Nordic Congress of Allergology


P 1 - Intravenous administration of immunoglobulins in a therapy-resistent asthmatic child. Inflammatory responses and minor clinical improvement

Nakstad B1, Pettersen M2

Background: High dose immunoglobulin (IgG)(OctagamTM, 0.8 g/kg i.v.) were given daily during a 3 day period to a 16 year old boy. The treatment was repeated after 6 weeks. He suffered from respiratory failure due to bronchopulmonary obstruction and severe atopy against house dust mites. His asthmatic symptoms had been resistant to therapy, including intravenously given high-dose steroids. One week after IgG treatment his clinical condition had improved slightly, but he was still not able to perform lung function tests.

Methods: Plasma IL-10 and TNFa both proinflammatory cytokines, concentrations were quantified by ELISA after incubation of whole blood for 6h. In each therapy period blood was drawn for pre-therapy levels 30 min before the first injection (1st day) and for post-therapy levels one week after the first injection (7th day). Expression of leukocyte CD14 (endotoxin receptor activated during inflammation) was analysed by flow cytometry.

Results: Comparing pre- and post-therapy levels, IL-10 levels increased 15-fold and 5-fold after the first and second treatment period, respectively. TNFa levels increased 7-fold and 20-fold after the first and second treatment period, respectively. CD14 increased 9-fold in monocytes.

Conclusion: IL-10 and TNFa levels in blood seem to increase, as does the expression of receptors associated with inflammation (CD14) during intravenous IgG treatment. A transient and minor clinical improvement was observed.

P 2 - Fluticasone propionate attenuated the late asthmatic reaction more effectively than montelukast

Bruce C, Palmqvist M, Sjöstrand M, Aronsson B, Arvidsson P, Lotvall J

Background: Asthma is an inflammatory disease. The aim of this study was to determine the anti-inflammatory effects of montelukast (M) compared to fluticasone propionate (FP) and placebo (P).

Methods: In a randomised, double blind study, mild allergic asthmatics with an early and late (EAR and LAR) asthmatic reaction after bronchial allergen challenge participated. Treatments with FP 250µg x 2, M 10 mg x 1 or P was given for 8 days. On day 7 a bronchial allergen challenge was done. After 7 and 24 hours a sputum induction was performed. A methacholine challenge was done after 24 hours.

Results: 8 patients (6 allergic to cat, 1 birch, 1 horse) participated. Their mean baseline FEV1 was 92% pred (67-104%). At screening thr max FEV1-fall during the EAR (0-1h) was 28% (20-42%) and during the LAR (3-7h) 28% (16-56%). After M the max FEV1-fall during EAR was 12%±6.4 (SD), compared to after FP 18%±8.8 (SD), p=0.05. The max fall in FEV1 during the LAR was significantly attenuated after FP, 3%±4.9 (SD), compared to after M, 14%±13.6 (SD), p=0.04, and after P, 19%±16.7 (SD), p=0.01. There was no statistically significant difference on the LAR between M and P. After FP the percentage eosinophils in sputum (sputum eos%) was significantly reduced at 7 h, 11%±17.1 (SD) compared to after P, 26%±27.4 (SD), p=0.02. Also after M sputum eos% was significantly reduced, 14%±15.5 (SD), compared to P, p=0.03. In opposite to eosinophils in sputum % there was no difference in blood eosinophils for the different treatments. Metacholine responsiveness at 24 h was in relation to P reduced by 2.2 dose steps after FP and by 0.2 dose steps after M (p=0.01).

Conclusion: In theses allergic asthmatics, fluticasone propionate inhibited the LAR, reduced the associated sputum eosinophilia and the metacholine responsiveness more effectively than montelukast. The superior anti-inflammatory effects by fluticasone propionate are confirmed.

P 3 - Close association between thyroid autoimmunity/ autoimmune disease and chronic idiopathic urticaria

Zauli D, Contestabile S, Grassi A, Zucchini S, D'Ecclesia AR

Abstract: Almost 20 years ago now a fairly high prevalence of thyroid autoantibodies was described in patients with chronic urticaria of unknown origin (idiopathic).

We have subsequently confirmed a stronger association in a series of 122 patients. In the present study, we have updated our data in a larger series of such patients: 246 cases, comprising 148 women and 88 men.

Anti-thyroid peroxidase antibody (anti-TPO) alone was found in 6%, anti-thyroglobulin (anti-TG) alone in 3.6% and both antibodies in 13%. Any autoantibody was therefore detected in 23.7% cases, which is significantly higher than the expected prevalence in the general population: 1-10%.

