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Am J Respir Crit Care Med. 2007 Sep 15;176(6):565-74. Epub 2007 Jun 15.

Atopic sensitization and the international variation of asthma symptom prevalence in children.

Collaborators (158)

Björkstén B, Brunekreef B, Cookson W, von Mutius E, Strachan D, Weiland SK, Büchele G, Dentler C, Kleiner A, Rzehak P, Weinmayr G, Weiland SK, Priftanji A, Shkurti A, Simenati J, Grabocka E, Shyti K, Agolli S, Gurakuqi A, Stein RT, Urrutia de Pereira M, Jones MH, Pitrez PM, Cooper PJ, Chico M, Chen YZ, Zhong NS, Lai C, Wong G, Riikjärv M-, Annus T, Annesi-Maesano I, Gotua M, Rukhadze M, Abramidze T, Kvachadze I, Karsanidze L, Kiladze M, Dolidze N, Leupold W, Keil U, von Mutius E, Weiland S, von Mutius E, Keil U, Weiland S, Arthur P, Addo-Yobo E, Gratziou C, Priftis C, Papadopoulou A, Katsardis C, Tsanakas J, Hatziagorou E, Kirvassillis F, Clausen M, Shah JR, Mathur RS, Khubchandani RP, Mantri S, Forastiere F, Di Domenicantonio R, De Sario M, Sammarro S, Pistelli R, Serra MG, Corbo G, Perucci CA, Svabe V, Sebre D, Casno G, Novikova I, Bagrade L, Brunekreef B, Schram D, Doekes G, Jansen-van Vliet PH, Janssen NA, Aarts FJ, de Meer G, Crane J, Wickens K, Barry D, Nystad W, Bolle R, Lund E, Batlles Garrido J, Rubi Ruiz T, Bonillo Perales A, Gonzalez Jiménez Y, Aguirre Rodriguez J, Momblan de Cabo J, Maldonado AL, Daza Torres A, García-Marcos L, Martinez Torres A, Guillén Pérez JJ, Piñana López A, Castejon Robles S, Martinez Torres A, García Hernandez G, Martinez Gimeno A, Moro Rodríguez AL, Luna Paredes C, Gonzalez Gill I, Suarez-Varela MM, Llopis Paredes A, Gonzalez Gill I, Suarez-Varela MM, Llopis González A, Escribano Montaner A, Tallon Guerola M, Bråbäck L, Kjellman M, Nilsson L, Mai X-, Bråbäck L, Sandin A, Saraçlar Y, Kuyucu S, Tuncer A, Saçkesen C, Sumbuloğlu V, Geyik P, Kocabaş C, Strachan DP, Kaur B, El-Sharif N, Nemery B, Barghuthy F, Abu Huij S, Qlebo M, Björkstén B, van Hage M, Aït-Khaled N, Anderson HR, Asher I, Beasley R, Björkstén B, Bunekreef B, Cookson W, Crane J, Ellwood P, Foliaki S, Keil U, Lai C, Mallol J, Mitchell E, Montefort S, von Mutius E, Odhiambo J, Pearce N, Robertson C, Shah J, Stewart A, Strachan DP, Weiland SK, Williams H.

Author information

Institute of Epidemiology, Ulm University, Helmholtzstrasse 22, D-89075 Ulm, Germany.



Atopic sensitization has long been known to be related to asthma in children, but its role in determining asthma prevalence remains to be elucidated further.


To investigate the role of atopic sensitization in the large international variation in the prevalence of childhood asthma.


Cross-sectional studies of random samples of 8- to 12-year-old children (n = 1,000 per center) were performed according to the standardized methodology of Phase Two of the International Study of Asthma and Allergy in Childhood (ISAAC). Thirty study centers in 22 countries worldwide participated and reflect a wide range of living conditions, from rural Africa to urban Europe. Data were collected by parental questionnaires (n = 54,439), skin prick tests (n = 31,759), and measurements of allergen-specific IgE levels in serum (n = 8,951). Economic development was assessed by gross national income per capita (GNI).


The prevalence of current wheeze (i.e., during the past year) ranged from 0.8% in Pichincha (Ecuador) to 25.6% in Uruguaiana (Brazil). The fraction of current wheeze attributable to atopic sensitization ranged from 0% in Ankara (Turkey) to 93.8% in Guangzhou (China). There were no correlations between prevalence rates of current wheeze and atopic sensitization, and only weak correlations of both with GNI. However, the fractions and prevalence rates of wheeze attributable to skin test reactivity correlated strongly with GNI (Spearman rank-order coefficient rho = 0.50, P = 0.006, and rho = 0.74, P < 0.0001, respectively). In addition, the strength of the association between current wheeze and skin test reactivity, assessed by odds ratios, increased with GNI (rho = 0.47, P = 0.01).


The link between atopic sensitization and asthma symptoms in children differs strongly between populations and increases with economic development.

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