The prevalence and risk factors of allergic rhinitis from a nationwide study of Korean elementary, middle, and high school students

Yeongho Kim; Ju-Hee Seo; Ji-Won Kwon; Eun Lee; Song-I Yang; Hyun-Ju Cho; Mina Ha; Eunae Burm; Kee-Jae Lee; Hwan-Cheol Kim; Sinye Lim; Hee-Tae Kang; Mia Son; Soo-Young Kim; Hae-Kwan Cheong; Yu-Mi Kim; Gyung-Jae Oh; Joon Sakong; Chul-Gab Lee; Sue Jin Kim; Yong-Wook Beak; Soo-Jong Hong

doi:10.4168/aard.2015.3.4.272

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Kim, Seo, Kwon, Lee, Yang, Cho, Ha, Burm, Lee, Kim, Lim, Kang, Son, Kim, Cheong, Kim, Oh, Sakong, Lee, Kim, Beak, and Hong: The prevalence and risk factors of allergic rhinitis from a nationwide study of Korean elementary, middle, and high school students

Original Article

Allergy, Asthma & Respiratory Disease 2015; 3(4): 272-280.

Published online: 28 July 2015

DOI: https://doi.org/10.4168/aard.2015.3.4.272

The prevalence and risk factors of allergic rhinitis from a nationwide study of Korean elementary, middle, and high school students

Yeongho Kim¹, Ju-Hee Seo², Ji-Won Kwon³, Eun Lee¹, Song-I Yang⁴, Hyun-Ju Cho¹, Mina Ha⁵, Eunae Burm⁶, Kee-Jae Lee⁷, Hwan-Cheol Kim⁸, Sinye Lim⁹, Hee-Tae Kang¹⁰, Mia Son¹¹, Soo-Young Kim¹², Hae-Kwan Cheong¹³, Yu-Mi Kim¹⁴, Gyung-Jae Oh¹⁵, Joon Sakong¹⁶, Chul-Gab Lee¹⁷, Sue Jin Kim¹⁸, Yong-Wook Beak¹⁸, Soo-Jong Hong¹

¹Department of Pediatrics, Childhood Asthma Atopy Center, Environmental Health Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

²Department of Pediatrics, Korea Cancer Center Hospital, Seoul, Korea.

³Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea.

⁴Department of Pediatrics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea.

⁵Department of Preventive Medicine, Dankook University College of Medicine, Cheonan, Korea.

⁶Department of Public Health, Graduate School of Dankook University, Cheonan, Korea.

⁷Department of Information Statistics, College of Natural Science, Korean National Open University, Seoul, Korea.

⁸Department of Occupational and Environmental Medicine, Inha University School of Medicine, Incheon, Korea.

⁹Department of Occupational and Environmental Medicine, Kyung Hee University School of Medicine, Seoul, Korea.

¹⁰Department of Occupational and Environmental Medicine, Wonju Severance Christian's Hospital, Yonsei University College of Medicine, Wonju, Korea.

¹¹Department of Preventive Medicine, Kangwon National University School of Medicine, Chuncheon, Korea.

¹²Department of Preventive Medicine, Eulji University School of Medicine, Daejeon, Korea.

¹³Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Suwon, Korea.

¹⁴Department of Preventive Medicine, Dong-A University College of Medicine, Busan, Korea.

¹⁵Department of Preventive Medicine, Wonkwang University School of Medicine, Iksan, Korea.

¹⁶Department of Preventive Medicine and Public Health, Yeungnam University College of Medicine, Daegu, Korea.

¹⁷Department of Occupational and Environmental Medicine, Chosun University School of Medicine, Gwangju, Korea.

¹⁸Division of Environmental Health, Department of Environmental Epidemiology, National Institute of Environment, Incheon, Korea.

Correspondence to: Soo-Jong Hong. Department of Pediatrics, Childhood Asthma Atopy Center, Environmental Health Center, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea. Tel: +82-2-3010-3379, Fax: +82-2-473-3725, sjhong@amc.seoul.kr

Received 25 April 2015 Revised 8 June 2015 Accepted 17 June 2015

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/).

