Is eczema really on the increase worldwide?

Hywel Williams, PhD,a Alistair Stewart, BSc,b Erika von Mutius, MD,c William Cookson, DPhil,d and H. Ross Anderson,
MD,e and the International Study of Asthma and Allergies in Childhood (ISAAC) Phase One and Three Study Groups
Nottingham and London, United Kingdom, Auckland, New Zealand, and Munich, Germany

Background: It is unclear whether eczema prevalence is truly

increasing worldwide. Abbreviation used
Objective: We sought to investigate worldwide secular trends in ISAAC: International Study of Asthma and Allergies in Childhood
childhood eczema.
Methods: Children (n 5 302,159) aged 13 to 14 years in 105
centers from 55 countries and children aged 6 to 7 years
(n 5 187,943) in 64 centers from 35 countries were surveyed from that eczema is common, with a range of 1-year period prevalences
the same study centers taking part in Phase One and Three of the from less than 2% in Iran and China to around 20% in Australasia,
International Study of Asthma and Allergies in Childhood by England, and Scandinavia.3 Eczema carries an economic burden
using identical validated and translated questionnaires. Eczema comparable with that of asthma,4 and the family stress related
was defined as an itchy, relapsing, flexural skin rash in the last 12 to the care of children with moderate or severe atopic dermatitis
months, and it was termed severe eczema when it was associated is greater than that of the care of children with type 1 diabetes
with 1 or more disturbed nights per week. mellitus,5 mainly because of sleep deprivation, employment loss,
Results: Annual prevalence changes in relation to average time to care for eczema, and financial costs.
prevalence across Phase One and Three were generally small Many reports seem to be saying that eczema, like other allergic
and differed in direction according to the age of the participants diseases, such as asthma and hay fever, has been on the increase
and world region. For children 13 to 14 years old, eczema over the last 30 to 40 years,6-8 yet there is very little good-quality
symptom prevalence decreased in some previously high- evidence to back such a claim.9-11 Such claims have often com-
prevalence centers from the developed world, such as the United pared successive prevalence surveys in the same country, yet
Kingdom and New Zealand, whereas centers with previously such comparisons are difficult to interpret because the surveys
high prevalence rates from developing countries continued to have often differed in terms of population age, sex, and geogra-
increase. In the children 6 to 7 years old, most centers showed phy.9 More importantly, disease definitions have varied between
an increase in current eczema symptoms. Similar patterns to successive surveys and range from maternal or self-reported ec-
these were present for severe eczema at both ages. zema through doctors’ diagnoses to positive answers from simple
Conclusion: The epidemic of eczema seems to be leveling or questionnaires and measures that involved skin examination, and
decreasing in some countries with previously high prevalence it is possible to create downward or upward trends, depending on
rates. The picture elsewhere is mixed, with many formerly which surveys are selected.9 Disease labeling by doctors and the
low-prevalence developing countries experiencing substantial fashionable use of the term allergy might have also contributed to
increases, especially in the younger age group. a pseudoepidemic of eczema in recent years. Some studies that
(J Allergy Clin Immunol 2008;121:947-54.) have used similar or identical methods from the same population,
along with secular trends for objective measures of atopy, such as
Key words: Eczema, atopic dermatitis, time trends, prevalence skin prick positivity, do, however, support the notion that a gen-
eral increase in eczema has occurred in some developed countries
Eczema1 (synonym atopic dermatitis) is an important skin dis- over the last 40 years.12-18 It has been unclear whether these iso-
ease worldwide.2 Data on eczema symptoms in more than half a lated findings have been happening elsewhere in the world or
million children participating in Phase One of the International whether eczema might have reached a plateau or a decrease in
Study of Asthma and Allergies in Childhood (ISAAC) show some countries.16 Knowledge of such secular trends is important
because they provide clues to the type and magnitude of possible
environmental causes of eczema, as well as informing prevention
From athe Centre of Evidence-Based Dermatology, University of Nottingham; bthe programs and public health planning by targeting those countries
School of Population Health, The University of Auckland; cUniversity Children’s and cities with anticipated epidemics.
Hospital, Munich; dthe National Heart and Lung Institute, London; and ethe Division
of Community Health Sciences, St George’s, University of London.
One of the main aims of Phase Three of the ISAAC study was to
Study collaborators are listed in full in Appendix E1 in the Online Repository at explore such secular trends for asthma, allergic rhinoconjuncti-
www.jacionline.org. vitis, and eczema in as many countries as possible by repeating
Disclosure of potential conflict of interest: The authors have declared that they have no identical, simple, validated questionnaire instruments on children
conflict of interest.
of the same age and area sampled in the same way 5 to 10 years
Received for publication August 23, 2007; revised November 7, 2007; accepted for pub-
lication November 7, 2007. after the initial Phase One survey.3,19 An overview of changes
Available online January 30, 2008. for all allergic diseases taken as a whole has been published
Reprint requests: Hywel Williams, PhD, Centre of Evidence-Based Dermatology, elsewhere.20 Here we report and discuss our detailed findings
Queen’s Medical Centre University Hospital NHS Trust, Nottingham NG7 2UH, on reported eczema symptoms for 302,159 children aged 13 to
United Kingdom. E-mail: [email protected]
0091-6749/$34.00
14 years from 105 centers in 55 countries and for 187,943 children
Ó 2008 American Academy of Allergy, Asthma & Immunology aged 6 to 7 years from 64 centers in 35 countries who participated
doi:10.1016/j.jaci.2007.11.004 in the Phase One and Three surveys.

