In recent decades, there has been a rapid growth of allergic diseases (AD) worldwide. There is an increase in the prevalence of AD in both developed and developing countries. Considering the complex epidemiological situation in the world regarding the prevalence of AD among children, which has a character of epidemy and requires constant monitoring to understand current trends and causes and urgent development of effective response strategy and tactics, improvement of medical services and provision of timely treatment and prevention service to population and considering the lack of current data on the prevalence of AD among children in Ukraine and, in particular, in the Kyiv region, the study of epidemiological orientation is relevant, because having the proper statistical data we understand the scale of the problem, thereby stimulating the scientific and civil society, as well as the government, to take active action.
The aim of the study was to improve the early diagnostics and prognosis of the development of AD by the determining of their prevalence, clinical features of the current course and age evolution in children of the Kyiv region.
The study had 2 stages: at the first stage, a survey of children in preschool and school educational institutions was conducted using a questionnaire of the international unified program ISAAC with the expansion of age categories of children (in addition to ISAAC methodology with 2 age categories (6-7 and 13-14-year-old children), they added groups of up to 5 years and 15-17-year-old children) and nosological forms. In the second stage, selected children from a cohort of respondents with suspected AD were examined with the determination of eosinophils in hematology test and nasal fluid, total serum IgE, parameters of external respiration function, assessment of allergy diagnostic data by skin prick-tests.
According to the results of the study, the current levels of asthma symptoms prevalence (16.8%), rhinitis (24.9%) and eczema (10.1%) were determined using a questionnaire of the international unified program ISAAC with the expansion of age categories of children.
For the first time, a comparative analysis of the prevalence rates of AD over the past nineteen years in children of the Kyiv region was performed, its results show their increase. The prevalence of asthma among children aged 6-7 years has grown by 1.2 times from 16.8% to 18.7%, and among 13-14-year-old children has slightly decreased from 15.2% to 12.6%, however there is a significant increase by 6.5 times in the prevalence of severe asthma in adolescents. There is a significant increase in the prevalence of allergic rhinitis in both compared age groups from 7.9% to 11.3% among 6-7-year-old children and, respectively, from 12.8% to 14.9% among 13-14-year-old children. The prevalence of eczema has also increased by 1.3 times in both groups: from 7.3% to 9.8% in children 6-7 years; from 6.7% to 8.4% in children 13-14 years, with a domination of disease occurrence frequency among children of early school age.
For the first time, the prevalence of food hypersensitivity (FH) (26.5%), insect allergy (26.1%), and acute urticaria/angioedema (7.4%) among children in the Kyiv region was determined.
Risk factors of AD in children were investigated with the selection of modern prognostic criteria for the formation of asthma, eczema, rhinitis. The formation of AD is significantly influenced by the following risk factors: burdened hereditary allergy history, however, there is a different degree of its influence on the formation of allergic diseases in different age groups; the presence of comorbid allergic pathology in a child. Thus, rhinitis, eczema and FH (respiratory manifestations) are prognostically important in the formation of asthma; historical episodes of recurrent wheezing or asthma, eczema, FH and episodes of acute urticaria/angioedema are significant for the development of rhinitis; FH – for eczema. Smoking also significantly increases the risk of asthma development in adolescents. After analysis of the risk factors for acute urticaria/angioedema, the highest risks were found with the presence of FH.
Current peculiarities of clinical manifestations and modern tendencies of AD, their age evolution and comorbidity are determined: there is a significant rejuvenation of AD in children with significant comorbidity (50,4%); also there is an earlier onset of asthma as well as late diagnosis of asthma (66,1%) is firstly diagnosed asthma of moderate severity with time of 2-5 years between first manifestations till diagnosis); the development of AD mostly occurs according to the classic variant of atopic march (64.4% of examined children, starting with eczema, mainly combined with FH till the formation of rhinitis and/or asthma), but 1/3 (31.9%) of children had distant manifestation of atopy with onset in early school or adolescent age, commonly started (8,9%) from combined manifestation of asthma with rhinitis.