Abstract

Purpose

We investigated the prevalence and risk factors of allergic rhinitis (AR), nationwide in random children and adolescents of Korea.

Methods

A modified International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire survey was done in 1,820 children from elementary, middle, and high school nationwide in Korea. The subjects were selected by the stratifying sampling method by school grade and five regions. Current AR was defined as having AR symptoms during the last 12 months with a history of physician-diagnosed AR. Skin prick tests for 18 common allergens were performed.

Results

The number of males was 945, and that of females was 875. The mean age of the patients was 12.61±3.40 years. The prevalence of current AR and atopic current AR were 29.0% and 18.7%, respectively. Risk factors for current AR were male (adjusted odds ratio [aOR], 1.486; 95% confidence interval [CI], 1.189-1.856), family history of paternal AR (aOR, 3.208; 95% CI, 2.460-4.182), family history of maternal AR (aOR, 3.138; 95% CI, 2.446-4.025), antibiotic use in infancy (aOR, 1.547; 95% CI, 1.228-1.949), mold exposure during infancy (aOR, 1.416; 95% CI, 1.103-1.819), mold exposure during the last 12 months (aOR, 1.285; 95% CI, 1.012-1.630), and sensitization on skin prick tests (aOR, 2.596; 95% CI, 2.055-3.279). Risk factors for atopic current AR were the same as those of current AR, whereas breast-milk feeding (aOR, 0.720; 95% CI, 0.530-0.976) was a protective factor. Sensitized allergens as risk factors for current AR were Dermatophagoides pteronyssinus, Dermatophagoides farina, ragweed, mugwort, oak, alder, birch, Japanese hop, cat, and dog.

Conclusion

The prevalences of current AR and atopic current AR were 29.0% and 18.7%, respectively. Male, sex parental AR, antibiotic use in infancy, mold exposure during the last 12 months, mold exposure during infancy, and atopic sensitization were risk factors for current AR. Breast-milk feeding was a protective factor for atopic current AR. Aeroallergen sensitization was an important risk factor for AR.

Keywords: Allergic rhinitis, Prevalence, Risk factors, Sensitization, Child

Figures and Tables

Fig. 1

The prevalence of current AR, rhinitis with sensitization and atopic current AR according to age. AR, allergic rhinitis. ^*Current AR: diagnosis ever plus symptoms within last 12 months. ^†Rhinitis with sensitization, last 12 mo: symptoms within last 12 months plus allergen sensitization. ^‡Atopic current AR: current AR plus allergen sensitization.

Table 1

Characteristics of the subjects (n=1,820)

Characteristic	Value
Age (yr)	12.61 ± 3.40
Sex
Male:female	945 (51.9):875 (48.1)
Body mass index (kg/m²)	19.74 ± 3.69
Family history of allergic rhinitis
AR diagnosis, ever, father	325/1,818 (17.9)
AR diagnosis, ever, mother	388/1,818 (21.3)
Family income (KRW)
Low, < 2,000,000	261/1,773 (14.7)
Middle, 2,000,000-4,000,000	728/1,773 (40.0)
High, ≥ 4,000,000	784/1,773 (44.2)
Environmental tobacco smoking	624/1,798 (34.7)
Living area
Seoul	273/1,820 (15.0)
Yeongnam area	375/1,820 (20.6)
Central area	591/1,820 (32.5)
Chungcheong area	288/1,820 (15.8)
Honam area	293/1,820 (16.1)
Other allergic diseases
Asthma symptoms, last 12 months	75/1,796 (4.2)
Asthma diagnosis, ever	158/1,787 (8.8)
Current asthma^*	33/1,777 (1.9)
AD symptoms, last 12 months	372/1,793 (20.7)
AD diagnosis, ever	528/1,795 (29.4)
Current AD^†	292/1,784 (16.4)
Current AR with current asthma	17/1,750 (1.0)
Current AR with current AD	103/1,765 (5.8)
Atopic sensitization^‡	807/1,751 (46.1)

Values are presented as mean±standard deviation or number (%).

