LITHUANIAN UNIVERSITY OF HEALTH SCIENCES MEDICAL ACADEMY
FACULTY OF MEDICINE
DEPARTMENT OF IMMUNOLOGY AND ALLERGOLOGY
RÉNAS ALIM KURSHID
THE PREVALENCE OF SELF-REPORTED ALLERGIES AMONG THE STUDENTS OF LITHUANIAN UNIVERSITY OF HEALTH SCIENCES
CROSS-SECTIONAL STUDY Master's Thesis
Supervisor:
Dr Edita Gasiūnienė
Kaunas, 2020
TABLE OF CONTENTS
1. SUMMARY ………...3
2. CONFLICT OF INTEREST ……….………...4
3. ABBREVIATIONS LIST ………….………...5
4. INTRODUCTION ...………..………...6
5. RESEARCH METHODOLOGY AND METHODS ...………7
5.1 Ethics ...………....………..….7
5.2 Population ...………...………...7
5.3 The questionnaire ………...………7
5.4 Statistical analysis ………..………7
6. REVIEW OF LITERATURE ………...8
6.1 Allergy ...…………...………..………8
6.2 Determinant factors in the development of allergies…..………9
6.3 Prevalence of allergies …..……...………10
6.4 Allergies and quality of life ...………..……….11
7. RESULTS ………...………12
7. DISCUSSION ……….………...16
8. CONCLUSIONS ………….………...19
9. LITERATURE LIST ………….……….…20
10. ANNEX ………...………21
1. SUMMARY OF RESEARCH
Master's thesis by Rénas Alim Kurshid. This is a cross-sectional study.
¨The prevalence of self-reported allergies among the students of Lithuanian University of Health Sciences¨.
Aim: This study was aimed to assess the prevalence of self-reported allergies among students of Lithuanian University of Health Sciences.
The objectives of the research are: To determine the prevalence of self-reported allergic conditions in medical students at Lithuanian University of Health Sciences. To compare prevalence of allergies among students from different countries. To assess the impact of allergies on the students' quality of life.
Methodology: A cross-sectional study design was conducted among medical students aged between 20-31 years attending Lithuanian University of Health Sciences (LSMU, Kaunas). A self-administered anonymous questionnaire was distributed to and answered by 160 medical students registered to the faculty of medicine at Lithuanian University of Health Sciences 2019. SPSS version 23 was used for statistical analysis. The significance level was set at p<0.05.
Results: The common allergies self-reported by the students included allergic conjunctivitis 66 (41.3%), allergic dermatitis 29 (18.1%), allergic rhinitis 101 (63.1%), food allergies 25 (15.6%) and eczema 47 (29.4%). The most common food allergies were associated with milk, other nuts(not peanuts) and "others". Drug allergies were reported by 13 (8.1%) students, most frequently to penicillin antibiotics. There was found no statistically significant correlation between allergies and where the students had spent most of their lives (P>0.05). The interference of daily activities and quality of life by allergic disease was found statistically significant (P<0.05).
Conclusion: Allergic rhinitis and allergic dermatitis were the frequent allergies reported. The allergy was seen to disrupt the quality of life of students. No geographical differences were found to correlate with allergies.
Keywords: allergy; allergic rhinitis; allergic dermatitis; eczema; self-reported; prevalence; student
2. CONFLICT OF INTEREST
The author does not declare any conflict of interest.
