Rhinitis Symptoms In Children Research Articles

The Effect of Serum Vitamin D Level on Allergic Rhinitis Symptoms in Children.

Background: Allergic rhinitis (AR) is a chronic disease that is becoming increasingly common worldwide and has a negative impact on school performance, work performance, and quality of life. The aim of this study was to investigate the effect of vitamin D on the symptoms of AR in children. Methods: Serum vitamin D levels of children with AR and age-matched healthy controls were compared using the high-pressure liquid chromatography method. The relationship between serum vitamin D levels and symptoms and severity of AR was then examined. Results: The study included 137 patients diagnosed with AR (76 males, 61 females; median age: 11 years). Serum vitamin D levels were lower in the patient group than in the control group (P = 0.001), lower in all aeroallergen groups (mites, pollen, and multiple inhalants) than in the healthy control group (P = 0.001), and lower in both the perennial AR group and the seasonal AR group than in the control group (P = 0.001). Spearman correlation analysis showed that there was no correlation between symptom score and vitamin D level (rs = -0.099; P = 0.25). Conclusions: We found no correlation between serum vitamin D level and symptoms and severity of AR. Serum vitamin D levels were lower in children with AR than in healthy children.

Treatment with a Probiotic Mixture Containing Bifidobacterium animalis Subsp. Lactis BB12 and Enterococcus faecium L3 for the Prevention of Allergic Rhinitis Symptoms in Children: A Randomized Controlled Trial.

Background: Probiotics may prevent the allergic response development due to their anti-inflammatory and immunomodulatory effects. The aim of this study is to determine if the prophylactic treatment with a mixture of Bifidobacterium animalis subsp. Lactis BB12 and Enterococcus faecium L3 would reduce symptoms and need for drug use in children with allergic rhinitis (AR). Methods: The study included 250 children aged from 6 to 17 years, affected by AR. Patients were randomly assigned to the intervention group (150) or to the placebo group (100). Patients in the intervention group, in addition to conventional therapy (local corticosteroids and/or oral antihistamines), were treated in the 3 months preceding the onset of symptoms related to the presence of the allergen to which the children were most sensitized, with a daily oral administration of a probiotic mixture containing the Bifidobacterium animalis subsp. Lactis BB12 DSM 15954 and the Enterococcus faecium L3 LMG P-27496 strain. We used Nasal Symptoms Score (NSS) to evaluate AR severity before and after the treatment with probiotics or placebo. Results: the patients in the intervention group had a significant reduction in their NSS after probiotic treatment (p-value = 2.2 × 10−10. Moreover, for the same group of patients, we obtained a significant reduction in the intake of pharmacological therapy. In particular, we obtained a reduction in the use of oral antihistamines (p-value = 2.2 × 10−16), local corticosteroids (p-value = 2.2 × 10−13), and of both drugs (p-value 1.5 × 10−15). Conclusions: When administered as a prophylactic treatment, a mixture of BB12 and L3 statistically decreased signs and symptoms of AR and reduced significantly the need of conventional therapy.

Polyvalent Mechanical Bacterial Lysate Administration Improves the Clinical Course of Grass Pollen–Induced Allergic Rhinitis in Children: A Randomized Controlled Trial

