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Allergy related symptoms and Infections
Questionnaire with ISAAC and hygiene questions.
Children aged 6-7 years, in two different
schools 1-a middle class school (43 children)
2-a low class school (20 children) Laura Vega
(MD Paediatrician) Marcelo Escobar
(biologist) Neuquén Argentina

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Background
Hygiene Hypothesis  This theory claims that
hygiene removed a protective influence against
atopy and asthma that was once provided by
exposure to infections in early
life.  Matricardi PM, Bouyque GR, Tripodi S.
Inner-city asthma and the hygiene hypothesis. Ann
Allergy Asthma Immunol 2002 Dec 89 (6 Suppl 1)
69-74
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Background
 In children aged 6-7 years the prevalence of
asthma ever ranged from 4,1-26,9 and the
prevalence of wheezing in the last 12 months from
8,6-26,9 .  The high figures for asthma in a
region with a high level of gastrointestinal
parasite infestation, and a high burden of acute
respiratory infections occurring early in life,
suggest that these factors, considered as
protective in other regions, do not have the
same effect in this region. The prevalence of
asthma and related symptoms in Latin America is
as high and variable as described in
industrialized or developed regions of the
world.  Mallol, J et al. Prevalence of asthma
symptoms in Latin America The International
Study of Asthma and Allergies in Childhood
(ISAAC).Pediatr.Pulmonol.2000 Dec30 (6) 439-44

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Objective To study the relationship between
hygiene conditions and allergy related symptoms
in this region, in order to verify the hygiene
hypothesis. Introduction In my personal
experience as a paediatrician and allergy
specialist, I do not see differences in
allergic diseases frequency between people
belonging to different social classes, despite
their huge differences in quality of life.
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Methods
A questionnaire filled by parents, with ISAAC
core questions to which hygiene questions were
added, for school children 6-7 years old. Weight
and Height were obtained by the authors in all
the children that completed the
questionnaire. Asher MI, Anderson JIR, Beasley
R, et al.International Study of Asthma and
Allergies in Childhood (ISAAC) rationale and
methods. Eur Respir J 19958483-491. Breast
feeding, tobacco smoking, respiratory infections,
diarrhea, parasites, hepatitis,
vaccinations,hospitalisations, pets at home,
lodging conditions, cooking conditions, heating
conditions, number of family members, day care
attendance, sports.
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Geography
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Climate -Temperate mean temperature 15
centigrades (max 40, min 15) -Dry 56
Humidity,Year Av., Rain 199 mm year Av. -High
Winds (gusts until 120 km/hr, mainly in
Spring) -230 m above sea level -Soil typical of
the desert, with a superficial lay of muds,
sands and clays
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Neuquén
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Results
Middle Class School (43 children) Current
wheezing 30 Ever wheezing 51 Current rhinitis
21 Ever rhinitis 27 Atopic dermatitis 16 Low
Class School (20 children) Current wheezing
30 Ever wheezing 45 Current rhinitis 30 Ever
rhinitis 30 Atopic dermatitis 20
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Diarrhea
Middle Class School (43 children) Diarrhea
44 Diarrhea once 16 Diarrhea many times
25 Low Class School (20 children) Diarrhea
55 Diarrhea once 20 Diarrhea many times 25
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There is a positive correlation between
infections and allergy related symptoms Utilizing
descriptive statistics (chi-square tests for
cross tabs),we found that some variables are not
independent, and statistically significants, for
a P-Value 0,05

Parasites and current wheezing (p
0,002) Parasites and ever wheezing (p
0,016) Respiratory infections and ever wheezing
(p 0,005) Bronchiolitis and ever wheezing (p
0,010) Bronchiolitis and current rhinitis (p
0,013) Diarrhea and current rhinitis (p
0,022) Giardia Lamblia and ever rhinitis (p
0,023) Diarrhea and ever rhinitis (p
0,013) Hepatitis and Atopic dermatitis (p 0,002)
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Univariate logistic regression analysis
(SPSS) Factor current rhinitis
OR 95 CI Diarrhea 11
4,20
1,16-15,13 Diarrhea 3 6
3,91 1,06-14,43 Factor
ever rhinitis OR
95 CI Diarrhea 13
4,28 1,30-14,13 Diarrhea 2
5 5,39
1,13-25,64 Giardia L 5
5,39 1,13-25,64
In a multivariate logistic
regression analysis, diarrhea is a risk factor
for current rhinitis and ever rhinitis.

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Conclusion
Allergy related symptoms frequency (ISAAC
questions), is high and similar in both groups of
children. Infectious diseases (questionnaire)
are frequent in both groups of children. Could
it be that diarrhea and other infectious diseases
do not have the protective effect for allergy
that has been suggested in the hygiene
hypothesis?
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Future research

• 1- continue inviting school childrens parents
  to answer the questionnaire in different schools
  from Neuquén City, and other villages in the
  interior of the province.
• 2- perform objective tests in allergic
  individuals detected by the questionnaire, and in
  non allergic controls
• Skin Prick Tests (with common regional
  allergens)
• Spirometry (basal conditions and after exercise)

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Thanks
Jean Luc Malo Heberto Ghezzo Denyse
Gautrin Sylvie Levesque Andrés Finzi