3. ABBREVIATION LIST
AC = Allergic conjunctivitis
AD = Allergic dermatitis
APC = Antigen presenting cell
AR = Allergic rhinitis
ECRHS = European Community Respiratory Health Survey
IgE = specific E type immunoglobulin
Il-4 = Interleukin-4
Il-13 = interleukin-13
ISAAC = The International Study of Asthma and Allergies in Childhood
QoL = Quality of life
Th2 = T helper cell
4. INTRODUCTION
Since the industrial revolution and when humans got the capacity to manipulate the external world to protect themselves from various environmental factors, we have seen a marked increase in allergies in the world. The most extensive European study up to date, The European Community Respiratory Health Survey (ECRHS) that included 22 countries and around 140 000 individuals concluded that there are significant geographical differences in the prevalence of respiratory symptoms, asthma, bronchial responsiveness and atopic sensitization with high prevalence rates in English speaking countries and low prevalence rates in the Mediterranean region and Eastern Europe.[1] The general trend seems to be that the more infrastructurally modern and advanced the country has become, the prevalence of allergic diseases has increased in concordance.[2] In a nationwide study in Sweden conducted over three decades, it was suggested that environmental changes affecting the whole of society had promoted an increase in asthma, allergic rhinitis(AR) and eczema in both farming and non‐farming environments.[3] The increasing prevalence of allergic diseases has brought forward a multitude of ailments that cause a wide range of individual, societal and economic burdens. Allergies are known to be interruptive and affect the quality of life (QoL). For students in higher education, it can interfere with daily activities, sleep, attendance and extra-curricular activities.[4,5]
This study aimed to assess the self-reported prevalence of allergies among Lithuanian University of Health Sciences students.
The objectives of the research are:
• The aim of this study was to determine the self-reported prevalence of allergic conditions in medical students at Lithuanian University of Health sciences.
• Compare prevalence of allergies among students from different countries.
• To evaluate the impact of allergies on the students’ daily activities.
5. RESEARCH METHODOLOGY AND METHOD.
5.1 Ethics
The study was reviewed and approved by the Bioethics Committee of the Faculty of Public health of Lithuanian University of Health Sciences (No. BEC-MF-314). All students wishing to participate in the study were included. Those students who did not want to participate
in the study were excluded from the study.
5.2 Population
A cross-sectional study was carried out between the period October 2019-February 2020. The 160 participants of the study were students from the medical faculty attending the Lithuanian
University of Health Sciences. The data obtained from the participants of the survey was obtained in two ways. With permission from the responsible university administrators, random on-going classes were selected for the study. The objective of the study was explained to the study participants, and informed verbal consent was obtained. An online version of the questionnaire was created. A link of the questionnaire, with full disclosure of the study objective, was sent by email to medical students to be answered.
5.3 The questionnaire
The data was collected by using a self-administered pilot-tested questionnaire inspired by the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire and similar
previously conducted studies. The questionnaire comprises of a set of questions designed to determine the 12-month prevalence of AR, food allergies, AD and eczema. In addition, the questionnaire also contains epidemiological questions to determine age, gender and country where the participants spent the majority of their life.
5.4 Statistical analysis
Descriptive analysis was performed on the data collected using SPSS (Statistical Package for the Social Sciences) version 23. To measure correlation between prevalence of allergies and where
students spent most of their lives, the countries the respondent answered were distributed categorically in eight separate geographical regions. The countries were classified into different regions according to
the CIA world factbook and were then tested for statistically significant correlation with Pearson’s coefficient. [47] Pearson’s coefficient was used to test correlations between variables. The significance level was set at p<0.05.
6. REVIEW OF LITERATURE
6.1 Allergy
Hypersensitivity reactions are abnormal immunological reactions of human body towards substances that for the most people are completely harmless. Allergies or hypersensitivity reactions are classified into four different types of classifications after Gell and Coombs 1968.[6]
In this study, we will predominantly deal with the type 1 hypersensitivity reaction - Atopy.
Atopy is a term which is defined as a genetic predisposition to produce specific E type
immunoglobulin (IgE) after being exposed to allergens. IgE mediated inflammation causes diseases such as food allergies, allergic dermatitis, and allergic rhinitis.
