Living conditions in eastern Germany have changed rapidly since unification in 1990 and little is known about how these changes affect the prevalence of atopic diseases. This study describes methods and prevalences of a large epidemiological project investigating determinants of childhood asthma and allergies in eastern (Dresden and Leipzig) and western (Munich) Germany in 1995/1996.Community based random samples of 9±11 yr old children in Dresden (n=3,017) and Munich (n=2,612), and of 5±7 yr old children in Dresden (n=3,300), Leipzig (n=3,167) and Munich (n=2,165) were studied by parental questionnaires, bronchial challenges with hypertonic saline, skin examination, skin-prick tests, and measurements of specific and total serum immunoglobulin (Ig)E using Phase II modules of the International Study of Asthma and Allergies in Childhood (ISAAC).In 9±11 yr old children, the prevalence of physician diagnosed asthma (7.9% versus 10.3%; p<0.01) and bronchial hyperresponsiveness (15.7% versus 19.9%; p<0.05) was lower in Dresden than in Munich. No difference between Munich and Dresden was observed in the prevalence of diagnosed hay fever, skin test reactivity to $1 allergen, and increased levels (>0.35 kU . L -1 ) of specific IgE against inhalant and food allergens. Symptoms and visible signs of atopic eczema tended to be more prevalent in Dresden. Similar East-West differences between the three study areas were seen in the younger age group.These findings are in line with recently observed increases in the prevalence of hay fever and atopic sensitization, but not of asthma and bronchial hyperresponsiveness, among 9±11 yr old children in Leipzig.

The role of repeated infections early in life in the development of childhood asthma and allergies has not been clarified. The aim of this study was to investigate the effect of repeated episodes of fever and antibiotic treatments during the first years of life on the prevalence of asthma, bronchial hyperresponsiveness (BHR), and atopy at school age in a representative population.Random samples of schoolchildren aged 5±7 yrs (n=7,545) and 9±11 yrs (n=7,498) were studied using the International Study of Asthma and Allergies in Childhood (ISAAC) phase II protocol. To assess the prevalence of disease and early childhood exposures, parental questionnaires were administered (response rates 82.2% and 85.3%, respectively). In addition, children underwent skin prick tests, hypertonic saline challenge and blood sampling for the measurement of serum immunoglobulin (Ig)E.Repeated episodes of fever and antibiotic treatment in early life were strongly associated with the prevalence of asthma (odds ratio (OR)=7.95; 95% confidence interval (CI) 6.02±10.50) and current wheeze at school age. Within asthmatic children the number of fever episodes and antibiotic courses were strongly inversely related to the prevalence of atopy (OR=0.25; 95% CI 0.11±0.54 for skin test reactivity) and BHR (OR=0.31; 95% CI 0.10±0.92). Furthermore, asthmatic children with recurrent early childhood infections were at a lower risk of being symptomatic at school age. When considering atopic and nonatopic asthmatic children separately, the highest risk of asthma with repeated early childhood infections was found for nonatopic asthma (OR=24.29; 95% CI 11.86±49.76).These findings suggest that a subgroup of children with a triggering or inducing of asthmatic symptoms through repeated early childhood infections exists within the "asthma syndrome" which has a better prognosis and is less related to the atopic phenotype. Eur Respir J 1999; 14: 4±11. There is an ongoing debate about the potential harmful or protective effect of early childhood infections on the development of childhood asthma and atopic diseases. Follow-up studies of children with proven respiratory syncytial virus (RSV) bronchiolitis have shown a slightly increased prevalence of repeated mild episodes of wheeze during the first 4 yrs of life, reductions in pulmonary function and increased prevalence of airway hyperresponsiveness [1±3]. Some authors also reported a positive association between infant bronchiolitis and atopic sensitization at school age [4], but others failed to confirm this finding [2,3].In contrast, the results of recent studies suggest that repeated bacterial and viral infections early in childhood may exert a protective effect on the development of atopic diseases. In the Fiji Islands, FLYNN [5,6] showed that in the indigenous children with frequent respiratory infections and a high hospital admission rate for pneumonia, the prevalence of asthma and airway hyperresponsiveness was lower than in the less exposed children. A recent report from southern Italy [7] showe...

