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Notes: Background and objective The increasing urbanization and the decrease in the numbers of farms in southern Germany might be associated with an increasing prevalence of allergic diseases. We compared the prevalence of allergic diseases in farmers, and rural, suburban and urban residents in the small geographical area of Augsburg in southern Germany.Methods In a cross-sectional survey adults, aged 25–75 years selected from the community population register were investigated. Rural, suburban and urban residents were defined by community size and farmers by occupation. Allergic respiratory disorders were assessed by self-administered questionnaires and specific IgE antibodies to five common aeroallergens.Results In comparison to rural residents the urban population had an increased risk of allergic rhinitis (OR = 1.5; 95% CI: 1.2–1.9), atopic sensitization (OR = 1.2; 95% CI: 1.0–1.4) and sensitization against pollen (OR = 1.5; 95% CI: 1.2–1.9). There was no difference in the risk of asthma (OR = 1.0; 95% CI: 0.6–1.6) and a decreased risk in the sensitization against house dust mite (OR = 0.8; 95% CI: 0.7–1.0). The suburban residents did not differ from urban residents. Farmers had lower risks in allergic rhinitis, atopic sensitization, sensitization against pollen and mites (OR = 0.63; 0.86; 0.51 and 0.80, respectively) than rural non-farming residents, however, these differences were statistically not significant. Reported allergic rhinitis with sensitization to pollen was 2.5 times (95% CI: 1.8–3.6) more prevalent in urban than in rural residents.Conclusion A farming environment and rural lifestyle might be associated with unknown protective factors impacting the prevalence of allergies.

Notes: Background:  Worm infestations may play a role in preventing allergies. There is a lack of epidemiological information from Western countries on the association between worm infestation and eczema.Objective:  To investigate the association between worm infestation and eczema in a proper temporal sequence and under consideration of allergic sensitization.Methods:  Two surveys were performed in East German school children. Questionnaire data included the history of eczema and worm infestation and their time of onset. Specific IgE antibodies to five common aeroallergens were measured and used to define nonatopic and atopic eczema. Logistic regression analyses were performed to control for relevant confounders (age, sex, parental school education and history of allergies). In order to confirm the findings a corresponding conditional regression analysis was applied on cases and controls matched by age and sex.Results:  A total of 4169 children participated (response 75 and 76%) who were, on average, 9.2 years old (47% girls). Overall 17.0% reported a prior worm infestation (Ascaris 44%, Oxyuris 33%) and 18.1% had a history of eczema. Eczema occurred significantly less frequent in children who had a worm infestation (prior to the onset of eczema) compared with children without such a history (8.1%vs 16.5%, ORadj: 0.45, 95% CI: 0.33–0.60). The finding was confirmed by the corresponding matched case–control analysis (ORadj: 0.57, 95% CI: 0.41–0.79). Atopic eczema was affected more by a prior worm infestation (ORadj: 0.31, 95% CI: 0.18–0.56) than the nonatopic eczema (ORadj: 0.58, 95% CI: 0.40–0.84). A total of 29.1% exhibited specific IgE antibodies to at least one aeroallergen. Sensitized children gave significantly less frequent a history of worm infestation (14.2%vs 18.3%, ORadj: 0.74, 95% CI: 0.60–0.92). Stratified analysis revealed that this effect most pronounced for a sensitization to house dust mite.Conclusions:  A worm infestation is associated with a reduced frequency of subsequent eczema, especially the atopic type. Furthermore allergic sensitization, especially to house dust mite, and worm infestation are negatively associated. The data support the concept that a lack of immune-stimulation by parasitic infections contributes to the development of allergies.

Notes: Background:  There is evidence that the use of alternative medicine (AM) for allergies has increased. However, little is known from population-based studies about what determines its use. The objective of this study was to evaluate the patterns of use of AM for allergies. Methods:  A population-based nested case-control study was conducted in 2000–01 using computer-assisted telephone interviews. Three hundred and fifty-one adults participated (median age 46 years) with allergies including hay fever, asthma, atopic eczema, and food hypersensitivity. Information was obtained on demographics, prevalence, motivation, information, type of AM, provider, costs, willingness to pay, and subjective assessment of AM. Results:  26.5% of participants used AM because of their allergies. Compared to nonusers, this group of users was significantly younger (median age 43 vs 47; p =0.004) and better educated (school education 〉 8 year vs ≤ 8 year; odds ratio (OR) 2.17, 1.28–3.67) and was mostly motivated by the assumption of few side-effects (78.3%), by a wish to try everything (71.7%), and by unsatisfying results from conventional therapy (66.3%). Users also had more experience with conventional therapy than nonusers (94.6% vs 63.6%; OR 10.10, 4.00–25.72). Four procedures accounted for almost the entire usage: homeopathy (35.3%), autologous blood injection (28.1%), acupuncture (16.6%), and bioresonance (10.0%). The AM were mostly promoted (40.2%) and provided (60.9%) by medical doctors, and produced median costs for single and entire treatment of 4 € (15–205) and 205 € (15–1278)e. Reimbursement from insurance companies was received by 52.3%, in full (37.8%) or partial (14.5%). Most subjects (55.4%) admitted that they would pay more (median 153e) for the achieved result. Users scored the efficacy of conventional therapy significantly lower ( p 〈0.001) than nonusers, and assessed the results of AM as very good (28.6%) or rather good (53.8%). Conclusions:  AM is used widely for allergies by the general population and is associated with considerable costs. This has implications for the health care system and health policy.