This happens when the allergens are taken up and degraded by antigen-presenting cells (APCs). The APCs then interact with CD4+ coreceptor in a T helper cell (Th2), and it binds to proteins of the major histocompatibility complex (MHC) of the APCs. This process subsequently causes the Th2 cells to produce and secrete interleukin-4 (IL-4), interleukin-13 (IL-13), and interleukin-5 (IL-5). The IL-4, IL- 5, and IL-13 are essential promoters in the production of the allergen-specific IgE by plasma cells. [7]
The IgE then disperses through the body and binds to high-affinity Fc receptors (Fc-epsilon-RI) on the surface of tissue mast cells and circulating basophils. Hypersensitivity type 1 reactions are induced when IgE coated cells encounter specific allergens. The degranulation process of mast cells or basophilic granulocytes starts, which induces a release of histamine, leukotrienes, and other immunological substances. [8]
The mast cells are found in abundance in the skin and mucosa of the airways, and the IgE-mediated release of immunological inflammatory cytokines cause an allergic inflammation, which usually presents as swelling and increase mucus production of the mucous membranes in the nose, eyes. In the airways, the bronchial muscles contracts which lead to cough and difficulty to breathe and asthma.
Sensitization is a term which refers to the reaction to an allergen which induces a production to allergen-specific IgE. However, it does not cause the individual to develop symptoms upon exposure.
It is usually demonstrated by skin testing or immunoassays for IgE to specific allergens. It means that sensitization is required but not sufficient for the development of the allergic disease.
Someone is considered to have an allergic disease if they both have allergen-specific IgE and develop symptoms when exposed to that allergen. Therefore, there is a discrepancy among the population sensitized to an allergen and individuals who develop a clinical allergy.[9] There are both hereditary and environmental factors which matter in the development of allergies.
6.2. Determinant factors in the development of allergy.
The modern, highly industrialized, postmodern civilization and living habits of today have been standard for around one century and represent a few millionth parts of 1% of the evolution of
mammals. In an evolutionary perspective, the way we are living our lives in modern society is a lifestyle not yet adapted to our primitive natural environmental conditions.
The research in this topic up to this date states that the most likely dominant factors in the development of allergy are environmental factors and not genetics. Given the fact that the modern Homo Sapiens evolved in about 200,000 years ago, the period necessary for a subpopulation of the to develop genetic changes that render them susceptible to allergic diseases is too short to be the cause of the marked increase seen in the incidence of allergies since the industrial revolution. You could also see
supporting evidence to this conclusion by looking at statistics concerning allergies in young twins. The evidence that there are discordant identical-twins and that they can differ in the contraction of allergic disease; although not in most of the cases, support this hypothesis. [10–12] This does not state that the genetic background of an individual does not matter. It has been shown that the combination of alleles (haplotypes) of MHC class I and II antigens, the germline batteries of V, D and J elements, and the polymorphism of various molecules of gene segments may affect an individuals ability to recognize sequences of peptides or conformation of antigens, elicit T cell response of synthesize different IgG, IgE or other antibodies toward an antigen.[13] These are all factors which play a part in the risk of an individual to develop an allergic response to specific environmental antigens.
