I In nt te er rn na at ti io on na al l s st tu ud dy y o of f a as st th hm ma a a an nd d a al ll le er rg gi ie es s i in n c ch hi il ld dh ho oo od d ( (I ISIts specific aims are: 1) to describe the prevalence and severity of asthma, rhinitis and eczema in children living in different centres, and to make comparisons within and between countries; 2) to obtain baseline measures for assessment of future trends in the prevalence and severity of these diseases; and 3) to provide a framework for further aetiological research into genetic, lifestyle, environmental, and medical care factors affecting these diseases.The ISAAC design comprises three phases. Phase 1 uses core questionnaires designed to assess the prevalence and severity of asthma and allergic disease in defined populations. Phase 2 will investigate possible aetiological factors, particularly those suggested by the findings of Phase 1. Phase 3 will be a repetition of Phase 1 to assess trends in prevalence.

The level of agreement between 14 physicians as to what constitutes a case of atopic dermatitis was tested on 15 selected patients with a range of diagnoses. Between-observer agreement was good, with a mean pair agreement index (P0) of 0.94, and a chance corrected index (kappa) of 0.78. Between-observer agreement in the recording of 18 separate physical signs of atopic dermatitis was then tested by asking the 14 physicians to note the presence or absence of each sign in a different group of patients to those seen in the first part of the exercise. Substantial between-observer agreement (kappa > 0.61) was only present for truncal dermatitis. Most signs showed only fair to moderate agreement (kappa 0.21-0.60), and some signs, such as keratosis pilaris, xerosis, orbital pigmentation, fine hair, and extensor dermatitis, showed poor agreement (kappa 0.01-0.20). The findings were similar when the responses of two independent observers from the national study outlined in Paper I were compared for each sign. Within-observer variation for the recording of physical signs was substantially better than between-observer variation. Physicians interested in atopic dermatitis agree reasonably well on what constitutes a typical case of atopic dermatitis. Between-observer variation with regard to some physical signs of atopic dermatitis is of a magnitude which argues against their continued use in clinical and epidemiological studies.

Background The increasing prevalence of asthma and allergy might be related to diet, particularly in Western countries. A study was undertaken to assess the association between dietary factors, asthma and allergy in a large international study including objective measurements of atopy. Methods Between 1995 and 2005, cross-sectional studies were performed in 29 centres in 20 countries. Parental questionnaires were used to collect information on allergic diseases and exposure factors and data from 50 004 randomly selected schoolchildren (8e12 years, 29 579 with skin prick testing) were analysed. Random effect models for meta-analysis were applied to calculate combined ORs. Results Fruit intake was associated with a low prevalence of current wheeze in affluent (OR adj 0.86, 95% CI 0.73 to 1.02) and non-affluent countries (OR adj 0.71, 95% CI 0.57 to 0.88). Consumption of fish in affluent countries (OR adj 0.85, 95% CI 0.74 to 0.97) and of cooked green vegetables in non-affluent countries (OR adj 0.78, 95% CI 0.65 to 0.95) was associated with a lower prevalence of current wheeze.

The Global Asthma Network (GAN), established in 2012, followed the International Study of Asthma and Allergies in Childhood (ISAAC). ISAAC Phase One involved over 700 000 adolescents and children from 156 centres in 56 countries; it found marked worldwide variation in symptom prevalence of asthma, rhinitis and eczema that was not explained by the current understanding of these diseases; ISAAC Phase Three involved over 1 187 496 adolescents and children (237 centres in 98 countries). It found that asthma symptom prevalence was increasing in many locations especially in low- and middle-income countries where severity was also high, and identified several environmental factors that required further investigation.GAN Phase I, described in this article, builds on the ISAAC findings by collecting further information on asthma, rhinitis and eczema prevalence, severity, diagnoses, asthma emergency room visits, hospital admissions, management and use of asthma essential medicines. The subjects will be the same age groups as ISAAC, and their parents. In this first global monitoring of asthma in children and adults since 2003, further evidence will be obtained to understand asthma, management practices and risk factors, leading to further recognition that asthma is an important non-communicable disease and to reduce its global burden.

