Prevalence of adult eczema, hay fever, and asthma, and associated risk factors: a population-based study in the northern Grassland of China

Xiaoyan Wang, Yan Zhuang, Yanlei Chen, Hongtian Wang, Xueyan Wang, Xiaoyan Wang, Yan Zhuang, Yanlei Chen, Hongtian Wang, Xueyan Wang

Abstract

Background: There has been research about the prevalence and risk factors of eczema, hay fever, and asthma in children, but little is known about these conditions in adults in China.

Objectives: To explore the prevalence of adult eczema/atopic dermatitis (AD) and its risk factors in northern China.

Methods: A cluster sampling randomized population-based survey was conducted using a face-to-face questionnaire combined with skin prick tests of ten common aeroallergens including nine pollen allergens and Dermatophagoides pteronyssinu (Dp) allergen. The questionnaire was designed by specialists and included questions on the prevalence of eczema, hay fever, and asthma, socioeconomic risk factors, family history of atopy and environmental exposures. The prevalence of eczema with asthma and/or hay fever (EAH) was applied as a proxy of AD in this study.

Results: Overall, 2096 subjects were enrolled and completed the study. The prevalence of eczema was 15.7% (95% CI 14.3-17.4), while the prevalence of hay fever and asthma were 20.6% (95% CI 18.9-22.4) and 6.5% (95% CI 5.5-7.6), respectively. In particular, the prevalence of EAH was 5.1% (95% CI 4.4-7.0). The prevalence of eczema and EAH was significantly associated with younger age, atopy family history, high education level, urbanization, and antibiotic overuse (P < 0.05, logistic regression). The sensitization rate was higher in EAH compared with eczema (48.2% vs 41.0%, P = 0.018), with weed pollen sensitization being the most common. Subjects with two or more concomitant allergic diseases had increased risk of eczema and EAH (P < 0.001). Allergen sensitization increased the risk of eczema and EAH (P < 0.001, both).

Conclusions: Adult eczema and EAH are prevalent in northern China under high pollen exposure. Socioeconomic and environmental factors affected the prevalence of adult AD in China. Dp had a particular impact on the prevalence of eczema/AD in the grassland region.

Keywords: Allergen sensitization; Atopic dermatitis; Eczema; Risk factors; Socioeconomic status.

Conflict of interest statement

The authors declare that no conflicts of interest exist.

Figures

Fig. 1
Fig. 1
The flow chart of the survey
Fig. 2
Fig. 2
Geographic locations of the study sites, including the Erenhot, Xilinhot, Duolun, Tongliao, Jarud, and Kailu areas of northern China
Fig. 3
Fig. 3
Distribution of eczema, hay fever, and asthma among the study cohort
Fig. 4
Fig. 4
Variation in eczema and EAH prevalence across different age groups and geographic regions
Fig. 5
Fig. 5
The sensitizati›on rate from SPT in eczema and EAH groups. a Demonstrates the sensitization rate in the eczema group, while b demonstrates the sensitization rate of the EAH group

