A matched patient-sibling study on the usage of paracetamol and the subsequent development of allergy and asthma.

A number of studies have suggested that intake of paracetamol during pregnancy and during the first months of life is associated with an increased risk of childhood asthma. We aimed to determine the association between paracetamol usage during pregnancy and the first 6 months of life, and childhood allergy (i.e. positive skin prick tests), allergic asthma, and asthma, using a matched patient-sibling study comparing patients with allergic asthma with their healthy siblings without any symptoms of allergic diseases. Allergy in patients and their siblings was determined by skin prick tests. Children having at least one positive skin prick test were considered to be allergic. Intake of paracetamol was assessed by standardized, interviewer-administered, questionnaire. Nineteen pairs of allergic asthma patients vs. non-allergic siblings were compared to determine the risk factors for allergic asthma, while 15 pairs of allergic asthma patients vs. allergic siblings were compared to determine the risk factors for asthma. Moreover, 33 pairs of allergic asthma patients vs. non-asthmatic siblings (with and without allergy) were compared to determine the risk factors for asthma. In addition, 17 allergic siblings (without asthma) were compared with 19 non-allergic siblings (without asthma) to determine the risk factors for allergy. Usage of paracetamol during pregnancy was associated with allergic asthma (p = 0.03). Furthermore, usage of paracetamol between birth and 6 months of age, and between 4 and 6 months of age, was also found to be associated with non-allergic asthma (p = 0.008 and p = 0.03 respectively). Usage of paracetamol during pregnancy and during the early months of life may play a role in the development of allergic and non-allergic asthma in children. However, due to obvious ethical reasons, direct evidence for this association (i.e. a double-blind, prospective study) is not available.

Prevalence of asthma and comorbid allergy symptoms in Singaporean preschoolers.

The cross-sectional prevalence of wheeze, rhinitis and eczema in 7,549 randomly selected Singaporean preschoolers aged 4 to 6 years old is reported in this study. Cumulative and past 12 months ('current') prevalence of wheeze was 27.5% and 16.0%, respectively. 'Asthma' was reported by 11.7%. Current rhinitis prevalence was 25.3% and rhinoconjunctivitis, 7.6%. Current chronic rash affected 13.5% of subjects while 9.9% reported chronic rash with flexural distribution. After multivariate analysis, the main risk factors for 'current wheeze' and self-reported asthma, respectively, were family history of allergy (adjusted odds ratio [aOR] 3.22 [2.79-3.71], aOR 3.93 [3.34-4.63]); concurrent rhinoconjunctivitis (aOR 4.04 [3.31-4.92], aOR 3.02 [2.43-3.76]); concurrent chronic flexural rash (aOR 2.56 [2.13-3.08], aOR 2.95 [2.41-3.62]) and previous respiratory infection (aOR 4.80 [4.17-5.53], aOR 3.28 [2.80-3.85]). Thus, these allergy-associated symptoms already affect a considerable portion of children by the preschool years, supporting the need for allergy education and intervention program in this age group.

Prevalence of allergy-related symptoms in Singaporean children in the second year of life.

This study describes the cross-sectional prevalence of symptoms associated with eczema (chronic itchy rash), asthma (wheeze), and allergic rhinitis (rhinoconjunctivitis) in 1026 subjects between 18.5 and 23 months old (median age is 21 months) in Singapore. The first 2 yr cumulative prevalence of chronic itchy rash, wheeze, and rhinoconjunctivitis were 22.1% (n=227), 22.9% (n=235), and 8.4% (n=86) respectively. In total, 42.2% (414 of 979) reported ever having any of these symptoms. Eczema, although prevalent, was diagnosed only in 34.4% (n=78) of children with chronic itchy rash. Children with this eczematous rash were also more prone to wheeze (cOR=2.0, 95% CI: 1.2-3.0) and rhinoconjunctivitis (cOR=2.0, 95% CI: 1.4-2.8). Similarly, subjects who reported rhinoconjunctivitis and chronic itchy rash were 2.4 times (95% CI: 1.6-3.6) and 1.4 times (95% CI: 1.0-2.0) more at risk of wheezing respectively. Family history of allergy was a significant risk factor for chronic itchy rash (aOR=1.8, 95% CI: 1.3-2.4) and wheeze (aOR=1.7, 95% CI: 1.3-2.4). Thus, symptoms related to allergy were already prevalent during the second year of life. Significant proportions of these symptoms are likely to be due to true atopy as strong relationship with familial history and comorbidity with other potential allergic symptoms were observed.

Snoring and atopic disease: a strong association.

The prevalence and factors associated with snoring and habitual snoring in Asian children are largely unknown. Our objectives were to evaluate the prevalence and factors associated with snoring and habitual snoring in preschool and primary school children in Singapore. A self-response questionnaire on snoring was administered to parents of children aged 4-7 years in randomly selected preschools and primary schools in Singapore. The overall response rate was 91.3% (nt = 11,114). Snoring and habitual snoring were reported in 28.1% and in 6.0% of the children, respectively. On multivariate logistic regression analysis, snoring was significantly associated with male gender, race, atopy (asthma, allergic rhinitis, or atopic dermatitis), maternal atopy (allergic rhinitis or atopic dermatitis), maternal smoking, and breastfeeding. Habitual snoring was significantly associated with obesity (odds ratio (OR), 3.75; 95% confidence interval (CI), 1.67-8.42), allergic rhinitis (OR, 2.90; 95% CI, 2.06-4.08), atopic dermatitis (OR, 1.80; 95% CI, 1.28-2.54), maternal smoking (OR, 2.22; 95% CI, 1.09-4.53), and breastfeeding (OR, 1.49; 95% CI, 1.11-1.98). Atopy was the strongest risk factor for habitual snoring, and the effect was cumulative. The odds ratio of a child with all three atopic diseases (asthma, allergic rhinitis, and atopic dermatitis) to have habitual snoring was 7.45 (95% CI, 3.48-15.97). In conclusion, snoring and habitual snoring are common in Asian children. Atopy is strongly associated with snoring and habitual snoring. We suggest that children who are significantly atopic receive additional attention during screening for snoring, habitual snoring, and other features of obstructive sleep apnea syndrome.

An evaluation of asthma morbidity in Singaporean schoolchildren--a teachers' survey.

Asthma is the most common chronic illness in childhood. This study evaluated the asthma morbidity among Singaporean schoolchildren. The survey involved 1,744 schoolteachers using a structured written questionnaire. 73.4% of class teachers reported at least 1 asthmatic student in their class. 37.1% of teachers had students absent from school for up to 3 days per month and 5.1% missed school for 4 to 14 days in a month. 87.4% of the physical education (PE) teachers reported at least 1 asthmatic student in their class. 65.2% reported an average of 1-3 students sitting out at each PE lesson and 15.1% reported students who were exempted from PE for more than 3 months in a year due to asthma. The morbidity of asthma in Singaporean schoolchildren in terms of school absenteeism and exemption from PE classes is substantial. The data supports a need to improve asthma control amongst our schoolchildren.