Sneezing, sniffling, scratching or snoring, what is worse for allergic children in Singapore

Abstract

Rationale Allergic symptoms have a general tendency for nocturnal exacerbations. Nocturnal symptoms and awakenings are an important factor in disease specific quality of life assessments. We aimed to define the underlying risk factors for night time awakenings in allergic children in Singapore. Methods A prospective analysis of children referred for aeroallergen skin prick tests (SPTs) in the KK children's hospital outpatient clinic in Singapore, from March 2003 to Aug 2003. All patients were asked to complete a detailed questionnaire including environmental risk factors (smoking, pets, soft toys, etc.) and a combined allergy symptom score, modified from the rhinitis outcomes questionnaire (ROQ), with a maximal score of 52 points. We included in the analysis all patients with at least one positive SPT and a clinical diagnosis of allergic disease. Results 60 patients were included, 44(77%) males, 47(78%) Chinese, age mean 8.0 years (range 3 – 15 years). Patients were referred to the skin prick test with a diagnosis of one or more of: Allergic Rhinitis 38 (63%), Asthma 26 (43%) or Atopic Dermatitis 13 (22%). The median combined symptom score was 11 (Min 1, Max 36, 3rd quartile 18.5). There was no significant difference in the combined symptom score, between patient groups according to the referral diagnosis. Nocturnal awakenings were reported by 18 (36%) of patients, their presence correlated only with the skin specific symptom score and specifically with skin itching. Conclusions In a tropical climate, the presence of skin itch seems to be the most important predictive factor causing nocturnal awakenings in allergic children.