. 2022 Jan;33(1):e13656.

doi: 10.1111/pai.13656. Epub 2021 Sep 21.

Worldwide time trends in prevalence of symptoms of rhinoconjunctivitis in children: Global Asthma Network Phase I

David P Strachan¹, Charlotte E Rutter², Monica Innes Asher³, Karen Bissell⁴, Chen-Yuan Chiang^{5

6

7}, Asma El Sony⁸, Eamon Ellwood³, Philippa Ellwood³, Luis García-Marcos^{9

10}, Guy B Marks¹¹, Eva Morales^{12

13}, Kevin Mortimer¹⁴, Neil Pearce², Virginia Pérez-Fernández^{13

15}, Steven Robertson², Richard J Silverwood^{2

16}; Global Asthma Network Phase I Study Group

Collaborators, Affiliations

Collaborators

Global Asthma Network Phase I Study Group:
E M Navarrete-Rodriguez, A López-Silvarrey Varela, M I Asher, K Bissell, C-Y Chiang, A El Sony, P Ellwood, L García-Marcos, K Mortimer, N Pearce, D P Strachan, P Ellwood, E Ellwood, M I Asher, L García-Marcos, V Perez-Fernández, E Morales, A Martinez-Torres, D P Strachan, N Pearce, S Robertson, C E Rutter, R J Silverwood, J Mallol, M Soto-Martinez, M Singh, V Singh, S Awasthi, S K Kabra, S Salvi, J V Mérida-Palacio, S N González-Díaz, José Eleuterio González, J F Sánchez, A Falade, H J Zar, A López-Silvarrey Varela, C González Díaz, L García-Marcos, M Nour, G Dib, J-L Huang, S Chinratanapisit, M E Soto-Quirós, A El Sony, P Vichyanond, P Aguilar, M E Soto-Quirós, S Barba, M Sabir, L Kumar, V Singh, T U Sukumaran, S Awasthi, S K Sharma, N M Hanumante, R García-Almaráz, J V Merida-Palacio, B E Del-Río-Navarro, S N González-Díaz, José Eleuterio González, F J Linares-Zapién, M I Asher, J F Sánchez, H J Zar, C González Díaz, L García-Marcos, Oaa Musa, Y Mohammad, J-L Huang, P Vichyanond, V Aguirre, M Baeza-Bacab, A El Sony, S Mohammad, E Cortéz, M E Soto-Quirós, C H Gratziou, L Kumar, T U Sukumaran, K Chopra, N M Hanumante, M I Asher, B O Onadeko, A D Rubio, L García-Marcos, K-H Hsieh, J Mallol, J Shah

Affiliations

¹ Population Health Research Institute, St George's, University of London, London, UK.
² Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK.
³ Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Private Bag, Auckland, New Zealand.
⁴ School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Private Bag, Auckland, New Zealand.
⁵ International Union Against Tuberculosis and Lung Disease, Paris, France.
⁶ Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
⁷ Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
⁸ Epidemiological Laboratory (Epi-Lab) for Public Health, Research and Development, Khartoum, Sudan.
⁹ Paediatric Allergy and Pulmonology Units, Virgen de la Arrixaca University Children's Hospital, University of Murcia and IMIB Bio-health Research Institute, Murcia, Spain.
¹⁰ ARADyAL Allergy Network, Edificio Departamental-Laib, Murcia, Spain.
¹¹ Respiratory & Environmental Epidemiology, University of New South Wales, Sydney, New South Wales, Australia.
¹² Department of Public Health Sciences, University of Murcia, Murcia, Spain.
¹³ IMIB Bio-health Research Institute, Edificio Departamental-Laib, Murcia, Spain.
¹⁴ Liverpool School of Tropical Medicine, Liverpool, UK.
¹⁵ Department of Paediatrics, University of Murcia, Murcia, Spain.
¹⁶ Centre for Longitudinal Studies, UCL Social Research Institute, University College London, London, UK.