947
948 WILLIAMS ET AL J ALLERGY CLIN IMMUNOL
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TABLE I. Questions on eczema symptoms used in ISAAC Phase One and Phase Three surveys for children 13 to 14 years old
and 6 to 7 years old (in parentheses)
1. Have you (Has your child) ever had an itchy skin rash that was coming and going for at least 6 months?
2. Have you (Has your child) had this itchy rash at any time in the last 12 months?
3. Has this itchy rash at any time affected any of the following places: the folds of the elbows, behind the knees, in front of the ankles, under the buttocks, or
around the neck, ears, or eyes?
If yes to question 3:
In the last 12 months, how often, on average, have you (has your child) been kept awake at night by this itchy rash? (Never in the last 12 months, less than
1 night per week, 1 or more nights per week).
All respondents were asked:
Have you (Has your child) ever had eczema?
For exact stem and branch structure and additional questions, please refer to the ISAAC manual.26

METHODS 1000) were also included, providing they fulfilled the criteria described in
the Phase Three manual.25
ISAAC study and centers
The ISAAC collaborative research initiative comprised 3 phases. In Phase
One 257,800 children aged 6 to 7 years in 90 centers and 463,801 children Analysis
aged 13 to 14 years in 155 centers from 56 countries around the world were All data submitted to the ISAAC International Data Centre were checked
surveyed by using standardized questionnaires to determine the prevalence of for coding errors, omissions, and inconsistencies and were corrected with the
eczema, asthma, and allergic rhinoconjunctivitis symptoms, the results of assistance of the collaborator. Symptom prevalences in each center were
which are reported elsewhere.3,21-23 Phase 2 involved more detailed objective calculated by dividing the number of positive responses to each question by
exploration of possible causative factors for allergic diseases in 9- to 11-year- the number of completed questionnaires. Because the duration between
old children in 30 centers from 22 countries.24 Phase Three is a repeat of Phase successive Phase One and Phase Three ISAAC surveys differed between
One to observe whether allergic disease symptom prevalences have increased different ISAAC centers (5-10 years), the main outcome was annual change in
in the 5 to 10 years since centers had undertaken Phase One. As many coun- prevalence, measured as the prevalence difference between Phase Three and
tries as possible were encouraged to take part on a voluntary basis. Additional Phase One studies divided by the number of years between the 2 surveys. We
centers from around the world that did not participate in Phase One have also present the time trend analysis by center. Data are presented in tabular form
been invited to join in Phase Three to provide a more comprehensive and up- with the Phase Three prevalence and annual change in prevalence for each
to-date map of global eczema prevalence. This article focuses on secular question. Regional and global summary data have been weighted by the
trends in those centers from around the world that successfully completed inverse of the variance of the estimates. Ranked prevalence plots of the change
both Phase One and Three studies by using identical survey methods described in prevalence between successive surveys ordered by average prevalence
in detail elsewhere.25 Briefly, 13 to 14 years is the recommended age group between the 2 surveys (which is statistically independent of the change in
who participate in the ISAAC study, and children at this age self-complete prevalence to avoid the phenomenon of regression to the mean) were
the questionnaire at their school. The 6- to 7-year-old children’s group is op- generated. The ranked prevalence plots also show 95% CIs about zero change
tional, and they take the questionnaire home for parental/guardian completion. for a given prevalence level given a sample size of 3000 and no cluster
Schools are the sampling units, with a minimum of 10 schools randomly sampling effect. The variance of prevalence change for a center is the sum of
selected per center (or all schools used in smaller centers). the variances of the 2 prevalences each adjusted by the design effect resulting
from sampling by school divided by the time interval between surveys. World
maps for both age groups were created, illustrating 5 categories calculated by
Disease definition
dividing average change per year by the SE of the change within centers such
The same standardized core questionnaires developed for use in Phase
that average prevalence reduced by 2 SEs or 1 SE or increased by 1 SE or
One were used. Questions on symptoms of eczema include both sensitive and
2 SE, with changes between these groups classified as no change.
specific questions, which are repeatable and have good content, construct,
Additional exploratory analyses included evaluating sex, wealth, and
concurrent, and predictive validity.3,26 The exact questions are shown in Table
language effects. Sex differences for changes in eczema symptom prevalence
I. A positive response to an itchy flexural rash in the last 12 months was used as
were explored by using a logistic regression model, testing for interaction
the main outcome measure. Eczema symptoms associated with sleep distur-
between sex and study phase. We also looked to see whether there was a link
bance 1 or more nights per week was used as a surrogate of severe eczema.
between trends in eczema over time and gross national income at country level.
Children were also asked whether they had ever had eczema (or an appropriate
In addition, we explored a possible English-language bias by looking at those
local term) to explore the effects of disease labeling. The translation of written
centers that reported data by using only English-language questionnaires
questionnaires in non–English-speaking countries followed a strict process
separately.
whereby they must have the same structure and logic as the English-language
questionnaire, were required to be back translated into English by an indepen-
dent translator, and had copies archived at the ISAAC International Data Cen-
RESULTS
tre. Translations had to be understandable by adolescents and parents by using
lay rather than medical language.27 Translation guidelines have been devel- Raw data
oped and included in the ISAAC Phase Three manual.25 Overall, Phase Three was completed with a mean of 7 years
after Phase One. Mean response rates at centers were 85% for
children 6 to 7 years old and 91% for children 13 to 14 years old
Sample size
(range, 64% to 100%). Tables E1 and E2 in the Online Repository
A sample size of 3000 participants per age group was recommended to
detect annual changes in prevalence in symptoms of 60.3% to 0.7% at 5% (at www.jacionline.org) show the actual prevalence data for
levels of significance with a power of 90% over the range of prevalences in ISAAC Phase One and Three for the 13- to 14-year-old and
ISAAC centers.25 The sample sizes are sufficiently large to allow good power 6- to 7-year-old age groups, respectively. Tables E1 and E2 also
in the presence of moderate intracluster correlations from school sampling. show mean changes in prevalence per year for eczema symptoms
Centers able to obtain fewer than 3000 participants (but no fewer than in the past year, severe eczema, and ever-reported eczema at the
J ALLERGY CLIN IMMUNOL WILLIAMS ET AL 949
VOLUME 121, NUMBER 4

