The Prevalence of Allergies The Prevalence of Allergies and and AtopyAtopy in Indonesiain Indonesia

Heru Sundaru

Division of Allergy and Clinical ImmunologyDepartment of Internal Medicine, Fac. of Medicine

Univ. Indonesia / Cipto Mangunkusumo General HospitalJakarta

1920 1940 1960 1980 2000 2020

0.1

1

10

100

Distribution of Asthma Prevalence among Young Adult from Publication

Percen

tage

year

0.01

Increase Prevalence of asthmaIncrease Prevalence of asthmaCountries

England

Scotlandia

Japan

Taiwan

Singapore

Age Age

4 4 -- 1212

8 8 -- 1313

ChildrenChildren

7 7 -- 1515

4 4 -- 17176 6 -- 1414

Sample of Sample of studystudy5806605634034034

55388456752367892471222682457

yearyear

19731973198619861989198919941994198219821992199219741974199119911967196719921992

PrevalencePrevalence(%)(%)2.02.04.14.1

10.210.219.619.63.33.34.64.61.31.35.85.8

3 3 -- 5.55.519.519.5

The rolee of Th1 and Th2 in Asthma and Allergic diseases

Prevalence(%) of Allergy in West and East Germany

West Jerman(n=5030)

East Jerman(n=2623)

OR CI 95%

The Doctor’s diagnosis

Asthma ever 9.3 + 7.2 1.3 1.1;1.6

“current” Asthma 5.9 ‡ 3.9 1.5 1.2;1.9

Bronchitis 15.9 ‡ 33.7 0.4 0.3;0.4

Atopic Rhinitis 8.6 ‡ 2.7 3.4 2.6;4.4

Symptoms

- Wheezing 17.0 ‡ 26.8 0.6 0.5;0.6- Short of breath 8.7 9.6 0.9 0.8;1.1- Night cough 3.4 ‡ 6.1 0.5 0.4;0.7- exercise cough 11.7 + 14.2 0.8 0.7;0.9

Poluted

- SO2 14μg/m3 150 μg/m3

- PM10 47μg/m3 80 μg/m3

+ : p<0,005 compare to East Jerman, ‡ : p<0,0005 compare to east ‡ : p<0,0005 compare to east JermanJermanvon Mutius dkk. Am J Respir Crit Care Med 1994;149:358-64

The asthma prevalence in adults based on repeated The asthma prevalence in adults based on repeated wheezing symptom, wheezing symptom, dyspneadyspnea accompanied by accompanied by

wheezing and doctor’s diagnosiswheezing and doctor’s diagnosisUtanUtan KayuKayu, Central Jakarta, Central Jakarta

N = 473 Current prevalence

Cumulative prevalence

Repeated wheezingDyspnea and wheezingThe doctor’s diagnosis

8.9%6.9%3.4%

10.9%7.6%3.8%

Heru et al. 1990

ISAAC Phase 1 in Indonesia 1996ISAAC Phase 1 in Indonesia 1996

Wheeze in the past year

Nose symptoms Rash 12 months

N % N % N %

MedanN=250

PalembangN=762

JakartaN=361

BandungN=2249

BaliN=258

ManadoN=578

Ujung PandangN=799

IndonesiaN=5277

11

27

22

47

19

24

72

222

4.4

3.54

5.77

2.09

7.36

17.47

9.01

4.21

97

274

86

733

88

358

420

2056

38.8

35.96

22.57

32.59

34.11

61.94

52.56

38.96

47

43

7

54

1

101

97

350

18.8

5.64

1.84

2.4

0.39

17.47

12.14

6.63

ISAAC Phase 1 children

13-14 years

ISAAC Phase 3 in Indonesia 2003ISAAC Phase 3 in Indonesia 2003

Wheeze in the past year

Nose symptoms Rash 12 months

N % N % N %

BandungN=2850

BaliN=2576JakartaN=1385

SemarangN=3526

IndonesiaN=10337

147

111

107

193

558

5.16

4.31

7.73

5.47

5.40

550

828

370

619

2367

19.3

32.14

26.71

17.56

22.40

90

164

97

191

542

3.16

6.37

7.00

5.42

5.24

ISAAC Phase 1 children

13-14 years

Karnen et al. 2004

Asthma and atopy : Urban vs. Rural

Ciater, Subang Pagaden, Subang

Pegaden, Subang Cijambe, Subang

Central Jakarta

The prevalence of allergic symptoms in Jakarta The prevalence of allergic symptoms in Jakarta (urban) and (urban) and SubangSubang (rural) among school children (rural) among school children

age 13age 13--14 years old14 years old

Jakarta (urban) Subang (rural)