PMID: 34453861
PMCID: PMC9012331
DOI: 10.1111/pai.13656

Worldwide time trends in prevalence of symptoms of rhinoconjunctivitis in children: Global Asthma Network Phase I

David P Strachan et al. Pediatr Allergy Immunol. 2022 Jan.

. 2022 Jan;33(1):e13656.

doi: 10.1111/pai.13656. Epub 2021 Sep 21.

Authors

Collaborators

Global Asthma Network Phase I Study Group:
E M Navarrete-Rodriguez, A López-Silvarrey Varela, M I Asher, K Bissell, C-Y Chiang, A El Sony, P Ellwood, L García-Marcos, K Mortimer, N Pearce, D P Strachan, P Ellwood, E Ellwood, M I Asher, L García-Marcos, V Perez-Fernández, E Morales, A Martinez-Torres, D P Strachan, N Pearce, S Robertson, C E Rutter, R J Silverwood, J Mallol, M Soto-Martinez, M Singh, V Singh, S Awasthi, S K Kabra, S Salvi, J V Mérida-Palacio, S N González-Díaz, José Eleuterio González, J F Sánchez, A Falade, H J Zar, A López-Silvarrey Varela, C González Díaz, L García-Marcos, M Nour, G Dib, J-L Huang, S Chinratanapisit, M E Soto-Quirós, A El Sony, P Vichyanond, P Aguilar, M E Soto-Quirós, S Barba, M Sabir, L Kumar, V Singh, T U Sukumaran, S Awasthi, S K Sharma, N M Hanumante, R García-Almaráz, J V Merida-Palacio, B E Del-Río-Navarro, S N González-Díaz, José Eleuterio González, F J Linares-Zapién, M I Asher, J F Sánchez, H J Zar, C González Díaz, L García-Marcos, Oaa Musa, Y Mohammad, J-L Huang, P Vichyanond, V Aguirre, M Baeza-Bacab, A El Sony, S Mohammad, E Cortéz, M E Soto-Quirós, C H Gratziou, L Kumar, T U Sukumaran, K Chopra, N M Hanumante, M I Asher, B O Onadeko, A D Rubio, L García-Marcos, K-H Hsieh, J Mallol, J Shah

Affiliations

¹ Population Health Research Institute, St George's, University of London, London, UK.
² Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK.
³ Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Private Bag, Auckland, New Zealand.
⁴ School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Private Bag, Auckland, New Zealand.
⁵ International Union Against Tuberculosis and Lung Disease, Paris, France.
⁶ Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
⁷ Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
⁸ Epidemiological Laboratory (Epi-Lab) for Public Health, Research and Development, Khartoum, Sudan.
⁹ Paediatric Allergy and Pulmonology Units, Virgen de la Arrixaca University Children's Hospital, University of Murcia and IMIB Bio-health Research Institute, Murcia, Spain.
¹⁰ ARADyAL Allergy Network, Edificio Departamental-Laib, Murcia, Spain.
¹¹ Respiratory & Environmental Epidemiology, University of New South Wales, Sydney, New South Wales, Australia.
¹² Department of Public Health Sciences, University of Murcia, Murcia, Spain.
¹³ IMIB Bio-health Research Institute, Edificio Departamental-Laib, Murcia, Spain.
¹⁴ Liverpool School of Tropical Medicine, Liverpool, UK.
¹⁵ Department of Paediatrics, University of Murcia, Murcia, Spain.
¹⁶ Centre for Longitudinal Studies, UCL Social Research Institute, University College London, London, UK.

PMID: 34453861
PMCID: PMC9012331
DOI: 10.1111/pai.13656

Abstract

Background: The Global Asthma Network (GAN), by using the International Study of Asthma and Allergies in Childhood (ISAAC) methodology, has updated trends in prevalence of symptoms of childhood allergic diseases, including non-infective rhinitis and conjunctivitis ('rhinoconjunctivitis'), which is reported here.