Notes: Background: We aimed to determine the prevalence of contact sensitization in the general population and to investigate associations with important sociodemographic and medical characteristics. Methods: Within a population-based nested, case-control study in Germany, we performed patch tests with 25 standard allergens in 1141 adults (50.4% female, age median 50 years). Additional information was obtained by a dermatologic examination, a standardized interview, and blood analysis. Results: At least one positive reaction was exhibited by 40.0% of the subjects, with reactions most frequently observed to fragrance mix (15.9%), nickel (13.1%), thimerosal (4.7%), and balsam of Peru (3.8%). Women were sensitized more often than men (50.2%vs 29.9%, OR 2.36, CI 1.84–3.03), and this was also significant for fragrance mix, nickel, turpentine, cobalt chloride, and thimerosal. Contact sensitization was more frequent in subjects who reported adverse skin reactions (53.8% vs. 32.6%; OR 2.41, CI 1.85–3.14), and this was particularly true for sensitization to nickel (45.5%vs 8.8%, OR 8.64, CI 5.67–13.17) and fragrance mix (29.0%vs 14.0%, OR 2.51, CI 1.60–3.91) and the corresponding intolerance of fashion jewelry and fragrances. Contact sensitization decreased with increasing degree of occupational training (unskilled 45.9%, apprenticeship 40.1%, technical college 40.4%, and school of engineering 12.5%; P=0.023; trend test P=0.042). Significant associations of contact sensitization and presence of allergen-specific IgE antibodies, atopic eczema, or psoriasis were not observed. Frequency estimates for the general adult population based on these findings were 28.0% for overall contact sensitization and 11.4% for fragrance mix, 9.9% for nickel, and 3.2% for thimerosal. Conclusions: It is concluded that contact allergy is influenced by sociodemographic parameters and plays an important role in the general population.

Notes: Determination of Hymenoptera venom (HV)-specific serum IgE antibodies is a useful diagnostic method in patients with systemic anaphylactic reaction (SAR) to Hymenoptera stings. In a general population cohort, we determined the prevalence of SAR and HV-specific IgE antibodies and assessed parameters associated with the latter. A total of 277 voluntarily participating inhabitants of rural Bavaria (Germany) (232 adults, mean age 38.0 years; 45 children, mean age 8.4 years) were investigated for a history of atopic disease or SAR to insect stings; in 258 of these, total IgE and specific IgE antibodies to HV (Apis melliferu, Vespulu vulguris/germanica) and four common aeroallergens (birch pollen, grass pollen, house-dust mite, and cat dander) in the serum were determined. Nine (3.3%) subjects reported SAR to insect stings. In 27.1% of the sera, specific IgE antibodies to HV were found, to bee venom in 24.8%, and to wasp venom in 8.5% (P〈0.000l) Of those exhibiting HV-specific IgE, 7.1% reported SAR to insect stings. A personal history of atopic disease (hay fever, asthma, or atopic eczema) was present in 16.7%, specific IgE to common aeroallergens was found in 32.6%, and total IgE〉 100 kU/1 was found in 22.5%. Specific serum IgE to HV was significantly associated with male sex (female vs. male, OR =0.47; CI 0.25-0.86), young age (children vs. adults, OR =2.80; CI 1.25-6-28), a history of SAR to insect stings (OR=4.16; CI 1.15-15.03), total sIgE〉 100 kU/1 (OR=3.88; CI 1.98-7.60), and specific IgE antibodies to three of the four aeroallergens (grass pollen, OR = 7.24 CI 3.66-14.38; birch pollen, OR=3.67 CI 1.54-8.81; and house-dust mite, ORz4.61 CI 2.08–10.32). It is concluded that immunologic sensitization to HV is common in the general population and is associated with atopy-related I humoral IgE hyperresponsiveness.

