Leisure time activity and new onset of wheezing during adolescence.

Asthma prevalence is increasing in adult and paediatric patients. In the present study, the association between different leisure time activities and new onset of wheezing was analysed in adolescents aged 16-18 yrs taking part in a questionnaire-based follow-up of the International Study on Asthma and Allergies in Childhood in Munich and Dresden, Germany. Of the 3,785 adolescents who took part in the follow-up (76% response), 2,910 adolescents without earlier episodes of wheezing in childhood were included in the analyses. Of these, 330 (11.3%) reported new onset of wheeze during the previous 12 months. In the bivariate analyses, exercising more than once per week or performing computer work >1 h.day(-1) were inversely related to new onset of wheeze. In contrast, visiting discotheques on a regular basis increased the risk of new onset of wheeze (12.9 versus 9.9%). The observed inverse relationship between physical activity and new onset of wheeze was not an independent effect but mediated by differences in active smoking. The association between physical activity and new onset of wheeze disappeared when active smoking was taken into account. However, the present data do not allow for determining whether smoking operated as a confounder or as an intermediate factor, i.e. whether physical activities prevented active smoking.

First months of employment and new onset of rhinitis in adolescents.

The aim of the present study was to investigate the incidence of rhinitis in adolescents, taking into account the duration and type of employment in holiday and vocational jobs, and to study latency until development of symptoms. Participants of the International Study of Asthma and Allergies in Childhood (ISAAC)-II study in Munich and Dresden (Germany), who were enrolled in 1995, were re-contacted by a postal questionnaire in 2002 (aged 16-18 yrs). The questionnaire focused on allergic rhinitis, type and duration of all jobs, and potential confounders. All jobs held for >/=8 h.week(-1) and >/=1 month were coded and occupational exposure was assigned by a job-exposure matrix. Out of the 3,785 participants, 964 reported an employment history. The median (25th-75th percentile) duration of employment was 10 (1-16) months. After adjusting for potential confounders, those working in high-risk occupations (odds ratio (OR) 1.4, 95% confidence interval (CI) 1.0-2.1) had an increased risk for new onset of rhinitis, especially those exposed to low molecular weight agents (OR 1.8, 95% CI 1.1-2.8). The incidence of rhinitis was highest among those currently employed in a high-risk job for <10 months. Teenagers who start working in high-risk occupations have a higher incidence of rhinitis compared with those not working. This increased risk might occur early on during employment.

Do respiratory symptoms predict job choices in teenagers?

Existing guidelines advise adolescents with asthma and allergies against high-risk occupations. The aim of the current authors' analyses was to investigate the resulting self-selection in a prospective cohort study. The participants of Phase II of the International Study of Asthma and Allergies in Childhood in Germany (aged 9-11 yrs at baseline) were re-contacted after 7 yrs (response rate was 77%) and were asked to complete a questionnaire, which included items on atopic diseases. The subjects were also asked about the type of job they would like to have in the future (preferred job choice). Exposure to agents with potential asthma risk was evaluated using a job exposure matrix. The analyses were restricted to those in school-based vocational training programmes without occupational exposures. A total of 33% of subjects chose jobs with high asthma risk, 23% selected low asthma risk jobs and the remaining adolescents indicated jobs without known asthma risk (reference category). There were no statistically significant associations between asthma, allergic rhinitis or atopic dermatitis and selecting jobs with asthma risk. Participants with allergic rhinitis tended to select high risk jobs less frequently. In conclusion, self-selection into low risk jobs seems to play a minor role in teenagers with asthma or allergies.

Smoking and the incidence of asthma during adolescence: results of a large cohort study in Germany.