Recent studies highlight the immunoregulatory potential of bacterial lysates, indicating their potential use in the prevention and treatment of allergic diseases. To investigate the clinical efficacy of polyvalent mechanical bacterial lysates (PMBLs) in children with grass pollen-induced allergic rhinitis. Seventy children with seasonal allergic rhinitis were enrolled to this study and were randomly assigned to the PMBL and placebo groups. Severity of seasonal allergic rhinitis symptoms was assessed by the total nasal symptom score, total ocular symptom score, and visual analogue scale. During 3 visits, peak nasal inspiratory flow was measured, and nasal smears for the presence of eosinophils and nasal lavage fluids for the presence of allergen-specific IgE against timothy grass pollen allergens were sampled. A statistically significant decrease in total nasal symptom score (P= .001), total ocular symptom score (P=.04), and visual analogue scale score for nasal and eye symptoms (P < .001 and P < .001, respectively) and an increase in peak nasal inspiratory flow (P= .04) were observed in the PMBL group versus the placebo group. During the grass pollen season, an increase and then a decrease in the number of eosinophils in nasal smears was observed in both groups; however, the number of eosinophils was significantly lower in the PMBL group versus the placebo group. No significant changes in allergen-specific IgE concentrations were observed in the PMBL group, whereas in the placebo group a statistically significant increase in allergen-specific IgE concentration was observed. Sublingual administration of PMBLs during the grass pollen season offers significant efficacy in alleviating seasonal allergic rhinitis symptoms in children sensitized to grass pollen allergens. PMBLs probably affect mucosal immunity, weakening the response of TH2 cells.

Determination of Loratadine and Its Active Metabolite in Plasma by LC/MS/MS: An Adapted Method for Children

Introduction: Loratadine (LOR) (Fig. 1), an active H1 receptor antagonist, is often used in the treatment of allergic disorders such as seasonal allergies and skin rash [1]. LOR was clinically approved for symptomatic relief of nasal and non-nasal symptoms of allergic rhinitis in children ≥2years. Materials and Methods: An adapted method of liquid chromatography-mass spectrometry (LC/MS/MS) was developed and validated to measure the concentrations of loratadine (LOR) and its active metabolite descarboethoxyloratadine (DCL) from pediatric plasma. After being mixed with the internal standard (IS, propranolol) and precipitated with methanol, samples were centrifuged and 20 μL of the supernatants were injected into the HPLC system. Separation was carried out on a reversed-phase C18 gradient column using a mobile phase consisting of water (containing 0.1 % formic acid) and acetonitrile. The flow rate was 0.5 mL/min and the running time was 5.0 min for each sample. Results and Conclusion: Quantitation of LOR, DCL and IS was performed using MRM mode and the transitions were: 383.1 → 337.1 for LOR, 311.1 → 259.0 for DCL and 260.2 → 116.0 for propranolol, respectively. The method was validated according to FDA guidelines, precisions and accuracies met the requirements in all cases. Calibration curves were 0.2–50.0 ng/mL for both LOR and DCL. This method was then applied for a pilot study examining the pharmacokinetics and therapeutic drug monitoring of LOR in children.

Effects of Vacuuming Mattresses on Allergic Rhinitis Symptoms in Children.

PurposeTo evaluate the effects of daily vacuuming of mattresses on the concentration of house dust mite (HDM) allergens and on allergic rhinitis (AR) symptoms in children sensitized to HDM.MethodsForty children between the ages of 6 and 12 years with mild persistent AR and sensitized only to HDM were enrolled and randomly allocated to 2 groups. Caregivers of children in the experimental group cleaned the children's rooms and vacuumed their mattresses daily for 2 weeks. Caregivers of children in the control group cleaned the children's rooms without vacuuming mattresses. Symptoms of AR were checked weekly and dust samples were collected from the mattresses before and after the study.ResultsDemographics at the beginning of the study were not significantly different between the 2 groups. In the experimental group, symptoms of AR and dust weight were significantly decreased after 2 weeks (total symptoms of AR, P <0.001; sneezing, P < 0.001; rhinorrhea, P <0.001; nasal obstruction, P < 0.001; itching, P <0.001; and dust weight, P = 0.006). The concentrations of HDM allergens were not changed significantly (Der p1, P = 0.333; Der f1, P = 0.841). In the control group, there were no significant changes in symptoms of AR, dust weight, or the concentration of HDM allergens.ConclusionsOur findings showed that daily vacuuming of mattresses reduced dust weight and symptoms of AR. However, the concentration of HDM allergens did not significantly decrease.

