Objective - To investigate the relation between different types of heating and the prevalence of atopic diseases, skin test reactivity, and bronchial hyperresponsiveness. Design - Cross sectional survey among schoolchildren aged 9-11 years. Skin prick tests, pulmonary function tests, and bronchial challenge in the children and self completion of a written questionnaire by the children's parents. Subjects - 1958 children in a rural area in southern Bavaria, Germany. Main outcome measures - Prevalence of asthma, hay fever, and atopic dermatitis as determined by parents' answers to a questionnaire; the atopic status of the child assessed by skin prick tests; and bronchial responsiveness to cold air challenge in the children. Results - After possible confounders were controlled for, the risk of developing hay fever (odds ratio = 0.57; 95% confidence interval 0.34 to 0.98), atopy defined as at least one positive reaction to a panel of common aeroallergens (0.67; 0.49 to 0.93), sensitisation to pollen (0.60; 0.41 to 0.87), and of bronchial hyperresponsiveness (0.55; 0.34-0.90) was significantly lower in children living in homes where coal or wood was used for heating than in children living in homes with other heating systems. Conclusions - Factors directly or indirectly related to the heating systems used in rural Bavarian homes decrease the susceptibility of children to becoming atopic and to developing bronchial hyperresponsiveness.
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