FIG 1. Ranking plots depicting annual change in eczema prevalence (defined as symptoms of flexural
eczema in the last year) between the 2 ISAAC surveys on the horizontal axis against average prevalence
between the 2 surveys on the vertical axis. A, Children 13 to 14 years old. B, Children 6 to 7 years old. Coun-
tries are ordered by ascending average prevalence. The dashed lines denote 95% CIs about zero change for
a given prevalence level, given a sample size of 3000 and no cluster sampling effect. Red diamond points
denote countries that used English-language questionnaires.

center and regional level at each age. The raw data, along with relationship between the magnitude of change in prevalence
SEs, are presented in full for those wishing to know about absolute according to average prevalence. More centers demonstrated a
levels of prevalence and related changes in individual centers and 2-SE or greater increase in prevalence than a 2-SE or greater
regions for public health planning. decrease in prevalence (31 vs 22). There was no clear relationship
between change in prevalence and severe eczema symptoms
Ranked plots at age 13 to 14 years (see Fig E1 in the Online Repository at
Ranked prevalence plots for eczema symptoms in the last 12 www.jacionline.org). Absolute prevalence values for severe
months for children 13 and 14 years old and 6 and 7 years eczema symptoms were lower, and few changes reached 2
old are shown in Fig 1, A and B, respectively. For the children 13 SEs. Twenty-three centers showed a 2-SE or greater increase for
and 14 years old, no strong pattern emerges in Fig 1, A, for the severe eczema symptoms compared with 7 showing a 2-SE
950 WILLIAMS ET AL J ALLERGY CLIN IMMUNOL
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FIG 1. (Continued).

decrease. For self-report of ever having had eczema, many compared with 6 decreased by 2 SEs, as shown in Fig E4 in the
more centers showed an increase compared with a decrease Online Repository at www.jacionline.org).
(42 vs 8) at age 13 to 14 years (see Fig E2 in the Online
Repository at www.jacionline.org).
For children 6 and 7 years old, many more centers than in Maps
the 13- to 14-year-old data showed a 2 SE increase in mean Global maps depicting the geographic pattern of mean annual
annual prevalence change than a 2-SE decrease (36 vs 4, prevalence change according to 1 and 2 SEs of change for both
respectively), as shown in Fig 1, B. There was less difference ages are shown in Fig 2. For children 13 to 14 years old (Fig 2, A),
apparent for severe eczema (9 increasing 2 SEs and 5 dec- most of the largest decreases (2 SEs) in eczema symptom prev-
reasing 2 SEs, as in Fig E3 in the Online Repository at www. alence are seen in developed countries in Northwest Europe, such
jacionline.org). Many more centers showed an increase for as the United Kingdom, Ireland, Sweden, Germany, and also in
parental report of ever having eczema (38 increased by 2 SEs New Zealand. Most of the largest increases in prevalence were
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FIG 2. World maps of flexural eczema symptoms in the last year showing changes in the prevalence of
eczema symptoms for 13- to 14-year-olds (A) and 6- to 7-year-olds (B) in consecutive prevalence surveys
conducted 5 to 10 years apart.