N = 3840 % N = 3019 %WHEZEVWHEZ12ASTHMAEVPNOSEEVPNOSE12RASHEVRASH12ECZEMAEV

3892882981023843220178182

10.17.57.826.622.05.74.64.7

39929035316191046406303475

13.29.611.753.634.613.410.015.7

Variable

Heru et al. 2005

Perbandingan suhu, kelembaban (humidity), danpolusi udara di Jakarta dan Subang

SubangJakarta Pusatχ

(min-max) Kalijati Lapangan Bintang

Temp air (oC) 27.98 (23.39-33.22)

26.43 (21.10-33.62)

26.10(22.49-31.09)

Hum air (%) 59.91 (27.12-78.24)

69.17 (26.96-95.42)

67.59 (24.24-91.54)

PM10 (μg/m3 ) 89.37 (46.71-276.13)

85.76 (44.79-165.81)

72.73 (39.75-148.56)

SO2 (μg/m3) 30.75 (16.54-50.46)

114.08(110.10-118.59)

111.76 (108.23-121.30)

CO (mg/m3 ) 1.56 (0.50-3.67)

0.62 (0.14-2.88)

0.33 (0.11-0.72)

O3 (μg/m3 ) 86.81 (39.44-301.15)

33.17 (9.90-75.93)

54.17(25.77-99.75)

NO2 (μg/m3 ) 60.31 (13.57-128.56)

16.98 (7.08-38.49)

13.87 (2.38-44.54)

Crude prevalence ratios (with 95% confidence intervals) of symptom groups by district and year,

for the study cohort, in 1989, 1990 and 1991

YearRespiratory symptoms and asthma 1989 (baseline) 1990 (pre-

intervention)1991 (post-

intervention)Cough or sore throat S

KT16,1 (14,2-18,0)19,8 (18,0-21,6)

13,9 (12,1-15,7)16,8 (15,1-18,5)

11,7 (10,0-13,4)11,1 (9,7-12,5)

Phlegn SKT

16,8 (14,9-18,7)19,2 (17,4-21,0)

13,2 (11,4-15,0)14,2 (12,6-15,8)

9,4 (7,9-10,9)8,1 (6,9-9,3)

Wheezing or asthmatic diagnosis

S KT

11,3 (9,7-12,9) 12,7 (11,2-14,2)

10,5 (8,9-12,1) 11,2 (9,8-12,6)

9,2 (7,7-10,7) 9,3 (8,0-10,6)

Wheezing SKT

7,8 (6,4-9,2)10,5 (9,1-11,9)

9,5 (8,0-11,0)9,9 (8,6-11,2)

6,9 (5,6-8,2)7,2 (6,0-8,4)

Asthma SKT

7,4 (6,0-8,8)7,1 (6,0-8,2)

6,9 (5,6-8,2)6,9 (5,8-8,0)

5,8 (4,6-7,0)6,3 (5,2-7,4)

Nasal symptoms, allergic rhinitis or sinitis

S KT

35,6 (33,1-38,1) 38,1 (35,9-40,3)

31,0 (28,6-33,4) 31,4 (29,3-33,5)

32,6 (30,2-35,0) 32,4 (30,2-34,5)

Peters J, Hedley AJ, Wong CM, Lam TH, Ong SG, International Journal of Epidemiology 1996;25:821-828

S : Southern

KT : Kwai Tsing

Prevalence(%) of Allergy in West and East Germany

West Jerman(n=5030)

East Jerman(n=2623)

OR CI 95%

The Doctor’s diagnosis

Asthma ever 9.3 + 7.2 1.3 1.1;1.6

“current” Asthma 5.9 ‡ 3.9 1.5 1.2;1.9

Bronchitis 15.9 ‡ 33.7 0.4 0.3;0.4

Atopic Rhinitis 8.6 ‡ 2.7 3.4 2.6;4.4

Symptoms

- Wheezing 17.0 ‡ 26.8 0.6 0.5;0.6- Short of breath 8.7 9.6 0.9 0.8;1.1- Night cough 3.4 ‡ 6.1 0.5 0.4;0.7- exercise cough 11.7 + 14.2 0.8 0.7;0.9

