Multiple atopic sensitization and health care utilization in a cohort of immigrant children from a cross-sectional study of respiratory health and atopy in relation to poor-quality housing in Malmö, Sweden

Introduction: Exposure to allergens plays a role in the development of atopic sensitization and influencesallergic phenotype. The effects of exposure to relevant allergens both from the indoor and outdoorenvironment are complex. Immigrant children and their families are exposed to new spectra of seasonaland perennial allergens, and often new lifestyle factors, such as diet, and living conditions. Furthermorehealth literacy and accessibility of healthcare systems will play a role in what impact atopic diseases willhave on these populations.Methods: As part of a larger study into the health in its social context of an immigrant population living inpoor-quality housing in Malmö/Sweden, families with small children were identified from health care records(child treated in primary care with respiratory illness), and school records (matched for age range). Familieswere visited in their homes by health communicators fluent in their language. Family and individual levelhealth data, including skin-prick-tests (SPT) for a standard panel of aeroallergens, were analyzed togetherwith environmental exposures (mould, dampness, ETS, crowding and -in the part of the study presentedhere: health care utilization over 7 years at the primary care level (data linkage to relevant registries)Results: 130 families participated, with usable data for 359 children under the age of 13, and 230 parents.The overall exposure to potentially harmful factors was relatively high, the burden of atopy and respiratorydiseases was significant. 232 children under the age of 13 had SPTs performed, 48 of which were positive,of these 11 showed sensitization against 2 or more allergens. The spectrum of sensitizations wascomparable to a Swedish population (seasonal plant pollen; animal dander, moulds, and house dust mites(HDM). Utilization of primary health care resources amongst the polysensitized children was overallcomparable to that of a gender- and age-matched non-polysensitized control group (n=20) from the samecohort. Higher health care usage was seen in both groups only in children with a documented diagnosis ofasthma.Conclusion: In our cohort, it was rather the presence of an asthma diagnosis than polysensitization thatdrove higher utilization of primary health care resources, confirming that atopic sensitization in itself is not adisease state, but rather a marker of potential for atopic disease