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Thorax. 1994 December; 49(12): 1205–1210.
PMCID: PMC475324

Asthma, allergy, and atopy in three south-east Asian populations.


BACKGROUND--Whilst many recent reports have suggested a rise in the prevalence of asthma and allergic disease in Western countries, little is known about the epidemiology of these common conditions in south-east Asia. This study compared the prevalence of asthma and allergic disease amongst secondary school students in three south-east Asian populations--Hong Kong, Kota Kinabalu in Malaysia, and San Bu in China--and investigated the associations with atopy and family history. METHODS--Secondary school students were given standard questionnaires on respiratory and allergic symptoms for completion by parents with response rates of 89.2% in Hong Kong (611 male, 451 female; mean (SD) age = 13.9 (1.8 years), 87.6% in Kota Kinabalu (134 male, 275 female; 15.5 (2.1) years), and 98.6% in San Bu (492 male, 245 female; 16.4 (1.8) years). Skin tests were performed in a subsample of students to determine atopic status. RESULTS--The respective prevalence (and 95% CI) for hayfever, eczema, and wheeze or asthma were 15.7% (13.5, 17.9), 20.1% (17.7, 22.5), 11.6% (9.3, 13.9) in Hong Kong, 11.2% (8.2, 14.3), 7.6% (5.0, 10.1), 8.2% (5.5, 10.9) in Kota Kinabalu, and 2.1% (1.2, 3.1), 7.2% (5.4, 9.1), 1.9% (0.7, 3.1) in San Bu. Atopy was common and was present in 49.0-63.9% of subjects in the three populations. Dust mite and cockroach were the commonest allergens that gave positive reactions in 42.8-60.5% and 25.7-35.9% of students respectively. A higher proportion of students in Hong Kong had severe degree of reactivity on skin test than the other two populations. Family history was associated with asthma and allergic symptoms in the three populations conferring a 3-80-fold increase in risk to family members and was a stronger predictor for asthma and allergy than atopy. CONCLUSIONS--Prevalence of asthma and allergic disease is low compared with Western countries, but considerable differences exist between the three south-east Asian populations despite similar rates of atopy. Asthma and allergic disease are more strongly associated with family history than atopy, which suggests that genetic and environmental factors common to the family, other than aeroallergen sensitisation, are important in the pathogenesis of asthma and allergy in the region.