The hygiene hypothesis is a theory that is based on the presumption that microorganisms, parasites and other contagious agents contribute to strengthening the immune system. Stated in this hypothesis is that the risk of having an allergic or autoimmune disease is increased due to the
decreased subjugation of these contagious agents. The theory was first coined in a study conducted by professor David Strachan, which stated that the observed increase in allergies in children was
correlated with those children in these days are not subjected to bacteria to the same extent as before and are subjected to fewer infections during childhood.[14] Over the past two decades, several epidemiological and immunological researchers have found evidence supporting this hypothesis. For example, it has been shown that children cared at home due to less exposure to cross-infection, are more likely to develop allergies than those cared for at nurseries.[15]
However, recent studies criticize the hygiene hypothesis due to the neglection of the impact of changes in the biodiversity of environmental antigens. The focus of the hygiene hypothesis article was not about the connection of change in biodiversity in food, house, soil and skin microorganisms. The focus was not present in the recent review of the hygiene hypothesis by Platts-Mills either.[16] The
immunological mechanisms suggested by the hygiene hypothesis stress that the lack of frequent
microbial infections elevates the TH2 pathway someway. Other research in the topic concludes that the reason why the elevated TH2 response is due to the drastic change of environmental antigens we are in contact with. The fact that in modern societies, the dramatic rise of allergy, is directed toward a limited number of very few environmental antigens out of the millions of environmental substances that we are facing naturally in nature is a suggestion of this. Among these few allergens that are causing most of the allergic response are dust, mites, animal dander, pollen of a few species of trees, grasses and weeds. This phenomenon was explained and added to the "Hygiene hypothesis" by Tse Wen Chang as
"skewed antigen exposure theory". The theory stated that a changing pattern of antigen exposure causes an increase in allergy. [2,17] Due to the development of "hygiene-conscious" lifestyles of modern societies, the only remainder of major protein antigens that induce mucosal IgE-production to appear to be potentially allergic substances in the air and food. This may be a cause of the observed increase in food allergies, allergic dermatitis (AD), seasonal allergic rhinitis(AR) and allergic conjunctivitis(AC).
6.3 Prevalence of allergies
As stated in the several studies conducted to research the prevalence rate of allergies in the world, we can see that the allergic diseases have been increasing in prevalence the last couple of decades. It has been put forth extensive efforts to study the prevalence of allergic diseases. The results have been conclusive - allergies are on the rise. However, there have been observed differences in prevalence in different places of the world. In one of the most extensive worldwide study up to date, the ISAAC study surveyed approximately 460,000 children in 56 different countries. Researchers observed the self-reported 12-month prevalence rate of AR, AD and asthma have been seen to range between (range 1.4-39.7%), (range 0.3-20.5%) and (range 1.6-36.8%) respectively.[18] The results suggested that there are significant geographical differences in prevalence rates throughout the world.
These differences in prevalence rates of allergic diseases are also found in other extensive studies. In one of the most significant studies up to date in Europe, the ECRHS study (conducted in 2001), analyzed information about allergies in around 120,000 individuals and from 22 countries in Europe.
The prevalence data they acquired was found to correlate well to the ISAAC study, where the prevalence rates differed in correlation to geographical differences.[1] The prevalence of respiratory
symptoms and asthma was found to be high in Australia, New Zealand, United States, Ireland and the UK and low in Iceland, parts of Spain, Germany, Italy, Algeria and India. [19] Studies measuring sensitization have also shown that children from former socialist Eastern Europe states have lower prevalence rates of atopy and asthma than children in Western Europe. [20] In more recent studies, these geographical differences between regions seem to last, although, in some areas, the rise of allergies seems to have plateaued.[21] In a meta-analysis researching prevalence rates of food allergies in Europe, they observed the lifetime self-reported prevalence rate to common foods ranged from 0.1 to 6.0%. There could also be seen differences in prevalence rates that correlated with geographical differences in this study. Food allergies to most foods, except soy and peanut, were observed to be higher in Northern European countries. [22] Frequent studies of prevalence rates of allergic diseases throughout the world had seen that the countries in Asia had substantially lower prevalence rates than those of "Western countries". These substantial differences in prevalence rates have slowly been converging towards a more similar prevalence rate as the western countries, although they still have not fully reached the prevalence rates of the west. [21]
Regarding the prevalence of drug allergies. In a large systematic review of observational studies assessing the prevalence of self-reported drug allergies, where they acquired self-reported data from fifty-three studies and around 120,000 participants. Data concluded the prevalence rate of self-reported drug allergies to be 8.3% (range 0.7-38.5% depending on the study). The most frequently reported culprit drug classes were antibiotics, nonsteroidal anti-inflammatory drugs(NSAIDs), and anaesthetics.