As expected prevalence rates were higher in women than in men: 29% vs 14.7%.

A condition of frank or subclinical dysthyroidism was present in about 40% antibody positive cases. Whereas both hypo (32%) and hyperthyroidism (9%) were detected in female patients, in men only hypothyroidism (38%) was documented.

A low rate of response of urticaria symptoms to treatment of the thyroid dysfunction was observed in our cases.

In conclusion, although many recently published guidelines for the management of chronic idiopathic urticaria do not include evaluation of thyroid autoimmunity and function and the benefit of treatment seems low, we still highly recommend to test for anti-TPO, anti-TG and serum thyrotropin all idiopathic cases. This also in view of the morbidity associated with both hypo and hyperthyroidism.

P 4 - Quality of life and capsaicin sensitivity in patients with airway symptoms induced by chemical agent

Ternesten-Hasséus E, Löwhagen O, Millqvist E

Objectives: Earlier studies have shown increased cough sensitivity to inhaled capsaicin in patients developing airway symptoms from chemical agents, but without bronchoconstriction or an IgE-mediated allergy.

Our aim was to study cough sensitivity to and reproducibility of a capsaicin inhalation test in such patients, and to illuminate health economical factors and estimate their quality of life.

Methods: Eighteen patients with airway symptoms triggered by chemical agents, but with negative asthma/allergy tests, were provoked with a capsaicin inhalation test in three increasing dose steps, every third month. They were interviewed once a month about their work capacity and medication. Quality of life was measured with a general health profile (Nottingham Health Profile [NHP]).

Results: The mean number of coughs on the second dose of capsaicin was 49 [32; 66] at the first visit, 54 [35; 72] at the second, 54 [37; 70] at the third, and 43 [27; 59] at the last visit. The corresponding values among healthy control subjects were 9 [6; 12].

Eleven per cent of the patients had early disability retirement, 50% were periodically on sick leave and 56% had changed work because of their sensitivity to chemicals. Thirty-three per cent took nasal decongestants regularly and 50% used medication for the lower airways.

The NHP showed an influence on several dimensions of daily life.

Conclusions: Sensitivity to inhaled capsaicin seems to be stable and to have good reproducibility. Airway symptoms induced by chemical agents have a great influence on patients' quality of life and on health economical factors.

P 5 - An anthroposophic lifestyle and intestinal microflora in infancy

Alm J, Swartz J, Björkstén B, Engstrand L, Engström J, Kühn I, Lilja G, Möllby R, Norin E, Pershagen G, Reinders C, Wreiber K, Scheynius A

The intestinal flora is supposed to have an impact on the immune system. In the anthroposophic life style vegetables fermented by lactobacilli, and a restrictive use of antibiotics, antipyretics and vaccinations is typical. The aim of this study was to assess the gut flora in infants in relation to certain life style characteristics associated with anthroposophy.

Sixty-nine children below two years of age with an anthroposophic life style and 59 similarly aged controls were clinically examined and questionnaire replies assessed. Faecal samples were analysed by bacterial enumeration, bacterial typing through biochemical fingerprinting and by measuring microflora-associated characteristics (MACs).

The numbers of colony forming units (Cfu) per g of faeces were significantly higher for enterococci and lactic acid bacteria in children who had never been exposed to antibiotics (5.5x107 vs 2.1x107; p<0.001) and (10x107 vs 4.1x107; p<0.01), respectively. The number of enterococci was significantly higher in breastfed and vegetarian infants (p<0.01). The diversity of lactobacilli, as determined by biochemical fingerprinting, was higher in infants born at home, than in those born in hospital (p<0.01). Several MACs were related to specific life style features, and infants with an anthroposophic life style had a higher proportion of acetic acid and a lower proportion of propionic acid in their stool, as compared to the control children.

Life style factors related to the anthroposophic way of life influenced the composition of the gut flora in the infants. These differences may contribute to the lower prevalence of atopic disease previously observed in children in anthroposophic families.

P 6 - Fish and crustacea allergy. Report of three cases

Carrapatoso I, Todo-Bom A, Loureiro C, Chieira C

Fish and crustacean are relatively common food allergens and can cause severe clinical reactions. We report the cases of three adults referenced to our outpatient department with symptoms suggestive of food allergy, after ingestion of fish or crustacean.