BACKGROUND: The association between smoking and asthma or wheeze has been extensively studied in cross sectional studies, but evidence from large prospective cohort studies on the incidence of asthma during adolescence is scarce. METHODS: We report data from a cohort study in two German cities, Dresden and Munich. The study population (n = 2936) was first studied in 1995/6 at age 9-11 years as part of phase II of the International Study of Asthma and Allergies in Childhood (ISAAC II) and followed up in 2002/3. At baseline the parents completed a questionnaire and children underwent clinical examination and blood sampling. At follow up the young adults completed questionnaires on respiratory health, living, and exposure conditions. Incidence risk ratios (IRR) were calculated and adjusted for potential confounders using a modified Poisson regression approach. RESULTS: The adjusted IRR for incident wheeze for active smokers compared with non-smokers was 2.30 (95% confidence interval (CI) 1.88 to 2.82). The adjusted IRR was slightly higher for incident wheeze without a cold (2.76, 95% CI 1.99 to 3.84) and the incidence of diagnosed asthma (2.56, 95% CI 1.55 to 4.21). Analysis of duration and intensity of active smoking indicated dose dependent associations. Stratified analyses showed that the risk of incident wheeze without a cold in atopic smokers increased with decreasing plasma alpha(1)-antitrypsin levels at baseline (1.64, 95% CI 1.22 to 2.20 per interquartile range). CONCLUSIONS: Active smoking is an important risk factor for the incidence of asthma during adolescence. Relatively lower plasma levels of alpha(1)-antitrypsin, although well above currently accepted thresholds, may increase susceptibility to respiratory disease among atopic smokers.

Atopic dermatitis, extrinsic atopic dermatitis and the hygiene hypothesis: results from a cross-sectional study.

BACKGROUND: Atopic Dermatitis (AD), hayfever and asthma are commonly summarized as atopic diseases. The spatial distribution of AD differs from that of asthma and hayfever, suggesting that AD might follow a different risk pattern than these diseases. AD can be differentiated into an allergic extrinsic form (EAD) and a non-allergic intrinsic form (IAD). Only EAD might follow the distribution and risk pattern that have been ascribed to asthma and hayfever. OBJECTIVE: To investigate the distribution and risk factor profile of AD and EAD focusing on environmental factors relating to the hygiene hypothesis. METHODS: Population-based cross-sectional study on 12,601 children aged 5-7 and 9-11 years from Dresden (Eastern Germany) and Munich (Western Germany). Information was obtained by International Study of Asthma and Allergic Childhood questionnaires, dermatological examinations and skin prick testing. AD-diagnosis ever, current AD-symptoms and visible eczema were investigated with their respective extrinsic forms. RESULTS: Maternal and paternal history of AD were equally strong determinants of the child's AD status. Factors related to the hygiene hypothesis like day-care attendance and number of older siblings were not associated with a decreased risk of AD. The proportion of EAD within AD was higher in Eastern than in Western Germany. The determinants of the diseases appeared to be similar for both EAD and IAD. CONCLUSIONS: There was no evidence of the hygiene hypothesis holding true for AD or EAD. AD might be a separate entity than respiratory atopic diseases. Little is known about the risk factors of AD and factors different from those of respiratory allergic diseases should be considered in future research.

A prospective, randomized, double-blind, placebo-controlled multi-centre study on the efficacy and safety of sublingual immunotherapy (SLIT) in children with seasonal allergic rhinoconjunctivitis to grass pollen.

BACKGROUND: Especially in childhood, sublingual immunotherapy (SLIT) could offer advantages over subcutaneous therapy. However, limited data on its efficacy is available. METHODS: In four German centres 97 children (age 3-14 years) with allergic rhinoconjunctivitis to grass pollen were enrolled in a prospective, double-blind trial comparing SLIT (Pangramin SLIT; ALK-SCHERAX, 0.5 microg major allergens, three times per week, 32 months) with placebo. Primary endpoint was a multiple symptom-medication score for changes in seasonal diary entries between the first and third year of the study (SLIT n=39; placebo n=38). RESULTS: The multiple symptom-medication score was significantly reduced by SLIT to 77.3% of the placebo group (P=0.0498). The subsequent analysis of the single endpoints did not reveal significant differences for symptom scores in favour of SLIT (85.1% of placebo group; P=0.22). However, the medication score improved significantly (67.1% of placebo group; P=0.0025). Furthermore, secondary endpoints assessing in vivo immune responses did not differ significantly between the groups. However, retrospective analysis showed some inhomogeneity for clinical and in vitro parameters at the beginning of the study. Allergic side effects with possible relation to the study drug were reported in both groups (SLIT 49%, placebo 27%, P=0.026). CONCLUSION: Our study indicates that SLIT had a positive effect on the reduction of a multiple symptom-medication score, mainly by significantly reducing rescue medication use, but had no significant effect on symptoms alone in children with rhinoconjunctivitis to grass pollen compared with a placebo.