[23] In Krakow, where they conducted a study on the parental-reported drug allergy in school children, they surveyed over 4000 participants and showed that the prevalence of drug allergy according to answers given by parents was 3.38%. The most commonly reported drugs in this study were penicillin and its derivatives(39%), sulphonamides(25%), cephalosporins (9%) and NSAIDs (8%).[24]
6.4 Allergies and quality of life.
The observation that allergic diseases have a negative impact on the quality of life (QoL) has been studied and confirmed in several studies. In a prospective observational cross-sectional study, researchers evaluated the impact of AR in 990 patients. They concluded that ocular symptoms, and to a lesser degree, nasal obstruction and pruritus have a significant impact on QoL.[25] Another study, the Nasal Allergy Survey Assessing Limitation (NASAL), showed that people with AR, compared with the general population, complained more about sleep disturbances as a result of their nasal symptoms.
They also showed that more than half of the individuals with AR describe their symptoms as impacting daily life to a lot or a moderate degree. [26]When researching the impact on food allergy has on the QoL, it has been shown that it has a strong impact in terms of social, dietary, and psychological
factors. The restrictions with food that impact individuals with food allergies are shown to extend far beyond mealtimes. Social events and interactions are experienced differently in people with food allergies. [27,28]
7. RESULTS
A total of 160 students 73 (45.6%) males and 87 (54.4%) females were included. The mean age was 24 ± 2.6 years. The characteristics of the study population are shown in Table 1. A female
overrepresentation was shown in atopic dermatitis and food allergies. Details of gender-based distribution of allergies are detailed in Table 2.
Table 1: Sociodemographic characteristics of study participants.
Characteristic Item Number Percentage (%)
Gender Male 73 45.6
Female 87 54.4
Age Mean ± standard deviation 24 ± 2,6
Total participants 160 100
Eastern Europe 18 11.3
Western Europe 16 10.0
Northern Europe 45 28.1
Nationality Central Europe 24 15.0
Middle east 41 25.6
East Asia 2 1.3
North Asia 1 0.6
South Asia 10 6.3
Africa 3 1.9
Table 2: Gender-based distribution of allergic disorders among university students.
Allergies Male Female Total P value
Allergic conjuctivitis 26 (35.6%) 40 (46.0%) NS
Allergic dermatitis 15 (20.5%) 32 (36.8%) <0.05
Eczema 11 (15.1%) 18 (20.7%) NS
Dust allergies 20 (27,4%) 22 (25.3%) NS
Food allergies 6 (8.8%) 18 (23.7%) <0.05
Drug allergies 7 (9.6%) 6 (6.9%) NS
Pollen allergies 16 (21.9%) 18 (20.7%) NS
NS. Indicates not statistically significant corrolation.
The common allergies self-reported by the students included AC 66 (41.3%). AD 29 (18.1%), AR 101 (63.1%) food allergies 25 (15.6%) and eczema 47 (29.4%). Among those who reported affliction of AR reported the main symptoms to be sneezing 68, (68.0%), running nose 76, (76.0%) and blocked nose 63, (63.0%). Among those who reported affliction of AC reported the main symptoms to be redness (35, (53.0%), itchy eyes 46, (69.7%) and watery eyes 44, (66.7%). The details of self-reported allergies based on frequency are detailed in Figure 1.
Figure 1. Distribution frequency based on allergies. AR: allergic rhinitis; AC: allergic conjunctivitis; AD: allergic dermatitis.
Among those who reported food allergies reported the main allergies to be “Other” 13, (52.0%), other nuts 5, (20.0%) and shellfish 4, (16.0%). The details of allergies based on different food sources are detailed in Figure 2.
Figure 2. Frequency of allergies based on different foods.