Patient 1: A 19 years old atopic female reported facial and pharyngeal oedema and dyspnoea at age 2 after ingestion of codfish. Controlled consumption of other fishes was allowed, until two recent crises occurred, after ingestion of tambourine and tuna.

Patient 2: A 33 years old atopic female described generalised urticaria and facial angioedema, at age 21, after contact with boiled shrimp.

Patient 3: A 18 years old female with 2 episodes of urticaria, facial angioedema and dyspnoea, after ingestion of codfish and sardine, when she was 10 years old.

Besides a restrictive diet, patients 2 and 3 describe recurrent episodes of urticaria, pharyngeal oedema and wheezing after exposure to the cooking vapours of crustaceans or fish.

Skin prick tests (SPT) Leti ® and specific IgE determination (CAP - System Pharmacia ®) were performed:

We discuss clinical evolution of fish and crustacean sensitisation as well as cross-reactivity between food allergens and aeroallergens.

P 7 - Sensitization to rosaceae fruits and dried fruits. A case report

Carrapatoso I, Tavares B, Pereira C, Chieira C

Allergy to peach and other fruits of the rosaceae family, have been frequently reported in countries of Southern Europe. Clinical manifestations of food allergy can be quite severe and life threatening. We report the case of a 30 years old female who complained of generalise urticaria and angioedema, at age 14, after ingestion of apple. One year later she describes facial and pharyngeal angioedema and generalise urticaria, 15 minutes after eating peach. An identical episode occurred, with ingestion of pear a few months later. At age 27 she had the same complaints, when eating peanuts. All episodes were treated in emergency room with complete recover.

Hypersensitivity to rosaceae fruits was demonstrated by skin prick tests, Leti ", and serum specific IgE determination, CAP - System Pharmacia®. Skin prick tests were positive to peanut, chestnut, hazelnut and walnut, but specific IgE detection by CAP - System Pharmacia® was negative.

We discuss the occurrence of food allergy, to fruits of rosaceae family, in a patient without pollinosis. Clinical sensitisation to dried fruits could be related with cross-reacting allergens.

P 8 - Atopy in urban children of Heraklion, Crete, Greece

Dimitroulis I1*, Pedioti A2, Barrett S1, Harris J1, Bibakis I2, Bibaki-Liakou V2, Newman Taylor A1, Cullinan P1

Little is known about the prevalence of atopy rates in children of Crete, in terms of skin prick test (SPT) sensitization.

Objectives: We investigated those rates with a spectrum of aeroallergens which we felt are common in Crete.

Methods: The study population was school students aged 8-18 [n=853, girls=519(61%), boys=334(39%)]. We carried out a set of SPTs shown in table. A wheal of 3mm or greater than the negative control was regarded as a positive reaction. Body Mass Index (BMI) was calculated using the formula W(kg)/H2(cm).

Results: Are shown as mean(SD) in the table above, according to sex.

There was a correlation between the month of birth and sensitization to any pollen but not to D.P. (figure).

Using chi-square analysis for trends we found that there is a tendency for over-weight students (BMI quartile 23.93-41.51) to be atopic (p=0.06).

Conclusion: Pollens are the main sensitizing allergens in Heraklion children, followed by mites. Month of birth seems to be important for the development of specific allergies. There is a tendency for over-weight children to be sensitized.

P 9 - Prematurity and development of hypersensitivity

Stencel-Gabriel K, Lukas A, Obuchowicz A

The aim of the study was to estimate the factors influencing during pregnancy and first months after birth on appearance of hypersensitivity later in life.

Group of 2800 children were admitted to hospital because of pulmonal disease such as pneumonia, bronchopneumonia, chronic recurrent obstructive bronchitis(r.b.o). 33 children(group A) who were born before 37-week-of gestation and 99 infants after 37 weeks(group B) were chosen. Comparing the average of mothers' age was around 28 years old and was about 3 years older than in group B. 2% of deliveries were done by ceasarean section in both groups. Vaginal bacterial flora is supposed to enhance development of Th1/Th2 balance in infants. Mothers from group A were 4 times more often treated with antibiotic therapy than in group B. In addition, higher socio-economic status was found in group B. In both examined groups the number of smoking mothers was comparable but more passive smokers were in group B. Children who were breast-fed until 6-months-old in group-3% and in group B-70%. All infants had skin PRICK tests, IgE total for grass, tree pollen, house dust mite+ food allergens done. The results were statistically lower for group A.