Glutathione S transferase deficiency and passive smoking increase childhood asthma.

BACKGROUND: It has been suggested that the genetically determined deficiency of glutathione S transferase (GST) enzymes involved in the detoxification of environmental tobacco smoke (ETS) components may contribute to the development of asthma. METHODS: A large population of German schoolchildren (n = 3054) was genotyped for deficiencies of the GST isoforms M1 and T1. The association between GSTM1 and GSTT1 genotypes and asthma as well as atopy was investigated with respect to current and in utero ETS exposure. RESULTS: In children lacking the GSTM1 allele who were exposed to current ETS the risk for current asthma (OR 5.5, 95% CI 1.6 to 18.6) and asthma symptoms such as wheeze ever (OR 2.8, 95% CI 1.3 to 6.0), current wheezing (OR 4.7, 95% CI 1.8 to 12.6) and shortness of breath (OR 8.9, 95% CI 2.1 to 38.4) was higher than in GSTM1 positive individuals without ETS exposure. Hints of an interaction between ETS exposure and GSTM1 deficiency were identified. In utero smoke exposure in GSTT1 deficient children was associated with significant decrements in lung function compared with GSTT1 positive children not exposed to ETS. CONCLUSIONS: GSTM1 and GSTT1 deficiency may increase the adverse health effects of in utero and current smoke exposure.

A promoter polymorphism in the CD14 gene is associated with elevated levels of soluble CD14 but not with IgE or atopic diseases.

BACKGROUND: A polymorphism in the promoter region of the CD14 gene, C-159T, has been shown to be associated with increased levels of soluble CD14 (sCD14) and decreased serum immunoglobulin E (IgE) and the expression of a more severe atopic phenotype in previous studies. METHODS: To test if these associations are consistently found in different populations and different age groups, we genotyped 2048 children of different age groups as well as 888 adults from different regions of Germany for the CD14 C-159T polymorphism. RESULTS: While an association between this promoter polymorphism and levels of sCD14 could be confirmed in our study population (CC: 1017 ng/ml vs TT: 1370 ng/ml, P = 0.03), no association between CD14 C-159T genotypes and IgE levels or the prevalence of atopic diseases was seen. CONCLUSIONS: The lack of association between CD14 genotypes and IgE as well as atopic outcomes in this large German study population seems to indicate that CD14 genotypes may not directly be involved in the development of allergies during childhood.

The management of childhood asthma in the community.

The aim of the present study was to assess the management of children with asthma in the community. Community-based random samples of children aged 5-7 and 9-11 yrs in Dresden and Munich, Germany, were studied in 1995-1996 using the phase II protocol of the International Study of Asthma and Allergies in Childhood. Detailed information on the use of antiasthma drugs and accessory treatment in the past year was collected by parental questionnaire. A total of 11,094 (response rate 83%) children participated. Among children with wheeze in the last year, 36% had used bronchodilators and 19% were on regular anti-inflammatory treatment. The strongest determinant of treatment was a physician's diagnosis of asthma. Forty-seven per cent of the children with current wheeze had not been diagnosed as asthmatics and received hardly any treatment (9% bronchodilators and 2% anti-inflammatory drugs), despite an increased prevalence of severe asthma symptoms, bronchial hyperresponsiveness and atopic sensitisation compared with children without asthma symptoms. The proportion of children regularly using inhaled steroids was small (6%) among current wheezers and reached only 21% among children with diagnosed asthma and >12 wheezing attacks in the last year. Inhaled steroid use was lower in Munich than in Dresden and inversely related to the use of alternative remedies. Further efforts to improve the diagnosis and treatment of childhood asthma are needed. These should aim to increase awareness of the chronic nature of asthma and the need for treatment according to current guidelines.

