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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

© 2015 The Korean Academy of Pediatric Allergy and Respiratory Disease; The Korean Academy of Asthma, Allergy and Clinical Immunology

(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.

aard-3-272-g001
Table 1

Characteristics of the subjects (n=1,820)

aard-3-272-i001
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

aard-3-272-i002
Variable Prevalence, n (%) Total
Elementary Middle High
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

aard-3-272-i003
Variable Univariate analysis Multivariate analysis
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

aard-3-272-i004
Variable Univariate analysis Multivariate analysis
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

aard-3-272-i005
Variable aOR* (95% CI)
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
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ORCID iDs

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

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