seen in developing countries, such as Mexico, Chile, Kenya, and decreased in some countries with formerly very high preva-
Algeria, and in 7 countries in Southeast Asia. Fewer data points lences, such as the United Kingdom and New Zealand,3 provid-
are available for 6- to 7-year-old children in Fig 2, B, yet most ing some reassurance that an allergic disease epidemic is not
of the largest changes (2 SEs) denote increases in prevalence increasing inexorably throughout the world. A maximum preva-
and are located in Western Europe, Canada, South America, lence plateau of around 20% suggests that there might be a finite
Australasia, and the Far East. number of persons susceptible to developing eczema in any pop-
On further exploratory analyses, we did not find any differences ulation, rather than a distribution of risk whereby anyone could
in secular trends according to the sex of the study participant (data develop eczema if exposed to enough key risk factors.28 The
not shown) or with gross national income at a country level. Those situation is not so good for most countries included in the ISAAC
centers that used an English-language questionnaire are shown as survey, however, especially for children aged 6 to 7 years, where
red diamonds in the ranking plots (Fig 1). Apart from eczema most countries showed an increase of 2 SEs or greater in eczema
symptoms in the last year for children 13 to 14 years old showing symptoms over a 5- to 10-year period. The ratio of an increase
that fewer centers using the English-language questionnaire re- to decrease in eczema symptom prevalence of 2 SEs or greater
ported an increase of 2 SEs or greater in eczema prevalence was much greater in the 6- and 7-year-old group than in the
than reported a decrease (3 compared with 13, respectively), there 13- and 14-year-old age group (9-fold compared with 2-fold),
was little indication of any systematic English-language bias in suggesting a possible cohort effect in children born in the late
any of the other plots. 1990s or possibly better treatment over time in older children
with eczema. Changes in disease persistence might have also
occurred over time. For example, given that eczema often gets
DISCUSSION better around puberty, earlier pubescence might have accounted
Main findings for some of the reductions in eczema prevalence observed in
This study has shown that for children 13 to 14 years old, 13- and 14-year-olds. Very similar overall changes to the eczema
symptoms of eczema in the last year have leveled off or findings are seen for symptoms of allergic rhinoconjunctivitis,
952 WILLIAMS ET AL J ALLERGY CLIN IMMUNOL
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FIG 2. (Continued).

whereas relatively more centers reported a decrease in asthma factors could account for the changes described given the vast
symptoms for 13- and 14-year-olds.20 The different trends ac- number of putative environmental exposures and variations in
cording to age group are partly corroborated by a recent United genetic susceptibility for eczema that are likely to be acting
Kingdom study that uses a variety of databases to suggest that differently according to the population studied.31,32 Various risk
eczema and hay fever prevalence (diagnosed and symptoms) factors are also likely to change differently in different countries
might have leveled off or decreased over the last 10 years in those over time as a consequence of demographic factors that result in
aged 12 years or older, whereas it continues to increase for changes in family size, hygiene, and allergens. Risk factors, such
younger children.29 as atopy, might be significant in some developed countries but
less so in other developing countries, where changes in the
microbial environment in early life might be more important.33
Why is prevalence changing differently It is possible that important risk factors have yet to be discovered
around the world? or that several component exposures are needed to interact
The fact that large changes over the course of a period of 5 to 10 simultaneously in the presence of genetic predisposition. Alter-
years are seen in some countries argues that environmental factors natively, it is possible that what is now recognized as the pheno-
are key for eczema expression30 because it is highly unlikely that type of flexural eczema will eventually turn out to be a group of
genetic factors would change in such a short time, especially in several diseases with opposing risk factors that are missed when
cities that have not undergone large changes in migrants and data are aggregated. For example, recent research has suggested
immigrants. Most centers showed mixed changes in symptom that mutations in the genes that code for filaggrin, a protein
prevalence between the 3 allergic diseases over time in the found in the stratum corneum that plays a key role in ensuring
same centers,20 suggesting that environmental risk factors might integrity of the skin barrier, might play an important part in
be different for these 3 conditions. some populations with the eczema phenotype.34,35 It is plausible
No singular environmental or genetic risk factor adequately that excessive exposure to soaps in infants with filaggrin muta-
explains the changes in eczema symptoms described in this tions could disrupt the skin barrier, leading to low-grade skin
article. It is unreasonable to expect that just a few dominant risk inflammation and enhanced allergen penetration and hence
J ALLERGY CLIN IMMUNOL WILLIAMS ET AL 953
VOLUME 121, NUMBER 4

