Prevalence and early-life risk factors of school age allergic multimorbidity - the EuroPrevall-iFAAM birth cohort

Sigurveig T Sigurdardottir, Kristjan Jonasson, Michael Clausen, Kristin Lilja Bjornsdottir, Sigridur Erla Sigurdardottir, Graham Roberts, Kate Grimshaw, Nikolaos G Papadopoulos, Paraskevi Xepapadaki, Ana Fiandor, Santiago Quirce, Aline B Sprikkelman, Lies Hulshof, Marek L Kowalski, Marcin Kurowiski, Ruta Dubakiene, Odilija Rudzeviciene, Johanna Bellach, Songül Yürek, Andreas ReichSina Maria Erhard, Philip Couch, Montserrat Fernandez Rivas, Ronald van Ree, Clare Mills, Linus Grabenhenrich, Kirsten Beyer, Thomas Keil

Research output: Contribution to journalArticlepeer-review


Background: Coexistence of childhood asthma, eczema and allergic rhinitis is higher than can be expected by chance, suggesting a common mechanism. Data on allergic multimorbidity from a pan-European, population-based birth cohort study have been lacking. This study compares the prevalence and early-life risk factors of these diseases in European primary school children. Methods: In the prospective multicentre observational EuroPrevall-iFAAM birth cohort study, we used standardized questionnaires on sociodemographics, medical history, parental allergies and lifestyle, and environmental exposures at birth, 12 and 24 months. At primary school age, parents answered ISAAC-based questions on current asthma, rhinitis and eczema. Allergic multimorbidity was defined as the coexistence of at least two of these. Results: From 10,563 children recruited at birth in 8 study centres, we included data from 5,572 children (mean age 8.2 years; 51.8% boys). Prevalence estimates were as follows: asthma, 8.1%; allergic rhinitis, 13.3%; and eczema, 12.0%. Allergic multimorbidity was seen in 7.0% of the whole cohort, ranging from 1.2% (Athens, Greece) to 10.9% (Madrid, Spain). Risk factors for allergic multimorbidity, identified with AICc, included family-allergy-score, odds ratio (OR) 1.50 (95% CI 1.32–1.70) per standard deviation; early-life allergy symptoms, OR 2.72 (2.34–3.16) for each symptom; and caesarean birth, OR 1.35 (1.04–1.76). Female gender, OR 0.72 (0.58–0.90); older siblings, OR 0.79 (0.63–0.99); and day care, OR 0.81 (0.63–1.06) were protective factors. Conclusion: Allergic multimorbidity should be regarded as an important chronic childhood disease in Europe. Some of the associated early-life factors are modifiable and may be considered for prevention strategies.

Original languageEnglish
Early online date2 May 2021
Publication statusPublished - 8 Jun 2021


  • allergic multimorbidity
  • allergic rhinitis
  • asthma
  • children
  • eczema


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