

Comorbidity of eczema, rhinitis, and asthma in IgE-sensitised and non-IgE-sensitised children in MeDALL: a population-based cohort study.

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Cited by 12

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