Increasing prevalence of hay fever and atopy among children in Leipzig, East Germany

doi:10.1016/S0140-6736(97)10100-3

The Lancet

Volume 351, Issue 9106, 21 March 1998, Pages 862-866

https://doi.org/10.1016/S0140-6736(97)10100-3 Get rights and content

Summary

Background

Several surveys in children and adults have shown significantly lower prevalences of asthma and allergic diseases in eastern Europe than in western countries. In the former East Germany tremendous changes towards western lifestyle have occurred since unification. The aim of this survey was to investigate time trends in the prevalence of asthma and allergic diseases among children living in the eastern part of Germany.

Methods

In 1995–96, 2334 (87·5%) schoolchildren in Leipzig participated in a cross-sectional study that used the same methods as a previous survey done shortly after the fall of communism in 1991–92. A self-administered questionnaire was distributed to the parents. Children underwent cold-air challenge and allergy skinprick tests to six common aeroallergens.

Findings

The prevalence of hay fever (2·3% [34/1454] vs 5·1% [115/2252], p<0·0001) and atopic sensitisation (19·3% [252/1303] vs 26·7% [434/1624], p<0·0001) increased significantly between 1991–92 and 1995–96. However, there was no significant change in the prevalence of asthma, asthma-related symptoms, or bronchial hyper-responsiveness.

Interpretation

These findings suggest important differences in the development of atopic disorders. The children were born about 3 years before unification and were therefore exposed to western living conditions only after the third birthday. Thus, factors operating very early in life may be particularly important for the acquisition of childhood asthma, whereas the development of atopic sensitisation and hay fever may also be affected by environmental factors occurring beyond infancy.

Introduction

Several surveys in eastern Europe carried out after the fall of the communist system showed that the prevalence of atopic diseases in children and adults was low compared with that in western countries.1, 2 We previously reported lower prevalences of asthma, hay fever, airway hyper-responsiveness, and atopic sensitisation among schoolchildren aged 9–11 years living in Leipzig, East Germany, than in children of the same age living in Munich, West Germany.3, 4

The reasons for the striking differences in the prevalence of atopic diseases between people living in eastern and western Europe are the focus of much research. Factors associated with western lifestyle, such as smaller family size,⁵ high socioeconomic status,⁶ western diet,⁷ and increasing allergen exposure attributable to insulated housing conditions,⁸ have been proposed as potential explanations for the higher prevalence of atopic disorders in west European countries. Since the German unification in October, 1990, tremendous changes in everyday life towards western conditions have occurred in the former East Germany. If the adoption of a western lifestyle is associated with factors inducing atopic sensitisation and childhood asthma, a substantial rise in the prevalence of these disorders would therefore be expected.

In 1995–96, 5–6 years after the German unification, we undertook a prevalence study in Leipzig, using the same methods as in our previous study in 1991–92.⁴ The aim of the second survey was to investigate time trends in the prevalence of asthma and allergies in 9–11-year-old schoolchildren. These children spent their first 3 years of life under eastern living conditions and were subsequently exposed to western lifestyle.

Section snippets

Study population

Leipzig, a city of about 535 000 inhabitants, is located in the southeastern part of Germany. In 1995–96, we undertook a cross-sectional survey based on a cluster sample of 44 schools, enrolling 2666 children. The sampling procedure was the same as in the previous survey in 1991–92, of 1854 children.⁴ All pupils attending classes of the fourth grade (aged 9–11 years) were studied. In both surveys, questionnaires were sent through the schools to the parents for completion. Children underwent

Results

So that the populations in the two surveys were as similar as possible in terms of ethnic background, the analysis was restricted to children of German nationality in both surveys: 1492 and 2311 children with completed questionnaires; 1303 and 1624 children with skinprick tests by the multitest device; and 1272 and 1875 children undergoing bronchial challenge.

The prevalence of asthma and related symptoms, such as recurrent attacks of shortness of breath, recurrent wheeze, and nocturnal cough,

Discussion

The results of the 1995–96 survey show that at the same time as drastic changes towards western lifestyle in Leipzig there were rises in the frequencies of hay fever and atopic sensitisation in schoolchildren. The frequencies of asthma and airway hyper-responsiveness remained virtually unchanged. This discrepancy points towards important differences in the development of atopic disorders. The children surveyed were born about 3 years before the fall of the communist system and were therefore

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ArticlesIncreasing prevalence of hay fever and atopy among children in Leipzig, East Germany

Summary

Background

Methods

Findings

Interpretation

Introduction

Section snippets

Study population

Results

Discussion

J Allergy Clin Immunol

J Allergy Clin Immunol

Atopic sensitisation and respiratory symptoms among Polish and Swedish school children

Clin Exp Allergy

Prevalence of respiratory symptoms, bronchial hyperresponsiveness and atopy among adults: West and East Germany

Ear Respir J

The prevalence of asthma and allergic disorders among children in united Germany: a descriptive comparison

BMJ

Differences in the prevalence of asthma and atopic sensitisation between East and West Germany

Am J Respir Crit Care Med

Skin test reactivity and number of siblings

BMJ

Hay fever, a post industrial revolution epidemic: a history of a growth during the 19th century

Clin Allergy

Dietary fat and asthma: is there a connection?

Eur Respir J

Comparing the multitest to a conventional skin prick test (in German)

Allergologie

Reactivity to cold air hyperventilation in normal and asthmatic children in a survey of 5697 school children in Southern Bavaria

Am Rev Respir Dis

Articles
Increasing prevalence of hay fever and atopy among children in Leipzig, East Germany