[Epidemiology of respiratory allergy in children]

Abstract

Epidemiology of paediatric respiratory allergic disorders allows the approach to causal and preventive risk factors by studying groups or sub groups of children in different locations and under different conditions. This is, however, complicated by the lack of consensus on disease definitions, which renders comparisons between studies difficult. Atopy is usually defined by the presence of positive skin tests (wheal size of at least a mean diameter > or = 3 mm), by the presence of specific IgE, or by the presence of increased total IgE (> or = 100 UI/mL). Infantile asthma is not well defined, complicated by the high prevalence of bronchiolitis; one thus questions between wheezing or wheezy bronchitis. Prevalence is high: among early wheezers, two populations will be defined by the medium term evolution: transient wheezers and persistent wheezers. Risk factors for these two conditions are different. Childhood asthma may be defined by the diagnosis of asthma (specific but fairly non-sensitive), by asthmatic symptoms (wheezing, waking by an attack of shortness of breath) (sensitive but not very specific), or by the combination of symptoms and airway hyperresponsiveness. The ISAAC study has standardised a questionnaire to assess the prevalence of asthma. The preliminary results show that there are wide variations across the world. The prevalence is low in Africa and Asia, intermediate in Europe, and high in Anglo-Saxon countries. The prevalence of asthma has gradually increased over the past 20 years in developed countries. Asthma and atopy are closely associated in children. Risk factors are genetic, associated with sex and environmental factors. Among these, allergic sensitisation is associated with the degree of exposure to allergens. Westernization of way of life is associated with increased prevalence of atopy, allergic rhinitis and asthma. Atopy seems inversely correlated to certain infections. Passive smoking is clearly associated with early wheezing. This and atmospheric pollution aggravate childhood asthma. However, the inducing role of pollution on asthma is still controversial.