The students that reported a sole single allergic disorder was 38 (23.8%). AR and AC were coexistent in 33 students (20.6%), and the coexistence of AR and AD were in 9 (5.6%). Among the students that had a history within the family of AD, 12 (33.3%) subsequently had AD (P<0.01). Among the students that had a history within the family of AC, 19 (67.8%) subsequently had AC, (P<0.01). Regarding what time of the year the students felt that they had the most problems with their allergies, it showed that the students had more problems during the spring season (March-May).
There was found no statistically significant correlation between allergies and where the students had spent most of their lives. (P>0.05)
The students reported that there was in fact, interference with their daily activities, academic activities, and extra-curricular social activities due to allergies. AD interfered with daily activities in extra- curricular activities, attending social gatherings and college attendance in 7 (28.0%), 1 (8.3%) and 2 (20.0%). AR interfered with daily activities in extra-curricular activities, attending social gatherings and college attendance in 23(92.0%), 10(83.3%) and 8 (80.0%). The interference of daily activities by AD and AR was found statistically significant (P<0.05). The details about specific allergy impact on daily activities are detailed in Table 3.
Table 3: Impact of allergies on daily activities.
Allergies Extracurricular activities Social gatherings Collage attendence
Allergic conjuctivitis 17 (10.3%)* 5 (75.0%)* 8 (80.0%)
Allergic dermatitis 7 (28.0%) 1 (8.3%) 2 (20.0%)
Allergic rhinitis 23 (92.0%)* 10 (83.3%) 8 (80.0%)*
Dust allergies 9 (36.0%) 8 (66.7%)* 7 (70.0%)*
Food allergies 6 (8.8%) 3 (25.0%) 4 (40.0%)
Drug allergies 2 (8.0%) 2 (16.7%) 2 (20.0%)
Pollen allergies 8 (32.0%) 4 (33.3%) 5 (50.0%)*
*. Indicates statistically significant corrolation. (p<0.05)
The most common food allergies were associated with milk, other nuts, and others. Drug allergies were reported by 13 (8.1%) students, most frequently to penicillin antibiotics.
7. DISCUSSION
In our study sample, we saw an overrepresentation of allergies among women, with a majority of students aged 24 years old.
The affirmative response rate of AR (63.1%) in this study is an outlier, but it is not completely surprising. In a much larger study (n=7988) conducted 2013 in Germany, the prevalence of AR was found to be 12%. [29] In one of the largest epidemiological studies in the pacific-Asia region
conducted on allergies rhinitis up to date, the Allergies in Asia-Pacific Survey, the overall prevalence rate was reported to be 8.7%. The 12-month prevalence rate for AR was not an extreme outlier as you can find results in this range in similar studies conducted in Bangkok university where the 12-month prevalence was found to be 61%.[30] The unusually high response rate could also be a result of a misinterpretation of the question in the survey. If you use eye symptoms as a surrogate for the
diagnosis, as recommended by the ISAAC committee, the predictive value for the prevalence of AR is considered to be higher. [31] If you exclude those who stated that they did not have any eye symptoms, the 12-month prevalence of AR dropped to 20.6%. This value is a lot closer to results more similar to other epidemiological studies conducted in Ankara (12.3%), Bangkok (26%) and Hongkong (22%).
[32], (8), [33]
The 12-month prevalence of AD among students in this study was surprisingly high, at 18.1%.
The prevalence of AD in the past 12 months was higher than previously conducted studies. In comparison to other studies in Germany, an epidemiological study was conducted to find out the prevalence of allergic diseases in adults, and their results showed a 3.5% 12-month prevalence of AD.
