Temporal changes in the prevalence of childhood asthma and allergies in urban and rural areas of Cyprus: results from two cross sectional studies

<p>Abstract</p> <p>Background</p> <p>The prevalence of childhood asthma and allergies in Cyprus was significantly higher in urban compared to rural areas back in the year 2000, against a background of an overall low prevalence (e.g. current wheeze 6.9%) by comparison to northern European countries. In this study we aimed to assess temporal changes in the prevalence of asthma and allergies in Cyprus after an 8-year interval and to examine whether any differential changes have occurred in urban and rural parts of the island.</p> <p>Methods</p> <p>During the academic years 1999-2000 and 2007-2008, the parents of 7-8 year old children residing in the same set of urban and rural areas completed the ISAAC core questionnaire. In addition to providing prevalence estimates of allergic diseases in 2000 and 2008, changes between the two periods were expressed as odds ratios estimated in multiple logistic regression models adjusting for survey participants' characteristics.</p> <p>Results</p> <p>The prevalence of current wheeze was higher in 2008 (8.7%, 95% confidence interval 7.5%-9.9%, n = 2216) than the previously recorded figure in 2000 (6.9%, 95% CI 6.2%-7.6%, OR = 1.25, 95% CI: 1.02-1.53, n = 4944). Significant increases were also seen in the prevalence of lifetime asthma (11.3% vs. 17.4%, OR = 1.59, CI: 1.36-1.86), eczema (6.8% vs. 13.5%, OR = 1.91, CI: 1.59-2.29) and allergic rhinoconjuctivitis (2.6% vs. 5.2%, OR = 1.82, CI: 1.39-2.41). The prevalence of current wheeze nearly doubled between 2000 and 2008 in rural areas (5.4% vs. 9.7%, OR 1.81, CI: 1.24-2.64) while no significant change was observed in urban areas (7.5% vs. 8.4%, OR 1.08, CI: 0.84-1.37); p value for effect modification = 0.04. Rises in asthma and rhinitis prevalence, but not eczema were also more pronounced in rural compared to urban areas.</p> <p>Conclusions</p> <p>The prevalence of allergic diseases in Cyprus is still on the rise; recent increases appear more pronounced among children living in rural areas possibly indicating recent environmental and lifestyle changes in these communities</p

The significance of sputum ECP levels in differential diagnosis of asthma in children

Asthma and chronic bronchitis are diseases:that may present similar symptoms. Because eosinophil granulocytes play an,important role in the pathogenesis of asthma, the assessment of eosinophilic inflammation may be useful in making a differential diagnosis of these two diseases. This study investigated the serum and sputum eosinophil cationic protein (ECP) levels in children with asthma and chronic bronchitis and compared them with controls. Fifty asthmatic patients being treated for mild or moderately severe asthma at a university hospital were enrolled in the study. Fifteen children with symptoms of cough and sputum production lasting more than 3 months were studied in the chronic bronchitis group and 25 healthy children were included in the control group. Asthmatic patients were divided into subgroups:according to the presence or absence of asthmatic exacerbations. Clinical evaluation and determination of ECP concentrations in serum and sputum were performed for each group. In-creased activity of eosinophils was found in patients with asthma as assessed by high serum ECP (mean 21.44 +/- 20.33 mu g/L) and sputum ECP (mean 129.65 +/- 125.01 mu g/L) levels. In patients diagnosed with chronic bronchitis, serum ECP levels were similar to those of the control group (mean serum ECP 11.04 +/- 10.23 mu g/L and 12.07 +/- 6.12 mu g/L, respectively). More importantly, sputum ECP levels of the chronic bronchitis group were much lower (mean 53.36 +/- 55.43 mu g/L) than those in patients with asthma (mean 129.65 +/- 125.01 mu g/L). The serum and sputum ECP levels of the asthmatic patients who were evaluated during an acute exacerbation were also higher than those in the chronic bronchitis group. Sputum ECP levels may be helpful in the differential diagnosis of asthma and chronic bronchitis in children

Peripheral and nasal eosinophilia and serum total immunoglobulin E levels in children with ascariasis

In order to evaluate peripheral and nasal eosinophilia and serum total IgE levels in ascariasis, 30 children between two and 12 years of age whose fecal samples were found to contain Ascaris lumbricoides, and 30 children between 1.5 and 12 years of age who did not have ascaris in their fecal samples, were enrolled in the study. Peripheral eosinophil counts and serum total IgE levels were significantly higher in the study group, but there was no significant difference between the nasal eosinophil counts of the two groups. Since total serum IgE levels differ according to age, the patients and the control groups were also evaluated within three age-groups. Peripheral eosinophil counts and serum total IgE levels of patients with ascariasis in all age ranges were significantly higher, but nasal eosinophil values did not differ significantly. These results show that in ascariasis the presence of peripheral eosinophilia and high total serum IgE levels are similar to those in atopic diseases, and some allergic symptoms such as nasal itching can be caused by parasites. However, nasal itching does not correlate with nasal eosinophilia in ascariasis. This is an important feature in the differential diagnosis

Evaluation of the nasal provocation test for its necessity in the diagnosis of nasal allergy to house dust mite

The aim of this study was to evaluate rhinomanometric responses to nasal allergen provocation in children with allergic rhinitis sensitized to house dust mite. We studied 51 children, aged 6-16 years (mean: 11.5 +/- 2.6 years), with clinical symptoms of perennial allergic rhinitis without asthma and 20 non-atopic healthy controls in the same age range (mean: 11.8 +/- 3.8 years). All of the patients had positive skin prick test (SPT) results and serum specific IgE above 0.70 kU/I to Dermatophagoides pteronyssinus (Dp). Nasal provocation testing (NPT) was performed with increasing concentrations of Dp extracts and the nasal response was evaluated by active anterior rhinomanometry. A 100% increase of resistance in one or both nasal cavities was considered positive. There was a statistically significant difference of baseline nasal resistance (total, right and left sides) between the control and the patient groups (p < 0.001). A positive response to house dust mite allergens was recorded in 47/51 (92.2%) patients by rhinomanometry. The NPT presented no significant correlation with age, weight, height, SPT diameter, serum total and specific IgE levels to Dp and baseline nasal airway resistance values. This study suggests that a nasal provocation test with allergen is unnecessary in children with positive skin prick test and serum IgE specific to house dust mite. The rhinomanometric response to the allergen provocation does not correlate with the diameter of the skin prick test and the level of serum specific IgE