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. 2013 Jun 19;8(6):e67064.
doi: 10.1371/journal.pone.0067064. Print 2013.

Risk Factors Associated With the Development of Atopic Sensitization in Indonesia

Free PMC article

Risk Factors Associated With the Development of Atopic Sensitization in Indonesia

Firdaus Hamid et al. PLoS One. .
Free PMC article


Background: The prevalence of allergic diseases has increased not only in high income but also in low-to-middle income countries. However, risk factors for their development are still not well established, particularly in the latter.

Objective: To assess prevalence and identify risk factors for sensitization to two major inhalant allergens among children from semi-urban and rural areas in Indonesia.

Method: A cross-sectional survey was performed among 1,674 school children aged 5-15 years old. Information on potential risk factors and reported allergic symptoms were obtained by questionnaire. Helminth infections were assessed. Skin prick tests (SPT) were performed, total IgE as well as allergen-specific IgE for house dust mite (HDM) and cockroach were measured.

Result: The prevalence of allergic skin sensitization to both aeroallergens was significantly higher in the semi-urban than in the rural area. However, serum IgE against HDM and cockroach as well as total IgE were significantly lower in semi-urban than in rural children. In the semi-urban area, there was a significant positive association between SPT to HDM and higher paternal education but a negative one with hookworm infection. The risk factors linked to cockroach sensitization were different: being of a farmer offspring and lacking access to piped water were associated with an increased risk for a positive SPT to cockroach. No significant associations between measured risk factors and having a positive SPT were found in the rural area.

Conclusion: Sensitization to HDM and cockroach is common in Indonesia, more often translating into a positive SPT in the semi-urban than in the rural setting. Whereas high paternal education and low hookworm infection were associated with increased risk of SPT to HDM, we were surprised to find parameters of lower SES were identified as risk factor for cockroach SPT.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

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Grant support

This study was funded by The Royal Netherlands Academy of Arts and Science (KNAW), Ref. KNAW-05-PP-35, European Commission contracts INCO-CT-2006-031714 and INCO-CT-2006-032436, Glofal, FOOD-CT-2005-032436, and the Prof. Dr. P.C. Flu Foundation. FH has received an EAACI (the European Academy of Allergy and Clinical Immunology) Exchange Research Fellowship 2012 and a scholarship from the Directorate General of Higher Education (DIKTI) of the Ministry of Education Culture of the Republic of Indonesia. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.