Prevalence of asthma and atopy in two areas of West and East Germany.

TLDR

The German reunification provides a unique setting to examine how environmental differences influence childhood respiratory and allergic diseases in otherwise similar populations. The study examined the prevalence of asthma, hay fever, atopy, and bronchial hyperresponsiveness among 9‑ to 11‑year‑old children in West and East Germany. Data were collected through parent‑completed questionnaires and by subjecting children to cold‑air challenge tests and allergy skin‑prick assessments. West German children exhibited markedly higher rates of atopic sensitization, asthma, hay fever, and bronchial hyperresponsiveness, whereas bronchitis was more common in the East; multivariate analysis showed that aeroallergen sensitization, rather than geographic region, explained the asthma difference.

Abstract

The German reunification offers a unique opportunity to study the impact of environmental factors on the development of childhood respiratory and allergic disorders in ethnically similar populations. We investigated the prevalence of asthma, hay fever, atopy, and bronchial hyperresponsiveness (BHR) in 9- to 11-year old children in West Germany (n = 5,030) and East Germany (n = 2,623). A self-administered questionnaire was distributed to the parents. Children underwent cold air challenge and allergy skin prick tests. Atopic sensitization was considerably more frequent in West German children than in their peers in East Germany (36.7% versus 18.2%; odds ratio [OR] = 2.6, p < 0.0001). The prevalence of current asthma and hay fever was significantly higher in West Germany when compared with that in East Germany (5.9% versus 3.9%; OR = 1.5, p < 0.0001 and 8.6% versus 2.7%; OR = 3.4, p < 0.0001, respectively). Bronchitis, however, was more prevalent in East Germany than in the western part of the country. The prevalence of BHR as assessed by cold air challenge was higher in West Germany compared with that in East Germany (8.3% versus 5.5%, OR = 1.6, p < 0.001). Logistic regression showed that the West German study area was no longer a significant independent determinant of asthma once sensitization to mites, cats, and pollen was taken into account. We conclude that sensitization to aeroallergens is strikingly more frequent in West Germany than in East Germany and this may explain the differences in the prevalence of asthma and hay fever between the two parts of the country.