suspicious for metastatic disease, however, would have resulted in an unacceptably low sensitivity of 20%. Considering the high incidence of bone metastases at initial diagnosis, this might lead to a dramatic increase in the number of patients undergoing futile surgery or neoadjuvant chemotherapy.Contributors: MH had the original idea, designed the study, selected the patients, managed the study, interpreted the results, wrote the first draft of the paper, and edited the paper. JH gathered, interviewed, and examined the patients. CA interpreted the bone scans; gathered, interviewed, and physically examined the patients; interpreted the results, and prepared the manuscript. KN interpreted the magnetic resonance images. HS had the original idea, interpreted the bone scans, and prepared the manuscripts. MH and HS are guarantors.Funding: None. The prevalence of symptoms of asthma, allergic rhinitis, and atopic eczema in children in the United Kingdom ranks among the highest in the world.

Objective: To investigate variations in the prevalence of self reported symptoms, diagnosis, and treatment of asthma in 12-14 year old children. Design: Self completion questionnaire. Setting: Great Britain.

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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.

Objectives-To describe the prevalence of atopic symptoms in children throughout the UK. Method-A questionnaire survey of 12-14 year olds throughout England, Wales, Scotland, and the Scottish Islands using the international study of asthma and allergies in childhood (ISAAC) protocol. Results-A total of 27 507 (86%) children took part. Recent rhinoconjunctivitis was reported by 18.2%, with 6.2% reporting symptoms between March and September; 16.4% reported itchy flexural rash in the past 12 months. The prevalence of atopic symptoms was higher in girls and subjects born within the UK. The prevalence of severe wheeze was highest in subjects reporting perennial rhinoconjunctivitis, as opposed to summertime only symptoms. Winter rhinoconjunctivitis was associated with severe wheeze and severe flexural rash. One or more current symptoms were reported by 47.6% of all children and 4% reported all three symptoms. Conclusion-In general, geographical variations were small but the prevalence of symptoms was significantly higher in Scotland and northern England. The study demonstrates the importance of atopic diseases both in their own right and in association with asthma. (Arch Dis Child 1999;81:225-230) Keywords: international study of asthma and allergies in childhood; hay fever; eczema; epidemiology; atopic diseaseThe prevalence of childhood hay fever shows wide variation throughout the world, ranging from 1.4% to 39.7%.1 The literature suggests that the prevalence of atopy has increased throughout the UK over the past five decades. In terms of eczema, the national British birth cohort study showed a rise in prevalence from 5.1% in 6 year olds born in 1946 to 12.2% for children born in 1970 and assessed at 5 years of age, 2 whereas data from the Welsh study of 12 year olds by Burr et al showed a rise from 5% in 1973 to 16% in 1988. 3 Similarly, the prevalence of hay fever in the same Welsh study rose from 9% to 15% over the 15 year period, whereas for Scottish children Russell reported a rise over a 25 year period from 3.2% in 1964 to 12.7% in 1994. 4 5 Ross and Fleming examined general practice data, which showed that the prevalence of hay fever was maximal in the age group 5-14 years and did not show any significant diVerences in geographical distribution throughout England or Wales. 6 Prevalence studies in diVerent geographical areas are often diYcult to compare because of variations in methodology. In addition, the term atopy, meaning a predisposition to develop type I hypersensitivity demonstrated by skin prick testing and assay of IgE, is often used in relation to atopic diseases such as hay fever and eczema. Many of these diYculties have been overcome by the protocol developed for the international study of asthma and allergies in childhood (ISAAC), which standardises both methodology and terminology. The distribution of hay fever and eczema are of interest not only in their own right, but also as an indicator of the pattern of atopy, which contributes to the burden of asthma. The literature demons...

A questionnaire which included items on wheeze, cough, eczema, hay fever, and indoor environment, including parental smoking habits, pet ownership, heating and cooking methods, home insulation, damp, mould, and years lived in their houses, was given to 1801 children, aged 12 and 14 from the Highland Region in Scotland. Of the 1537 (85%) who replied, 267 (17%) reported current wheeze, 135 (9%) cough for three months in the year, 272 (18%) eczema, and 317 (21%) hay fever. There was no consistent relationship between respiratory symptoms and indoor environment although cough was associated with damp, double glazing, and maternal smoking. The prevalence of wheeze, cough, and atopy was higher in children who had lived in more than one house during their lifetime. These results suggest that increasing mobility of families in recent years may be more important in the aetiology of asthma than exposure to any one individual allergen or pollutant. (Arch Dis Child 1997;76:22-26)

To establish the prevalence of asthma and wheeze in 12 year old children in a region with low background pollution levels, a population of children resident in the Highland Region of Scotland was studied by questionnaire supported by objective data.A

Aims: To explore associations of deprivation and smoking, with prevalence of asthma, wheeze, and quality of life. Methods: Survey, using International Study of Asthma and Allergies in Childhood (ISAAC) methodology, of children aged 13-14 years attending Scottish schools previously surveyed in 1995. Results: 4665/5247 (89%) pupils completed questionnaires. 3656/4665 (78.4%) had missed school for any reason in the last 12 months, 587 (12.6%) because of asthma or wheeze. Compared to children with 1-3 wheeze attacks per year, those with .12 attacks in the last year were more likely to have missed school, twice as likely to have missed physical education in the last month, to report interference with home activities, or to have visited accident and emergency departments, and three times more likely to have been hospitalised. Deprivation was not independently associated with self-reported asthma or wheeze, but was associated with school absence, either for any reason or specifically for asthma or wheeze, but not with use of services such as accident and emergency visits, doctor visits, or hospital admissions. Active smoking was associated with wheezy symptoms, and active and passive smoking with use of medical services. These associations were independent of wheeze severity, treatment taken, and other associated atopic conditions. Smoking also had an impact on school absence and home and school activities. Conclusions: Deprivation does not affect the prevalence of asthma or wheeze. Exposure to cigarette smoke was associated with the increased use of services. Deprivation and smoking have independent adverse effects on the quality of life in subjects with asthma or wheeze.