increased rates of subsequent atopic eczema.36,37 The increasing duration. For example, a 0.6% change per year in Algeria (Wi-
use of soaps, shower gels, shampoos, and other harsh cleansing laya) has meant that prevalence has doubled from 3.2% to 6.5%
products,38 especially in developing country cities undergoing in the 6-year period between successive ISAAC surveys. Eczema
rapid economic change, could be one reason for the comprehen- needs to be tackled at a public health level in many countries.
sive increase in eczema prevalence observed in our study and is There is already some evidence that eczema might be preventable
further supported by a previous cohort study that showed an to some degree,42 and there is plenty of evidence on effective
independent association between an increased hygiene score approaches to managing existing eczema symptoms43,44; both
(that included the frequency of washing/wiping hands and faces approaches should be considered in response to increasing dis-
and bathing practices of young children) and subsequent eczema ease levels in context to other local health needs. All public health
risk.39 responses to the eczema epidemic should ideally include an
evaluative component so that others in the world can understand
which approaches are more likely to be successful than others in
Strengths and limitations of this study different circumstances.
Strengths of the ISAAC study include its size, comprehen-
siveness, high response rates, inclusion of hitherto unstudied We are grateful to the children, parents, and school staff participating in
populations, and use of identical, standardized, and simple ISAAC. We thank the principal investigators and their colleagues listed in Ap-
validated questionnaire instruments based on eczema symptoms pendix E1 in the Online Repository at www.jacionline.org. Special thanks go
(as opposed to disease labels, such as eczema) in the same to Dr Michael Burr, Wales, for comments on data interpretation. Our thanks
centers during successive phases of the prevalence surveys. The also go to funding bodies throughout the world that supported ISAAC: the
validity of the diagnosis of eczema might have been compro- Health Research Council of New Zealand, the Asthma and Respiratory Foun-
mised by problems with translation or cultural conceptions in dation of New Zealand, the Child Health Research Foundation, the Hawke’s
some individual countries,40 but these are more likely to affect Bay Medical Research Foundation, the Waikato Medical Research Founda-
tion, Glaxo Wellcome New Zealand, the NZ Lottery Board and AstraZeneca
interpretations of absolute prevalence values than changes over
New Zealand, and Glaxo Wellcome International Medical Affairs.
time. The variable time period between the ISAAC Phase One
and Three surveys was taken into account by measuring annual
Clinical implications: Environmental factors are important for
mean prevalence change, although this does not mean that the
determining eczema expression.
changes over time were linear in those periods. It is possible
that seasonal effects could have diminished genuine secular
trends. The ISAAC protocol specified that sampling for Phase
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24. Weiland SK, Björkstén B, Brunekreef B, Cookson WO, von Mutius E, Strachan
DP, et al. Phase II of the International Study of Asthma and Allergies in Childhood
Institutet, Stockholm, Sweden), B. Brunekreef (Institute of Risk
(ISAAC II): rationale and methods. Eur Respir J 2004;24:406-12. Assessment Science, Universiteit Utrecht, The Netherlands), W.
25. Ellwood P, Asher MI, Beasley R, Clayton TO, Stewart AW, and the ISAAC Steer- Cookson (Asthma Genetics Group, Wellcome Trust Centre for
ing Committee. The International Study of Asthma and Allergies in Childhood Human Genetics, University of Oxford, Oxford, United King-
(ISAAC): Phase Three rationale and methods. Int J Tuberc Lung Dis 2005;9:10-6.
dom), J. Crane (Wellington Asthma Research Group, Wellington
26. ISAAC Steering Committee. International Study of Asthma and Allergies in Child-
hood Manual. Auckland/Münster; 1993. Available at: http://isaac.auckland.ac.nz/ School of Medicine, New Zealand), P. Ellwood (Department of
PhaseOne/Manual/ManFrame.html. Accessed December 3, 2007. Paediatrics, Faculty of Medical and Health Sciences, The Univer-