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  • Clifford RD, Howell JB, Radford M, Holgate ST. Associations between respiratory symptoms, bronchial response to methacholine, and atopy in two age groups of schoolchildren. Arch Dis Child. 1989 Aug;64(8):1133–1139. [PMC free article] [PubMed]
  • Jones DT, Sears MR, Holdaway MD, Hewitt CJ, Flannery EM, Herbison GP, Silva PA. Childhood asthma in New Zealand. Br J Dis Chest. 1987 Oct;81(4):332–340. [PubMed]
  • Robertson CF, Heycock E, Bishop J, Nolan T, Olinsky A, Phelan PD. Prevalence of asthma in Melbourne schoolchildren: changes over 26 years. BMJ. 1991 May 11;302(6785):1116–1118. [PMC free article] [PubMed]
  • Burr ML, Butland BK, King S, Vaughan-Williams E. Changes in asthma prevalence: two surveys 15 years apart. Arch Dis Child. 1989 Oct;64(10):1452–1456. [PMC free article] [PubMed]
  • Ninan TK, Russell G. Respiratory symptoms and atopy in Aberdeen schoolchildren: evidence from two surveys 25 years apart. BMJ. 1992 Apr 4;304(6831):873–875. [PMC free article] [PubMed]
  • Peat JK, Haby M, Spijker J, Berry G, Woolcock AJ. Prevalence of asthma in adults in Busselton, Western Australia. BMJ. 1992 Nov 28;305(6865):1326–1329. [PMC free article] [PubMed]
  • Omar AH. Respiratory symptoms and asthma in primary school children in Kuala Lumpur. Acta Paediatr Jpn. 1990 Apr;32(2):183–187. [PubMed]
  • Zhong NS, Chen RC, O-yang M, Wu JY, Fu WX, Shi LJ. Bronchial hyperresponsiveness in young students of southern China: relation to respiratory symptoms, diagnosed asthma, and risk factors. Thorax. 1990 Nov;45(11):860–865. [PMC free article] [PubMed]
  • Leung R, Jenkins M. Asthma, allergy and atopy in southern Chinese school students. Clin Exp Allergy. 1994 Apr;24(4):353–358. [PubMed]
  • Hsieh KH, Shen JJ. Prevalence of childhood asthma in Taipei, Taiwan, and other Asian Pacific countries. J Asthma. 1988;25(2):73–82. [PubMed]
  • Samet JM. A historical and epidemiologic perspective on respiratory symptoms questionnaires. Am J Epidemiol. 1978 Dec;108(6):435–446. [PubMed]
  • Abramson M, Kutin J, Bowes G. The prevalence of asthma in Victorian adults. Aust N Z J Med. 1992 Aug;22(4):358–363. [PubMed]
  • Peat JK, Britton WJ, Salome CM, Woolcock AJ. Bronchial hyperresponsiveness in two populations of Australian schoolchildren. III. Effect of exposure to environmental allergens. Clin Allergy. 1987 Jul;17(4):291–300. [PubMed]
  • Burney P, Chinn S. Developing a new questionnaire for measuring the prevalence and distribution of asthma. Chest. 1987 Jun;91(6 Suppl):79S–83S. [PubMed]
  • Josephs LK, Gregg I, Mullee MA, Holgate ST. Nonspecific bronchial reactivity and its relationship to the clinical expression of asthma. A longitudinal study. Am Rev Respir Dis. 1989 Aug;140(2):350–357. [PubMed]
  • Salome CM, Peat JK, Britton WJ, Woolcock AJ. Bronchial hyperresponsiveness in two populations of Australian schoolchildren. I. Relation to respiratory symptoms and diagnosed asthma. Clin Allergy. 1987 Jul;17(4):271–281. [PubMed]
  • Johnston SL, Clough JB, Pattemore PK, Smith S, Holgate ST. Longitudinal changes in skin-prick test reactivity over 2 years in a population of schoolchildren with respiratory symptoms. Clin Exp Allergy. 1992 Oct;22(10):948–957. [PubMed]
  • Elfert H, Anderson JM, Lai M. Parents' perceptions of children with chronic illness: a study of immigrant Chinese families. J Pediatr Nurs. 1991 Apr;6(2):114–120. [PubMed]
  • Ong SG, Liu J, Wong CM, Lam TH, Tam AY, Daniel L, Hedley AJ. Studies on the respiratory health of primary school children in urban communities of Hong Kong. Sci Total Environ. 1991 Jul 1;106(1-2):121–135. [PubMed]
  • Abramson M, Voigt T. Ambient air pollution and respiratory disease. Med J Aust. 1991 Apr 15;154(8):543–553. [PubMed]
  • Utell MJ, Samet JM. Particulate air pollution and health. New evidence on an old problem. Am Rev Respir Dis. 1993 Jun;147(6 Pt 1):1334–1335. [PubMed]
  • Evans D, Levison MJ, Feldman CH, Clark NM, Wasilewski Y, Levin B, Mellins RB. The impact of passive smoking on emergency room visits of urban children with asthma. Am Rev Respir Dis. 1987 Mar;135(3):567–572. [PubMed]
  • Gerrard JW, Cockcroft DW, Mink JT, Cotton DJ, Poonawala R, Dosman JA. Increased nonspecific bronchial reactivity in cigarette smokers with normal lung function. Am Rev Respir Dis. 1980 Oct;122(4):577–581. [PubMed]
  • O'Connor GT, Weiss ST, Tager IB, Speizer FE. The effect of passive smoking on pulmonary function and nonspecific bronchial responsiveness in a population-based sample of children and young adults. Am Rev Respir Dis. 1987 Apr;135(4):800–804. [PubMed]
  • Kennedy SM, Elwood RK, Wiggs BJ, Paré PD, Hogg JC. Increased airway mucosal permeability of smokers. Relationship to airway reactivity. Am Rev Respir Dis. 1984 Jan;129(1):143–148. [PubMed]
  • Kjellman NI. Effect of parental smoking on IgE levels in children. Lancet. 1981 May 2;1(8227):993–994. [PubMed]
  • Chien YK, Yang WP, Xue ZL, Massey DG. House dust mite asthma in China: a review. Ann Allergy. 1987 Aug;59(2):147–148. [PubMed]
  • Gabriel M, Cunnington AM, Allan WG, Pickering CA, Wraith DG. Mite allergy in Hong Kong. Clin Allergy. 1982 Mar;12(2):157–171. [PubMed]
  • Hsieh KH. A study of intracutaneous skin tests and radioallergosorbent tests on 1,000 asthmatic children in Taiwan. Asian Pac J Allergy Immunol. 1984 Jun;2(1):56–60. [PubMed]
  • Lai NK. [Study of dust mite allergy in the Guangzhou area]. Zhonghua Yu Fang Yi Xue Za Zhi. 1988 Nov;22(6):347–349. [PubMed]
  • Huston DP, Kavanaugh AF, Rohane PW, Huston MM. Immunoglobulin deficiency syndromes and therapy. J Allergy Clin Immunol. 1991 Jan;87(1 Pt 1):1–17. [PubMed]
  • Gelber LE, Seltzer LH, Bouzoukis JK, Pollart SM, Chapman MD, Platts-Mills TA. Sensitization and exposure to indoor allergens as risk factors for asthma among patients presenting to hospital. Am Rev Respir Dis. 1993 Mar;147(3):573–578. [PubMed]
  • Sherman CB, Tosteson TD, Tager IB, Speizer FE, Weiss ST. Early childhood predictors of asthma. Am J Epidemiol. 1990 Jul;132(1):83–95. [PubMed]
  • Cookson WO, Sharp PA, Faux JA, Hopkin JM. Linkage between immunoglobulin E responses underlying asthma and rhinitis and chromosome 11q. Lancet. 1989 Jun 10;1(8650):1292–1295. [PubMed]
  • Wang WX, Yang SZ, Chui XW, Zhang HL. Association of HLA-Bw61 with asthma in the Chinese. Tissue Antigens. 1988 Oct;32(4):215–217. [PubMed]
  • Turton CW, Morris L, Buckingham JA, Lawler SD, Turner-Warwick M. Histocompatibility antigens in asthma: population and family studies. Thorax. 1979 Oct;34(5):670–676. [PMC free article] [PubMed]
  • Morris MJ, Faux JA, Ting A, Morris PJ, Lane DJ. HLA-A, B and C and HLA-DR antigens in intrinsic and allergic asthma. Clin Allergy. 1980 Mar;10(2):173–179. [PubMed]
  • Duffy DL, Martin NG, Battistutta D, Hopper JL, Mathews JD. Genetics of asthma and hay fever in Australian twins. Am Rev Respir Dis. 1990 Dec;142(6 Pt 1):1351–1358. [PubMed]

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