Life‐course of atopy and allergy‐related disease events in tropical sub‐Saharan Africa: A birth cohort study

• Published in: Pediatric allergy and immunology Vol. 28; no. 4; pp. 377 - 383
• Main Authors: 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.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.06.2017; John Wiley and Sons Inc
• Subjects: Africa; Africa South of the Sahara - epidemiology; Allergens; Allergens - immunology; Allergies; Asthma; Atopy; birth cohort; Child; Child, Preschool; Children; Cohort analysis; Cohort Studies; Comorbidity; conjunctivitis; Developing Countries; Eczema; Epidemiology; Female; Follow-Up Studies; Humans; Hypersensitivity, Immediate - epidemiology; Male; Original; Pediatrics; Poverty; Prevalence; Respiratory Sounds; Rhinitis; Skin diseases; Skin Tests; Surveys and Questionnaires; Tropical environment; Uganda; Uganda - epidemiology; urticaria; wheeze; birth cohort; wheeze; Africa; urticaria; atopy; eczema; Uganda; rhinitis; conjunctivitis
• ISSN: 0905-6157; 1399-3038
• DOI: 10.1111/pai.12719

Background In high‐income countries, allergy‐related diseases (ARDs) follow a typical sequence, the ‘Atopic March’. Little is known about the life‐course of ARDs in the markedly different, low‐income, tropical environment. We describe ARDs in a tropical, African birth cohort. Methods Ugandan children were followed from birth to 9 years. ISAAC questionnaires were completed at intervals; doctor‐diagnosed ARDs were recorded throughout follow‐up. Skin prick tests (SPTs) 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.