27. Weiland SK, Kugler J, von Mutius E, Schmitz N, Fritzsch C, Wahn U, et al. Die sity of Auckland, New Zealand), S. Foliaki* (Centre for Public
Sprache asthmakranker Kinder. Eine Untersuchung zur Symptombeschreibung. Health Research, Massey University, Wellington, New Zealand),
Monatsschrift fur Kinderheilkunde 1993;141:878-82.
U. Keil* (Institut für Epidemiologie und Sozialmedizin, der
28. Williams HC. What is atopic dermatitis and how should it be defined in epidemi-
ological studies?. In: Williams HC, editor. Atopic dermatitis—the epidemiology, Universität Münster, Germany), C. K. W. Lai* (Department of
causes and prevention of atopic eczema. Cambridge: Cambridge University Press; Medicine and Therapeutics, The Chinese University of Hong
2000. p. 3-24. Kong, SAR China), J. Mallol* (Department of Respiratory Med-
29. Gupta R, Sheikh A, Strachan DP, Anderson HR. Time trends in allergic disorders in icine, Hospital CRS El Pino, University of Santiago de Chile,
the UK. Thorax 2007;62:91-6.
30. Williams HC. Atopic eczema—why we should look to the environment. BMJ
Chile), C. Robertson (Department of Respiratory Medicine,
1995;311:1241-2. Royal Children’s Hospital, Parkville, Australia), E. A. Mitchell
31. Akdis CA, Akdis M, Bieber T, Bindslev-Jensen C, Boguniewicz M, Eigenmann P, (Department of Paediatrics, Faculty of Medical and Health Sci-
et al. Diagnosis and treatment of atopic dermatitis in children and adults: European ences, The University of Auckland, New Zealand), S. Montefort*
Academy of Allergology and Clinical Immunology/American Academy of Allergy,
(Department of Medicine, University of Malta, Malta), J. Od-
Asthma and Immunology/PRACTALL Consensus Report. J Allergy Clin Immunol
2006;118:152-69. hiambo* (Centre for Respiratory Diseases Research Unit, Kenya
32. Morar N, Willis-Owen SA, Moffatt MF, Cookson WO. The genetics of atopic der- Medical Research Institute, Nairobi, Kenya), N. Pearce (Centre
matitis. J Allergy Clin Immunol 2006;118:24-34. for Public Health Research, Massey University, Wellington,
33. Flohr C, Johansson SGO, Wahlgren CF, Williams HC. How ‘‘atopic’’ is atopic der- New Zealand), J. Shah* (Jaslok Hospital and Research Centre,
matitis? J Allergy Clin Immunol 2004;114:150-8.
Mumbai, India), A. W. Stewart (School of Population Health, Fac-
34. Palmer CN, Irvine AD, Terron-Kwiatkowski A, Zhao Y, Liao H, Lee SP, et al.
Common loss-of-function variants of the epidermal barrier protein filaggrin are a ulty of Medical and Health Sciences, The University of Auckland,
major predisposing factor for atopic dermatitis. Nat Genet 2006;38:441-6. New Zealand), D. P. Strachan (Division of Community Health
35. Morar N, Cookson WO, Harper JI, Moffatt MF. Filaggrin mutations in children Sciences, St Georges, University of London, London, United
with severe atopic dermatitis. J Invest Dermatol 2007;127:1667-72. Kingdom), E. von Mutius (Dr von Haunerschen Kinderklinik de
36. Cork MJ, Robinson DA, Vasilopoulos Y, Ferguson A, Moustafa M, MacGowan A,
et al. New perspectives on epidermal barrier dysfunction in atopic dermatitis: gene-
Universität München, Germany), S. K. Weiland (Department of
environment interactions. J Allergy Clin Immunol 2006;118:3-21. Epidemiology, University of Ulm, Germany), H. Williams (Cen-
37. Irvine AD. Fleshing out filaggrin phenotypes. J Invest Dermatol 2007;127:504-7. tre for Evidence Based Dermatology, Queen’s Medical Centre,
38. Soap and other detergents, except specialty cleaners (SIC 2841). In: Gale Encyclopedia of University Hospital, Nottingham, United Kingdom).
American Industries. The Gale Group, Inc; 2005 Available at:http://www.answers.com/
topic/soap-and-other-detergents-except-specialty-cleaners Accessed August 3, 2007.
39. Sherriff A, Golding J, Alspac Study Team. Hygiene levels in a contemporary ISAAC International Data Centre
population cohort are associated with wheezing and atopic eczema in preschool M. I. Asher, T. O. Clayton, P. Ellwood, and E. A. Mitchell,
infants. Arch Dis Child 2002;87:26-9.
40. Chalmers DA, Todd G, Saxe N, Tolosano S, Ngcelwane PN, Hlaba BN, et al. Val-
Department of Paediatrics, and A. W. Stewart, School of Popu-
idation of the United Kingdom Working Party diagnostic criteria for atopic eczema lation Health, Faculty of Medical and Health Sciences, The
in an African setting. Br J Dermatol 2007;156:111-6. University of Auckland, New Zealand.
J ALLERGY CLIN IMMUNOL WILLIAMS ET AL 954.e1
VOLUME 121, NUMBER 4

