ORIGINAL ARTICLE
Parental smoking and allergic rhinitis in children Maryam Salehi, MD1 , Mehdi Bakhshaee, MD3 , Sara Jafari Ashtiani, MD4 , Mona Najafi, MD2 , Samineh Sehatbakhsh, MD4 and Mana Hossainzadeh, MD4
Background: Parental smoking is one of the controversial risk factors associated with allergic rhinitis. The aim of this study was to investigate the relationship between parental smoking and allergic rhinitis; considering confounding factors.
0.22–5.05), family income (OR 0.60; 95% CI, 0.24–1.47), and parents’ education (OR 1.79; 95% CI, 0.61–5.20) were not statistically significant.
Methods: A cross-sectional study was conducted on 671 children aged 2 to 7 years. Random cluster sampling was used to select the participants. The signs and symptoms of allergic rhinitis in children were assessed through standard questionnaires and physical examinations.
C 2014 ARS-AAOA, LLC.
Results: In the multivariate analysis, parental smoking (odds ratio [OR] 1.07; 95% confidence interval [CI], 0.48– 2.41) was not a significant risk factor for allergic rhinitis; positive family history of allergy was the only significant factor among other factors (OR 23.64; 95% CI, 11.63–48.04). Sex (OR 1.16; 95% CI, 0.60–2.24), family size (OR 1.06; 95% CI,
A
llergic rhinitis is not a life-threatening disease in children; however, it has a considerable impact on their quality of life, as well as that of their caretakers. Allergic rhinitis also imposes a substantial economic burden on society. These children often have difficulty completing their schoolwork, as a result of the early onset of symptoms, usually beginning before school age.1–3 There has been an increase in the prevalence of allergic rhinitis,4 with 0.8% to 1 Immunology
Research Center, Mashhad University of Medical Sciences and Assistant Professor of Community Medicine, Community Medicine Department, Faculty of Medicine, Mashhad, Iran; 2 Department of Community Medicine, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; 3 Sinus and Surgical Endoscopic Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; 4 Sinus and Surgical Endoscopic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran Correspondence to: Mehdi Bakhshaee, MD, Associate professor of the Sinus and Surgical Endoscopic Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; e-mail: [email protected] Potential conflict of interest: None provided. Received: 11 August 2013; Revised: 22 November 2013; Accepted: 7 December 2013 DOI: 10.1002/alr.21286 View this article online at wileyonlinelibrary.com.
357
International Forum of Allergy & Rhinology, Vol. 4, No. 5, May 2014
Conclusion: The findings suggest that there is no significant relationship between parental smoking and allergic rhinitis.
Key Words: allergic rhinitis; smoking; passive smoking; parental smoking; children
How to Cite this Article: Salehi M, Bakhshaee M, Jafari Ashtiani S, Najafi M, Sehatbakhsh S, Hossainzadeh M. Parental smoking and allergic rhinitis in children. Int Forum Allergy Rhinol. 2014;4:357– 360.
39.7% of children affected in various parts of the world.5 Complications include otitis media with effusion, hypertrophy of adenoids, and asthma, all of which require treatment in children.2 According to a recent systematic review, 67% of research articles have found a significant relationship between sleep-disordered breathing and allergic rhinitis in children.6 Some risk factors such as family history of allergy are well known, but there are also some controversial risk factors associated with this disease. The risk factors include: parental smoking, sex, nutrition, living area,3 and socioeconomic status.7 A number of studies have investigated the effects of parental smoking on allergic rhinitis. About 43% of children between the ages of 2 to 11 years are exposed to tobacco smoke in the environment.8 Increased risk of allergic rhinitis has been shown among infants who were exposed to more than 20 cigarettes daily.8 In another study in Sweden, passive exposure to tobacco smoke at an early age was associated with increased reports of allergic symptoms. Children who had a family history of allergy and were exposed to cigarette smoke, were more at risk of allergic rhinitis.9 However, other studies have yielded contradicting results. For example, a study conducted in Istanbul discovered there was no association between allergic rhinitis in children aged 6 to 12 and exposure to cigarette smoke.5
Salehi et al.
TABLE 1. Univariate analysis of risk factors for allergic rhinitis with prevalence and ORs Allergic rhinitis Yes Variable
No
n
%
n
%
OR
95% CI
p
Male
95
51.9
228
46.7
1.23
0.87–1.73
0.23
Female
88
48.1
260
53.3
1
Ref.
Ref.
162
88.5
397
81.3
1.74
0.80–3.77
0.16
21
11.5
91
18.7
1
Ref.
