title: Interrelationships between Atopic Disorders in Children: A Meta-Analysis Based on ISAAC Questionnaires.
abstract: OBJECTIVE
  To study the prevalence and interrelationship between asthma, allergic rhinitis and eczema using data obtained from ISAAC questionnaires.
  
  
  METHODS
  The Medline, Pubmed Publisher, EMBASE, Google Scholar and the Cochrane Controlled Clinical Trials Register databases were systematically reviewed to evaluate epidemiological data of children with atopic disorders. To study these interrelationships, a new approach was used. Risk ratios were calculated, describing the risk of having two different atopic disorders when the child is known with one disorder.
  
  
  RESULTS
  Included were 31 studies, covering a large number of surveyed children (n=1,430,329) in 102 countries. The calculated worldwide prevalence for asthma, eczema and allergic rhinitis is 12.00% (95% CI: 11.99-12.00), 7.88% (95% CI: 7.88-7.89) and 12.66% (95% CI: 12.65-12.67), respectively. The observed prevalence [1.17% (95% CI: 1.17-1.17)] of having all three diseases is 9.8 times higher than could be expected by chance. For children with asthma the calculated risk ratio of having the other two disorders is 5.41 (95% CI: 4.76-6.16), for children with eczema 4.24 (95% CI: 3.75-4.79), and for children with allergic rhinitis 6.20 (95% CI: 5.30-7.27). No studied confounders had a significant influence on these risk ratios.
  
  
  CONCLUSIONS
  Only a minority of children suffers from all three atopic disorders, however this co-occurrence is significantly higher than could be expected by chance and supports a close relationship of these disorders in children. The data of this meta-analysis supports the hypothesis that there could be a fourth distinct group of children with all three disorders. Researchers and clinicians might need to consider these children as a separate group with distinct characteristics regarding severity, causes, treatment or prognosis.
authors.affiliation: Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: David H J
authors.initials: DH
authors.lastname: Pols
authors.affiliation: Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Jorien B
authors.initials: JB
authors.lastname: Wartna
authors.affiliation: Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Elvira I
authors.initials: EI
authors.lastname: van Alphen
authors.affiliation: Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Heleen
authors.initials: H
authors.lastname: Moed
authors.affiliation: Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Nadine
authors.initials: N
authors.lastname: Rasenberg
authors.affiliation: Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Patrick J E
authors.initials: PJ
authors.lastname: Bindels
authors.affiliation: Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Arthur M
authors.initials: AM
authors.lastname: Bohnen
mesh_terms: D000293:Adolescent; D000465:Algorithms; D001249:Asthma / Q000150:complications / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D002986:Clinical Trials as Topic; D015897:Comorbidity; D016208:Databases, Factual; D004485:Eczema / Q000150:complications / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015233:Models, Statistical; D015995:Prevalence; D011336:Probability; D012042:Registries; D065631:Rhinitis, Allergic / Q000150:complications / Q000453:epidemiology*; D011795:Surveys and Questionnaires