Rhinoconjunctivitis among Adolescents in Kuwait and Associated Risk Factors: A Cross-Sectional Study

Ali H Ziyab 1, Yaser M Ali 2

Affiliations

11 November 2019

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doi: 10.1155/2019/3981064

Abstract

Rhinoconjunctivitis is a public health problem that causes major illness and disability worldwide. Epidemiological studies intended to determine the burden of rhinoconjunctivitis in Kuwait are limited. Hence, this study sought to estimate the prevalence of rhinoconjunctivitis among adolescents in Kuwait and explore its association with different risk factors. Schoolchildren aged 11-14 years (n = 3,864) were enrolled in a cross-sectional study. Parents completed questionnaires regarding their children's clinical history and symptoms of rhinoconjunctivitis and relevant exposures. Associations were assessed using Poisson regression with robust variance estimation, and adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) were estimated. The 12-month (current) prevalence estimates of rhinitis, rhinoconjunctivitis, and severe rhinoconjunctivitis were 28.6% (1,040/3,643), 13.5% (497/3,689), and 1.2% (44/3,689), respectively. The prevalence of current rhinoconjunctivitis symptoms was higher in boys compared to girls (aPR = 1.19, 95% CI: 1.01-1.41). Parental history of rhinitis and asthma showed positive associations with rhinoconjunctivitis in offspring. Trend analyses showed that rhinoconjunctivitis prevalence decreased with increasing numbers of total siblings (aPR = 0.92, P trend < 0.001) and older siblings (aPR = 0.90, P trend < 0.001). Rhinoconjunctivitis is common among adolescents in Kuwait and its epidemiology is similar to that found in western countries.

Conflict of interest statement

The authors declare that there are no conflicts of interest regarding the publication of this article.

Figures

Figure 1 Monthly and seasonal variations in the prevalence of rhinoconjunctivitis symptoms. The shown prevalence estimates were calculated among individuals reporting rhinoconjunctivitis symptoms in the past 12 months.

Figure 1 Monthly and seasonal variations in the prevalence of rhinoconjunctivitis symptoms. The shown prevalence estimates were calculated among individuals reporting rhinoconjunctivitis symptoms in the past 12 months.

Figure 2 Prevalence of severe rhinoconjunctivitis symptoms according to perennial rhinoconjunctivitis symptoms. Participants were considered to have perennial rhinoconjunctivitis if symptoms were reported for more than 9 months in the past 12 months; otherwise, participants were not considered to have perennial rhinoconjunctivitis symptoms.

Figure 2 Prevalence of severe rhinoconjunctivitis symptoms according to perennial rhinoconjunctivitis symptoms. Participants were considered to have perennial rhinoconjunctivitis if symptoms were reported for more than 9 months in the past 12 months; otherwise, participants were not considered to have perennial rhinoconjunctivitis symptoms.