Cross-sectional study about impact of parental smoking on rhinitis symptoms in children.

Assess the prevalence of rhinitis and exposure to environmental tobacco smoke (ETS) of children in our community and its relationship with symptoms of rhinitis METHODS (DESIGN, SETTING, PARTICIPANTS, MAIN OUTCOME MEASURES): Cross-sectional study using questionnaire on rhinitis of the International Study of Asthma and Allergies in Childhood, in children (6-7years) and adolescents (13-14years). Categories: "rhinitis ever", "recent rhinitis", "recent rhinoconjunctivitis", "severe rhinoconjunctivitis". Parental smoking: (i) neither parent smokes; (ii) only the mother smokes; (iii) only the father smokes; and (iv) both parents smoke. Odds ratio of the prevalence of symptoms of rhinitis according to ETS exposure was calculated using logistic regression. 10690 children and 10730 adolescents. The prevalence of "rhinitis ever" in children: 29.4%, "recent rhinitis" 24%, "recent rhinoconjunctivitis" 11.5% and "severe rhinoconjunctivitis" 0.1%. In adolescents: 46.2%, 34.5%, 16.2% and 0.2%, respectively. Environmental tobacco smoke exposure in the home occurred in 51% of cases. Parental smoking was associated with a higher prevalence of forms of rhinitis in adolescents when only the mother was a smoker. In children when both parents were smokers. Rhinitis is highly prevalent in our community. Environmental tobacco smoke exposure is still very common. The relationship between ETS and rhinitis symptoms in children of this community is not as robust as that found for asthma.

Association between desloratadine and prednisolone in the treatment of children with acute symptoms of allergic rhinitis: a double-blind, randomized and controlled clinical trial

IntroductionA combination of antihistamines and oral corticosteroids is often used to treat acute symptoms of allergic rhinitis. ObjectiveTo evaluate safety and efficacy of desloratadine plus prednisolone in the treatment of acute symptoms of children (2–12 years) with allergic rhinitis, and to compare it to dexchlorpheniramine plus betamethasone. MethodsChildren with moderate/severe persistent allergic rhinitis and symptomatic (nasal symptoms score [0–12]≥6) were allocated in a double-blind, randomized fashion to receive dexchlorpheniramine plus betamethasone (n=105; three daily doses) or desloratadine plus prednisolone (n=105; single dose followed by two of placebo) for 7 days. At the beginning and end of the evaluation, the following were obtained: nasal symptoms score, extra nasal symptoms score, peak nasal inspiratory flow, blood biochemistry, and electrocardiogram. Ninety-six children of the dexchlorpheniramine plus betamethasone group and 98 of the desloratadine plus prednisolone group completed the protocol. ResultsThe two groups were similar regarding initial and final nasal symptoms scores, extra nasal symptoms scores and peak nasal inspiratory flow. A drop of 76.4% and 79.1% for nasal symptoms score, 86.0% and 79.2% for extra nasal symptoms score, as well as an increase of 25.2% and 24.3% for peak nasal inspiratory flow occurred for those treated with desloratadine plus prednisolone and dexchlorpheniramine plus betamethasone, respectively. There were no significant changes in blood chemistry. Sinus tachycardia was the most frequent electrocardiogram change, but with no clinical significance. Drowsiness was reported significantly more often among those of dexchlorpheniramine plus betamethasone group (17.14%×8.57%, respectively). ConclusionThe desloratadine plus prednisolone combination was able to effectively control acute symptoms of rhinitis in children, improving symptoms and nasal function. Compared to the dexchlorpheniramine plus betamethasone combination, it showed similar clinical action, but with a lower incidence of adverse events and higher dosing convenience.