AR, allergic rhinitis; KRW, Korean won (the currency of South Korea); AD, atopic dermatitis.

^*Current asthma: asthma diagnosis ever plus symptom within last 12 months. ^†Current AD: AD diagnosis ever plus symptom within last 12 months. ^‡Defined as at least 1 positive skin prick test (allergen wheal diameter is greater than 3 mm and histamine wheal diameter).

Table 2

Comparison of the prevalence of allergic rhinitis according to school grade

Variable	Prevalence, n (%)			Total
Variable	Elementary	Middle	High	Total
AR symptoms, ever	462/902 (51.2)	183/437 (41.9)	194/456 (42.5)	839/1,759 (46.7)
AR symptoms, last 12 months	411/894 (46.0)	163/441 (37.0)	182/456 (39.9)	756/1,791 (42.2)
AR diagnosis, ever	385/903 (42.6)	149/440 (33.9)	154/456 (33.8)	688/1,799 (38.2)
AR treatment, ever	353/899 (39.3)	138/440 (31.4)	140/455 (30.8)	631/1,794 (35.2)
AR treatment, last 12 months	223/879 (25.4)	71/433 (16.4)	79/449 (17.6)	373/1,761 (21.2)
Current AR^*	289/891 (32.4)	110/440 (25.0)	119/453 (26.3)	518/1,784 (29.0)
Rhinitis with sensitization, last 12 months^†	215/843 (25.5)	93/432 (21.5)	120/452 (26.2)	428/1,727 (24.8)
Atopic current AR^‡	161/840 (19.2)	69/431 (16.0)	91/449 (20.3)	321/1,720 (18.7)

AR, allergic rhinitis.

^*Current AR: diagnosis ever plus symptom within last 12 months. ^†Rhinitis with sensitization, last 12 months: symptom within last 12 months plus allergen sensitization. ^‡Atopic current AR: current AR plus allergen sensitization.

Table 3

Crude odds ratio (cOR) and adjusted odds ratio (aOR) of risk factors for current AR

Variable	Univariate analysis		Multivariate analysis
Variable	cOR (95% CI)	P-value	aOR^* (95% CI)	P-value
Age	0.966 (0.937-0.995)	0.024	0.983 (0.946-1.021)	0.367
Male sex	1.402 (1.141-1.724)	0.001	1.486 (1.189-1.856)	< 0.001
Body mass index	0.999 (0.972-1.027)	0.934	1.025 (0.991-1.060)	0.154
AR diagnosis, ever, father	3.356 (2.615-4.306)	< 0.001	3.208 (2.460-4.182)	< 0.001
AR diagnosis, ever, mother	3.260 (2.575-4.127)	< 0.001	3.138 (2.446-4.025)	< 0.001
Natural childbirth	1.027 (0.832-1.268)	0.806	1.022 (0.813-1.284)	0.855
Breast milk feeding	0.954 (0.748-1.216)	0.703	0.820 (0.629-1.069)	0.143
Antibiotics use in infancy	1.848 (1.499-2.278)	< 0.001	1.547 (1.228-1.949)	< 0.001
Having older siblings	0.834 (0.678-1.026)	0.086	0.877 (0.700-1.099)	0.255
Mold exposure during infancy	1.571 (1.250-1.976)	< 0.001	1.416 (1.103-1.819)	0.006
Mold exposure, last 12 months	1.433 (1.152-1.783)	0.001	1.285 (1.012-1.630)	0.039
House remodeling during pregnancy	2.041 (0.998-4.171)	0.050	1.571 (0.727-3.392)	0.250
House remodeling, last 2 years	1.047 (0.785-1.396)	0.754	0.867 (0.633-1.188)	0.375
Passive smoking	0.822 (0.661-1.024)	0.080	0.903 (0.711-1.146)	0.400
Passive smoking during pregnancy	1.290 (1.031-1.615)	0.026	1.247 (0.966-1.610)	0.091
Income	1.066 (1.005-1.129)	0.032	1.026 (0.964-1.092)	0.423
Living area	1.008 (0.930-1.093)	0.838	1.029 (0.943-1.123)	0.522
Atopic sensitization^†	2.902 (2.336-3.605)	< 0.001	2.596 (2.055-3.279)	< 0.001
Asthma symptoms, last 12 months	2.275 (1.415-3.657)	0.001	1.880 (1.082-3.264)	0.025
Asthma diagnosis, ever	2.688 (1.920-3.763)	< 0.001	2.276 (1.552-3.338)	< 0.001
Current asthma^‡	3.283 (1.582-6.809)	0.001	2.562 (2.022-3.246)	< 0.001
AD symptoms, last 12 months	1.235 (0.964-1.582)	0.095	0.975 (0.734-1.293)	0.859
AD diagnosis, ever	1.788 (1.437-2.223)	< 0.001	1.537 (1.201-1.966)	0.001
Current AD^§	1.453 (1.113-1.897)	0.006	1.242 (0.918-1.680)	0.160

