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. 2018 Mar;73(3):602-614.
doi: 10.1111/all.13312. Epub 2017 Nov 7.

The sex-shift in single disease and multimorbid asthma and rhinitis during puberty - a study by MeDALL

T Keller  1 , C Hohmann  1 , M Standl  2 , A H Wijga  3 , U Gehring  4 , E Melén  5   6 , C Almqvist  5   7 , S Lau  8 , E Eller  9 , U Wahn  8 , E S Christiansen  9   10 , A von Berg  11 , J Heinrich  2   12 , I Lehmann  13 , D Maier  14 , D S Postma  15 , J M Antó  16   17   18   19 , J Bousquet  18   20   21   22 , T Keil  1 , S Roll  1
Affiliations

The sex-shift in single disease and multimorbid asthma and rhinitis during puberty - a study by MeDALL

T Keller et al. Allergy. 2018 Mar.

Abstract

Background: Cross-sectional studies suggested that allergy prevalence in childhood is higher in boys compared to girls, but it remains unclear whether this inequality changes after puberty. We examined the sex-specific prevalence of asthma and rhinitis as single and as multimorbid diseases before and after puberty onset in longitudinal cohort data.

Methods: In six European population-based birth cohorts of MeDALL, we assessed the outcomes: current rhinitis, current asthma, current allergic multimorbidity (ie, concurrent asthma and rhinitis), puberty status and allergic sensitization by specific serum antibodies (immunoglobulin E) against aero-allergens. With generalized estimating equations, we analysed the effects of sex, age, puberty (yes/no) and possible confounders on the prevalence of asthma and rhinitis, and allergic multimorbidity in each cohort separately and performed individual participant data meta-analysis.

Findings: We included data from 19 013 participants from birth to age 14-20 years. Current rhinitis only affected girls less often than boys before and after puberty onset: adjusted odds ratio for females vs males 0.79 (95%-confidence interval 0.73-0.86) and 0.86 (0.79-0.94), respectively (sex-puberty interaction P = .089). Similarly, for current asthma only, females were less often affected than boys both before and after puberty onset: 0.71, 0.63-0.81 and 0.81, 0.64-1.02, respectively (sex-puberty interaction P = .327). The prevalence of allergic multimorbidity showed the strongest sex effect before puberty onset (female-male-OR 0.55, 0.46-0.64) and a considerable shift towards a sex-balanced prevalence after puberty onset (0.89, 0.74-1.04); sex-puberty interaction: P < .001.

Interpretation: The male predominance in prevalence before puberty and the "sex-shift" towards females after puberty onset were strongest in multimorbid patients who had asthma and rhinitis concurrently.

Keywords: allergic multimorbidity; asthma; birth cohort; puberty; rhinitis.

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Figures

Figure 1
Figure 1
Sex‐specific prevalence with 95% CI of current rhinitis only (on a logarithmic scale) in six European birth cohorts by age
Figure 2
Figure 2
Sex‐specific prevalence with 95% CI of current asthma only (on a logarithmic scale) in six European birth cohorts by age
Figure 3
Figure 3
Sex‐specific prevalence with 95% CI of current allergic multimorbidity (on a logarithmic scale) in six European birth cohorts by age
Figure 4
Figure 4
Odds Ratios from one‐stage IPD meta‐analysis of sex effect (female vs male) before and after puberty for all outcomes
See this image and copyright information in PMC

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