Allergic diseases have become a worldwide public health concern. A defining feature of allergic diseases is they often coexist in children from birth to adolescence.
Objective
To investigate the prevalence of comorbid allergic diseases in allergic children in Shanghai, China.
Methods
A retrospective study of 333 029 children diagnosed with allergic diseases aged 0 to 12 years (mean age: 3.04 years, 59.3% boys) was conducted using the electronic medical records of Shanghai Children’s Hospital from January 2013 to July 2018. Comorbidity of allergic diseases is defined as the coexistence of 2 or 3 following diseases in the same child such as asthma (AS)/wheezing, allergic rhinitis (AR), or eczema (EC).
Results
The proportion of children with comorbid allergic diseases was 6.7% (22 351/333 029). Among them, EC + AS/wheezing was the most common (61.3%, 13 711/22 351). Children with a comorbidity had significantly earlier disease onset age than subjects with only 1 disease (2.72 vs 3.06, P < .05). The serum total immunoglobulin E (tIgE) levels of children with comorbid allergic diseases were higher than those with only 1 disease. In children with a disease onset age of 0 to 9 years, the levels of tIgE for children with AS/wheezing + EC were higher than children with AS/wheezing only or EC only; in children with disease onset age of 2 to 5 and 10 to 12 years, the levels of tIgE for children with AS/wheezing + AR were higher than children with AS/wheezing only or AR only; in children with a disease onset age of 2 to 5 years, the levels of tIgE for children with AR + EC were higher than children with AR only or EC only.
Conclusion
Comorbidity of allergic diseases is common in children in Shanghai, China. The onset age of comorbidity is earlier than that of only 1 disease, and the levels of serum tIgE are higher in patients with an allergic comorbidity.
Moreno-MaciasH, RomieuI.Effects of antioxidant supplements and nutrients on patients with asthma and allergies.J Allergy Clin Immunol. 2014;
5:1245.
2.
CecchiLD'AmatoGAnnesi-MaesanoI.External exposome and allergic respiratory and skin diseases.J Allergy Clin Immunol. 2018;
3:846–857.
3.
BallardiniNKullILindT, et al.
Development and comorbidity of eczema, asthma and rhinitis to age 12: data from the BAMSE birth cohort.Allergy. 2012;
4:537–544.
4.
DharmageS CLoweA JMathesonM C, et al.
Atopic dermatitis and the atopic march revisited.Allergy. 2014;
1:17–27.
5.
IlliSvon MutiusELauS, et al.
The natural course of atopic dermatitis from birth to age 7 years and the association with asthma.J Allergy Clin Immunol. 2004;
5:925–931.
6.
ZiyabA HKarmausWZhangH, et al.
Allergic sensitization and filaggrin variants predispose to the comorbidity of eczema, asthma, and rhinitis: results from the Isle of Wight birth cohort.Clin Exp Allergy. 2014;
9:1170–1178.
7.
Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention.www.ginasthma.com. Updated 2006. Accessed October 5, 2019.
BrozekJLBousquetJBaena-CagnaniCE, et al.
Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines: 2010 revision.J Allergy Clin Immunol. 2010;
3:466–476.
10.
BrozekJLBousquetJAgacheI, et al.
Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines-2016 revision.J Allergy Clin Immunol. 2017;
4:950–958.
11.
EichenfieldLFHanifinJMLugerTA, et al.
Consensus conference on pediatric atopic dermatitis.J Am Acad Dermatol.2003;
6:1088–1095.
12.
EichenfieldLFTomWLChamlinSL, et al.
Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis.J Am Acad Dermatol. 2014;
2:338–351.
13.
EichenfieldLFTomWLBergerTG, et al.
Guidelines of care for the management of atopic dermatitis: section 2. Management and treatment of atopic dermatitis with topical therapies.J Am Acad Dermatol. 2014;
1:116–132.
14.
SidburyRDavisDMCohenDE, et al.
Guidelines of care for the management of atopic dermatitis: section 3. Management and treatment with phototherapy and systemic agents.J Am Acad Dermatol. 2014;
2:327–349.
15.
SidburyRTomWLBergmanJN, et al.
Guidelines of care for the management of atopic dermatitis: section 4. Prevention of disease flares and use of adjunctive therapies and approaches Work Group.J Am Acad Dermatol. 2014;
6:1218–1233.
16.
BousquetJAntoJMWickmanM, et al.
Are allergic multimorbidities and IgE polysensitization associated with the persistence or re-occurrence of foetal type 2 signalling? The MeDALL hypothesis.Allergy. 2015;
9:1062–1078.
17.
GoughHGrabenhenrichLReichA, et al.
Allergic multimorbidity of asthma, rhinitis and eczema over 20 years in the German birth cohort MAS.Pediatr Allergy Immunol. 2015;
5:431–437.
18.
PinartMBenetMAnnesi-MaesanoI, et al.
Comorbidity of eczema, rhinitis, and asthma in IgE-sensitised and non-IgE-sensitised children in MeDALL: a population-based cohort study.Lancet Respiratory Med.2014;
2:131–140.
19.
CalcagnoMAForastieroMASaracinoMP, et al.
Serum IgE and IgG4 against muscle larva excretory-secretory products during the early and late phases of human trichinellosis.Parasitol Res.2017;
11:2933–2939.
20.
ZhaoTWangHJChenY, et al.