Study objective -To examine in detail the cause specific associations between height and mortality.

Background-Respiratory diseases are common in childhood and may lead to chronic disease in adult life; environmental factors probably play an important part in their causation. Methods-A survey of respiratory symptoms in children aged 12-14 years was conducted throughout Great Britain as part of the International Study of Asthma and Allergies in Childhood (ISAAC). Information was obtained on certain aspects of the home environment in order to assess their importance as risk factors. Results-The response rate was 79.3%, and 25 393 children in 93 schools participated. In a multiple regression analysis, wheeze was reported more often in nonmetropolitan areas and in association with active smoking, passive smoking, the presence of a furry pet, bottled gas, paraffin, and other unusual heating fuels; small regional diVerences persisted. Current smoking, previous smoking, and passive smoking accounted for 10.4%, 6.8%, and 6.5%, respectively, of wheezing in the past 12 months, and furry pets accounted for 5.0%. Cough and phlegm were associated with active and passive smoking and with the miscellaneous fuels; similar associations were found for rhinitis, but were less consistent for rhinitis occurring in spring and summer. Gas cooking showed little association with respiratory symptoms. Conclusions-Passive as well as active smoking is an important cause of respiratory symptoms in adolescence. Pets seem to increase the risk of wheeze and rhinitis, and fumes from certain unusual heating fuels may have adverse eVects. Home environment and geographical location have independent eVects on the prevalence of respiratory symptoms.

The relations among parental reports of respiratory symptoms, bronchospasm measured after exercise, and the presence of visible fungal mould in the home was assessed in a population sample of 7 year old children (n=873). Wheeze in the past year was the symptom most closely associated with reported dampness and particularly with mould. The unadjusted odds ratio relating mould and wheeze was 3 70 (95% confidence interval 2-22 to 6.15), and after adjustment for housing tenure, number of people per room, number of smokers in the household, and gas cooking this remained highly significant (odds ratio 300 (1.72 to 5.25)). The reduction in forced expiratory volume in one second after six minutes of free running was used to validate reporting of wheeze. At all levels of measured bronchial lability wheeze was reported more commonly in the children from homes with mould. There was no significant difference in the degree of bronchospasm measured among children from homes with and without mould.Awareness of dampness or mould in the home may be a determinant of parental reporting of symptoms and may account for much of the observed association between mould and respiratory symptoms.

Parents of 5472 children aged 5-17 years from 3209 families were interviewed in a nationwide household survey. In the past year, 15.0% ofchildren had wheezed, 2.2% had more than 12 attacks, and 2.3% had experienced a speech limiting attack. Altogether 4.3% were woken more than once a week by wheezing, 13/1% had doctor diagnosed asthma, and 13*6% had been prescribed antiasthmatic drugs in the past year. With increasing age, morbidity related to wheezing declined to a greater extent than annual period prevalence.The prevalence of wheeze varied little by socioeconomic group, but there were marked trends in all three indices of severity towards increased morbidity in poorer families. Diagnostic labelling and drug treatment ofwheezy children did not differ substantially with socioeconomic status. Thus, a degree of socioeconomic equality exists in the process of medical care for childhood asthma in Britain. This does not appear to have resulted in equality of outcome. (Arch Dis Child 1994; 70: 174-178) of the disease have been largely obtained.6-9The National Study of Health and Growth, which obtained data from a sample of 22 English primary schools after stratification for socioeconomic factors, is less useful for examining the geographical distribution of asthma.4 These existing studies, apart from being out of date, do not provide adequate information on the prevalence of severe asthma, the effect of age, or details of treatment, the main form of control of the disease.The opportunity to address these questions arose from two independent initiatives. The first was the development of a simple 'core' questionnaire designed for large scale epidemiological studies of childhood asthma within and between countries (International Study of Asthma and Allergies in Childhood; ISAAC1I). The second was the commissioning by Allen and Hanburys of a national survey to assess the impact of wheezing illness on children. The resulting study, reported in this paper, describes the prevalence and severity of wheezing illness and asthma in a national sample of children aged 5-17 years. It also considers the relations of wheezing illness to age, sex, social factors, region, and degree of urbanisation.