Abstract
BackgroundThe prevalence of allergy-related diseases (ARDs), including rhinitis, allergic conjunctivitis and eczema, is on the increase globally. The causes of this increase are not well established.ObjectivesTo investigate the risk factors associated with ARDs among schoolchildren in Uganda.MethodsWe conducted a secondary data analysis of a large asthma case–control study involving 1700 schoolchildren, 5–17 years, in urban Uganda. ARDs were defined according to the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. Skin prick testing (SPT) was conducted using standard procedures and allergen-specific IgE (asIgE) using ImmunoCAP®. We employed inverse probability weighted analysis to generate estimated prevalence data and weighted odds ratios.ResultsThe lifetime estimated weighted prevalence of reported rhinitis, allergic conjunctivitis and eczema was 43.3%, 39.5% and 13.5%; weighted prevalence in 12 months was 10.1%, 9.1% and 2.3%, respectively. There was overlap of ARDs, with 66.3% of 1193 schoolchildren who reported having ever an ARDs (including asthma) reporting two or more. Risk factors associated with reported rhinitis in the last 12 months were city residence at birth [adjusted odds ratio (95% confidence interval) 2.66 (1.42–4.99) compared to rural]; father’s [2.62 (1.79–3.83)] and mother’s history of allergic disease [2.12 (1.48–3.02)]; frequent de-worming in the last 12 months [2.01 (1.30–3.11), ≥2 versus none]; current high frequency of ‘trucks passing on the street near home’ [2.59 (1.48–4.52), ‘almost all the time’ versus rarely] and positive SPT [1.54 (1.09–2.18)] but not asIgE [1.38 (0.60–3.15)]. The same pattern of risk factors was observed for allergic conjunctivitis and eczema.ConclusionWe found extensive multi-morbidity of, and overlap in the risk factors for, rhinitis, conjunctivitis and eczema—similar to asthma risk factors—among schoolchildren in urban Uganda. This suggests a similar underlying cause for all ARDs, associated with exposure to urban lifestyles and environment in Uganda.
Highlights
Allergy-related diseases (ARDs) including rhinitis, allergic conjunctivitis and eczema are on the increase in most parts of the world1, 2, but the causes of these diseases are generally not established3
Risk factors associated with rhinitis Schoolchildren with reported rhinitis in the last 12 months were more likely than their counterparts without rhinitis to report a father’s [adjusted odds ratio (95% confidence interval), 2.62 (1.79-3.83)]; and mother’s history of allergic disease [2.12 (1.48-3.02)]; residing in the city at birth [2.66 (1.42-4.99)]; using firewood/charcoal stove as main fuel for indoor cooking [2.46 (1.53-3.97)]; the highest reported frequency of de-worming in the last 12 months [2.01 (1.30-3.11)] and the highest reported frequency of ‘trucks passing on the street near their home’ currently [2.59 (1.48-4.52)] (Table 2)
Risk factors associated with allergic conjunctivitis Schoolchildren with a lifetime history of allergic conjunctivitis were more likely than their counterparts without allergic conjunctivitis to report a father’s [2.06 (1.56-2.71)] and mother’s history of allergic disease [1.57 (1.24-1.98)]; residing in the city at birth [1.69 (1.09-2.64)]; being exposed to farm animals in early life [1.33 (1.05-1.67)]; having a father with tertiary education [1.35 (1.03-1.79)]; the highest reported frequency of de-worming in last 12 months [1.94 (1.44-2.63)] and the highest reported frequency of ‘trucks passing on the street near their home’ currently [1.60 (1.03-2.48)] (Table 3)
Summary
Allergy-related diseases (ARDs) including rhinitis, allergic conjunctivitis and eczema are on the increase in most parts of the world , but the causes of these diseases are generally not established. Data on risk factors for ARDs from Africa is scarce, there is evidence to suggest that there may be important differences in risk factors between high income countries (HICs) and LMICs. For example, the International Study of Asthma and Allergies in Childhood (ISAAC) study reported a weaker association between ARDs and allergic sensitisation in LMICs than in HICs12. The International Study of Asthma and Allergies in Childhood (ISAAC) study reported a weaker association between ARDs and allergic sensitisation in LMICs than in HICs12 These differences were supported by results from our own work on risk factors for asthma, another important ARD, among Ugandan schoolchildren. We undertook a secondary data analysis of a large asthma case-control study involving schoolchildren in urban Uganda, in order to investigate the risk factors associated with rhinitis, allergic conjunctivitis and eczema. This suggests a similar underlying cause for all ARDs, associated with exposure to urban lifestyles and environment in Uganda
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