AR, allergic rhinitis; CI, confidence interval; AD, atopic dermatitis.

^*Adjusted by age, sex, body mass index, AR diagnosis ever father, AR diagnosis ever mother, passive smoking, income, living area and atopic sensitization. ^†Defined as at least 1 positive skin prick test (allergen wheal diameter is greater than 3 mm and histamine wheal diameter). ^‡Current asthma: asthma diagnosis ever plus symptom within last 12 months. ^§Current AD: AD diagnosis ever plus symptom within last 12 months.

Table 4

Crude odds ratio (cOR) and adjusted odds ratio (aOR) of risk factors for atopic current AR

Variable	Univariate analysis		Multivariate analysis
Variable	cOR (95% CI)	P-value	aOR^* (95% CI)	P-value
Age	1.015 (0.980-1.052)	0.049	1.033 (0.988-1.080)	0.152
Male sex	1.800 (1.401-2.313)	< 0.001	1.851 (1.418-2.416)	< 0.001
Body mass index	1.031 (0.998-1.064)	0.063	1.034 (0.995-1.075)	0.090
AR diagnosis, ever, father	3.206 (2.436-4.220)	< 0.001	3.257 (2.429-4.367)	< 0.001
AR diagnosis, ever, mother	2.529 (1.939-3.298)	< 0.001	2.415 (1.819-3.207)	< 0.001
Natural childbirth	1.120 (0.871-1.441)	0.376	1.124 (0.858-1.471)	0.396
Breast milk feeding	0.796 (0.601-1.054)	0.111	0.720 (0.530-0.976)	0.035
Antibiotics use in infancy	1.522 (1.189-1.947)	0.001	1.329 (1.012-1.745)	0.041
Having older siblings	0.876 (0.685-1.120)	0.292	0.913 (0.700-1.189)	0.498
Mold exposure during infancy	1.227 (0.993-1.613)	0.143	1.139 (0.846-1.532)	0.391
Mold exposure, last 12 months	1.245 (0.961-1.613)	0.097	1.172 (0.886-1.551)	0.266
House remodeling during pregnancy	2.447 (1.160-5.519)	0.019	2.204 (0.993-4.894)	0.052
House remodeling, last 2 years	1.075 (0.766-1.509)	0.677	0.911 (0.631-1.315)	0.618
Passive smoking	0.873 (0.673-1.132)	0.307	0.956 (0.722-1.265)	0.753
Passive smoking during pregnancy	1.284 (0.984-1.676)	0.066	1.248 (0.926-1.682)	0.146
Income	1.089 (1.016-1.168)	0.017	1.056 (0.980-1.137)	0.153
Living area	0.973 (0.885-1.069)	0.566	0.985 (0.889-1.090)	0.765
Asthma symptoms, last 12 months	2.269 (1.339-3.843)	0.002	1.949 (1.092-3.480)	0.024
Asthma diagnosis, ever	2.722 (1.896-3.907)	< 0.001	2.282 (1.537-3.390)	< 0.001
Current asthma^†	3.343 (1.565-7.139)	0.002	3.110 (1.326-7.298)	0.009
AD symptoms, last 12 months	1.257 (0.940-1.680)	0.124	1.098 (0.802-1.504)	0.558
AD diagnosis, ever	1.706 (1.323-2.220)	< 0.001	1.586 (1.206-2.086)	0.001
Current AD^‡	1.472 (1.082-2.004)	0.014	1.345 (0.965-1.875)	0.081

AR, allergic rhinitis; CI, confidence interval; AD, atopic dermatitis.