The Effect of Black Carbon Exposure on Rhinoconjunctivitis Quality of Life in Peri-Urban Peruvian Children with Asthma

INTRODUCTION:Ambient air pollution,including traffic-related pollution,has been reported to be linked to rhinitis symptoms in children and adolescents.However,the impact of variations in pollutant exposure upon rhinoconjunctivitis quality of life (QOL) is unknown.METHODS:Three hundred ninety-three children with asthma, ages 9 to 19 years,in two periurban regions of Peru and self-reporting rhinoconjunctivitis symptoms were administered the Pediatric Rhinoconjunctivitis QOL Questionnaire (PRQLQ) or its adolescent counterpart (ARQLQ) at repeated intervals over 1 year. RQLQ scores were dichotomized to: not bothered(score=0) or bothered(score&gt;0). Exposures to particulate matter&lt;2.5μm (PM2.5) and one component,black carbon(BC), were determined by inverse distance weighted methods based on 1-month average gravimetric measurements preceding each visit. Multivariable logistic regression based on generalized estimating equations were used to estimate associations between pollutant exposure and QOL scores.RESULTS:Participants had a mean(SD) age of 14(2.6) years, and 44% were male. Majority of children were atopic(78%), of normal weight(74%), and had good control of their asthma(88%). Mean(SD) PM2.5 and BC exposure across all children-visits were 20.7(3.1) μg/m3 and 4.4(2.6) μg/m3, respectively. After adjustment for potential confounders, each 10μg/m3 increase in PM2.5 was significantly associated with increased odds of being bothered by rhinoconjunctivitis symptoms (odds ratio[OR]; 95% confidence interval[CI]: 1.14; 1.03,1.94). When considering BC as a fractional component of total PM, a 10% increase in BC proportion was associated with increased odds of being bothered (OR:1.21; 95% CI: 1.05,1.39). In contrast,increases in the non-BC fraction of PM were not linked to higher risk of being bothered by rhinoconjunctivitis.CONCLUSION:This is the first study showing the potential role of the BC component of PM in rhinoconjunctivitis quality of life among asthmatic children.

Assessing rhinitis symptoms in children – a need for action

Assessing rhinitis symptoms in children – a need for action

Evaluation of Prevalence of Allergic Rhinitis Symptoms in Kurdistan, a Western Province in Iran

Introduction Allergic rhinitis, like other allergic diseases, is one of the most common disorders during childhood; this study was conducted to assess and compare the prevalence and severity of allergic rhinitis in children and adolescents living in Kurdistan province. The study was aimed to provide a ground for the identification of likely causes and risk factors of this disorder. Materials and Methods This study was a cross-sectional study. In order to collect data, 4,000 questionnaires were distributed to elementary schools and junior high schools and 3,890 questionnaires were completed; as a result, the survey response rate was 97%. The study was carried out based on International Study of Asthma and Allergies in Childhood (ISAAC): ISAAC questionnaire. After entering the data into SPSS version 13, they were analyzed using logistic regression and Chi- square test. Results Of a total 3,890 people, 29.7% of the subjects in this study reported a history of sneezing or runny nose in the past 12 months; it was reported more in boys in the age group 13-14 years and the difference between the sexes was significant [Odds ratio(OR)=1.35, Confidence interval (CI)]: 1.09-1.67, P < 0.01). Based on physician diagnosis, 9.37% of the subjects were overtaken by allergic rhinitis and it was more prevalent in boys at both educational levels and the difference was statistically significant in subjects aged 13-14 years old (OR=1.44 CI: 1.07-1.94, P <0.05). Conclusion The prevalence of the allergic rhinitis symptoms in children and adolescents living in Kurdistan province is relatively high and it is necessary to carry out extensive studies on its important risk factors.

Allergic rhinitis, rhinoconjunctivitis and hayfever symptoms among children are associated with frequency of truck traffic near residences: a cross sectional study.

