The sex‐shift in single disease and multimorbid asthma and rhinitis during puberty ‐ a study by MeDALL

Abstract

BackgroundCross‐sectional studies suggested that allergy prevalence in childhood is higher in boys compared to girls, but it remains unclear whether this inequality changes after puberty. We examined the sex‐specific prevalence of asthma and rhinitis as single and as multimorbid diseases before and after puberty onset in longitudinal cohort data.MethodsIn six European population‐based birth cohorts of MeDALL, we assessed the outcomes: current rhinitis, current asthma, current allergic multimorbidity (ie, concurrent asthma and rhinitis), puberty status and allergic sensitization by specific serum antibodies (immunoglobulin E) against aero‐allergens. With generalized estimating equations, we analysed the effects of sex, age, puberty (yes/no) and possible confounders on the prevalence of asthma and rhinitis, and allergic multimorbidity in each cohort separately and performed individual participant data meta‐analysis.FindingsWe included data from 19 013 participants from birth to age 14‐20 years. Current rhinitis only affected girls less often than boys before and after puberty onset: adjusted odds ratio for females vs males 0.79 (95%‐confidence interval 0.73‐0.86) and 0.86 (0.79‐0.94), respectively (sex‐puberty interaction P = .089). Similarly, for current asthma only, females were less often affected than boys both before and after puberty onset: 0.71, 0.63‐0.81 and 0.81, 0.64‐1.02, respectively (sex‐puberty interaction P = .327). The prevalence of allergic multimorbidity showed the strongest sex effect before puberty onset (female‐male‐OR 0.55, 0.46‐0.64) and a considerable shift towards a sex‐balanced prevalence after puberty onset (0.89, 0.74‐1.04); sex‐puberty interaction: P < .001.InterpretationThe male predominance in prevalence before puberty and the “sex‐shift” towards females after puberty onset were strongest in multimorbid patients who had asthma and rhinitis concurrently.

Prevalence of chronic urticaria in children and adults across the globe: Systematic review with meta‐analysis

“…Evaluating sex‐specific differences in children < 15 years in three studies, we found again no sex‐specific difference. A sex‐related prevalence shift from childhood to adulthood has been identified for allergies, like allergic rhinitis in adolescence and asthma after the onset of puberty . Maybe the sex‐specific difference in CU that has been shown for patients results because in the transition to adulthood more females are developing urticaria?…”

“…A sex-related prevalence shift from childhood to adulthood has been identified for allergies, like allergic rhinitis in adolescence 42,43 and asthma after the onset of puberty. 44,45 Maybe the sex-specific difference in CU that has been shown for patients 41 results because in the transition to adulthood more females are de-…”

Sex and Gender Aspects for Patient Stratification in Allergy Prevention and Treatment

“…For asthma as a single entity, the female prevalence that arises after puberty persists in adulthood. Less clear are sex specific prevalences before and after puberty [50,51]. Lungs in females are lighter and smaller than in males and have a lower total number of alveoli with higher forced expiratory flow rates [52].…”

Cumulative Evidence for Association of Acetaminophen Exposure and Allergic Rhinitis

“…In our subgroup analysis, the findings from the prospective cohort studies subgroup indicated a significant association between acetaminophen exposure in early life and the risk of allergic rhinitis. Gender may also affect the risk of allergic rhinitis [42,43]. In our subgroup analysis, the association between acetaminophen exposure and allergic rhinitis was even stronger when adjusted for gender.…”