Ref.
166
90.7
429
87.9
1.34
0.76–2.37
0.28
17
9.3
59
12.1
1
Ref.
Ref.
Yes
36
19.7
79
16.2
1.27
0.81–1.96
0.29
No
147
80.3
409
83.8
1
Ref.
Ref.
Yes
128
70.0
49
10.0
10.89–40.57
0.001
No
55
30.0
439
90.0
1
Ref.
Ref.
ࣘ3
124
67.8
306
62.7
1.25
0.87–1.79
0.22
ࣙ4
59
32.2
182
37.3
1
Ref.
Ref.
1.13
0.94
1.36
Sex
Father’s education Diploma and upper Under dipolma Family income Moderate and high Poor Parental smoking
Family history of llergy 21.02
Family size
Age, years (mean ± SD)
5.1 ± 0.9
CI = confidence interval; OR = odds ratio; SD = standard deviation.
The effect of parental smoking on the risk of allergic rhinitis in children has not yet been established. As a result, this cross-sectional study was performed to study the prevalence of allergic rhinitis among children aged between 2 and 7 and its relationship with parental smoking; considering other related factors.
Subjects and methods A cross-sectional study was conducted on 671 preschool children between the ages 2 and 7 from July 2011 to August 2012 in Mashhad, a city located in northeast Iran. The Ethics Committee of Mashhad University of Medical Sciences approved the study. Random cluster sampling was used to select the participants. The number of children selected was proportional to the population coverage of the regional welfare organizations. A questionnaire was used for data collection on the possible risk factors, including: age, gender, smoking status of parents, family education, income, family history of allergy, number of family members, and history of allergic rhinitis. The socioeconomic status of families was estimated accord-
ing to the educational level of parents and family income. The diagnosis of allergic rhinitis was based on the standard International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire along with physical examination. The standard ISAAC questionnaire is a valid instrument for diagnosing allergic rhinitis and has been used in other studies.10 The data was analyzed using SPSS software (version 11.5, Chicago, IL, US). Descriptive statistics were used to describe the quantitative (mean and standard deviation) and qualitative (frequencies) variables. Variables were entered into the binary logistic regression model and odds ratios (OR) with 95% confidence intervals (CIs) were calculated. The multivariate analysis was performed with an Enter method of logistic regression analysis. A p value of
Parental smoking and allergic rhinitis in children Maryam Salehi, MD1 , Mehdi Bakhshaee, MD3 , Sara Jafari Ashtiani, MD4 , Mona Najafi, MD2 , Samineh Sehatbakhsh, MD4 and Mana Hossainzadeh, MD4
Background: Parental smoking is one of the controversial risk factors associated with allergic rhinitis. The aim of this study was to investigate the relationship between parental smoking and allergic rhinitis; considering confounding factors.
0.22–5.05), family income (OR 0.60; 95% CI, 0.24–1.47), and parents’ education (OR 1.79; 95% CI, 0.61–5.20) were not statistically significant.
Methods: A cross-sectional study was conducted on 671 children aged 2 to 7 years. Random cluster sampling was used to select the participants. The signs and symptoms of allergic rhinitis in children were assessed through standard questionnaires and physical examinations.
C 2014 ARS-AAOA, LLC.
Results: In the multivariate analysis, parental smoking (odds ratio [OR] 1.07; 95% confidence interval [CI], 0.48– 2.41) was not a significant risk factor for allergic rhinitis; positive family history of allergy was the only significant factor among other factors (OR 23.64; 95% CI, 11.63–48.04). Sex (OR 1.16; 95% CI, 0.60–2.24), family size (OR 1.06; 95% CI,
A
llergic rhinitis is not a life-threatening disease in children; however, it has a considerable impact on their quality of life, as well as that of their caretakers. Allergic rhinitis also imposes a substantial economic burden on society. These children often have difficulty completing their schoolwork, as a result of the early onset of symptoms, usually beginning before school age.1–3 There has been an increase in the prevalence of allergic rhinitis,4 with 0.8% to 1 Immunology
Research Center, Mashhad University of Medical Sciences and Assistant Professor of Community Medicine, Community Medicine Department, Faculty of Medicine, Mashhad, Iran; 2 Department of Community Medicine, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; 3 Sinus and Surgical Endoscopic Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; 4 Sinus and Surgical Endoscopic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran Correspondence to: Mehdi Bakhshaee, MD, Associate professor of the Sinus and Surgical Endoscopic Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; e-mail: [email protected] Potential conflict of interest: None provided. Received: 11 August 2013; Revised: 22 November 2013; Accepted: 7 December 2013 DOI: 10.1002/alr.21286 View this article online at wileyonlinelibrary.com.