Considering time of birth and pollen season 10% more premature children were born at that time. During otolaryngological consultation rhinitis allergica and otitis was rarely diagnosed.

We conclude immature immunological system is not able to respond so that it can protect from further development of allergy.

P 10 - Activity of cetirizine and desloratadine on skin reactions induced by histamine over 24 hours

Frossard N, Purohit A, Mélac M, Pauli G

This study compared the activity of cetirizine (10 mg) and desloratadine (5 mg) on the skin reaction to histamine administered by prick tests (100 mg/ml) measured by the wheal and flare surface areas over 24 hours (before treatment, 0.5, 1, 2, 3, 4, 6, 8, 10, 12 and 24 h). This was a double blind, randomized, placebo-controlled, single oral dose, cross-over trial. Eighteen healthy volunteers (33.9 y; 13 females) participated into this study. The areas under the curves (AUC) of the wheal and flare areas as a function of time (primary efficacy variables) were compared by ANOVA. A highly significant overall treatment effect (p<0.0001) was detected for both wheal and flare inhibition. In addition, the pairwise comparisons revealed that the activity of cetirizine and desloratadine was significantly superior to that of placebo (p<0.0001), and the activity of cetirizine was significantly superior to that of desloratadine (p<0.0001). Under desloratadine, 3 out of 18 subjects achieved a wheal inhibition of at least 70% between 3 and 10 hours, whereas all subjects under cetirizine reached a wheal inhibition of at least 70% between 1 and 3 hours (median time = 1.7 h). The difference between the 2 active drugs was highly significant (p<0.0001). The median duration during which the wheal inhibition was of at least 70% was zero under placebo and under desloratadine, and was 21.9 hours under cetirizine (p<0.0001). No uncommon adverse events were reported and no subject withdrew from the study due to an adverse event. In conclusion, this study clearly shows the superior activity of cetirizine to suppress skin reactivity to histamine compared with desloratadine during 24 hours after a single dose, with a consistency of the duration of action of cetirizine as previously reported.

P 11 - Anaphylaxis to horse

Gawlik R, Pitsch T

There is limited information about allergy to horse, although allergy to furred animals is a widespreading phenomenon. Horse allergy occurs among people who regularly handle horses, either professionally or for recreational purposes. There are only few reports about anaphylaxis episodes connected with allergy to horse.

We report the case of a six-year old girl, who was admitted to the allergology clinic after presenting an episode of anaphylaxis three days before during snow sledging. The reaction occurred shortly after 10 minutes period of riding sleigh drawn by a horse . The symptoms included sneezing, running nose, blushed skin, oedemated palpebras and lips, difficult breathing, syncope. The girl was transferred to the emergency ward and in the clinical examination the symptoms of tachypnoe, tachycardia (110/min), blood pressure 80/50 mmHg, body temperature 35.3 C and wheezes and crackles over the lungs were observed. In the emergency department she received intramuscular clemastine, intravenous hydrocortisone and oral prednisone and quick improvement was reported.

The skin prick tests with common inhalant allergens were performed in our clinic (Allergopharma, Germany). Negative skin prick tests exept to horse, cat and dog epithelium were observed. The arithmetic means of wheal diameters were as follows: 14mm for horse, 5 mm for cat, 4 for dog, and 4mm for histamine HCl 0,1%. Specific IgE (DPC, Biermann, Germany) measurements were positive against horse dander (>100 kU/l), cat and dog dander (respectively - 2,43 and 5,95 kU/l) and motherwort, birch, alder, hazel pollens ( all- 0,15 kU/l) were observed. Total serum IgE ( DPC, Biermann, Germany ) was 248 kU/l.

Repeated exposition to horse allergen were done when the girl visited stable, what elicited early asthmatic response, confirmed by spirometry ( 25% fall in FEV1 after 20 min.)( Jaeger, Germany).

It seems probable that children are especially susceptible to horse allergens as a factor that may provoke allergic reactions. Presented case show that it also may cause a life-threatening situation, and thus it must be taken under consideration by pediatricians as a risk factor.

P 12 - Effect of elimination diets on the nutrional status of breastfeeding mothers with food-allergic infants

Ullner PM, Järvinen KM, Suomalainen HK

Objective: Maternal elimination diet is recommended as a part of management of breastfed infants suffering from food allergies. In this study, we sought to determine how lactation and furthermore restriction diets impact nutritional status and bone metabolism of breastfeeding mothers.