References

    1. Drucker AM. Atopic dermatitis: burden of illness, quality of life, and associated complications. Allergy Asthma Proc. 2017;38(1):3–8. doi: 10.2500/aap.2017.38.4005.
    1. Napolitano M, et al. Adult atopic dermatitis: a review. G Ital Dermatol Venereol. 2016;151(4):403–411.
    1. Paller A, et al. Major comorbidities of atopic dermatitis: beyond allergic disorders. Am J Clin Dermatol. 2018;19(6):821–838. doi: 10.1007/s40257-018-0383-4.
    1. Ronnstad A, et al. Association of atopic dermatitis with depression, anxiety, and suicidal ideation in children and adults: a systematic review and meta-analysis. J Am Acad Dermatol. 2018;79(3):448–456.e30. doi: 10.1016/j.jaad.2018.03.017.
    1. Kauppi S, et al. Adult patients with atopic eczema have a high burden of psychiatric disease: a Finnish nationwide registry study. Acta Derm Venereol. 2019;99(7):647–651. doi: 10.2340/00015555-3165.
    1. Lee HH, et al. A systematic review and meta-analysis of the prevalence and phenotype of adult-onset atopic dermatitis. J Am Acad Dermatol. 2019;80(6):1526–1532.e7. doi: 10.1016/j.jaad.2018.05.1241.
    1. Mortz CG, et al. Atopic dermatitis from adolescence to adulthood in the TOACS cohort: prevalence, persistence and comorbidities. Allergy. 2015;70(7):836–845. doi: 10.1111/all.12619.
    1. Silvestre SJ, Romero-Perez D, Encabo-Duran B. Atopic dermatitis in adults: a diagnostic challenge. J Investig Allergol Clin Immunol. 2017;27(2):78–88. doi: 10.18176/jiaci.0138.
    1. Singh S, et al. Allergic rhinitis, rhinoconjunctivitis, and eczema: prevalence and associated factors in children. Clin Respir J. 2018;12(2):547–556. doi: 10.1111/crj.12561.
    1. Wang J, et al. Association between breastfeeding and eczema during childhood and adolescence: a cohort study. PLoS ONE. 2017;12(9):e0185066. doi: 10.1371/journal.pone.0185066.
    1. Silverberg JI, Simpson EL. Association between severe eczema in children and multiple comorbid conditions and increased healthcare utilization. Pediatr Allergy Immunol. 2013;24(5):476–486. doi: 10.1111/pai.12095.
    1. Toledo MF, et al. Changes over time in the prevalence of asthma, rhinitis and atopic eczema in adolescents from Taubate, Sao Paulo, Brazil (2005–2012): relationship with living near a heavily travelled highway. Allergol Immunopathol (Madr) 2016;44(5):439–444. doi: 10.1016/j.aller.2016.02.006.
    1. Silverberg JI, Hanifin J, Simpson EL. Climatic factors are associated with childhood eczema prevalence in the United States. J Invest Dermatol. 2013;133(7):1752–1759. doi: 10.1038/jid.2013.19.
    1. Ballardini N, et al. Development and comorbidity of eczema, asthma and rhinitis to age 12: data from the BAMSE birth cohort. Allergy. 2012;67(4):537–544. doi: 10.1111/j.1398-9995.2012.02786.x.
    1. Hsu DY, Shinkai K, Silverberg JI. Epidemiology of eczema herpeticum in hospitalized U.S. children: analysis of a Nationwide Cohort. J Invest Dermatol. 2018;138(2):265–272. doi: 10.1016/j.jid.2017.08.039.
    1. Silverberg JI, Greenland P. Eczema and cardiovascular risk factors in 2 US adult population studies. J Allergy Clin Immunol. 2015;135(3):721–728.e6. doi: 10.1016/j.jaci.2014.11.023.
    1. Pesce G, et al. Adult eczema in Italy: prevalence and associations with environmental factors. J Eur Acad Dermatol Venereol. 2015;29(6):1180–1187. doi: 10.1111/jdv.12784.
    1. Ronmark EP, et al. Eczema among adults: prevalence, risk factors and relation to airway diseases. Results from a large-scale population survey in Sweden. Br J Dermatol. 2012;166(6):1301–1308. doi: 10.1111/j.1365-2133.2012.10904.x.
    1. Silvestre Salvador JF, Romero-Pérez D, Encabo-Durán B. Atopic dermatitis in adults: a diagnostic challenge. J Invest Allergol Clin Immunol. 2017;27(2):78–88. doi: 10.18176/jiaci.0138.
    1. Weidinger S, Novak N. Atopic dermatitis. Lancet. 2016;387(10023):1109–1122. doi: 10.1016/S0140-6736(15)00149-X.
    1. Barbarot S, et al. Epidemiology of atopic dermatitis in adults: results from an international survey. Allergy. 2018;73(6):1284–1293. doi: 10.1111/all.13401.
    1. Silverberg JI, Hanifin JM. Adult eczema prevalence and associations with asthma and other health and demographic factors: a US population-based study. J Allergy Clin Immunol. 2013;132(5):1132–1138. doi: 10.1016/j.jaci.2013.08.031.
    1. Guo Y, et al. Prevalence of atopic dermatitis in Chinese children aged 1–7 ys. Sci Rep. 2016;19(6):29751. doi: 10.1038/srep29751.
    1. Xu F, et al. Prevalence of childhood atopic dermatitis: an urban and rural community-based study in Shanghai, China. PLoS ONE. 2012;7(5):e36174. doi: 10.1371/journal.pone.0036174.
    1. Xiao Y, et al. The prevalence of atopic dermatitis and chronic spontaneous urticaria are associated with parental socioeconomic status in adolescents in China. Acta Derm Venereol. 2019;99(3):321–326. doi: 10.2340/00015555-3104.
