title: Risk factors for atopic and non-atopic asthma in a rural area of Ecuador.
abstract: BACKGROUND Asthma has emerged as an important public health problem of urban populations in Latin America. Epidemiological data suggest that a minority of asthma cases in Latin America may be associated with allergic sensitisation and that other mechanisms causing asthma have been overlooked. The aim of the present study was to investigate risk factors for atopic and non-atopic asthma in school-age children. METHODS A cross-sectional study was conducted among 3960 children aged 6-16 years living in Afro-Ecuadorian rural communities in Esmeraldas province in Ecuador. Allergic diseases and risk factors were assessed by questionnaire and allergic sensitisation by allergen skin prick reactivity. RESULTS A total of 390 (10.5%) children had wheeze within the previous 12 months, of whom 14.4% had at least one positive skin test. The population-attributable fraction for recent wheeze associated with atopy was 2.4%. Heavy Trichuris trichiura infections were strongly inversely associated with atopic wheeze. Non-atopic wheeze was positively associated with maternal allergic symptoms and sedentarism (watching television (>3 h/day)) but inversely associated with age and birth order. CONCLUSIONS The present study showed a predominance of non-atopic compared with atopic wheeze among schoolchildren living in a poor rural region of tropical Latin America. Distinct risk factors were associated with the two wheeze phenotypes and may indicate different causal mechanisms. Future preventive strategies in such populations may need to be targeted at the causes of non-atopic wheeze.
authors.affiliation: Instituto de Saúde Coletiva-Universidade Federal da Bahia, Rua Basílio da Gama, s/n, Salvador, Bahia, CEP: 40.110-040 Brazil. almoncayo@hotmail.com
authors.forename: Ana Lucia
authors.initials: AL
authors.lastname: Moncayo
authors.forename: Maritza
authors.initials: M
authors.lastname: Vaca
authors.forename: Gisela
authors.initials: G
authors.lastname: Oviedo
authors.forename: Silvia
authors.initials: S
authors.lastname: Erazo
authors.forename: Isabel
authors.initials: I
authors.lastname: Quinzo
authors.forename: Rosemeire L
authors.initials: RL
authors.lastname: Fiaccone
authors.forename: Martha E
authors.initials: ME
authors.lastname: Chico
authors.forename: Mauricio L
authors.initials: ML
authors.lastname: Barreto
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Cooper
mesh_terms: D000293:Adolescent; D000485:Allergens / Q000276:immunology; D001249:Asthma / Q000453:epidemiology / Q000209:etiology* / Q000276:immunology; D002648:Child; D003430:Cross-Sectional Studies; D004484:Ecuador / Q000453:epidemiology; D005260:Female; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000453:epidemiology / Q000209:etiology / Q000276:immunology; D008297:Male; D012135:Respiratory Sounds / Q000276:immunology; D012307:Risk Factors; D012423:Rural Health / Q000706:statistics & numerical data; D012882:Skin Tests / Q000379:methods; D012959:Socioeconomic Factors
chemical_list: D000485:Allergens