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References

  1.  
    1. Papadopoulos N. G., Guibas G. V. Rhinitis subtypes, endotypes, and definitions. Immunology and Allergy Clinics of North America. 2016;36(2):215–233. doi: 10.1016/j.iac.2015.12.001. - DOI - PMC - PubMed
  2.  
    1. de Groot H., Brand P. L. P., Fokkens W. F., Berger M. Y. Allergic rhinoconjunctivitis in children. BMJ. 2007;335(7627):985–988. doi: 10.1136/bmj.39365.617905.be. - DOI - PMC - PubMed
  3.  
    1. Greiner A. N., Hellings P. W., Rotiroti G., Scadding G. K. Allergic rhinitis. The Lancet. 2011;378(9809):2112–2122. doi: 10.1016/s0140-6736(11)60130-x. - DOI - PubMed
  4.  
    1. Meltzer E. O. Allergic rhinitis. Immunology and Allergy Clinics of North America. 2016;36(2):235–248. doi: 10.1016/j.iac.2015.12.002. - DOI - PubMed
  5.  
    1. Aït-Khaled N., Pearce N., Anderson H. R., et al. Global map of the prevalence of symptoms of rhinoconjunctivitis in children: the international study of asthma and allergies in childhood (ISAAC) phase three. Allergy. 2009;64(1):123–148. doi: 10.1111/j.1398-9995.2008.01884.x. - DOI - PubMed
  6.  
    1. Mims J. W. Epidemiology of allergic rhinitis. International Forum of Allergy & Rhinology. 2014;4(S2):S18–S20. doi: 10.1002/alr.21385. - DOI - PubMed
  7.  
    1. Björkstén B., Clayton T., Ellwood P., Stewart A., Strachan D. Worldwide time trends for symptoms of rhinitis and conjunctivitis: phase III of the international study of asthma and allergies in childhood. Pediatric Allergy and Immunology. 2008;19(2):110–124. doi: 10.1111/j.1399-3038.2007.00601.x. - DOI - PubMed
  8.  
    1. Ziyab A. H. Prevalence of food allergy among schoolchildren in Kuwait and its association with the coexistence and severity of asthma, rhinitis, and eczema: a cross-sectional study. World Allergy Organization Journal. 2019;12(4):p. 100024. doi: 10.1016/j.waojou.2019.100024. - DOI - PMC - PubMed
  9.  
    1. Asher M. I., Keil U., Anderson H. R., et al. International study of asthma and allergies in childhood (ISAAC): rationale and methods. European Respiratory Journal. 1995;8(3):483–491. doi: 10.1183/09031936.95.08030483. - DOI - PubMed
  10.  
    1. Skoner D. P. Allergic rhinitis: definition, epidemiology, pathophysiology, detection, and diagnosis. Journal of Allergy and Clinical Immunology. 2001;108(1):S2–S8. doi: 10.1067/mai.2001.115569. - DOI - PubMed
  11.  
    1. de Onis M., Onyango A. W., Borghi E., et al. Development of a WHO growth reference for school-aged children and adolescents. Bulletin of the World Health Organization. 2007;85(9):660–667. doi: 10.2471/blt.07.043497. - DOI - PMC - PubMed
  12.  
    1. Zou G. A modified Poisson regression approach to prospective studies with binary data. American Journal of Epidemiology. 2004;159(7):702–706. doi: 10.1093/aje/kwh090. - DOI - PubMed
  13.  
    1. Maldonado G., Greenland S. Simulation study of confounder-selection strategies. American Journal of Epidemiology. 1993;138(11):923–936. doi: 10.1093/oxfordjournals.aje.a116813. - DOI - PubMed
  14.  
    1. Ziyab A. H. Prevalence and risk factors of asthma, rhinitis, and eczema and their multimorbidity among young adults in Kuwait: a cross-sectional study. BioMed Research International. 2017;2017:10. doi: 10.1155/2017/2184193.2184193 - DOI - PMC - PubMed
  15.  
    1. Owayed A., Behbehani N., Al-Momen J. Changing prevalence of asthma and allergic diseases among Kuwaiti children: an ISAAC study (phase III) Medical Principles and Practice. 2008;17(4):284–289. doi: 10.1159/000129607. - DOI - PubMed
  16.  
    1. Behbehani N., Arifhodzic N., Al-Mousawi M., et al. The seasonal variation in allergic rhinitis and its correlation with outdoor allergens in Kuwait. International Archives of Allergy and Immunology. 2004;133(2):164–167. doi: 10.1159/000076622. - DOI - PubMed
  17.  
    1. Batlles-Garrido J., Torres-Borrego J., Rubí-Ruiz T., et al. Prevalence and factors linked to allergic rhinitis in 10 and 11-year-old children in Almería. ISAAC phase II, Spain. Allergologia et Immunopathologia. 2010;38(3):135–141. doi: 10.1016/j.aller.2009.09.005. - DOI - PubMed
  18.  
    1. Singh K., Axelrod S., Bielory L. The epidemiology of ocular and nasal allergy in the United States, 1988–1994. Journal of Allergy and Clinical Immunology. 2010;126(4):778–783. doi: 10.1016/j.jaci.2010.06.050. - DOI - PubMed
  19.  
    1. Togias A., Gergen P. J., Hu J. W., et al. Rhinitis in children and adolescents with asthma: ubiquitous, difficult to control, and associated with asthma outcomes. Journal of Allergy and Clinical Immunology. 2019;143(3):1003–1011. doi: 10.1016/j.jaci.2018.07.041. - DOI - PMC - PubMed
  20.  