APPENDIX E1 Hong Kong (6-7 years), Professor Yu Lung Lau

Indonesia
ISAAC Phase Three principal investigators Bandung, Professor Dr Cissy B. Kartasasmita
(*national coordinator) Malaysia
Alor Setar, Dr Keng Hwang Teh
Africa (English-speaking) Klang Valley, Associate Professor Jessie de Bruyne*
Ethiopia Kota Bharu, Associate Professor Ban Seng Quah
Addis Ababa, Associate Professor Kibrebeal Melaku Philippines
Kenya Metro Manila, Professor Felicidad Cua-Lim*
Eldoret, Dr Fabian O. Esamai Singapore
Nairobi, Dr Lucy Ng’ang’a* Singapore, Associate Professor Daniel Yam Thiam Goh
Nigeria South Korea
Ibadan, Professor Babatunde O. Onadeko Seoul and Provincial Korea, Professor Ha-baik Lee*
South Africa Taiwan
Cape Town, Dr Heather J. Zar* Taipei, Dr Jing-Long Huang*
Thailand
Africa (French-speaking)
Bangkok, Dr Pakit Vichyanond*
Algeria
Chiang Mai, Associate Professor Muthita Trakultivakorn
Wilaya of Algiers (West Algiers), Professor Badia Benhabylès
Eastern Mediterranean
Morocco
Iran
Casablanca and Marrakech, Professor Zoubida Bouayad*
Tehran and Rasht, Dr Mohammed-Reza Masjedi*
Tunisia
Kuwait
Sousse, Professor M. Jerray
Kuwait, Dr Jawad A. al-Momen
Latin America Malta
Argentina Malta, Dr Stephen Montefort*
Córdoba, Dr Carlos E. Baena-Cagnani* Pakistan
Brazil Karachi, Dr Naseeruddin Mahmood*
Curitiba, Professor Nelson Rosário Sultanate of Oman
Porto Alegre, Dr Gilberto B. Fischer Al-Khodh, Associate Professor Omar Al-Rawas*
Recife, Dr Murilo de Britto Northern and Eastern Europe
Salvador, Associate Professor Leda de Freitas Souza Albania
São Paulo, Professor Dirceu Solé* Tiranë, Professor Alfred Priftanji*
Chile Estonia
Punta Arenas, Dr Lidia Amarales Tallinn, Dr Mall-Anne Riikjärv*
South Santiago, Dr Pedro Aguilar Finland
Valdivia, Dr Mario A. Calvo Kuopio County, Dr Juha Pekkanen*
Costa Rica Georgia
Costa Rica, Dr Manuel E. Soto-Quirós Kutaisi, Dr Maia Gotua*
Mexico Latvia
Cuernavaca, Professor Isabelle Romieu Riga, Dr Vija Svabe
Panama Lithuania
David-Panama, Dr Gherson Cukier Kaunas, Associate Professor Jolante Kudzyte*
Paraguay Poland
Asunción, Dr Jaime A. Guggiari-Chase Kraków, Associate Professor Grzegorz Lis*
Peru Poznań, Associate Professor Anna Bre˛borowicz
Lima, Dr Pascual Chiarella* Romania
Uruguay Cluj, Dr Diana Dumitrascu
Montevideo, Dr D. Holgado Russia
North America Novosibirsk, Professor Elena Kondiourina
Barbados Sweden
Barbados, Dr Malcolm E. Howitt Linköping, Dr Hartmut Vogt
Canada Ukraine
Saskatoon, Dr D. Rennie Kharkiv, Associate Professor Viktor Ognev*
United States Western Europe
Seattle, Professor Gregory J. Redding Austria
Asia-Pacific Urfahr-Umgebung, Kärnten, Associate Professor Gerald
China Haidinger*
Beijing, Professor Yu-Zhi Chen* Belgium
Guangzhou, Professor Nan-Shan Zhong Antwerp, Professor Joost Weyler
Hong Kong Channel Islands
Hong Kong (13-14 years), Professor Gary Wong Guernsey, Dr Peter Standring
954.e2 WILLIAMS ET AL J ALLERGY CLIN IMMUNOL
APRIL 2008

Jersey, Ms Rosie Goulding United Kingdom

Germany South Thames, North Thames, Professor H. Ross Anderson*
Münster, Professor Dr Ulrich Keil* Scotland, Dr Jane Austin
Isle of Man Sunderland, Dr Mohammad H. Shamssain
Isle of Man, Dr Andreea Steriu Surrey/Sussex, Professor David Strachan
Italy Wales, Dr Michael Burr
Cosenza, Dr Enea Bonci Indian Subcontinent
Emilia-Romagna, Dr Claudia Galassi India
Empoli, Dr M. G. Petronio Borivali, Dr Vasant A. Khatav
Firenze, Dr Elisabetta Chellini Chandigarh, Professor Lata Kumar
Milano, Dr Luigi Bisanti Chennai (3), Dr Gururaj Setty
Roma, Dr Francesco Forastiere* Jodhpur, Dr K. C. Jain
Siena, Dr Piersante Sestini Kottayam, Dr T. U. Sukumaran
Torino, Dr Giovannino Ciccone Mumbai (16), Dr Mohan Joshi
Trento, Dr Silvano Piffer Mumbai (18), Dr Asha Pherwani
Portugal New Delhi (7), Professor S. K. Sharma
Funchal, Dr Rita Câmara Pune, Dr Neeta Milind Hanumante
Lisboa, Professor José E. Rosado Pinto* Oceania
Portimao, Dr Carlos Nunes New Zealand
Porto, Dr José M. Lopes dos Santos Auckland, Professor Innes Asher*
Republic of Ireland Bay of Plenty, Dr Chris Moyes
Republic of Ireland, Professor Luke Clancy Christchurch, Dr Philip Pattemore
Spain Nelson, Dr Richard Mackay
Barcelona, Dr Rosa M. Busquets Wellington, Professor Neil Pearce
Bilbao, Dr Carlos González Dı́az Australia
Cartagena, Professor Luis Garcı́a-Marcos* Melbourne, Professor Colin Robertson*
Castellón, Dr Alberto Arnedo-Pena Additional national coordinators: V. Aguirre (Chile), C. Lai
Madrid, Dr Gloria Garcia Hernández (Hong Kong, SAR China), J. Shah (India), K. Baratawidjaja
Pamplona, Professor Francisco Guillén-Grima (Indonesia), S. Nishima (Japan), M. Baeza-Bacab (Mexico), P.
Valencia, Professor Maria M. Morales Suárez-Varela Manning (Republic of Ireland), B. Lee (Singapore), L. Nilsson
Valladolid, Professor Alfredo Blanco Quirós (Sweden), and M. Sears (Canada).
J ALLERGY CLIN IMMUNOL WILLIAMS ET AL 954.e3
VOLUME 121, NUMBER 4