BackgroundAllergic rhinitis (AR) is an increasing and common condition affecting many people globally, especially children. The aim of the study was to investigate the association between the frequency of truck traffic and allergic rhinitis symptoms, rhinoconjunctivitis and hayfever among 13 to 14 year old school children in Ekurhuleni Metropolitan Municipality, Gauteng Province, South Africa.MethodsIn a cross-sectional study design, 3764 children from 16 randomly selected high schools were eligible to participate, 3468 completed the International Study of Asthma and Allergies in Childhood (ISAAC) Phase I questionnaire of which 3424 were suitable for analysis; the overall response rate was 92 %. Data were analysed using multilevel logistic regression analysis.ResultsThe prevalence of self-reported rhinitis ever, current rhinitis rhinoconjunctivitis and hayfever was 52, 40, 21 and 37 % respectively. Rhinitis ever, current rhinitis and current rhinoconjunctivitis were significantly associated with the frequency of trucks passing near residences almost all day on weekdays, (OR 1.46 95 % CI: 1.16 − 1.84), (OR 1.60 95 % CI: 1.24–2.02) and (OR 1.42 95 % CI: 1.09–1.84) respectively. No association was observed between truck traffic and hay fever in the multiple analyses.ConclusionThe study shows a high prevalence of allergic rhinitis symptoms amongst children. The results support the hypothesis that traffic related pollution plays a role in the prevalence of allergic rhinitis symptoms in children residing in the area.

Improvement of Allergic Rhinitis Symptoms in Children Receiving Hymenoptera Immunotherapy

Improvement of Allergic Rhinitis Symptoms in Children Receiving Hymenoptera Immunotherapy

Regular Use of Cetirizine Demonstrates Consistent Relief from Symptoms of Seasonal Allergic Rhinitis in Children

Regular Use of Cetirizine Demonstrates Consistent Relief from Symptoms of Seasonal Allergic Rhinitis in Children

Factors associated with allergic rhinitis in children and adolescents from northern Mexico: International Study of Asthma and Allergies in Childhood Phase IIIB

The epidemiology of allergic diseases has not been studied extensively in Mexico. The present study, based on the International Study of Asthma and Allergies in Childhood Phase IIIB survey, reports the prevalence of allergic rhinitis and the associated risk factors in the pediatric population in four cities in northern Mexico. Children (6-7 years old) and adolescents (13-14 years old) in public elementary and secondary schools were surveyed in 2002 and 2003. The subjects were chosen randomly from Ciudad Victoria, Mexicali, Monterrey, and Tijuana. The following categories were analyzed: occurrence of rhinitis symptoms (currently or in the last 12 months), rhinoconjunctivitis symptoms, a previous diagnosis of allergic rhinitis, and relevant environmental factors. Factors associated with rhinitis that were identified previously with the chi-squared test were analyzed using logistic regression. The number of valid questionnaires was 10,892 for schoolchildren and 12,299 for adolescents. In 6- to 7-year-old children, the following frequencies were determined: rhinitis (ever), 27.9%; current rhinitis, 24.2%; rhinoconjunctivitis, 9.2%; and diagnosis of allergic rhinitis, 5.5%. The corresponding frequencies in 13- to 14-year-old children were 33.3, 34.1, 18.4, and 3.8%. In both 6- to 7-year-old and 13- to 14-year-old children, all rhinitis items were associated with asthma symptoms, dermatitis symptoms, paracetamol consumption, and maternal smoking (odds ratio, >1; p < 0.05). The main risk factors associated with allergic rhinitis symptoms in children and adolescents from cities in northern Mexico were other allergic conditions, paracetamol consumption, and passive smoking.