Croatia where they studied the prevalence of AD in primary school children they saw that the 12-
month prevalence rate was 5.34%.[34] It has conducted far more comprehensive epidemiological studies on the prevalence of allergic diseases on children than adults. This is because there is more medical record data to obtain from the primary schools' physical examinations. However, we also know that AD is found more frequently in young adults than older people and that the 12-month prevalence is substantially higher in women than men.[35] The high 12-month prevalence in this study may be a result of a lower number of participants that skewed the result, a younger study population and a majority of women who answered the survey. Therefore, we should treat the result of the 12- month prevalence concerning the factors which are mentioned above. In a cross-sectional study of 5412 children conducted in Edirne, Turkey, the last 12-month prevalence for atopic dermatitis to be 0.9%.[32] In contrast, a similar study of 31,201 children conducted in Seoul, the prevalence was found to be 14.5%.[36] The largest study up to date is the ISAAC study where the prevalence was found to be between 0.3-20.5%, with noticeable prevalence differences in different regions of the world.[18]
These geographical differences could not be seen in the result of this study.
In the present study, 15.6% stated that they were allergic to foods. If they answered with an affirmative response to the question, they were subsequently asked to specify to what food they were allergic to from a selection of most common food allergy items. The respondents of this study were most allergic to "other", milk, shellfish, and other nuts (not peanuts). When comparing this data to other studies researching the prevalence of food allergies, it was comparingly high. In the National Health and Nutrition Examination Survey (NHANES) conducted in the United States, where a total of 20,686 individuals were surveyed between 2007 and 2010, and they found a self-reported food allergy prevalence rate at 9.72% in adults. In the NHANES study, "Other", milk, peanut and shellfish were the most common self-reported allergies in both children and adults.[37] In a questionnaire-based study conducted in Taiwan, where they surveyed a total of 30,018 individuals, the prevalence rate was found to be 6.40%. In this study, the most commonly reported food allergen was shell food, mango, milk and peanuts. [38] In larger epidemiological studies and meta-analyses conducted to try to research the prevalence rate using electronic health records and IgE-sensitization to common food allergens, the cumulative prevalence of food allergies was found to be between 3-6%. The most common food allergen in these studies was shellfish, fruit or vegetable, milk, and peanut. [39,40] The data suggests that the most common food allergen seems to be approximately the same throughout different
conducted studies where shellfish and milk seem to be the biggest culprits in food allergies. The increased prevalence of food allergies found in this study compared to the other studies mentioned could be a result of the lower respondent participant rate. Therefore, the results could be skewed. If the study registered more responses, the data would presumably normalize in a range more like the
previously mentioned more thoroughly conducted studies.
Lithuanian University of Health Sciences, as a university, has students from a wide variety of places throughout the world. As seen in the participants of the study, there were respondents from 24 countries and five continents. In this study, we could not see a statistically significant correlation between where the respondent had lived the majority of their lives and prevalence of allergies p>0.05.
Data differ from previously observed among trends in allergies, where you could spot geographical differences in the prevalence of allergic diseases. In the European Community Respiratory Health Survey (ERCHS) conducted in 2001, they analyzed information about allergies in around 120,000 individuals and from 22 countries in Europe to attain the data about the state of allergic diseases in Europe. They concluded that there were statistically significant differences in the prevalence of allergic diseases in different regions of Europe. It showed that the prevalence of allergic diseases was lower in Eastern Europe former socialist countries than in Western Europe. [1] Similar results were seen in the ISAAC study.[18] This geographical correlation was not found in this study. One reason for this might be that there is evidence that the prevalence of allergic diseases is increasing in
correlation with the economic development of the country.[41–44] The rising prevalence of allergies is generally seen as being associated with various aspects of a "Western lifestyle". The economic
development of the Eastern European countries, and the subsequent subscription of a "Western lifestyle" ideology that is common in developed countries, may have resulted in an increase of the prevalence of allergic diseases since the ERCHS and ISAAC studies were conducted. Evidence to support this hypothesis is what we saw happened since the time of reunification of the German states that made up former East Germany. The previously considerably lower prevalence rates of allergic disease in Eastern Germany now has converged with the rest of Western Germany because the two regions have become more similar.[45] The correlation could also not be seen in this study because of uneven distribution or not sufficiently high number of respondents from the different countries.
