1. VALIDATION OF THE QUESTIONNAIRE SURVEY RESULTS IN IDENTIFICATION OF ATOPY IN SCHOOL CHILDREN INSTITUTE OF OCCUPATIONAL MEDICINE AND ENVIRONMENTAL HEALTH SOSNOWIEC - POLAND

2. INTRODUCTION Within the study supported by a grant from the Polish Scientific Research Committee (KBN - 4 PO5D 07517) the identification of atopic subjects was done by skin prick testing (SPT). Protocol for SPT followed methods used in ISAAC and CESAR study. Skin prick tests have been conducted in children living in rural environment in Poland. All study methods have been approved by the ethics committee and written consent was obtained from the parents of children.

3. OBJECTIVES 1. To determine - by SPT - the prevalence of atopy in children living in rural environment. 2. To examine the reliability of the questionnaire survey results in identification of atopy.

4. METHODS * Cross-sectional design * Rural study areas in Silesian voivodeship: community Wielowies/Rudziniec * Primary school children, aged 7-11 years * Questionnaire distributed via schools completed by parents * SPT performed in the schools - the panel of six common aeroallergens (SoluPrick SQ, ALK) Dermatophagoides pteronyssinus, Dermatophagoides farinae, Cat dander, Alternaria tenuis, Mixed grasses, Mixed trees * An allergen mean weal diameter of 3 mm or more was defined as positive SPT - presence of atopy

5. STATISTICAL ANALYSIS Assessment of diagnostic validity of the question when compared with the atopy occurrence by SPT ------------------------------------------------------------------------- Atopy occurrence (Golden standard) (+) (-)Total Answer Positive a ba + b Negative c dc + d Total a + c b + d a + b + c + d Sensitivity = a / a + c Specificity = d / b + d Positive predicitive value = a / a + b Negative predicitive value = d / c + d

6. STUDY SUBJECTS Invited: 912 children Health questionnaire: 739 children Tested: 661 children Tested and completed questionnaire: 637 children boys 309 / 48.5% girls 328 / 51.5%

7. The prevalence (in %) of atopy based on SPT

8. Assessment of diagnostic validity of the question (in %): prevalence (1), sensitivity (2), specificity (3), positive predicitive value (4), negative predicitive value (5) 1 2 3 4 5 Chronic cough 8.8 16.7 91.9 21.4 89.8 Chest wheezing: ever 15.9 25.0 84.6 17.8 90.0 Chest wheezing: last year 6.8 15.3 93.1 25.6 89.9 Attacks of dyspnea with chest wheeze 4.6 12.5 96.1 31.0 89.8 Dgn of of asthma 1.6 4.2 98.8 30.0 89.1 Dgn of bronchitis 47.1 44.4 52.6 10.7 88.4 Sneezing nose 24.7 41.7 77.4 19.1 91.4 Attacks of sneezing 9.7 23.6 88.5 27.4 90.3 Itching skin rash 6.6 15.3 94.5 26.2 89.9 Allergy to pollen 6.9 19.4 94.5 31.8 90.5 Allergy to house dust 3.8 16.7 97.2 50.0 90.3 Allergy to pets 3.0 13.9 97.5 52.6 90.3 Allergy to medication 2.8 2.8 97.2 11.1 88.8

9. CONCLUSIONS The occurrence of atopy (the overall frequency – 11.3%) was significantly associated with chronic cough (p=0.01), chest wheezing in the last year (p=0.005), sneezing nose (p=0.0001), eczema (p=0.001), allergy to pollen, house dust and pets (p=0.0001). The specifity of questions concerning respiratory / allergic symptoms and diseases ranged between 52.6% (dgn of bronchitis) and 98.8% (dgn of asthma); the sensitivity was low, ranging from 2.8% (allergy to medication) to 44.4% (dgn of bronchitis). Good specificity of the symptoms supports the opinion that questionnaire could be used as the first step in screening for atopy and should be followed by SPT, as the second, necessary screening procedure.