T. Schäfer

Epidemiology of contact allergy in adults

Background: We aimed to determine the prevalence of contact sensitization in the general population and to investigate associations with important sociodemographic and medical characteristics.

Epidemiology of food allergy/food intolerance in adults: associations with other manifestations of atopy

Background:u2002Food 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.

Epidemiology of acne in the general population: the risk of smoking

Backgroundu2003Acne is a common skin disorder, but epidemiological data from the general population obtained by examination are scarce. Clinical experience suggests an association between smoking and acne, although confirmatory evidence from appropriate studies is lacking.Objectivesu2003To determine the prevalence and demographic factors of acne in a general population sample and to investigate the association of smoking and acne on a qualitative and quantitative level.Methodsu2003In a cross‐sectional study, 896 citizens (aged 1–87 years, median 42) of the City of Hamburg were dermatologically examined. The prevalence and severity of acne were recorded and further information on demographic variables, medical history, and alcohol and cigarette consumption were obtained by a standardized interview.Resultsu2003According to the clinical examination, acne was present in 26·8% overall, and was more prevalent in men (29·9%) than women (23·7%) (odds ratio, OR 1·37, 95% confidence interval, CI 1·01–1·87). Prevalence followed a significant linear trend over age with peak prevalence between 14 and 29 years (Pu2003<u20030·001). The reported age at onset was significantly lower in women than men (Pu2003=u20030·015). According to multiple logistic regression analyses acne prevalence was significantly higher in active smokers (40·8%, OR 2·04, 95% CI 1·40–2·99) as compared with non‐smokers (25·2%). A significant linear relationship between acne prevalence and number of cigarettes smoked daily was obtained (trend test: Pu2003<u20030·0001). In addition, a significant dose‐dependent relationship between acne severity and daily cigarette consumption was shown by linear regression analysis (Pu2003=u20030·001).Conclusionsu2003Smoking is a clinically important contributory factor to acne prevalence and severity.

The excess of atopic eczema in East Germany is related to the intrinsic type

Backgroundu2002Prevalence data for atopic eczema based on a dermatological examination have not so far been available for East and West Germany. Possible differences in the proportions of extrinsic and intrinsic types of eczema, and how far these could explain differences in the prevalence of eczema, need to be clarified. Objectivesu2002To compare the prevalence of atopic eczema in pre‐school children between different locations in East and West Germany, and over a period of 7u2003years, at three time points. Additionally, to determine the proportions of intrinsic and extrinsic types of eczema by taking skin prick test reactivity into account.

Farming, rural lifestyle and atopy in adults from southern Germany – results from the MONICA/KORA study Augsburg

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.

Environmental Risk Factors for Respiratory and Skin Atopy: Results from Epidemiological Studies in Former East and West Germany

The fall of the Berlin wall in 1989 offered the unique opportunity to compare populations of a similar genetic and geographic background which had been living under quite different environmental exposure conditions for over 40 years. Since 1990 comparative epidemiological studies were performed between various regions in former East and West Germany with yearly questionnaires and 3 years’ physical, dermatological, allergological and exposure examination in a total of about 30,000 preschool children. There were striking differences between the various German regions with higher prevalence rates of respiratory atopy (hay fever, asthma) and atopic sensitization (prick test, RAST) in West Germany, while atopic eczema was significantly higher in East Germany (17.5 vs. 11.4% in West Germany). Total serum IgE levels were markedly higher in children in the east of Germany, similarly to the prevalence of parasitic infestation (questionnaire data as well as positive ascaris RAST). In multivariate logistic regression analysis the following factors were significantly associated with atopic eczema: animal contact (odds ratio, OR 2.9), animal furs in the bedroom (OR 2.2), use of gas without ventilation (OR 1.7) and living near road with heavy traffic (OR 1.7). Furthermore, socioeconomic factors measured as parental educational status (university vs. elementary school) were significantly associated (OR 2.3) with atopy. Respiratory tract infections and irritant responses decreased together with decreasing SO2 and suspended particulate air pollution in East Germany from 1991 to 1997. It is concluded that environmental factors from the physical, chemical, biological, and psychological environment (characteristic of a ‘modern’ or ‘western’ society) do influence the development of atopic sensitization and disease.

Experiences with the severity scoring of atopic dermatitis in a population of German pre‐school children

Severity scoring of atopic dermatitis (SCORAD) was introduced as a standard tool but has not been used in a population‐based epidemiological study; the objective of the present study was to determine the practicability of this instrument in this setting. We assessed the distribution of the severity of atopic eczema in the community and investigated differences between east and west Germany. A factor analysis was then carried out to characterize the variables of this scoring system and to analyse possible relationships within them. A multicentre cross‐sectional study was carried out in five east German and two west German locations in 1994; pre‐school children (5–6 years old) were investigated and cases of atopic eczema identified by a dermatological examination. The SCORAD was used to determine the severity of atopic eczema and the results assessed using analysis of variance and principal component analysis (varimax rotation). In all, 1511 (76·2%) of the children originally contacted participated and 11·3% were diagnosed with atopic eczema at the time of examination. The median severity score was 21·4 (interquartile range 13·5) and there was a tendency to higher scores in west Germany for the mean overall score, the intensity score and the extent. ‘Erythema’ (1·30 vs. 1·06; P= 0·006) and ‘excoriation’ (0·77 vs. 0·36; P= 0·002) were significantly more prominent in children with eczema from west Germany (adjusted for observer). Interobserver variabilities of the SCORAD parameters were calculated, adjusted for location and were in accordance with earlier findings. Principal component analysis identified three independent factors accounting for 54·1% of the total variance. A severity factor, characterized by ‘extent’, ‘lichenification’, ‘excoriation’ and ‘pruritus’, was separated from a factor with an acute eczema‐type profile (‘erythema’, ‘oedema’, ‘oozing’) and a factor whose major characteristics were ‘extent’, ‘dryness’, and ‘sleep loss’. We conclude that atopic eczema is frequent in pre‐school children. The SCORAD proved to be readily applicable and useful in epidemiological studies, but further validation is needed.

Intake of unsaturated fatty acids and HDL cholesterol levels are associated with manifestations of atopy in adults

Background The increase in allergic diseases is still unexplained. It was hypothesized that the intake of unsaturated fatty acids is a contributing cause of this development. We investigated the relationship between serum cholesterol levels, intake of polyunsaturated fatty acids (PUFA) and manifestations of atopy in a population‐based setting.

Differences in allergy trends between East and West Germany and possible explanations

Background At the time of the German reunification in 1990, manifestations of most allergic diseases were less prevalent in East than in West Germany. It was hypothesized that these East–West differences would diminish with lifestyle and pollution changes in East Germany.

School education and allergic sensitization in adults

Background:u2002There 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.