[Prevalence of asymptommatic coeliac disease in children and adults in the Dresden region of Germany]. / Prävalenz der asymptomatischen Zöliakie bei Kindern und Erwachsenen in der Region Dresden.

BACKGROUND AND OBJECTIVE: Coeliac disease (CD) can be present without any, only a few, or many symptoms. Since asymptomatic CD can have the same complications and also carries the same risk for malignant disease as clinically typical CD inadequately treated by diet, early diagnosis is essential. The prevalence of asymptomatic CD in the Dresden region was determined by antibody screening. At the same time the sensitivity and specificity of the different antibodies were calculated. MATERIAL AND METHODS: Anti-gliadin and endomysium antibodies and total IgA content were measured in the serum of 3004 children (group A), aged 5-12 years, and of 4313 blood donors (group B), aged 17-64 years. Small-intestine biopsies were recommended if either (1) endomysium antibodies (EmA) or (2) anti-gliadin antibodies (ACA) and clinical symptoms or (3) AGA-IgG in the presence of total IgA deficiency and clinical symptoms had been demonstrated. RESULTS: EmA were demonstrated in 0.17% of group A and in 0.28% of group B. But AGA were found much more frequently (group A: 3.89%, group B: 3.76%). The number of cases of CD confirmed by biopsy indicated a prevalence of asymptomatic CD of 1 in 500 children and 1 in 540 adults. Sensitivity and specificity of EmA were significantly higher than those of AGA. CONCLUSION: Compared with a previous study on the prevalence of clinically typical CD in the same region, the present investigation indicates a four-fold higher prevalence of asymptomatic CD. Coeliac-specific antibodies should, therefore, be measured much more widely in the presence of certain symptoms and risk factors. While in adults the measurement of EmA is sufficient to provide the indication for a small-intestine biopsy, both EmA and AGA should be determined before a biopsy is undertaken in children.

Pulmonary fibrosis and other clinical manifestations of small vessel vasculitis in a family with seropositive juvenile rheumatoid arthritis.

We report on a family (mother, daughter, and son) suffering from progressive pulmonary fibrosis associated with deforming arthritis, sinusitis, glomerulonephritis, and cutaneous vasculitis. We suggest that these clinical features display the variable expressions of small-vessel vasculitis in juvenile rheumatoid arthritis.

Inverse association of overweight and breast feeding in 9 to 10-y-old children in Germany.

OBJECTIVE: To evaluate whether breast feeding is associated with prevalent overweight in pre-adolescent children. METHODS: Cross-sectional studies of 9 to 10-y-old children attending fourth grade in 1995/1996 in Dresden (n=1046) and Munich (n=1062), Germany, according to the International Study of Asthma and Allergies in Childhood (ISAAC) Phase II protocol. A comprehensive questionnaire including detailed breast feeding history was filled out by the child's parent. Height and weight were measured in a random subsample of children undergoing spirometry. Overweight was defined as body mass index > or =90th age- and sex-specific percentile of the German reference. RESULTS: While the prevalence of overweight differed substantially between Dresden (girls 9.1%, boys 12.5%) and Munich (17% both), we observed a markedly lower overweight prevalence among breast fed than non-breast fed children in both cities. Controlling for age, sex and city, breast-fed children were substantially less likely to be overweight at 9-10 y (OR 0.55, 95% CI 0.41-0.74). Results were slightly attenuated after adjustment for nationality, socio-economic status, number of siblings, parental smoking (OR 0.66, 95% CI 0.52-0.87). A longer overall duration and duration of exclusive breast feeding was associated significantly with decreasing prevalence of overweight. CONCLUSION: The results highlight the importance and possible preventive potential of early nutrition in the development of overweight in children. Both feeding behaviors acquired by the nursing infant and metabolic effects may contribute to the observed inverse association of breast feeding and overweight in children.

The use of anti-asthmatic drugs in children: results of a community-based survey in Germany.

