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Meta-Analysis
. 2015 Jul 2;10(7):e0131869.
doi: 10.1371/journal.pone.0131869. eCollection 2015.

Interrelationships between Atopic Disorders in Children: A Meta-Analysis Based on ISAAC Questionnaires

David H J Pols  1 , Jorien B Wartna  1 , Elvira I van Alphen  1 , Heleen Moed  1 , Nadine Rasenberg  1 , Patrick J E Bindels  1 , Arthur M Bohnen  1
Affiliations
Meta-Analysis

Interrelationships between Atopic Disorders in Children: A Meta-Analysis Based on ISAAC Questionnaires

David H J Pols et al. PLoS One. .

Abstract

Purpose: To study the prevalence and interrelationship between asthma, allergic rhinitis and eczema using data obtained from ISAAC questionnaires.

Method: The Medline, Pubmed Publisher, EMBASE, Google Scholar and the Cochrane Controlled Clinical Trials Register databases were systematically reviewed to evaluate epidemiological data of children with atopic disorders. To study these interrelationships, a new approach was used. Risk ratios were calculated, describing the risk of having two different atopic disorders when the child is known with one disorder.

Results: Included were 31 studies, covering a large number of surveyed children (n=1,430,329) in 102 countries. The calculated worldwide prevalence for asthma, eczema and allergic rhinitis is 12.00% (95% CI: 11.99-12.00), 7.88% (95% CI: 7.88-7.89) and 12.66% (95% CI: 12.65-12.67), respectively. The observed prevalence [1.17% (95% CI: 1.17-1.17)] of having all three diseases is 9.8 times higher than could be expected by chance. For children with asthma the calculated risk ratio of having the other two disorders is 5.41 (95% CI: 4.76-6.16), for children with eczema 4.24 (95% CI: 3.75-4.79), and for children with allergic rhinitis 6.20 (95% CI: 5.30-7.27). No studied confounders had a significant influence on these risk ratios.

Conclusions: Only a minority of children suffers from all three atopic disorders, however this co-occurrence is significantly higher than could be expected by chance and supports a close relationship of these disorders in children. The data of this meta-analysis supports the hypothesis that there could be a fourth distinct group of children with all three disorders. Researchers and clinicians might need to consider these children as a separate group with distinct characteristics regarding severity, causes, treatment or prognosis.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow diagram for selection of studies identified in the systematic review.
Fig 2
Fig 2. Prevalence (%) of the atopic disorders per continent.
Fig 3
Fig 3. Forest plot of risk ratios for asthma.
Fig 4
Fig 4. Forest plot of risk ratios for eczema.
Fig 5
Fig 5. Forest plot of risk ratios for allergic rhinitis.
See this image and copyright information in PMC

References

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