Prevalence of childhood asthma, allergic rhinitis and eczema in Urumqi and Beijing.J Paediatr Child Health. 2000;
2:128–133.
21.
ZhaoJBaiJShenK, et al.
Self-reported prevalence of childhood allergic diseases in three cities of China: a multicenter study.BMC Public Health. 2010;
10: 551.
22.
LiFZhouYLiS, et al.
Prevalence and risk factors of childhood allergic diseases in eight metropolitan cities in China: a multicenter study.BMC Public Health. 2011;
437.
23.
AgondiRCAndradeMCTakejimaP, et al.
Atopy is associated with age at asthma onset in elderly patients.J Allergy Clin Immunol Pract.2018;
3:865–871.
24.
SunHLYehCJKuMS, et al.
Coexistence of allergic diseases: patterns and frequencies.Allergy Asthma Proc. 2012;
1:e1–e4.
25.
GoksorELoidPAlmB, et al.
The allergic march comprises the coexistence of related patterns of allergic disease not just the progressive development of one disease.Acta Paediatr.2016;
12:1472–1479.
26.
NissenSPKjaerHFHostA, et al.
The natural course of sensitization and allergic diseases from childhood to adulthood.Pediatr Allergy Immunol. 2013;
6:549–555.
27.
BallardiniNKullISoderhallC, et al.
Eczema severity in preadolescent children and its relation to sex, filaggrin mutations, asthma, rhinitis, aggravating factors and topical treatment: a report from the BAMSE birth cohort.Br J Dermatol.2013;
3:588–594.
28.
HavstadSJohnsonCCKimH, et al.
Atopic phenotypes identified with latent class analyses at age 2 years.J Allergy Clin Immunol.2014;
3:722–727.
29.
JustJDeslandes-BoutmyEAmatF, et al.
Natural history of allergic sensitization in infants with early-onset atopic dermatitis: results from ORCA Study.Pediatr Allergy Immunol. 2014;
7:668–673.
30.
LazicNRobertsGCustovicA, et al.
Multiple atopy phenotypes and their associations with asthma: similar findings from two birth cohorts.Allergy. 2013;
6:764–770.
31.
SkrindoILupinekCValentaR, et al.
The use of the MeDALL-chip to assess IgE sensitization: a new diagnostic tool for allergic disease?Pediatr Allergy Immunol.2015;
3:239–246.
32.
WestmanMLupinekCBousquetJ, et al.
Early childhood IgE reactivity to pathogenesis-related class 10 proteins predicts allergic rhinitis in adolescence.J Allergy Clin Immunol.2015;
5:1199–1206.
33.
ZhangHKaushalASoto-RamirezN, et al.
Acquisition, remission, and persistence of eczema, asthma, and rhinitis in children.Clin Exp Allergy.2018;
5:568–576.
34.
ArshadSHTariqSM, SMatthewsS, et al.
Sensitization to common allergens and its association with allergic disorders at age 4 years: a whole population birth cohort study.Pediatrics.2001;
2:E33.
35.
BusseWW.The role of allergy in disease.Immunol Rev. 2011;
1:5–9.
36.
JuhnYJ.Risks for infection in patients with asthma (or other atopic conditions): Is asthma more than a chronic airway disease?J Allergy Clin Immunol. 2014;
2:258–259.
37.
JamesKMPeeblesRSJr., et al.
Response to infections in patients with asthma and atopic disease: an epiphenomenon or reflection of host susceptibility?J Allergy Clin Immunol.2012;
2:343–351.
38.
RothenbergME.Molecular, genetic, and cellular bases for treating eosinophilic esophagitis.Gastroenterology.2015;
6:1143–1157.
39.
SorensenMKlingenbergCWickmanM, et al.
Staphylococcus aureus enterotoxin sensitization is associated with allergic poly-sensitization and allergic multimorbidity in adolescents.Allergy. 2017;
10:1548–1555.
40.
Du ToitGRobertsGSayrePH, et al.
Identifying infants at high risk of peanut allergy: the Learning Early About Peanut Allergy (LEAP) screening study.J Allergy Clin Immunol. 2013;
1:135–143.
41.
ChanezPVignolaAMVicP, et al.
Comparison between nasal and bronchial inflammation in asthmatic and control subjects.Am J Respir Crit Care Med. 1999;
2:588–595.
42.
OlivieriMHeinrichJSchlunssenV, et al.
The risk of respiratory symptoms on allergen exposure increases with increasing specific IgE levels.Allergy. 2016;
6:859–868.
43.
BallardiniNBergstromAWahlgrenCF, et al.
IgE antibodies in relation to prevalence and multimorbidity of eczema, asthma, and rhinitis from birth to adolescence.Allergy.2016;
3:342–349.
44.
GarmhausenDHagemannTBieberT, et al.
Characterization of different courses of atopic dermatitis in adolescent and adult patients.Allergy. 2013;
4:498–506.
45.
Toppila-SalmiSHuhtalaHKarjalainenJ, et al.
Sensitization pattern affects the asthma risk in Finnish adult population.Allergy. 2015;
9:1112–1120.
46.
MortzCGAndersenKEDellgrenC, et al.
Atopic dermatitis from adolescence to adulthood in the TOACS cohort: prevalence, persistence and comorbidities.Allergy. 2015;
7:836–845.