PURPOSE: To describe the use of anti-asthma drugs in children in the general population and in children with asthma using data from two large surveys in Germany. METHODS: Community-based random sample of 5-7 and 9-11-year-old children in Dresden and Munich were studied in 1995/96 by parental questionnaires using the Phase II protocol of the International Study of Asthma and Allergies in Childhood (ISAAC). A total of 11,094 children participated in the surveys (response rate 83%). RESULTS: In all children, inhaled beta 2-agonists were used most frequently during the last 12 months (2.6%), followed by inhaled cromolyns (2.5%), oral beta 2-agonists (1.5%), and inhaled steroids (0.9%). Drug use was significantly higher among boys than girls and in older children compared to younger ones (P < 0.05 for both). Among children with current asthma, 47% had used inhaled beta 2-agonists, 43% inhaled cromolyns, 22% oral beta 2-agonists, and 16% inhaled steroids. Inhaled steroids were used significantly more often in Dresden (21.7%) than in Munich (11.2%) (P < 0.05). CONCLUSIONS: Among anti-asthma drugs, agents used for symptomatic relief were the most frequently reported followed by inhaled anti-inflammatory agents. Most of the anti-inflammatory drugs used were SCG, which may indicate under-treatment with inhaled steroids.

Traffic exposure and allergic sensitization against latex in children.

BACKGROUND: Latex antigens have been found in urban air samples and in debris deposited near freeways. OBJECTIVE: We investigated whether exposure to road traffic in a large city is associated with allergic sensitization against latex in children. METHODS: A population-based sample of 2505 children aged 5 to 11 years was examined in a cross-sectional study in the city of Dresden, Germany. Specific IgE levels against latex and a panel of common aeroallergens (timothy grass, rye, birch, mugwort, Cladosporium herbarum, Dermatophagoides pteronyssinus, cat dander, and dog dander) was determined by using a fluorescence immunoassay (CAP Pharmacia). Traffic exposure was assessed by (1) parental self-report on traffic frequency and truck traffic in the street of residence, (2) traffic counts, and (3) measurements of benzene at 182 points on a 1-km(2) grid for 1 year, which were used to estimate the children's individual exposure at the home address. RESULTS: Eight hundred fifty-four (34.1%) of the children were sensitized against any of the allergens, and 150 (6.0%) had specific IgE (>0.35 kU/L) against latex. The prevalence of latex sensitization was not positively associated with self-reported traffic exposure, traffic counts in the street of residence (adjusted prevalence odds ratio for >5000 vs < or =5000 cars/d, 0.7; 95% confidence interval, 0.4-1.3), or benzene exposure (adjusted prevalence odds ratio for an increase of 1 microg/m(3) air, 0.8; 95% confidence interval, 0.7-1.05). CONCLUSION: The data suggest that exposure to road traffic is not associated with allergic sensitization to latex in children.

House-dust-mite allergen concentrations (Der f 1) and mold spores in apartment bedrooms before and after installation of insulated windows and central heating systems.

BACKGROUND: It has been hypothesized that changes in heating systems and insulation of homes in developed countries have generated an indoor climate favorable to organisms that excrete allergens inducing sensitization and allergic disease. The purpose of this study was to determine the influence of the installation of highly insulated windows and central heating systems on indoor climate, and mite-allergen (Der f 1) and mold spore concentrations. METHODS: The bedrooms of 98 apartments were examined before and 7 months (mean) after installation of insulated windows and central heating systems. The air-exchange rate, temperature, and humidity were measured. In settled dust on carpets and mattresses, the number of colony-forming mold spores and the Der f 1 concentration were determined. The inhabitants completed a questionnaire about their lifestyles and housing conditions. RESULTS: The air-exchange rate decreased from geometric mean 0.73 to 0.52 per hour (P=0.029). Temperature (mean 13.4 vs 17.5 degrees C, P<0.001), and absolute humidity (mean 4.6 g vs 6.2 g H2O/kg air, P<0.001) increased. Relative humidity remained nearly unchanged (mean 47.6 vs 49.1%). Der f 1 concentrations on carpets (geometric mean 0.65 vs 1.28 microg/g dust, P < 0.001) and mattresses (geometric mean 1.56 vs 2.40 microg/g, P=0.002) increased. Among the fungi that were analyzed, only the thermotolerant species Aspergillus fumigatus increased (geometric mean 20 vs. 60 colony-forming units/g carpet dust, P = 0.02). CONCLUSIONS: The findings of this study suggest that the installation of insulated windows and central heating systems is associated with an increase of Der f 1 concentrations in carpet and mattress dust and of A. fumigatus in carpet dust in apartment bedrooms.

