Life-course of atopy and allergy-related disease events in tropical sub-Saharan Africa: A birth cohort study.
In high-income countries, allergy-related diseases (ARDs) follow a typical sequence, the 'Atopic March'. Little is known about the life-course of ARDs in the markedly different, low-income, tropical environment. We describe ARDs in a tropical, African birth cohort.



Ugandan children were followed from birth to 9 years. ISAAC questionnaires were completed at intervals; doctor-diagnosed ARDs were recorded throughout follow-up. Skin prick tests (SPTs) were performed at 3 and 9 years. Atopy was defined as ≥1 positive SPT.



Of the 2345 live-born children, 1214 (52%) were seen at 9 years. Wheeze and eczema were common in infancy, but by 9 years, only 4% reported recent wheeze, 5% eczema and 5% rhinitis. Between 3 and 9 years, atopy prevalence increased from 19% to 25%. Atopy at 3 or 9 years was associated with reported ARD events at 9 years, for example OR = 5.2 (95% CI 2.9-10.7) for atopy and recent wheeze at 9 years. Reported or doctor-diagnosed ARD events in early childhood were associated with the same events in later childhood, for example OR = 4.4 (2.3-8.4) for the association between reported wheeze before 3 years with reported recent wheeze at 9 years, but progression from early eczema to later rhinitis or asthma was not observed.



Allergen sensitization started early in childhood and increased with age. Eczema and wheeze were common in infancy and declined with age. Atopy was strongly associated with ARD among the few affected children. The typical Atopic March did not occur. Environmental exposures during childhood may dissociate atopy and ARD.
London School of Hygiene and Tropical Medicine, London, UK.|MRC/UVRI Uganda Research Unit, Entebbe, Uganda.
Swaib A
0000-0002-6271-2033
SA
Lule
MRC/UVRI Uganda Research Unit, Entebbe, Uganda.
Harriet
H
Mpairwe
MRC/UVRI Uganda Research Unit, Entebbe, Uganda.
Margaret
M
Nampijja
MRC/UVRI Uganda Research Unit, Entebbe, Uganda.
Florence
F
Akello
MRC/UVRI Uganda Research Unit, Entebbe, Uganda.
Joyce
J
Kabagenyi
MRC/UVRI Uganda Research Unit, Entebbe, Uganda.
Benigna
B
Namara
London School of Hygiene and Tropical Medicine, London, UK.|MRC/UVRI Uganda Research Unit, Entebbe, Uganda.
Gyaviira
0000-0003-4062-9105
G
Nkurunungi
MRC/UVRI Uganda Research Unit, Entebbe, Uganda.
Dennison
D
Kizito
MRC/UVRI Uganda Research Unit, Entebbe, Uganda.
Joseph
J
Kahwa
MRC/UVRI Uganda Research Unit, Entebbe, Uganda.
Lawrence
L
Muhangi
London School of Hygiene and Tropical Medicine, London, UK.
Stephen
0000-0003-2086-1740
S
Nash
Entebbe Hospital, Entebbe, Uganda.
Moses
M
Muwanga
London School of Hygiene and Tropical Medicine, London, UK.
Emily L
EL
Webb
London School of Hygiene and Tropical Medicine, London, UK.|MRC/UVRI Uganda Research Unit, Entebbe, Uganda.
Alison M
AM
Elliott
D017954:Africa South of the Sahara / Q000453:epidemiology; D000485:Allergens / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D015897:Comorbidity; D003906:Developing Countries; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000453:epidemiology*; D008297:Male; D011203:Poverty; D015995:Prevalence; D012135:Respiratory Sounds; D012882:Skin Tests; D011795:Surveys and Questionnaires; D014454:Uganda / Q000453:epidemiology
D000485:Allergens
Africa; Uganda; atopy; birth cohort; conjunctivitis; eczema; rhinitis; urticaria; wheeze