    1. Ridolo E., Incorvaia C., Martignago I., Caminati M., Canonica G. W., Senna G. Sex in respiratory and skin allergies. Clinical Reviews in Allergy & Immunology. 2019;56(3):322–332. doi: 10.1007/s12016-017-8661-0. - DOI - PubMed
  21.  
    1. Frohlich M., Pinart M., Keller T., et al. Is there a sex-shift in prevalence of allergic rhinitis and comorbid asthma from childhood to adulthood? A meta-analysis. Clinical and Translational Allergy. 2017;7:p. 44. doi: 10.1186/s13601-017-0176-5. - DOI - PMC - PubMed
  22.  
    1. Pinart M., Keller T., Reich A., et al. Sex-related allergic rhinitis prevalence switch from childhood to adulthood: a systematic review and meta-analysis. International Archives of Allergy and Immunology. 2017;172(4):224–235. doi: 10.1159/000464324. - DOI - PubMed
  23.  
    1. Roved J., Westerdahl H., Hasselquist D. Sex differences in immune responses: hormonal effects, antagonistic selection, and evolutionary consequences. Hormones and Behavior. 2017;88:95–105. doi: 10.1016/j.yhbeh.2016.11.017. - DOI - PubMed
  24.  
    1. Chen W., Mempel M., Schober W., Behrendt H., Ring J. Gender difference, sex hormones, and immediate type hypersensitivity reactions. Allergy. 2008;63(11):1418–1427. doi: 10.1111/j.1398-9995.2008.01880.x. - DOI - PubMed
  25.  
    1. Naydenov K., Popov T., Mustakov T., Melikov A., Bornehag C.-G., Sundell J. The association of pet keeping at home with symptoms in airways, nose and skin among Bulgarian children. Pediatric Allergy and Immunology. 2008;19(8):702–708. doi: 10.1111/j.1399-3038.2008.00721.x. - DOI - PubMed
  26.  
    1. Brunekreef B., Von Mutius E., Wong G., Odhiambo J., García-Marcos L., Foliaki S. Exposure to cats and dogs, and symptoms of asthma, rhinoconjunctivitis, and eczema. Epidemiology. 2012;23(5):742–750. doi: 10.1097/ede.0b013e318261f040. - DOI - PubMed
  27.  
    1. Luo S., Sun Y., Hou J., et al. Pet keeping in childhood and asthma and allergy among children in Tianjin area, China. PLoS One. 2018;13(5) doi: 10.1371/journal.pone.0197274.e0197274 - DOI - PMC - PubMed
  28.  
    1. Mendy A., Wilkerson J., Salo P. M., Cohn R. D., Zeldin D. C., Thorne P. S. Exposure and sensitization to pets modify endotoxin association with asthma and wheeze. The Journal of Allergy and Clinical Immunology: In Practice. 2018;6(6):2006–2013. doi: 10.1016/j.jaip.2018.04.009. - DOI - PMC - PubMed
  29.  
    1. Thorne P. S., Cohn R. D., Mav D., Arbes S. J., Zeldin D. C. Predictors of endotoxin levels in U.S. Housing. Environmental Health Perspectives. 2009;117(5):763–771. doi: 10.1289/ehp.11759. - DOI - PMC - PubMed
  30.  
    1. Arshad S. H., Karmaus W., Raza A., et al. The effect of parental allergy on childhood allergic diseases depends on the sex of the child. Journal of Allergy and Clinical Immunology. 2012;130(2):427–434. doi: 10.1016/j.jaci.2012.03.042. - DOI - PMC - PubMed
  31.  
    1. Ober C., Yao T.-C. The genetics of asthma and allergic disease: a 21st century perspective. Immunological Reviews. 2011;242(1):10–30. doi: 10.1111/j.1600-065x.2011.01029.x. - DOI - PMC - PubMed
  32.  
    1. Morkve Knudsen T., Rezwan F. I., Jiang Y., et al. Transgenerational and intergenerational epigenetic inheritance in allergic diseases. Journal of Allergy and Clinical Immunology. 2018;142(3):765–772. doi: 10.1016/j.jaci.2018.07.007. - DOI - PMC - PubMed
  33.  
    1. Strachan D. P. Hay fever, hygiene, and household size. BMJ. 1989;299(6710):1259–1260. doi: 10.1136/bmj.299.6710.1259. - DOI - PMC - PubMed
  34.  
    1. Strachan D. P., Aït-Khaled N., Foliaki S., et al. Siblings, asthma, rhinoconjunctivitis and eczema: a worldwide perspective from the international study of asthma and allergies in childhood. Clinical & Experimental Allergy. 2015;45(1):126–136. doi: 10.1111/cea.12349. - DOI - PMC - PubMed
  35.  
    1. Karmaus W., Botezan C. Does a higher number of siblings protect against the development of allergy and asthma? A review. Journal of Epidemiology & Community Health. 2002;56(3):209–217. doi: 10.1136/jech.56.3.209. - DOI - PMC - PubMed
  36.  
    1. Bloomfield S. F., Stanwell-Smith R., Crevel R. W. Too clean, or not too clean: the hygiene hypothesis and home hygiene. Clinical Experimental Allergy. 2006;36(4):402–425. doi: 10.1111/j.1365-2222.2006.02463.x. - DOI - PMC - PubMed
  37.  
    1. Wills-Karp M., Santeliz J., Karp C. L. The germless theory of allergic disease: revisiting the hygiene hypothesis. Nature Reviews Immunology. 2001;1:69–75. doi: 10.1038/35095579. - DOI - PubMed
  38.  
    1. Karmaus W., Arshad H., Mattes J. Does the sibling effect have its origin in utero? Investigating birth order, cord blood immunoglobulin E concentration, and allergic sensitization at age 4 years. American Journal of Epidemiology. 2001;154:909–915. doi: 10.1093/aje/154.10.909. - DOI - PubMed

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