Exposure and allergic sensitization to cockroach allergen in East Germany.

BACKGROUND: Some studies suggest that the prevalence of sensitization to cockroach allergens may be higher in the United States than in Europe, but there are no comparable data from population-based studies. OBJECTIVES: To determine the prevalence of allergic sensitization to German cockroach (GCR) in German schoolchildren and to assess its clinical relevance; and to determine the exposure to the major GCR allergen Bla g 2 in non-selected homes and nurseries. METHODS: The prevalence of allergic sensitization to GCR and other allergens was determined by measurement of specific IgE and skin-prick tests in a cross-sectional study of 2993 children aged 5-11 years in Dresden, Germany. The prevalence of atopic disease was determined by questionnaire, and pulmonary function and bronchial hyperresponsiveness to hypertonic saline were measured. Bla g 2 exposure was determined on floors of 187 kitchens and 47 nurseries by a commercial sandwich ELISA. RESULTS: One hundred and twenty-seven (4.2%) of the children had specific IgE (> 0.7 kU/L) against GCR. Among children with current wheeze, 8.4% were GCR-sensitized. Compared to data from the United States, the prevalence of sensitization to cockroach was similar in children without asthma (3.9%), but less frequent in asthmatic children from Dresden (6.1%). After adjustment for positive reactions to other allergens (SX1 test) no significant impact of GCR sensitization on wheeze or other symptoms and diagnoses was found. Bla g 2 was detected in 29% of the kitchens and 43% of the nurseries. None of these sites had exposure levels above the proposed threshold for causing disease of 80 ng/g dust. CONCLUSION: The data suggest that allergic sensitization to GCR is less frequent in asthmatics from Dresden, Germany than in US cities. The data indicate that GCR sensitization is not an independent risk factor for asthma and other atopic diseases in 5-11-year-olds from this city.

Prevalence of respiratory and atopic disorders among children in the East and West of Germany five years after unification.

Living conditions in eastern Germany have changed rapidly since unification in 1990 and little is known about how these changes affect the prevalence of atopic diseases. This study describes methods and prevalences of a large epidemiological project investigating determinants of childhood asthma and allergies in eastern (Dresden and Leipzig) and western (Munich) Germany in 1995/1996. Community based random samples of 9-11 yr old children in Dresden (n=3,017) and Munich (n=2,612), and of 5-7 yr old children in Dresden (n=3,300), Leipzig (n=3,167) and Munich (n=2,165) were studied by parental questionnaires, bronchial challenges with hypertonic saline, skin examination, skin-prick tests, and measurements of specific and total serum immunoglobulin (Ig)E using Phase II modules of the International Study of Asthma and Allergies in Childhood (ISAAC). In 9-11 yr old children, the prevalence of physician diagnosed asthma (7.9% versus 10.3%; p<0.01) and bronchial hyperresponsiveness (15.7% versus 19.9%; p<0.05) was lower in Dresden than in Munich. No difference between Munich and Dresden was observed in the prevalence of diagnosed hay fever, skin test reactivity to > or = 1 allergen, and increased levels (>0.35 kU x L(-1)) of specific IgE against inhalant and food allergens. Symptoms and visible signs of atopic eczema tended to be more prevalent in Dresden. Similar East-West differences between the three study areas were seen in the younger age group. These findings are in line with recently observed increases in the prevalence of hay fever and atopic sensitization, but not of asthma and bronchial hyperresponsiveness, among 9-11 yr old children in Leipzig.