Methods: Prevalence and severity of rhinoconjunctivitis were assessed by questionnaire among schoolchildren in GAN Phase I and ISAAC Phase I and III surveys 15-23 years apart. Absolute rates of change in prevalence were estimated for each centre and modelled by multi-level linear regression to compare trends by age group, time period and per capita national income.

Results: Twenty-seven GAN centres in 14 countries surveyed 74,361 13- to 14-year-olds ('adolescents') and 45,434 6- to 7-year-olds ('children'), with average response proportions of 90% and 79%, respectively. Many centres showed highly significant (p < .001) changes in prevalence of rhinoconjunctivitis in the past year ('current rhinoconjunctivitis') compared with ISAAC. The direction and magnitude of centre-level trends varied significantly (p < .001) both within and between countries. Overall, current rhinoconjunctivitis prevalence decreased slightly from ISAAC Phase III to GAN: -1.32% per 10 years, 95% CI [-2.93%, +0.30%] among adolescents; and -0.44% [-1.29%, +0.42%] among children. Together, these differed significantly (p < .001) from the upward trend within ISAAC. Among adolescents, centre-level trends in current rhinoconjunctivitis were highly correlated with those for eczema symptoms (rho = 0.72, p < .0001) but not with centre-level trends in asthma symptoms (rho = 0.15, p = .48). Among children, these correlations were positive but not significant.

Conclusion: Symptoms of non-infective rhinoconjunctivitis among schoolchildren may no longer be on the increase globally, although trends vary substantially within and between countries.

Keywords: allergic disease; conjunctivitis; prevalence; rhinitis; time trend.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

**FIGURE 1**
Absolute changes over time in prevalence of current rhinoconjunctivitis (RC) symptoms by mean survey date for 13‐ to 14‐year‐olds (a: left graph) and 6‐ to 7‐year‐olds (b: right graph). Footnote for both subfigures 1a,b: Each coloured thin line represents one GAN Phase I centre. The thick black line shows the average absolute change from ISAAC Phase I to Phase III for those centres that did not participate in GAN Phase I. The span of the years of data collection for ISAAC Phase I, ISAAC Phase III and GAN Phase I is shown

**FIGURE 2**
Correlation of centre‐level time trends (absolute percentage change per decade) in prevalence of symptoms of current rhinoconjunctivitis (RC), asthma and eczema from ISAAC Phase III to GAN Phase I, for 13‐ to 14‐year‐olds (left column) and 6 to 7‐year‐olds (right column), countries grouped by GNI per capita

See this image and copyright information in PMC

References

1. Strachan D, Sibbald B, Weiland S, et al. Worldwide variations in prevalence of symptoms of allergic rhinoconjunctivitis in children: The International Study of Asthma and Allergies in Childhood (ISAAC). Pediatr Allergy Immunol. 1997;8:161‐176. - PubMed
1. Björkstén B, Clayton T, Ellwood P, et al. Worldwide time trends for symptoms of rhinitis and conjunctivitis: phase III of the international study of asthma and allergies in childhood. Pedatr Allergy Immunol. 2008;19:110‐124. - PubMed
1. Ellwood P, Asher M, Ellwood E & Global Asthma Network Steering Group The Global Asthma Network manual for global surveillance: prevalence, severity and risk factors; August 2015. Available from: http://www.globalasthmanetwork.org/surveillance/manual/manual.php
1. Ellwood P, Asher MI, Billo NE, et al. The Global Asthma Network rationale and methods for Phase I global surveillance: prevalence, severity, management and risk factors. Eur Respir J. 2017;49:1601605. - PubMed
1. Ellwood P, Ellwood E, Rutter C, et al. Global Asthma Network phase I surveillance: geographical coverage and response rates. J Clin Med. 2020;9:3688. - PMC - PubMed

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Worldwide time trends in prevalence of symptoms of rhinoconjunctivitis in children: Global Asthma Network Phase I

Collaborators

Affiliations

Worldwide time trends in prevalence of symptoms of rhinoconjunctivitis in children: Global Asthma Network Phase I

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous