High burden of atopy in immigrant families in substandard apartments in Sweden – on the contribution of bad housing to poor health in vulnerable populations

Abstract

BackgroundAtopic disorders are a global concern. Studies in migrant populations can illuminate the interplay of genetic and environmental factors. Exposures related to bad housing (indoor dampness, mould growth, crowding etc.) are likely to play a role in how socioeconomic inequalities can turn into health disparities for disadvantaged populations. The sizable immigrant population living in very poor-quality housing in Malmö, Sweden, became the focus of a cross-sectional study.ObjectiveTo describe atopic disorders and sensitizations in a population living in substandard housing in Malmö, Sweden, with an emphasis on their relation to harmful exposures from the built environment.MethodsFamilies were recruited via identification of any children with symptomatic airway afflictions from health care records, and also asymptomatic children from school lists. Interviewer-led health questionnaire data and data from self-reports about living conditions were obtained together with data from home inspections carried out by health communicators. Families underwent skin prick tests (SPT) against common aeroallergens.ResultsAs could be expected from background demographic information, it turned out that we effectively studied an immigrant population inhabiting very precarious housing outside the center of Malmö. A total of 359 children from 130 families (total 650 participants) were included. Overall the prevalence of potentially harmful environmental exposures was high (signs of moisture or mould in more than 50% of apartments, indoor smoking in 37% of households). Atopic disorders were common among both adults and children. SPTs showed a spectrum of sensitizations consistent with unselected populations in Sweden. Paternal sensitization in the SPT was associated with higher risk of sensitization for offspring than maternal sensitization. Few statistically significant associations of atopic sensitization with studied environmental exposures were detected (for example objective signs of dampness /mould in bathrooms). There were marked discrepancies between asthma diagnoses obtained from the health records and parental reports of such diagnoses and treatment for their children.ConclusionsThe atopic burden in this selected immigrant population was high, and results point to unmet medical needs. Health care systems caring for such populations need to be aware of their specific health needs; comprehensive asthma and allergy care should include consideration of harmful environmental exposures, adhering to the precautionary principle.

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“…One cited reason for this is that second-generation antihistamines are not approved for use in infants under 6 months old. However, it should be noted that first-generation antihistamines were licensed at a time when the requirements for registration of pharmaceuticals were less stringent 27. As such, first-generation antihistamines were licensed for use in the absence of clinical pharmacology and pharmacokinetic and pharmacodynamic data in children, infants, the elderly, and other special patient populations 27.…”

“…However, it should be noted that first-generation antihistamines were licensed at a time when the requirements for registration of pharmaceuticals were less stringent 27. As such, first-generation antihistamines were licensed for use in the absence of clinical pharmacology and pharmacokinetic and pharmacodynamic data in children, infants, the elderly, and other special patient populations 27. In today’s context, first-generation antihistamines have little place in managing AR and CSU 28…”

“…The symptoms of AR and CSU significantly impair quality of life both directly and indirectly, and contribute to absenteeism, presenteeism, and loss of work productivity 40,41. Incorrect choice of antihistamines can lead to poor symptom control and unwanted side effects; these in turn may impair cognitive performance and work productivity,27,32,42,43 and worsen overall quality of life.…”

“…The sedating effects of first-generation antihistamines are well documented,27,32,44 but their other adverse effects also warrant attention. Sedating antihistamines can affect rapid eye movement sleep,32 and impair cognitive and psychomotor performance,42 with potentially serious consequences in safety-critical occupations (eg, pilots, commercial vehicle drivers, or machine operators) 8.…”

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“…These findings underline that environmental factors can predispose to the development of atopic disease in immigrants, even if sensitization is not always associated with clinical hypersensitivity reactions [3]. A key environmental risk factor for atopy in immigrants is bad housing [4]. Additional studies are needed to identify immigrants at risk for atopic diseases and which factors are involved with aim of identifying preventive intervention.…”