Mometasone furoate nasal spray improves symptoms of perennial allergic rhinitis in children and adults in Peru

Mometasone furoate nasal spray improves symptoms of perennial allergic rhinitis in children and adults in Peru

Prevalence of Rhinitis among Children and Teenagers in Quito Ecuador

RATIONALE: ISAAC (International Study of Asthma and Allergy in Childhood) provides a worldwide opportunity to compare prevalence, incidence and severity of rhinitis symptoms in children and teenagers.METHODS: We used a self-administered ISAAC-III written questionnaire for mothers of 6-7 years old children, and another guided questionnaire for the teenager group (13-14 years old). The study took place in 34 elementary schools and in 22 high schools, both public and private schools. The Study was performed at 2003.RESULTS: 3055 mothers of 6-7 years old children completed the questionnaire. 37% declared children with nose symptoms, 27% symptoms in the last year, 14% nose and eyes symptoms. The 5% of the rhinitic children had severe symptoms. Physician diagnostic represented the 16%. The peak of symptoms was during raining season, specially in April.3014 teens answered the questionnaire. 48% had nose symptoms, 36% actual rhinitis, 23% rhinoconjuntivitis. Severe symptoms were noticed in 2% of them. The 16% of teens were diagnosticated previously. The major incidence of symptoms was in may.CONCLUSIONS: Quito is an andean city located at 2.800 mts of altitute, it's humidity has small variation and is about 60% to 72%, the temperature is between 8 to 22 centigrades during all the year. The prevalence of rhinitis is moderate. The symptons of the great majority of the rhinitic population studied are mild to moderate. RATIONALE: ISAAC (International Study of Asthma and Allergy in Childhood) provides a worldwide opportunity to compare prevalence, incidence and severity of rhinitis symptoms in children and teenagers. METHODS: We used a self-administered ISAAC-III written questionnaire for mothers of 6-7 years old children, and another guided questionnaire for the teenager group (13-14 years old). The study took place in 34 elementary schools and in 22 high schools, both public and private schools. The Study was performed at 2003. RESULTS: 3055 mothers of 6-7 years old children completed the questionnaire. 37% declared children with nose symptoms, 27% symptoms in the last year, 14% nose and eyes symptoms. The 5% of the rhinitic children had severe symptoms. Physician diagnostic represented the 16%. The peak of symptoms was during raining season, specially in April. 3014 teens answered the questionnaire. 48% had nose symptoms, 36% actual rhinitis, 23% rhinoconjuntivitis. Severe symptoms were noticed in 2% of them. The 16% of teens were diagnosticated previously. The major incidence of symptoms was in may. CONCLUSIONS: Quito is an andean city located at 2.800 mts of altitute, it's humidity has small variation and is about 60% to 72%, the temperature is between 8 to 22 centigrades during all the year. The prevalence of rhinitis is moderate. The symptons of the great majority of the rhinitic population studied are mild to moderate.

Acetaminophen use and the symptoms of asthma, allergic rhinitis and eczema in children.

Allergic diseases are frequent in children and their prevalence and severity differ in the different regions of the world. A number of studies have been performed to determine the factors which are effective in the incidence of these diseases. One of the drugs that might have a role in incidence or intensity of the symptoms of allergic diseases is Acetaminophen. In our survey conducted with standardized method (International Study of Asthma and Allergies in Childhood), 3000 children 6-7 years old and 3000 teenagers 13-14 years old were questioned regarding asthma, allergic rhinitis and eczema. The prevalence of ever wheezing in the children of 6-7 years old who took acetaminophen in the first year of their life was 11.3%, which is more than other group (Odds Ratio=1.54, 95% Confidence Interval: 1-2.38, P=0.049) and the prevalence of ever wheezing in older age group who have taken acetaminophen at least once in a month was 25.1% which is more than those taken less acetaminophen (OR=1.7, 95%CI=1.43-2.04, P=0.000). Moreover taking more acetaminophen during past 12 months led to more prevalence of night dry coughs and the symptoms of rhinitis in children 6-7 years old and eczema and rhinitis symptoms in the 13-14 years old. Our findings suggest that taking more acetaminophen may be associated with increasing allergic symptoms in children.