In this survey, 122 (76%) of the respondents, responded to be afflicted with at least one allergic condition. The allergic diseases were also related to the interference in daily activities with the most interfering allergies being rhinitis, dermatitis, and food allergies p<0.05. In a large study researching the impact of allergies on the QoL, it stated that most participants reported that AR impacted their QoL with nearly one-half citing impairments in school/work performance/productivity. [46] Compared to this study where the interference in daily activities was shown to have similar results where we saw that it interrupted daily activities in more than ¾ of the cases. These observations in the studies
mentioned above are in tune with the results of this study, where it was shown that the allergic diseases interfered with daily activities of students.[25–28]
8. CONCLUSION
Allergic rhinitis and allergic dermatitis were the most frequent allergies reported. Significant numbers of university students are suffering from allergic diseases, particularly from allergic rhinitis.
The allergy was seen to disrupt the daily activities of students. No geographical differences were found to correlate with allergies. The observations of the study highlight the need for further studies with a larger sample to determine the true prevalence and test if geographical differences still correlate with allergies in Europe. Adequate preventive strategies such as creating awareness of the allergic disease, risk factors and treatment options can bring down mortality, morbidity and disability caused by this public health problem.
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10. ANNEXES
The prevalence of allergic diseases in medical students
This study aimed to assess the prevalence of allergies among medical students from the Lithuanian University of Health Sciences. All data will be processed with ultimate confidentiality, and your responses will be registered anonymously.
* Required
1. Gender *
Mark only one oval.
Female Male
2. Age *
Example: December 15, 2012
3. Country where you spent majority of your life. *
4. In the past 12 months, have you had a problem with sneezing, or a runny, or a blocked nose when you did not(!) have a cold or flu? *
Mark only one oval.
Yes Skip to question 5.
No Skip to question 6.
5. If Yes, please specify.
Check all that apply.
Sneezing Runny nose Blocked nose
6. In the past 12 months, have you ever had redness or itchy-watery eyes? * Mark only one oval.
Yes Skip to question 7.
No Skip to question 8. 1
7. If Yes, please specify Check all that apply.
Redness Itchy eyes Watery eyes
8. In the past 12 months, have you ever had an itchy rash(eczema)? * Mark only one oval.
Yes No
9. In the past 12 months, have you ever had atopic dermatitis? * Mark only one oval.
Yes No
10. In which of the past 12 months do you have these previously mentioned problems?
*
Check all that apply.
January February March April May June July August September October November December
None of the above 11. Are you allergic to Dust?
Mark only one oval.
Yes No
2
12. Are you allergic to any Drugs?
Mark only one oval.
Yes Skip to question 13.
No Skip to question 14.
12. Please specify Drug or Drug Group.
13. Are you allergic to pollen?
Mark only one oval.
Yes Skip to question 15.
No Skip to question 16.
14. If Yes, please specify.
Check all that apply.
Trees Grasses Weeds
15. Are you allergic to any Food?
Mark only one oval.
Yes Skip to question 17.
No Skip to question 18.
16. If Yes, please specify.
Check all that apply.
Milk Egg Wheat Fish Shellfish Soya Peanut Other nuts Other
3
17. Do any of your family members have any of the following allergies? -> Allergic Dermatitis * Check all that apply.
Mother Father Brother Sister
None of the above
18. Do any of your family members have any of the following allergies? -> Allergic conjunctivitis
*
Check all that apply.
Mother Father Brother Sister
None of the above
19. Do any of your family members have any of the following allergies? -> Allergic rhinitis * Check all that apply.
Mother Father Brother Sister
None of the above
20. Do any of your family members have any of the following allergies? -> Food allergies * Check all that apply.
Mother Father Brother Sister
None of the above 4
21. Has your allergies interfered with any of the following? * Check all that apply.
College attendance Exam performance Daily Activities
Attending social gathering
Extra-curricular activities (sports, hobbies, exercise…) None of the above
5