The impact of inner city air pollution on the development of respiratory and atopic diseases in childhood is still unclear.In a cross sectional study in Dresden, Germany, 5,421 children in two age groups (5±7 yrs and 9±11 yrs) were studied according to the International Study of Asthma and Allergies in Childhood (ISAAC) phase II protocol. The prevalences of wheezing and cough as well as doctor diagnosed asthma and bronchitis were assessed by parental questionnaires. Children also underwent skin-prick testing, venipuncture for the measurement of serum immunoglobulin (Ig)E, lung function testing and a bronchial challenge test (4.5% saline) to assess airway hyperresponsiveness. Exposure was assessed on an individual basis by relating mean annual air pollution levels (SO 2 , NO 2 , CO, benzene, and O 3 ) which had been measured on a 1 km 2 grid, to the home and school address of each study subject.After adjusting for potential confounding factors an increase in the exposure to benzene of 1 mg . m 3 air was associated with an increased prevalence of morning cough (adjusted odds ratio (aOR)): 1.15; 1.04±1.27) and bronchitis (aOR: 1.11; 1.03±1.19). Similar associations were observed for NO 2 and CO. In turn, the prevalences of atopic sensitization, symptoms of atopic diseases and bronchial hyperresponsiveness were not positively associated with exposure to any of these pollutants.It is concluded that in this study a moderate increase in exposure to traffic-related air pollution was associated with an increased prevalence of cough and bronchitis, but not with atopic conditions in children. Eur Respir J 1999; 14: 669±677. [3,4,6] and the occurrence of respiratory tract illnesses. Not all reports attempted to discriminate between the different phenotypes of these conditions. Reports that provide detailed information suggest an effect on the prevalence of cough and bronchitis, but not on asthma and atopy [2,7,8].Other epidemiological studies found an association between automobile [9,10] or truck traffic frequency [11± 13] and wheeze. Higher exposure to truck traffic and black smoke was also associated with impaired forced expiratory volume in one second (FEV1) [14]. Some studies also reported an association between truck traffic frequency [12,13] or black smoke exposure [11] and symptoms of allergic rhinitis. A large Italian study on 39,275 children [15] found a significant association between truck traffic exposure and wheeze, but the associations with other respiratory symptoms (cough and phlegm) were more pronounced. No positive associations were seen between traffic exposure and doctor-diagnosed asthma [9, 11], atopy [11] or bronchial hyperrespon-siveness (BHR) [9]. In contrast to these findings data from in vitro studies and laboratory experiments suggest that particles from diesel exhaust, one of the major contributors to particulate matter pollution in urban areas, specifically promote allergic reactions and BHR [16].Limitations of study design and exposure assessment have hampered the interpretation ...

OBJECTIVE: To evaluate whether breast feeding is associated with prevalent overweight in pre-adolescent children. METHODS: Cross-sectional studies of 9 to 10-y-old children attending fourth grade in 1995=1996 in Dresden (n ¼ 1046) and Munich (n ¼ 1062), Germany, according to the International Study of Asthma and Allergies in Childhood (ISAAC) Phase II protocol. A comprehensive questionnaire including detailed breast feeding history was filled out by the child's parent. Height and weight were measured in a random subsample of children undergoing spirometry. Overweight was defined as body mass index 90th age-and sex-specific percentile of the German reference. RESULTS: While the prevalence of overweight differed substantially between Dresden (girls 9.1%, boys 12.5%) and Munich (17% both), we observed a markedly lower overweight prevalence among breast fed than non-breast fed children in both cities. Controlling for age, sex and city, breast-fed children were substantially less likely to be overweight at 9 -10 y (OR 0.55, 95% CI 0.41 -0.74). Results were slightly attenuated after adjustment for nationality, socio-economic status, number of siblings, parental smoking (OR 0.66, 95% CI 0.52 -0.87). A longer overall duration and duration of exclusive breast feeding was associated significantly with decreasing prevalence of overweight. CONCLUSION: The results highlight the importance and possible preventive potential of early nutrition in the development of overweight in children. Both feeding behaviors acquired by the nursing infant and metabolic effects may contribute to the observed inverse association of breast feeding and overweight in children.

SummaryBackground Atopic Dermatitis (AD), hayfever and asthma are commonly summarized as atopic diseases. The spatial distribution of AD differs from that of asthma and hayfever, suggesting that AD might follow a different risk pattern than these diseases. AD can be differentiated into an allergic extrinsic form (EAD) and a non-allergic intrinsic form (IAD). Only EAD might follow the distribution and risk pattern that have been ascribed to asthma and hayfever. Objective To investigate the distribution and risk factor profile of AD and EAD focusing on environmental factors relating to the hygiene hypothesis. Methods Population-based cross-sectional study on 12 601 children aged 5-7 and 9-11 years from Dresden (Eastern Germany) and Munich (Western Germany). Information was obtained by International Study of Asthma and Allergic Childhood questionnaires, dermatological examinations and skin prick testing. AD-diagnosis ever, current AD-symptoms and visible eczema were investigated with their respective extrinsic forms. Results Maternal and paternal history of AD were equally strong determinants of the child's AD status. Factors related to the hygiene hypothesis like day-care attendance and number of older siblings were not associated with a decreased risk of AD. The proportion of EAD within AD was higher in Eastern than in Western Germany. The determinants of the diseases appeared to be similar for both EAD and IAD. Conclusions There was no evidence of the hygiene hypothesis holding true for AD or EAD. AD might be a separate entity than respiratory atopic diseases. Little is known about the risk factors of AD and factors different from those of respiratory allergic diseases should be considered in future research.