Pediatric Allergic Rhinitis: Factors Affecting Treatment Choice

Allergic rhinitis is the mostprevalent chronic allergic disease in children. Although it is not life-threatening, it can have a significantly detrimental effect on a childs quality of life, and it may exacerbate a number of common comorbidities, including asthma and sinusitis. The Allergic Rhinitis and its Impact on Asthma guidelines, an evidence-based algorithm for the treatment of allergic rhinitis, advocate the use of antihistamines for the treatment of the broad spectrum of the disease. However, first-generation antihistamines are associated with a number of adverse events, including central nervous system impairment and anticholinergic and cardiovascular effects. Moreover, these agents have not been rigorously tested in the pediatric population. Nevertheless, first-generation antihistamines remain the most frequently prescribed agents in this class of drugs. This is despite the fact that the second-generation antihistamines are largely free of the undesirable side effects associated with their predecessors and the fact that they have been shown to be effective in relieving allergic rhinitis symptoms in children in a number of large-scale clinical trials. Therefore, when selecting an antihistamine for a child, it would be prudent to consider the full range of antihistamines and to base the selection of a particular drug on its efficacy, onset and duration of action, and safety profile.

Breastfeeding less than three months increases the risk for airway and rhinitis symptoms in children

Rationale As there has been debate on the benefits of breastfeeding and its role in preventing allergic manifestations, we looked at this question as part of a study, Dampness in Buildings and Health (DBH). Methods A questionnaire was sent to all parents of children 1-6 years old (n=14077) in the county of Värmland, Sweden, with a total population of 280 000. The questionnaire was for the children (using the ISAAC-questions), and also on symptoms of their parents, type of dwelling, condition of the dwellings regarding dampness/ventilation, farming life, number of siblings, ETS, breastfeeding, introduction of solid foods, etc. The response-rate was 79%. Results At least one symptom of allergy/asthma of the child was reported by 48,8%. 352 children were not breastfed at all, while 1269 were breastfed <three months. 9132 got some breast milk for more than three months. The statistical analysis showed an increased risk for cough at night without common cold, OR (crude) 1,44 (1.19-1.73, CI 95%), doctor's diagnosed asthma, OR 1.52 (1.23-1.88), rhinitis without cold during last year, OR 1.51 (1.31-1.76) and doctor's diagnosed allergic rhinitis, OR 1.44 (1.05-1.99), if the child had been breastfed less than three months, or not at all, compared with longer breastfeeding. Conclusions Our data support the view that breastfeeding for more then three months can protect against the development of symptoms among pre-school children.

The ecological relationship of tobacco smoking to the prevalence of symptoms of asthma and other atopic diseases in children: the International Study of Asthma and Allergies in Childhood (ISAAC).

This study examined the relationship between parental smoking and asthma and other atopic diseases at the ecological level. The prevalence of atopic symptoms in 6-7- and 13-14-year old children was assessed in 91 centres (from 38 countries) and 155 centres (from 56 countries) respectively in the International Study of Asthma and Allergy in Childhood (ISAAC). These symptoms were related to prevalence of tobacco smoking for each country by gender as reported by the World Health Organisation. There was a significant negative association between the prevalence of smoking by men and the prevalence of symptoms of asthma and rhinitis, but not eczema in the 13-14-year age group. There was a significant positive relationship between prevalence of smoking by women and prevalence of wheeze in the last 12 months, but not for any other symptoms in the 13-14-year age group. In the 6-7-year age group, there was a significant negative correlation between prevalence of smoking by men and the prevalence of wheeze causing sleep disturbance and a close to significant negative association at the 5% level with the prevalence of wheeze in the last 12 months and rhinitis. Thus, for the countries that are included in this analysis, countries that have high adult male smoking rates have a lower risk of asthma and rhinitis symptoms in children. It should be stressed that this analysis does not involve information on individual exposures and therefore does not contradict the well-established association of active and passive smoking in individuals with the occurrence of asthma symptoms in the same individuals. Rather, it indicates that this well-established individual-level association does not account for the international differences in asthma prevalence, and that other risk factors for asthma must be responsible for the observed international patterns.