title: Atopy and allergic respiratory disease in rural Poland before and after accession to the European Union.
abstract: BACKGROUND
  In 2003, we recorded a striking difference in the prevalence of atopy between village and small-town populations in southwest Poland. Nine years later, we undertook a second survey of the same area.
  
  
  OBJECTIVE
  We sought to assess whether rapid changes in farming practices, driven by accession to the European Union in 2004, were accompanied by an increase in atopy, asthma, and hay fever in these villages.
  
  
  METHODS
  In 2012, we surveyed 1730 inhabitants older than 5 years (response rate, 85%); 560 villagers and 348 town inhabitants who had taken part in the earlier survey. Participants completed a questionnaire on farm-related exposures and symptoms of asthma and hay fever. Atopy was assessed by using skin prick tests.
  
  
  RESULTS
  In 2012, far fewer villagers had contact with cows (4% vs 24.3% in 2003) or pigs (14% vs 33.5%), milked cows (2.7% vs 12.7%), or drank unpasteurized milk (9% vs 35%). Among the villagers, there was a significant increase at all ages in the prevalence of atopy between 2003 and 2012 both in the total population (7.3% vs 19.6%, P < .0001) and among those who took part in both surveys (7.9% vs 17.8%, P < .0001). Among the townspeople, the prevalence of atopy did not change substantially (20% vs 19.9% and 21.7% vs 18.5%, respectively). Hay fever increased 2-fold in the villages (3.0% vs 7.7%) but not in the town (7.1% vs 7.2%); there was little or no change in asthma prevalence in the villages (5.0% vs 4.3%) or town (4.3% vs 5.0%).
  
  
  CONCLUSIONS
  We report a substantial increase in atopy at all ages and in a remarkably short period of time in a Polish population whose farm-related exposures were dramatically reduced after their country's accession to the European Union.
authors.affiliation: 1st Department of Pediatrics, Allergology and Cardiology, Wrocław Medical University, Wrocław, Poland.
authors.forename: Barbara
authors.initials: B
authors.lastname: Sozańska
authors.affiliation: Faculty of Sociology, University of Wrocław, Wrocław, Poland.
authors.forename: Mateusz
authors.initials: M
authors.lastname: Błaszczyk
authors.affiliation: London School of Hygiene and Tropical Medicine, London, United Kingdom; Massey University, Wellington, New Zealand.
authors.forename: Neil
authors.initials: N
authors.lastname: Pearce
authors.affiliation: Imperial College (NHLI) and Royal Brompton Hospital, London, United Kingdom. Electronic address: p.cullinan@imperial.ac.uk.
authors.forename: Paul
authors.initials: P
authors.lastname: Cullinan
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000383:Agriculture; D001249:Asthma / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D005062:European Union; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011044:Poland / Q000453:epidemiology; D015995:Prevalence; D012189:Retrospective Studies; D006255:Rhinitis, Allergic, Seasonal / Q000453:epidemiology*; D012424:Rural Population; D011795:Surveys and Questionnaires
keywords: Atopy; asthma; changes in farming practices; farming exposures