gms | German Medical Science

Kongress Medizin und Gesellschaft 2007

17. bis 21.09.2007, Augsburg

International variation in the prevalence of flexural eczema and the role of atopic sensitisation: results from phase two of the International Study of Asthma and Allergies in Childhood (ISAAC)

Meeting Abstract

  • Andrea Kleiner - Universität Ulm, Ulm
  • Carsten Flohr - University of Nottingham, Nottingham
  • Stephan Weiland - Universität Ulm, Ulm
  • Gudrun Weinmayr - Universität Ulm, Ulm
  • Bengt Björkstén - Karolinska Institutet Stockholm, Stockholm
  • Lennart Bråbäck - Sundsvall Hospital, Sundsvall
  • Bert Brunekreef - University of Utrecht, Utrecht
  • Gisela Büchele - Universität Ulm, Ulm
  • Peter Rzehak - Universität Ulm, Ulm
  • Michael Clausen - Landspitalinn Hákskólasjúkrahus, Reykjavik
  • William Cookson - University of Oxford, Oxford
  • Erika von Mutius - University of Munich, München
  • David Strachan - St. Georges's Hospital Medical School, London
  • Hywel Williams - University of Nottingham, Nottingham
  • ISAAC Phase II Study Group

Kongress Medizin und Gesellschaft 2007. Augsburg, 17.-21.09.2007. Düsseldorf: German Medical Science GMS Publishing House; 2007. Doc07gmds196

The electronic version of this article is the complete one and can be found online at:

Published: September 6, 2007

© 2007 Kleiner et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Introduction: The role of atopic sensitisation in “atopic” eczema is still unclear. We investigated the worldwide variation in prevalence of flexural eczema and its association with atopic sensitisation.

Methods: A cross sectional study was carried out in 30 study centres in 22 countries: random samples (n ≥ 1000 per centre) of 8-12 year old children participated. A questionnaire inquiring on symptoms was filled in by the parents of 54,189 children. In addition, 31,728 children were physically examined for flexural eczema according to a defined protocol and 31,759 were skin prick tested. Six commonly occurring airborne allergens were tested in all centres. Allergens of local relevance were included from 18 study centres. The gross national income per capita (GNI) was used to approximate the economic development of the countries. Affluent countries were characterized by a GNI ≥ 9200$ per capita per year.

Results: The point prevalence of flexural eczema as determined from skin examination varied from 0.4% in Kintampo, Ghana, to 14.2% in Östersund, Sweden. Eczema symptoms in the past year were reported by 1.3% in Guangzhou, China, and occurred most frequently in Östersund (23.7%). The age- and sex adjusted combined odds ratio for the association of flexural eczema (examination) with atopic sensitization was stronger for affluent countries than for non-affluent countries (OR = 2.7 (95%-CI: 2.3-3.1) and OR = 1.2 (95%-CI: 0.8-1.7), respectively). The combined OR for the association of eczema symptoms in the past year with atopic sensitization was also higher for affluent countries (OR = 2.0 (95%-CI: 1.8-2.2) and OR = 1.4 (95%-CI: 1.1-1.7), respectively).

Conclusion: The association between eczema and atopic sensitization in children varies strongly between populations and is weaker in non-affluent countries than in affluent countries.