Notes: Background:  Atopic disorders are the result of complex interactions between genetic and environmental factors. Associations analyses between the promoter polymorphism rs1800875 in the mast cell chymase gene (CMA1) and atopy-related phenotypes have yielded inconsistent results.Methods:  We sequenced the CMA1 locus in 24 unrelated healthy individuals with serum IgE levels 〈50% percentile and 24 individuals with atopic eczema and serum IgE levels 〉90% percentile. Seven CMA1 single nucleotide polymorphisms (SNPs) were evaluated for evidence of associations with atopic phenotypes within a large population of German adults (n = 1875). Subjects were phenotyped by standardized questionnaires and interviews, skin prick testing and serum IgE measurements. Genotyping was performed using MALDI-TOF MS (Matrix-Assisted Laser Desorption Ionization–Time of Flight mass spectrometry).Results:  Promoter polymorphism rs1800875 was significantly associated with atopic eczema. No associations between any other single SNP and atopic phenotypes could be detected. Haplotype reconstruction revealed four of 128 possible haplotypes reaching estimated frequencies of 3% or more. Two of these haplotypes showed a borderline-significant association with atopic eczema, which did not remain significant after correction for multiple testing.Conclusions:  Results confirm previous observations of a significant association between the CMA1 promoter polymorphism rs1800875 and atopic eczema, but not with serum IgE levels, and support the hypothesis that CMA1 serves as candidate gene for atopic eczema.

Notes: Background: There is evidence of an association between socioeconomic status (SES) and atopy mainly from studies in children which investigated atopic diseases and parental SES. We determined the association of allergic sensitization, as measured by skin prick test (SPT) and allergen-specific IgE (RAST), and SES in a population-based study in adults. Methods: Within a population-based, nested, case-control study, a standardized interview was performed and allergic sensitization to common aeroallergens was determined by SPT and RAST. Results: A total of 1537 adults (50.4% female, age: median 50.0, range 28-78 years) were investigated, half of whom (50.2%) exhibited at least one positive RAST result according to the study design. SPT reactivity was 37.3% in this group and was estimated to be 26.1% in the representative study base of 4178 adults. Within increasing categories of school graduation (none; after 8, 10, 13, and 〉13 years), the prevalence of SPT (20.5%, 31.3%, 44.0%, 44.2%, 48.1%; P trend 〈0.0001) and RAST reactivity (35.0%, 48.0%, 52.3%, 48.4%, 58.4%; P trend=0.004) increased continuously. Similar results were obtained when testing this association on the level of single allergens. After control for age, sex, and parental history of atopic diseases, all but the first odds ratios for SPT remained significant (first category=reference, 2.06, 3.21, 3.88, 3.96). The same model for RAST reactivity revealed a similar result with effect estimate for the last category being significant (first category=reference, 1.89, 2.08, 2.10, 2.81). Conclusions: Allergic sensitization (SPT and RAST) to common aeroallergens in adults follows a significant and linear association with school education.

Notes: Background: Food allergy and food intolerance (FA/FI) are believed to be frequent medical problems; however, information from epidemiologic studies in adults is scarce. The objective was to determine the frequency of FA/FI and allergic sensitization to food in a large adult sample. Furthermore, the associations between FA/FI and other outcomes of atopy were studied. Methods: Within a population-based, nested, case-control study, a standardized interview was performed to obtain detailed information on FA/FI and the history of atopic diseases. In addition, a skin prick test with 10 common food and nine aeroallergens was performed. Results: Overall, 20.8% of the 1537 studied subjects (50.4% female, age median 50 years) reported FA/FI (women 27.5%, men 14.0%; OR 2.35, CI 1.80–3.08). Nuts, fruits, and milk most frequently led to adverse effects, and the sites of manifestation were oral (42.9%), skin (28.7%), gastrointestinal (13.0%), systemic (3.2%), and multiple (12.2%). One-quarter of the subjects (25.1%) were sensitized to at least one food allergen in the prick test, with hazelnut (17.8%), celery (14.6%), and peanut (11.1%) accounting for most of the positive reactions. The corresponding frequency estimates for the representative study base (n=4178) were 15.5% for reported adverse reactions and 16.8% for allergic sensitization. Relevant concomitant sensitization to food and aeroallergens was observed. Food-allergic subjects (positive history and sensitization to corresponding allergen) suffered significantly more often from urticaria, asthma, atopic eczema, and especially hay fever (73.1%) than controls (3.0%). Furthermore, hay fever was treated significantly more often in subjects who suffered from concomitant food allergy. Conclusions: FA/FI in adults is frequently reported and associated with other manifestations of atopy. Hay fever in conjunction with FA/FI tends to be clinically more severe since therapeutic needs are enhanced.