Poluted

- SO2 14μg/m3 150 μg/m3

- PM10 47μg/m3 80 μg/m3

+ : p<0,005 compare to East Jerman, ‡ : p<0,0005 compare to east ‡ : p<0,0005 compare to east JermanJermanvon Mutius dkk. Am J Respir Crit Care Med 1994;149:358-64

Frequency of allergic disease among Frequency of allergic disease among 872 hospital personnel872 hospital personnel

Place of workPlace of work AsthmaAsthma RhinitisRhinitis UrticariaUrticaria

1.1. Operating room nurses (n = 300)Operating room nurses (n = 300)2.2. Ward nurses (n = 300)Ward nurses (n = 300)3.3. Administration staffers (n = 272)Administration staffers (n = 272)

21 (7,0%)21 (7,0%)17 (5,7%)17 (5,7%)10 (3,7%)10 (3,7%)

21 (7,0%)21 (7,0%)26 (8,7%)26 (8,7%)14 (5,2%)14 (5,2%)

39 (13,0%)39 (13,0%)31 (10,3%)31 (10,3%)17 (6,3%)17 (6,3%)

Asthma is more prevalent in operating room nurses and ward nurseAsthma is more prevalent in operating room nurses and ward nurses s compared with administration staffers (p < 0.05), while there iscompared with administration staffers (p < 0.05), while there is no no difference in rhinitis and difference in rhinitis and urticariaurticaria (p > 0,05)(p > 0,05)

Huda, et al. 2005

Distribution of Distribution of atopyatopy and non and non atopyatopyamong 872 hospital personnelamong 872 hospital personnel

Place of workPlace of work AtopyAtopy Non Non atopyatopy

Operating room nursesOperating room nursesWard room nursesWard room nursesAdministration staffAdministration staff

104 (34,7 %)104 (34,7 %)99 (33,0 %)99 (33,0 %)91 (33,5 %)91 (33,5 %)

196 (65,3 %)196 (65,3 %)201 (67,0 %)201 (67,0 %)181 (66,5 %)181 (66,5 %)

* p > 0,05 for all groups* p > 0,05 for all groups

Huda, et al. 2005

Latex sensitization among 294 Latex sensitization among 294 atopicatopic personnelspersonnels

Latex (+)Latex (+) Latex (Latex (--)) TotalTotal

1.1. Operating room nursesOperating room nurses2.2. Ward nursesWard nurses3.3. Administrative staffersAdministrative staffers

11 (10,6 %)11 (10,6 %)10 (10,1 %)10 (10,1 %)2 (2,2 %)2 (2,2 %)

93 (89,4 %)93 (89,4 %)89 (89,9 %)89 (89,9 %)89 (97,8 %)89 (97,8 %)

10410499999191

TotalTotal 23 (7,8 %)23 (7,8 %) 271 (92,2 %)271 (92,2 %) 294294

Place of workPlace of work

There were more latex sensitization in operating room and ward There were more latex sensitization in operating room and ward nurses compared with administrative work (p < 0,01)nurses compared with administrative work (p < 0,01)

Huda, et al. 2005

Proportion distribution & OR of asthma Proportion distribution & OR of asthma according to allergen sensitization in Jakartaaccording to allergen sensitization in Jakarta

Control(N=274)

Asthma(N=207)

% %D.Pteronyssinus

-

+

216(78.83)

58(21.17)

47(22.71)

160(77.29)

1

12.68(7.50;21.44)

0.0000

D.farinae-

+

225(82.12)

49(17.88)

63(30.43)

144(69.57)

1

10.50(6.35;17.34)

0.0000

Cockroach-

+

239(87.23)

35(12.77)

114(55.07)

93(44.93)

1

5.57(3.44;9.01)

0.0000

Crude OR(95% IC) pSensitization

Proportion distribution & OR of asthma according Proportion distribution & OR of asthma according to allergen sensitization in Jakartato allergen sensitization in Jakarta

Control(N=274)

Asthma(N=207)

% %Dog

-

+

259(94.53)

15(5.47)

199(96.14)

8(3.86)

1

0.69(0.29;1.67)

0.4132

Cat-

+

266(97.08)

8(2.92)

193(93.24)

14(6.76)

1

2.41(0.99;6.56)

0.0460

C.albicans-

+

267(97.45)

7(2.55)

194(93.72)

13(6.28)

1

2.56(1.00;6.56)

0.0429

Atopy-

+

209(76.28)

65(23.72)

43(20.77)

164(79.23)

1

12.26(7.27;20.69)

