ArticleClinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology2019
Are environmental risk factors for current wheeze in the International Study of Asthma and Allergies in Childhood (ISAAC) phase three due to reverse causation?
Article in Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers.
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Who cites it
19 citing papers in PubMed, 35 citations in OpenAlex.
- Environmental risk factors for allergic rhinitis differ by income level: A Global Asthma Network survey.Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology · 2026Article
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- Global, regional, and national burden of asthma from 1990 to 2021: analysis of data from global disease burden in 2021.BMC pulmonary medicine · 2025Article
- Patterns and trends in asthma incidence rates in main Asian and Western countries and their prediction to 2030.Chinese medical journal pulmonary and critical care medicine · 2024Article
- Potential asthma risk factors do not account for global asthma symptom prevalence patterns and time trends in children and adolescents.The World Allergy Organization journal · 2024Article
- Assessing the long-term economic impact of wheezing episodes after severe RSV disease in children from Argentina: a cost of illness analysis.BMJ public health · 2024Article
- The influence of early-life animal exposure on the risk of childhood atopic dermatitis, asthma and allergic rhinoconjunctivitis: findings from the Danish National Birth Cohort.International journal of epidemiology · 2023Article
- Global, regional, and national burden of asthma and its attributable risk factors from 1990 to 2019: a systematic analysis for the Global Burden of Disease Study 2019.Respiratory research · 2023Article
- Asthma occurrence in children and early life systemic antibiotic use: an incidence density study.Allergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology · 2023Article
- The burden of asthma among children and adolescents in Saudi Arabia: A national cross-sectional survey.The journal of allergy and clinical immunology. Global · 2022Article
- Asthma, bronchitis respiratory symptoms, allergies and home environment: how are they related?Postepy dermatologii i alergologii · 2022Article
- Association of infant antibiotic exposure and risk of childhood asthma: A meta-analysis.The World Allergy Organization journal · 2021Article
- Worldwide trends in the burden of asthma symptoms in school-aged children: Global Asthma Network Phase I cross-sectional study.Lancet (London, England) · 2021Article
- Reporting of "Theoretical Design" in Explanatory Research: A Critical Appraisal of Research on Early Life Exposure to Antibiotics and the Occurrence of Asthma.Clinical epidemiology · 2021Article
- Global Asthma Network Phase I study in Mexico: prevalence of asthma symptoms, risk factors and altitude associations-a cross-sectional study.BMJ open respiratory research · 2020Article
- Identification and seasonality of rhinovirus and respiratory syncytial virus in asthmatic children in tropical climate.Bioscience reports · 2020Observational
- Comparison of individual-level and population-level risk factors for rhinoconjunctivitis, asthma, and eczema in the International Study of Asthma and Allergies in Childhood (ISAAC) Phase Three.The World Allergy Organization journal · 2020Article
- Pet-Keeping in Relation to Asthma, Rhinitis, and Eczema Symptoms Among Adolescents in Kuwait: A Cross-Sectional Study.Frontiers in pediatrics · 2020Article
- Are environmental risk factors for current wheeze in the International Study of Asthma and Allergies in Childhood (ISAAC) phase three due to reverse causation?Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology · 2019Article
Corrections and comments
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Authors and funding
8 authors at 5 institutions in 3 countries.
Funding
Abstract
backgroundPhase Three of the International Study of Asthma and Allergies in Childhood (ISAAC) measured the global prevalence of symptoms of asthma in children. We undertook comprehensive analyses addressing risk factors for asthma symptoms in combination, at both the individual and the school level, to explore the potential role of reverse causation due to selective avoidance or confounding by indication.
objectiveTo explore the role of reverse causation in risk factors of asthma symptoms.
methodsWe compared two sets of multilevel logistic regression analyses, using (a) individual level exposure data and (b) school level average exposure (ie prevalence), in two different age groups. In individual level analyses, reverse causation is a possible concern if individual level exposure statuses were changed as a result of asthma symptoms or diagnosis. School level analyses may suffer from ecologic confounding, but reverse causation is less of a concern because individual changes in exposure status as a result of asthma symptoms would only have a small effect on overall school exposure levels.
resultsThere were 131 924 children aged 6-7 years (2428 schools, 25 countries) with complete exposure, outcome and confounder data. The strongest associations in individual level analyses (fully adjusted) were for current paracetamol use (odds ratio = 2.06; 95% confidence interval 1.97-2.16), early life antibiotic use (1.65; 1.58-1.73) and open fire cooking (1.44; 1.26-1.65). In school level analyses, these risk factors again showed increased risks. There were 238 586 adolescents aged 13-14 years (2072 schools, 42 countries) with complete exposure, outcome and confounder data. The strongest associations in individual level analyses (fully adjusted) were for current paracetamol use (1.80; 1.75-1.86), cooking on an open fire (1.32; 1.22-1.43) and maternal tobacco use (1.23; 1.18-1.27). In school level analyses, these risk factors again showed increased risks. CONCLUSIONS & CLINICAL RELEVANCE: These analyses strengthen the potentially causal interpretation of previously reported individual level findings, by providing evidence against reverse causation.
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