357
International Forum of Allergy & Rhinology, Vol. 4, No. 5, May 2014
Conclusion: The findings suggest that there is no significant relationship between parental smoking and allergic rhinitis.
Key Words: allergic rhinitis; smoking; passive smoking; parental smoking; children
How to Cite this Article: Salehi M, Bakhshaee M, Jafari Ashtiani S, Najafi M, Sehatbakhsh S, Hossainzadeh M. Parental smoking and allergic rhinitis in children. Int Forum Allergy Rhinol. 2014;4:357– 360.
39.7% of children affected in various parts of the world.5 Complications include otitis media with effusion, hypertrophy of adenoids, and asthma, all of which require treatment in children.2 According to a recent systematic review, 67% of research articles have found a significant relationship between sleep-disordered breathing and allergic rhinitis in children.6 Some risk factors such as family history of allergy are well known, but there are also some controversial risk factors associated with this disease. The risk factors include: parental smoking, sex, nutrition, living area,3 and socioeconomic status.7 A number of studies have investigated the effects of parental smoking on allergic rhinitis. About 43% of children between the ages of 2 to 11 years are exposed to tobacco smoke in the environment.8 Increased risk of allergic rhinitis has been shown among infants who were exposed to more than 20 cigarettes daily.8 In another study in Sweden, passive exposure to tobacco smoke at an early age was associated with increased reports of allergic symptoms. Children who had a family history of allergy and were exposed to cigarette smoke, were more at risk of allergic rhinitis.9 However, other studies have yielded contradicting results. For example, a study conducted in Istanbul discovered there was no association between allergic rhinitis in children aged 6 to 12 and exposure to cigarette smoke.5
Salehi et al.
TABLE 1. Univariate analysis of risk factors for allergic rhinitis with prevalence and ORs Allergic rhinitis Yes Variable
No
n
%
n
%
OR
95% CI
p
Male
95
51.9
228
46.7
1.23
0.87–1.73
0.23
Female
88
48.1
260
53.3
1
Ref.
Ref.
162
88.5
397
81.3
1.74
0.80–3.77
0.16
21
11.5
91
18.7
1
Ref.
Ref.
166
90.7
429
87.9
1.34
0.76–2.37
0.28
17
9.3
59
12.1
1
Ref.
Ref.
Yes
36
19.7
79
16.2
1.27
0.81–1.96
0.29
No
147
80.3
409
83.8
1
Ref.
Ref.
Yes
128
70.0
49
10.0
10.89–40.57
0.001
No
55
30.0
439
90.0
1
Ref.
Ref.
ࣘ3
124
67.8
306
62.7
1.25
0.87–1.79
0.22
ࣙ4
59
32.2
182
37.3
1
Ref.
Ref.
1.13
0.94
1.36
Sex
Father’s education Diploma and upper Under dipolma Family income Moderate and high Poor Parental smoking
Family history of llergy 21.02
Family size
Age, years (mean ± SD)
5.1 ± 0.9
CI = confidence interval; OR = odds ratio; SD = standard deviation.
The effect of parental smoking on the risk of allergic rhinitis in children has not yet been established. As a result, this cross-sectional study was performed to study the prevalence of allergic rhinitis among children aged between 2 and 7 and its relationship with parental smoking; considering other related factors.
Subjects and methods A cross-sectional study was conducted on 671 preschool children between the ages 2 and 7 from July 2011 to August 2012 in Mashhad, a city located in northeast Iran. The Ethics Committee of Mashhad University of Medical Sciences approved the study. Random cluster sampling was used to select the participants. The number of children selected was proportional to the population coverage of the regional welfare organizations. A questionnaire was used for data collection on the possible risk factors, including: age, gender, smoking status of parents, family education, income, family history of allergy, number of family members, and history of allergic rhinitis. The socioeconomic status of families was estimated accord-
ing to the educational level of parents and family income. The diagnosis of allergic rhinitis was based on the standard International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire along with physical examination. The standard ISAAC questionnaire is a valid instrument for diagnosing allergic rhinitis and has been used in other studies.10 The data was analyzed using SPSS software (version 11.5, Chicago, IL, US). Descriptive statistics were used to describe the quantitative (mean and standard deviation) and qualitative (frequencies) variables. Variables were entered into the binary logistic regression model and odds ratios (OR) with 95% confidence intervals (CIs) were calculated. The multivariate analysis was performed with an Enter method of logistic regression analysis. A p value of