0.0000

Crude OR(95% IC) pSensitization

Proportion distribution & OR of asthma Proportion distribution & OR of asthma according to allergen sensitization in according to allergen sensitization in SubangSubang

Control(N=274)

Asthma(N=207)

% %D.Pteronyssinus

-

+

176(71.26)

71(28.74)

61(50.83)

59(49.17)

1

2.40(1.51;3.80)

0.0001

D.farinae-

+

193(78.14)

54(21.86)

73(60.83)

47(39.17)

1

2.30(1.42;3.73)

0.0005

Cockroach-

+

206(83.40)

41(16.60)

96(80.00)

24(20.00)

1

1.26(0.72;2.20)

0.4240

Crude OR(95% IC) pSensitization

Proportion distribution & OR of asthma according Proportion distribution & OR of asthma according to allergen sensitization in to allergen sensitization in SubangSubang

Control(N=274)

Asthma(N=207)

% %Dog

-

+

204(97.17)

7(2.83)

113(94.17)

7(5.83)

1

2.12(0.72;6.23)

0.1599

Cat-

+

236(95.55)

11(4.45)

113(93.24)

7(5.83)

1

1.33(0.50;3.53)

0.5664

C.albicans-

+

246(99.60)

1(0.40)

113(94.17)

7(5.83)

1

15.24(1.79;129.89)

0.0008

Atopy-

+

158(63.97)

89(36.03)

53(44.17)

67(55.83)

1

2.24(1.43;3.53)

0.0003

Crude OR(95% IC) pSensitization

AtopyAtopy and asthma (Australia/Europe)and asthma (Australia/Europe)

n Atopy asthma DX1. Simpson et.al 2001 5681 Adult

9-11 th

9-11 th

10

8-11 th

926(Belmon)

8-11 th 39% 38%

48.27% 9.7%

Current asma

DX asmaCurrent asma

Current asma

Wheezing 12 mth

Current asma

2. Von Mutius et.al 1994 4451(JB)

36.7% 5.9%

2335(JT)

18.2% 3.9%

3. Riikjark et.al 2000 979 14.3% 8.3%

4. Peat et.al 1996 1339(Sidney)

42% 24%

AtopyAtopy and asthma (Asia/Africa)and asthma (Asia/Africa)

n Atopy AsthmaYemaneran 1997 Rural 861 5-20 yr

2194409

1062737350

Rural 286 >15 yr 22% 3,5%

5-20 yr12-18 yr

12-18 yr12-18 yr

Nyan 2001 (Gambia) Urban >15 yr 35% 4.4%

12% 1%Africa urban 4% 4%Leung 1997 (Hongkong)

Malaysia 64% 4,9%

Hongkong 58% 3.7%China 49% 1.1%

Correlation allergen sensitization and asthma Correlation allergen sensitization and asthma prevalenceprevalence

Name of study location Sensitization TDR

Asthma prevalence (%)

Charpin, dkk MarseilleBriancon

28,010,0

42

Faniran, dkk AustraliaNigeria

28,2 20,7

21,910,2

Wieringa, dkk Urban AntwerpSuburb Antwero

26,017,0

74

Von Mutius Jerman BaratJerman Timur

10,34,20

5,93,9

Leung, dkk HongkongKota kinibaluSan Bu

55,460,242,7

3,74,91,1

This studi Jakarta 77,3 7,5Subang 49,2 9,5

Comparison Comparison DerDer p1, p1, DerDer f1 and Group I f1 and Group I allergen level between case and control allergen level between case and control

Jakarta (Urban) Subang (Rural)

Control (n=164)

Case(n=135)

P-value Control(n=138)

Case(n=135)

P-value

Der p1 (μg/g dust)

0.28(0.23;0.35)

0.29(0.23;0.35)

0.9501 0.28(0.22;0.36)

0.44(0.32;0.61)

0.0382

Der f1 (μg/g dust)

1.28(1.07;1.53)

1.49(1.24;1.80)

0.2371 0.33(0.26;0.43)

0.49(0.32;0.74)

0.1139

Group I (μg/g dust)

1.85(1.58;2.16)

2.08(1.78;2.42)

0.3021 0.83(0.66;1.04)

1.24(0.89;1.72)

0.0514

Allergen level

(HDM)

* Geometric

SUMMARY

Compare to developed countries the prevalence of asthma and allergic disease is still low, although there are tendencies to increase Other factor should have a role beside atopyin determining the prevalence of asthma and allergy in Indonesia