Methods: 25 women were recruited and divided into three groups. Group 1 included 9 nurturing mothers who had an unrestricted diet or avoided classical allergens due to having an infant with atopic dermatitis. Group 2 comprised 8 mothers who strictly avoided cow's milk (n=4), or cow's milk, wheat, rye, oats and barley (n=4) due to their babies' food allergies. Group 3 of 8 age-matched non-nursing women served as controls. Mothers were advised on avoidance and substitution of eliminated foods by a nutritionist. Anthropometric measurements (BMI, skinfold thickness, limb circumferences), bone density, serum indices of iron, protein and bone metabolism, and serum trace elements levels were determined after a minimum of a 2-month-avoidance diet.

Results: Parameters of iron and protein metabolism, trace elements, anthropometric assessments and bone density were comparable in all three groups. However, osteocalcin levels were significantly elevated in the mothers with the most restricted diet compared to the control group (p<0.05). Likewise, collagen peptides i.e. ICTP, PICP, PIIINP were higher in the mothers with no/minor dietary restrictions than in the control group, and the highest in those with major restrictions (p<0.05).

Conclusions: Elimination diets did not hazard the nutritional status of lactating mothers when avoided foods were properly substituted. Although bone turnover was increased, bone density remained unaffected.

P 13 - RSV infection in infancy leads to transient elevation of U-EPX levels

Kristjánsson S1, Pálsdóttir Á2, Þórarinsdóttir H3, Wennergren G4, Haraldsson Á1

Respiratory Syncytial Virus (RSV) is the single leading cause of respiratory tract infection during infancy. Early childhood RSV infection has been considered to be a risk factor for developing bronchial asthma. Eosinophil cationic protein (ECP) is increased in nasal secretions in children with RSV infection. Eosinophil protein X in urine (U-EPX) has been found to be increased in children with atopic asthma. The main purpose of this study was to find out if U-EPX is increased after RSV infection and if U-EPX levels correlate to development of repeated wheezing and asthma later on. Seventeen children < 18 months of age with an RSV infection (mean age 3.3 months), recruited from the emergency room, were enrolled in the study. RSV infection was confirmed by cell culture and immunofluorescence of nasal secretions. Urine was sampled before 12.00 a.m. The children were seen 3 weeks, 3 months and 2.5 years after the RSV infection. Skin Prick Test (SPT) for 10 different allergens was performed at the last visit and questions were asked about wheezing and treatment with antiasthma drugs, other infections and use of antibiotics. Healthy children aged 3, 6 and 18 months were included as controls (n=11, 16 and 23, respectively). U-EPX was measured using a specific competitive radioimmunoassay (Pharmacia & Upjohn, Uppsala, Sweden). At the visit 3 months after the infection U-EPX levels were significantly increased (p=0.007) in the RSV group compared to the age matched controls (192 vs. 101 µg/mmol creatinine). Compared to the initial values U-EPX was slightly elevated (p=0.07) in the RSV group at the 3 months visit (192 vs. 131 µg/mmol creatinine). The percentage of children with 3 or more episodes of wheezing during the last 12 months was not statistically different between the RSV group and the 18 months controls (41% vs. 25%). U-EPX measured at inclusion and after 3 months was not correlated to 3 or more wheezing periods in the RSV group. No child in the RSV group had a positive SPT. Frequency of ear inflammation and use of antibiotics was comparable in both groups. The increased U-EPX values at 3 months after the RSV infection indicate that the RSV infection causes activation of eosinophils and probably leads to a Th2 inflammation in the majority of the children. However, these effects were not seen at the visit 2.5 years after the RSV infection and wheezing was not correlated to U-EPX.

P 14 - Pneumococcal conjugate vaccine of serotype 19F induces antibodies in infants and mice that are cross-protective to serotype 19A in a murine pneumococcal pneumonia model