^*Adjusted by age, sex, body mass index, AR diagnosis ever father, AR diagnosis ever mother, passive smoking, income, living area. ^†Current asthma: asthma diagnosis ever plus symptom within last 12 months. ^‡Current AD: AD diagnosis ever plus symptom within last 12 months.

Table 5

Adjusted odds ratio (aOR) of specific allergen sensitization for current AR

Variable	aOR^* (95% CI)
Variable	Elementary school	Middle school	High school	Total
Der p	2.419 (1.729-3.385)	2.339 (1.435-3.813)	3.956 (2.447-6.394)	2.716 (2.144-3.436)
Der f	2.065 (1.483-2.876)	2.264 (1.398-3.666)	3.294 (2.091-5.228)	2.362 (1.871-2.981)
Alternaria	1.680 (0.779-3.621)	1.606 (0.662-3.895)	0.915 (0.357-2.343)	1.395 (0.860-2.263)
Aspergillus	3.638 (0.749-17.660)	2.235 (0.302-16.524)	0.983 (0.138-6.991)	2.247 (0.800-6.309)
Grasses	3.844 (1.231-12.004)	2.154 (0.550-8.432)	2.715 (0.585-12.609)	2.646 (1.281-5.467)
Ragweed	5.270 (1.507-18.429)	7.024 (1.401-35.226)	3.064 (0.550-17.066)	4.724 (2.052-10.875)
Mugwort	5.519 (1.821-16.722)	5.513 (1.514-20.083)	1.520 (0.678-3.407)	2.843 (1.642-4.923)
Oak	2.271 (1.180-4.370)	0.896 (0.313-2.565)	4.270 (1.697-10.744)	2.139 (1.354-3.380)
Alder	2.562 (1.319-4.976)	1.842 (0.679-4.997)	1.721 (0.812-3.647)	2.091 (1.384-3.244)
Birch	2.539 (1.424-4.524)	1.683 (0.728-3.890)	2.225 (1.030-4.805)	2.178 (1.460-3.250)
Japanese hop	2.342 (1.283-4.275)	5.594 (1.997-15.669)	3.398 (1.217-9.429)	2.926 (1.852-4.622)
Cat	1.409 (0.747-2.657)	2.265 (1.067-4.807)	2.695 (1.353-5.367)	2.012 (1.358-2.981)
Dog	1.413 (0.488-4.089)	3.730 (0.911-15.280)	1.930 (0.662-5.621)	2.045 (1.059-3.947)
Cockroach	0.637 (0.119-3.411)	NA	2.071 (0.600-7.147)	0.867 (0.348-2.161)
Any sensitization	2.128 (1.542-2.936)	2.441 (1.501-3.970)	4.421 (2.632-7.427)	2.596 (2.055-3.279)

AR, allergic rhinitis; CI, confidence interval; Der p, Dermatophagoides pteronyssinus; Der f, Dermatophagoides farina; NA, not available.

^*Adjusted by age, sex, body mass index, AR diagnosis ever father, AR diagnosis ever mother, passive smoking, income and living area.

Notes

This study was supported by the National Institute of Environmental Research (NIER).

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SUPPLEMENTARY MATERIALS

Supplementary Tables can be found via www.aard.or.kr/src/sm/aard-3-272-S001.pdf.

Supplementary Table 1

Comparison of the prevalence of allergic rhinitis according to residential areas

Supplementary Table 2

Comparison of the prevalence of allergic rhinitis according to income

Supplementary Table 3

Comparison of the prevalence of allergic rhinitis in 6-7 years and 12-13 years

TOOLS

ORCID iDs: Soo-Jong Hong
https://orcid.org/http://orcid.org/0000-0003-1409-2113
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