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Life‐course of atopy and allergy‐related disease events in tropical sub‐Saharan Africa: A birth cohort study
Author(s) -
Lule Swaib A.,
Mpairwe Harriet,
Nampijja Margaret,
Akello Florence,
Kabagenyi Joyce,
Namara Benigna,
Nkurunungi Gyaviira,
Kizito Dennison,
Kahwa Joseph,
Muhangi Lawrence,
Nash Stephen,
Muwanga Moses,
Webb Emily L.,
Elliott Alison M.
Publication year - 2017
Publication title -
pediatric allergy and immunology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.269
H-Index - 89
eISSN - 1399-3038
pISSN - 0905-6157
DOI - 10.1111/pai.12719
Subject(s) - wheeze , atopy , medicine , asthma , pediatrics , allergy , respiratory sounds , cohort , cohort study , immunology
Abstract Background In high‐income countries, allergy‐related diseases ( ARD s) follow a typical sequence, the ‘Atopic March’. Little is known about the life‐course of ARD s in the markedly different, low‐income, tropical environment. We describe ARD s in a tropical, African birth cohort. Methods Ugandan children were followed from birth to 9 years. ISAAC questionnaires were completed at intervals; doctor‐diagnosed ARD s were recorded throughout follow‐up. Skin prick tests ( SPT s) were performed at 3 and 9 years. Atopy was defined as ≥1 positive SPT . Results Of the 2345 live‐born children, 1214 (52%) were seen at 9 years. Wheeze and eczema were common in infancy, but by 9 years, only 4% reported recent wheeze, 5% eczema and 5% rhinitis. Between 3 and 9 years, atopy prevalence increased from 19% to 25%. Atopy at 3 or 9 years was associated with reported ARD events at 9 years, for example OR = 5.2 (95% CI 2.9–10.7) for atopy and recent wheeze at 9 years. Reported or doctor‐diagnosed ARD events in early childhood were associated with the same events in later childhood, for example OR = 4.4 (2.3–8.4) for the association between reported wheeze before 3 years with reported recent wheeze at 9 years, but progression from early eczema to later rhinitis or asthma was not observed. Conclusion Allergen sensitization started early in childhood and increased with age. Eczema and wheeze were common in infancy and declined with age. Atopy was strongly associated with ARD among the few affected children. The typical Atopic March did not occur. Environmental exposures during childhood may dissociate atopy and ARD .