Atopic dermatitis and skin disease
Global variations in prevalence of eczema symptoms in children from ISAAC Phase Three

https://doi.org/10.1016/j.jaci.2009.10.009Get rights and content

Background

In 1999, The International Study of Asthma and Allergies in Childhood (ISAAC) Phase One reported the prevalence of eczema symptoms in 715,033 children from 154 centers in 56 countries by using standardized epidemiologic tools.

Objective

To update the world map of eczema prevalence after 5 to 10 years (ISAAC Phase Three) and include additional data from over 100 new centers.

Methods

Cross-sectional surveys using the ISAAC questionnaire on eczema symptoms were completed by adolescents 13 to 14 years old and by parents of children 6 to 7 years old. Current eczema was defined as an itchy flexural rash in the past 12 months and was considered severe eczema if associated with 1 or more nights per week of sleep disturbance.

Results

For the age group 6 to 7 years, data on 385,853 participants from 143 centers in 60 countries showed that the prevalence of current eczema ranged from 0.9% in India to 22.5% in Ecuador, with new data showing high values in Asia and Latin America. For the age group 13 to 14 years, data on 663,256 participants from 230 centers in 96 countries showed prevalence values ranging from 0.2% in China to 24.6% in Columbia with the highest values in Africa and Latin America. Current eczema was lower for boys than girls (odds ratio, 0.94 and 0.72 at ages 6 to 7 years and 13 to 14 years, respectively).

Conclusion:ISAAC Phase Three provides comprehensive global data on the prevalence of eczema symptoms that is essential for public health planning. New data reveal that eczema is a disease of developing as well as developed countries.

Section snippets

Methods

ISAAC Phase Three used the same protocol, framework for registration of participating centers, and sampling as ISAAC Phase One.12, 14 Briefly, 2 age groups (6-7 and 13-14 years old) were chosen from a random sample of schools from defined geographical areas. A simple questionnaire with questions related to symptoms of wheezing, rhinoconjunctivitis, and eczema was completed by parents of the children and by the adolescents. Only the eczema data are reported and discussed here; the asthma and

Results

For the age group 6 to 7 years, data from 421,543 participants in 165 centers (65 countries), and for the age group 13 to 14 years, data for 814,837 participants in 242 centers (98 countries) were submitted to the ISAAC International Data Centre for analyses. Adherence to the ISAAC Protocol was assessed, and centers that had not included the eczema questionnaire or had serious deviations from protocol were excluded from the analyses (22 centers from 17 countries with 35,690 participants for the

Main findings

This is the largest study to date that estimates the prevalence of eczema symptoms in children and adolescents, and it contains over twice as much data and increased global coverage when compared with ISAAC Phase One. For the age group 6 to 7 years, Phase Three includes a further 87 centers from 27 new countries, and for the age group 13 to 14 years, a further 133 centers from 43 new countries. The increased coverage provides valuable new insights into the global variation of symptoms of

References (40)

  • C.L. Carroll et al.

    The burden of atopic dermatitis: impact on the patient, family, and society

    Pediatr Dermatol

    (2005)
  • S. Lewis-Jones

    Quality of life and childhood atopic dermatitis: the misery of living with childhood eczema

    Int J Clin Pract

    (2006)
  • L.J. Meltzer et al.

    Sleep disruptions in parents of children and adolescents with chronic illnesses: prevalence, causes, and consequences

    J Pediatr Psychol

    (2008)
  • L. Misery et al.

    Atopic dermatitis: impact on the quality of life of patients and their partners

    Dermatology

    (2007)
  • M.I. Asher et al.

    The International Study of Asthma and Allergies in Childhood (ISAAC)

    Clin Exp Allergy

    (1998)
  • H. Williams et al.

    Is eczema really on the increase worldwide?

    J Allergy Clin Immunol

    (2008)
  • P. Ellwood et al.

    The International Study of Asthma and Allergies in Childhood (ISAAC): Phase Three rationale and methods

    Int J Tuberc Lung Dis

    (2005)
  • N. Aït-Khaled et al.

    Global map of the prevalence of symptoms of rhinoconjunctivitis in children: the International Study of Asthma and Allergies in Childhood (ISAAC) Phase Three

    Allergy

    (2009)
  • C. Lai et al.

    Global variation in the prevalence and severity of asthma symptoms: Phase Three of the International Study of Asthma and Allergies in Childhood (ISAAC)

    Thorax

    (2009)
  • P. Ellwood et al.

    Translation of questions: the International Study of Asthma and Allergies in Childhood (ISAAC) experience

    Int J Tuberc Lung Dis

    (2009)
  • Cited by (717)

    View all citing articles on Scopus

    Currently the main source of funding for the ISAAC International Data Centre (IIDC) is the BUPA Foundation. Many New Zealand funding bodies have contributed support for the IIDC during the periods of fieldwork and data compilation (the Health Research Council of New Zealand, the Asthma and Respiratory Foundation of New Zealand, the Child Health Research Foundation, the Hawke's Bay Medical Research Foundation, the Waikato Medical Research Foundation, Glaxo Wellcome New Zealand, the NZ Lottery Board, and Astra Zeneca New Zealand). Glaxo Wellcome International Medical Affairs supported the regional coordination for Phase Three and the IIDC.

    Disclosure of potential conflict of interest: T. O. Clayton and M. I. Asher have received research support from the BUPA Foundation (UK). C. F. Robertson has received research support from the National Health Medical Research Council. J. A. Odhiambo and H. C. Williams have declared that they have no conflict of interest.

    Members listed in this article's Appendix E1 in the Online Repository at www.jacionline.org.

    View full text