Jónsdóttir I1, Sigurðsson VD1, Sigurðardóttir SÞ1, Schulz D2,

Jakobsen H1

To study whether immunization with pneumococcal conjugate vaccine containing serotype 19F induces cross-reactive and protective antibodies to serotype 19A, mice were immunized actively with a pneumococcal conjugate vaccine, 19F-TT (19F-TT, Aventis Pasteur, France), or passively with serum samples obtained from 14-months old infants vaccinated 4 times with an 11-valent pneumococcal conjugate vaccine (PNC, Aventis Pasteur) containing serotype 19F, but not 19A. IgG antibodies to serotypes 19F and 19A in mouse and infant sera were measured by ELISA. Two weeks after the 2nd 19F-TT immunization or 3 hours after passive immunization with infant sera, the mice were challenged intranasally with Streptococcus pneumoniae of serotype 19F or 19A and protection against lung infection evaluated by counting colony forming units (CFU). Immunization with 19F-TT induced significant IgG antibodies to both 19F and 19A, and reduced the number of CFU in lungs compared to unimmunized mice. In infants vaccinated with the 11-valent PNC, IgG anti-19F were significantly higher than IgG anti-19A, and there was a correlation between IgG 19F- and 19A-antibodies. Passive immunization of mice with infant sera reduced the number of 19F CFU in the lungs. A significant correlation was found between the number of 19F CFU and 19F-specific IgG titers in both infant and murine serum samples. Passive immunization with infant sera also reduced the number of 19A CFU in the lungs significantly compared to unimmunized mice. We conclude that immunization with tetanus-conjugated pneumococcal polysaccharide vaccine induces protective 19F-specific antibodies, which may cross-react and protect against serotype 19A infections.

P 15 - Nasopharyngeal (NP) carriage of vaccine serotype pneumococci is more common in children who respond poorly to the 11-valent pneumococcal conjugate (Pnc)

Sigurðardóttir SÞ1, Kristinsson KG1, Ingólfsdóttir G1, Guðnason Þ1, Davíðsdóttir K2, Kjartansson S1, Yaich M3, Jónsdóttir I1

We have previously reported equal safety and immunogenicity of two 11-valent Pnc formulations. Here we compare the serotype-specific IgG response in children carrying vaccine serotypes (VT) in the nasopharynx to that in children with no positive culture for the serotype in question.

Methods: 146 Icelandic infants received Pnc at 3, 4, 6 and 13 mo. NP samples were cultured at 4, 7, 10, 14, 18 and 24 mo. Antibodies to VT were measured by ELISA at 3, 7, 13, 14 and 24 mo. Unvaccinated controls of 105 children, matched for age and day-care centre, were recruited at 24 mo for NP culturing and pneumococcal antibody measurements.

Results: Of the 146 vaccinated infants, 14, 20 and 29 infants, respectively, had positive NP cultures for Pnc serotypes 6B, 19F and 23F, at least once between 4 and 24 mo. These infants had lower post-primary and post-booster vaccination IgG (mg/ml GMC) compared to the vaccinated infants with negative NP cultures at each visit (t-test). Vaccinees had higher GMC-IgG levels to the vaccine serotypes at 24 mo of age compared to the controls but at that time no difference was observed in NP carriage of pneumococci.

Conclusion: Infants who responded poorly to the Pnc conjugate vaccine were more often colonized with vaccine serotypes indicating mucosal protection of serotype-specific IgG. Prevention of NP colonization or eradication of NP pathogens may to some extent depend on IgG concentration in serum. An effective pneumococcal conjugate vaccine may decrease NP colonization of pneumococci and therefore decrease pneumococcal disease.

P 16 - Prevalence of Atopy and Atopic diseases

in Icelandic Schoolchildren

Clausen M1, Björkstèn B2, Haraldsson Á1, Kristjánsson S1

Background: The prevalence of adult atopic diseases in Iceland is lower than in Western Europe but there are no data concerning children.

Objective: To investigate the prevalence of atopic diseases and sensitivity to common allergens, in 10-11 year old schoolchildren as part of the phase-2 of the International Study of Asthma and Allergy in Children (ISAAC).

Methods: 946 children answered a questionnaire about atopic diseases. Skin prick tests (SPT) with 6 allergens were performed on 775 children and they were also examined for signs of atopic eczema.

Results: The prevalence of allergic rhinitis was 11% and asthma 9%. The reported prevalence to eczema was 26.9%, but only 10.3% had signs when inspected. A positive SPT was recorded in 24.9% of the children, i.e. 18.7% to grasses, 12.9% to cat, 3.6 to trees, 2.9% to D. pter, 1.4% to D. farinae and 0.5% to alternaria.

Conclusion: The high prevalence of atopic diseases in children at 10-11 years is surprising as the prevalence in adults is very low in Iceland. The findings resemble those in developing countries. Other changes in environmental factors would be operative, however, as Iceland has had an affluent lifestyle for a considerable time. The high prevalence of sensitivity to grass pollen may be explained by the long grass pollen season and low exposure to other allergens on the island.
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