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Allergy. 2015 Aug;70(8):973-84. doi: 10.1111/all.12640. Epub 2015 May 20.

Phenotyping asthma, rhinitis and eczema in MeDALL population-based birth cohorts: an allergic comorbidity cluster.

Author information

1
Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.
2
CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
3
Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, Barcelona, Spain.
4
VIB Inflammation Research Center and Department of Respiratory Medicine, Ghent University, Ghent, Belgium.
5
IMIM (Hospital del Mar Research Institute), Barcelona, Spain.
6
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
7
Inserm, U823, Institut Albert Bonniot, Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, Grenoble, France.
8
Université Joseph Fourier, Grenoble, France.
9
Groupe Hospitalier Trousseau-La Roche-Guyon, Centre de l'Asthme et des Allergies, APHP, Université Paris 6, Paris, France.
10
Department of Public Health and Biostatistics, EA 4064, Paris Descartes University, Paris, France.
11
Paris Municipal Department of Social Action, Childhood, and Health, Paris, France.
12
Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany.
13
Institute of Clinical Epidemiology and Biometry, University of Wuerzburg, Wuerzburg, Germany.
14
Department of Pediatrics, Charité - Universitätsmedizin Berlin, Berlin, Germany.
15
Institute of Epidemiology I, Helmholtz Zentrum, Munich, Germany.
16
Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy.
17
Department of Epidemiology, Lazio Regional Health Service, Rome, Italy.
18
Pediatric Pulmonology and Pediatric Allergology, GRIAC Research Institute, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
19
Department of Pulmonology, GRIAC Research Institute, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
20
Department of Pediatrics, Research Institute, Marien-Hospital Wesel, Wesel, Germany.
21
Division of Pediatric Gastroenterology and Hepatology, Dr von Haunersches Kinderspital, Ludwig-Maximilians-University of Munich, Munich, Germany.
22
Department of Epidemiology, GRIAC Research Institute, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
23
Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands.
24
Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
25
Sach's Children's Hospital, Stockholm, Sweden.
26
Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark.
27
Department of Paediatrics, Oslo University Hospital and University of Oslo, Oslo, Norway.
28
National School of Public Health, Athens, Greece.
29
Inserm (Institut National de la Santé et de la Recherche Médicale), CESP (Centre de recherche en Épidémiologie et Santé des Populations), U1018, Respiratory and Environmental Epidemiology Team, Villejuif, France.
30
UMRS 1018, Université Paris Sud 11, Villejuif, France.
31
Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France.

Abstract

BACKGROUND:

Asthma, rhinitis and eczema often co-occur in children, but their interrelationships at the population level have been poorly addressed. We assessed co-occurrence of childhood asthma, rhinitis and eczema using unsupervised statistical techniques.

METHODS:

We included 17 209 children at 4 years and 14 585 at 8 years from seven European population-based birth cohorts (MeDALL project). At each age period, children were grouped, using partitioning cluster analysis, according to the distribution of 23 variables covering symptoms 'ever' and 'in the last 12 months', doctor diagnosis, age of onset and treatments of asthma, rhinitis and eczema; immunoglobulin E sensitization; weight; and height. We tested the sensitivity of our estimates to subject and variable selections, and to different statistical approaches, including latent class analysis and self-organizing maps.

RESULTS:

Two groups were identified as the optimal way to cluster the data at both age periods and in all sensitivity analyses. The first (reference) group at 4 and 8 years (including 70% and 79% of children, respectively) was characterized by a low prevalence of symptoms and sensitization, whereas the second (symptomatic) group exhibited more frequent symptoms and sensitization. Ninety-nine percentage of children with comorbidities (co-occurrence of asthma, rhinitis and/or eczema) were included in the symptomatic group at both ages. The children's characteristics in both groups were consistent in all sensitivity analyses.

CONCLUSION:

At 4 and 8 years, at the population level, asthma, rhinitis and eczema can be classified together as an allergic comorbidity cluster. Future research including time-repeated assessments and biological data will help understanding the interrelationships between these diseases.

KEYWORDS:

allergy; asthma; cluster analysis; eczema; rhinitis

PMID:
25932997
DOI:
10.1111/all.12640
[Indexed for MEDLINE]

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