    1. Bastl K, Kmenta M, Berger UE. Defining pollen seasons: background and recommendations. Curr Allergy Asthma Rep. 2018;18(12):73. doi: 10.1007/s11882-018-0829-z.
    1. Wang XY, et al. Prevalence of pollen-induced allergic rhinitis with high pollen exposure in grasslands of northern China. Allergy. 2018;73(6):1232–1243. doi: 10.1111/all.13388.
    1. Heinzerling L, et al. The skin prick test—European standards. Clin Transl Allergy. 2013;3(1):3. doi: 10.1186/2045-7022-3-3.
    1. Harrop J, et al. Eczema, atopy and allergen exposure in adults: a population-based study. Clin Exp Allergy. 2007;37(4):526–535. doi: 10.1111/j.1365-2222.2007.02679.x.
    1. Muto T, et al. Prevalence of atopic dermatitis in Japanese adults. Br J Dermatol. 2003;148(1):117–121. doi: 10.1046/j.1365-2133.2003.05092.x.
    1. Yang Z, et al. Frequency of food group consumption and risk of allergic disease and sensitization in schoolchildren in urban and rural China. Clin Exp Allergy. 2015;45(12):1823–1832. doi: 10.1111/cea.12532.
    1. Sacotte R, Silverberg JI. Epidemiology of adult atopic dermatitis. Clin Dermatol. 2018;36(5):595–605. doi: 10.1016/j.clindermatol.2018.05.007.
    1. Morgenstern V, et al. Atopic diseases, allergic sensitization, and exposure to traffic-related air pollution in children. Am J Respir Crit Care Med. 2008;177(12):1331–1337. doi: 10.1164/rccm.200701-036OC.
    1. Eberlein-König B, et al. Influence of airborne nitrogen dioxide or formaldehyde on parameters of skin function and cellular activation in patients with atopic eczema and control subjects. J Allergy Clin Immunol. 1998;101(1 Pt 1):141–143. doi: 10.1016/S0091-6749(98)70212-X.
    1. Shaw TE, et al. Eczema prevalence in the United States: data from the 2003 National Survey of Children’s Health. J Invest Dermatol. 2011;131(1):67–73. doi: 10.1038/jid.2010.251.
    1. Silverberg JI, Paller AS. Association between eczema and stature in 9 US population-based studies. JAMA Dermatol. 2015;151(4):401–409. doi: 10.1001/jamadermatol.2014.3432.
    1. Deckers IA, et al. Investigating international time trends in the incidence and prevalence of atopic eczema 1990–2010: a systematic review of epidemiological studies. PLoS ONE. 2012;7(7):e39803. doi: 10.1371/journal.pone.0039803.
    1. Kim M, et al. Seasonal variation and monthly patterns of skin symptoms in Korean children with atopic eczema/dermatitis syndrome. Allergy Asthma Proc. 2017;38(4):294–299. doi: 10.2500/aap.2017.38.4055.
    1. Petherick ES, et al. Ethnic and socio-economic differences in the prevalence of wheeze, severe wheeze, asthma, eczema and medication usage at 4 years of age: findings from the Born in Bradford birth cohort. Respir Med. 2016;119:122–129. doi: 10.1016/j.rmed.2016.08.017.
    1. Chen YL, et al. Antibiotic overuse and allergy-related diseases: an epidemiological cross-sectional study in the grasslands of Northern China. Ther Clin Risk Manag. 2019;15:783–789. doi: 10.2147/TCRM.S203719.
    1. Sasaki M, et al. Environmental factors associated with childhood eczema: findings from a national web-based survey. Allergol Int. 2016;65(4):420–424. doi: 10.1016/j.alit.2016.03.007.
    1. Ferreira MA, et al. Shared genetic origin of asthma, hay fever and eczema elucidates allergic disease biology. Nat Genet. 2017;49(12):1752–1757. doi: 10.1038/ng.3985.
    1. Potaczek DP, Harb H, Michel S, Alhamwe BA, Renz H, Tost J. Epigenetics and allergy: from basic mechanisms to clinical applications. Epigenomics. 2017;9(4):539–571. doi: 10.2217/epi-2016-0162.
    1. Alashkar Alhamwe B, Alhamdan F, Ruhl A, Potaczek DP, Renz H. The role of epigenetics in allergy and asthma development. Curr Opin Allergy Clin Immunol. 2020;20(1):48–55. doi: 10.1097/ACI.0000000000000598.
    1. Andersen Y, et al. Adult atopic dermatitis and the risk of type 2 diabetes. J Allergy Clin Immunol. 2017;139(3):1057–1059. doi: 10.1016/j.jaci.2016.08.049.
    1. Silverberg JI. Association between adult atopic dermatitis, cardiovascular disease, and increased heart attacks in three population-based studies. Allergy. 2015;70(10):1300–1308. doi: 10.1111/all.12685.
    1. Yu SH, Silverberg JI. Association between atopic dermatitis and depression in US adults. J Invest Dermatol. 2015;135(12):3183–3186. doi: 10.1038/jid.2015.337.
    1. Drucker AM, et al. Atopic dermatitis and risk of hypertension, type 2 diabetes, myocardial infarction and stroke in a cross-sectional analysis from the Canadian Partnership for Tomorrow Project. Br J Dermatol. 2017;177(4):1043–1051. doi: 10.1111/bjd.15727.
    1. Lowe KE, et al. Atopic eczema and fracture risk in adults: a population-based cohort study. J Allergy Clin Immunol. 2020;145(2):563–571.e8. doi: 10.1016/j.jaci.2019.09.015.

Source: PubMed

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