Lower prevalence of asthma and atopy in Turkish children living in Germany. M. Kabesch, W. Schaal, T. Nicolai, E. von Mutius. #ERS Journals Ltd 1999. ABSTRACT: Ethnic origin has been reported to affect the prevalence of atopic diseases in several studies in different parts of the world. However, little is known about the prevalence of asthma and atopy in immigrants living in Europe. The objective of this study was to evaluate the prevalence of asthma and atopy in Turkish children living in Germany and to investigate the role of ethnic origin on the development of asthma and atopy in this population.In a cross-sectional survey the prevalence of physician-diagnosed asthma, atopy, skin-prick tests and bronchial hyperresponsiveness (BHR) to cold dry air challenge was assessed in 7,445 school children aged 9±11 yrs, living in Munich, south Germany. Questionnaires were distributed to the parents for self-completion and children underwent skin prick tests and cold air hyperventilation challenge.The Turkish children showed a significantly lower prevalence of asthma (5.3 versus 9.4%, p<0.05) than their German peers. Furthermore, atopy, as assessed by skin prick tests (24.7 versus 36.7%, p<0.001) and BHR (3.9 versus 7.7%, p<0.001), was less common in Turkish children. In multivariate regression models controlling for potential explanatory factors, Turkish origin still showed a significantly lower risk of developing asthma, atopic sensitization and BHR.The prevalence of childhood asthma was therefore shown to be lower in Turkish children living in Germany than in Turkey. These findings suggest that the lower prevalence of asthma and allergy in Turkish children living in Germany might be attributable to a selection bias affecting the parents of these children, as healthy individuals may have decided to come to Germany for work. Eur Respir J 1999; 13: 577±582.

Exposure to environmental tobacco smoke (ETS) and other air pollutants has been associated with small decrements in lung function. The susceptibility to pollution exposure may, however, vary substantially between individuals. Children with an impaired protease-antiprotease balance may be particularly vulnerable. Therefore this study aimed to investigate the effects of ETS exposure on children with reduced levels of a 1 -antitrypsin (a 1 -AT).Random samples of school children (aged 9-11 yrs) (n=3,526) were studied according to the International Study of Asthma and Allergies in Childhood (ISAAC) phase II protocol, including parental questionnaires, pulmonary function and allergy testing. Blood samples were obtained to measure plasma levels of a 1 -AT and to genotype for pleomorphic protein inhibitor (Pi)Z and PiS alleles.Children with low levels of a 1 -AT (¡116 mg?dL -1 ) showed significant, albeit small decrements in baseline lung function. When exposed to ETS, pronounced decrements of pulmonary function, particularly in measures of mid-to end-expiratory flow rates, were seen in these children as compared to exposed children with normal levels of a 1 -AT. The mean levels of % predicted ¡ SE in both groups were: maximum expiratory flow at 50% of vital capacity 79.4 ¡ 7.2 versus 99.0 ¡ 1.5, maximum expiratory flow at 25% of vital capacity 67.4 ¡ 10.0 versus 100.3 ¡ 2.1, maximal midexpiratory flow 73.7 ¡ 8.6 versus 99.9 ¡ 1.7.These findings suggest that school children with low levels of a 1 -antitrypsin are at risk of developing pronounced decrements in pulmonary function, particularly if they are exposed to environmental tobacco smoke. Parents of children with heterozygous a 1 -antitrypsin deficiency resulting in significantly reduced blood concentrations should be advised to prevent their children from being exposed to environmental tobacco smoke and dissuade them from taking up smoking.