FIG E1. Ranking plots of changes in symptoms of severe eczema for 13- and 14-year-olds ordered by
average prevalence.
954.e4 WILLIAMS ET AL J ALLERGY CLIN IMMUNOL
APRIL 2008

FIG E2. Ranking plots of changes in symptoms of reporting the disease label of eczema for 13- and 14-year-
olds ordered by average prevalence.
J ALLERGY CLIN IMMUNOL WILLIAMS ET AL 954.e5
VOLUME 121, NUMBER 4

FIG E3. Ranking plots of changes in symptoms of severe eczema for 6- and 7-year olds ordered by average
prevalence.
954.e6 WILLIAMS ET AL J ALLERGY CLIN IMMUNOL
APRIL 2008

FIG E4. Ranking plots of changes in symptoms of reporting the disease label of eczema for 6- and 7-year
olds ordered by average prevalence.
 VOLUME 121, NUMBER 4
J ALLERGY CLIN IMMUNOL
TABLE E1. Summary of changes in prevalence of eczema symptoms for 13- and 14-year-old participants in the ISAAC Phase One and Phase Three surveys
Prevalence in last 12 mo of symptoms Prevalence in last 12 mo of symptoms Prevalence of ever
Phase One Phase Three of flexural eczema of severe eczema having had eczema
Phase Phase Percentage change Phase Phase Percentage change Phase Phase Percentage change
Center Year N Year N One Three per year (SE) One Three per year (SE) One Three per year (SE)

Africa (English speaking)

Ethiopia
Addis Ababa 1995 2951 2003 3195 19.9 19.0 20.12 (0.18) 2.6 2.5 20.01 (0.06) 11.2 6.6 20.58 (0.12)
Kenya
Eldoret 1995 3024 2001 3289 11.4 15.5 0.67 (0.35) 2.4 4.0 0.28 (0.13) 13.2 28.5 2.54 (0.39)

Nairobi 1995 3226 2001 3023 9.5 14.9 0.90 (0.24) 3.6 4.3 0.11 (0.13) 18.5 20.3 0.30 (0.35)
Country total 1995 6250 2001 6312 10.4 15.2 0.83 (0.21) 3.0 4.2 0.19 (0.09) 16.0 24.6 1.28 (0.28)
Nigeria
Ibadan 1995 3057 2001 3142 17.7 7.7 21.66 (0.49) 4.3 1.3 20.50 (0.17) 38.4 19.4 23.18 (0.50)
South Africa
Cape Town 1995 5169 2002 5037 8.3 13.3 0.71 (0.18) 2.3 3.8 0.22 (0.07) 9.6 16.7 1.01 (0.22)
Region total 1995 17,427 2002 17,686 12.7 14.0 0.36 (0.15) 3.0 3.3 0.07 (0.05) 17.2 18.1 20.11 (0.23)
Africa (French speaking)
Algeria
Wilaya of Algiers 1996 2024 2002 4203 3.2 6.5 0.56 (0.13) 0.6 1.6 0.17 (0.05) 3.2 6.4 0.53 (0.10)
Morocco
Casablanca 1995 3183 2001 1777 12.0 23.0 1.83 (0.36) 2.9 5.7 0.48 (0.14) 13.9 19.7 0.96 (0.24)
Marrakech 1995 2900 2002 1689 9.2 20.5 1.61 (0.35) 2.9 5.8 0.42 (0.15) 13.1 20.5 1.05 (0.27)
Country total 1995 6083 2002 3466 10.7 21.8 1.72 (0.26) 2.9 5.8 0.45 (0.10) 13.5 20.1 1.00 (0.18)
Tunisia
Sousse 1996 3020 2001 3042 8.0 9.4 0.28 (0.42) 1.4 2.1 0.14 (0.11) 5.0 9.6 0.92 (0.28)
Region total 1996 11,127 2002 10,711 8.6 12.3 0.78 (0.23) 2.1 3.1 0.21 (0.07) 9.3 11.7 0.66 (0.21)
Asia-Pacific
China
Beijing 1994 4166 2001 3530 1.6 1.2 20.06 (0.05) 0.2 0.2 0.00 (0.02) 10.3 12.4 0.29 (0.18)
Guangzhou 1994 3855 2001 3514 0.8 1.6 0.12 (0.04) 0.0 0.2 0.02 (0.01) 18.3 17.6 20.09 (0.32)
Country total 1994 8021 2001 7044 1.2 1.4 0.05 (0.03) 0.1 0.2 0.02 (0.01) 14.2 15.0 0.20 (0.23)
Hong Kong
Hong Kong 1995 4666 2002 3321 2.7 3.3 0.08 (0.07) 0.3 0.3 0.00 (0.02) 15.4 13.4 20.29 (0.24)
Indonesia
Bandung 1996 2247 2002 2826 1.2 2.2 0.16 (0.08) 0.4 0.2 20.02 (0.03) 0.4 7.5 1.18 (0.12)
Malaysia
Alor Setar 1995 3298 2002 2941 9.7 12.2 0.36 (0.27) 0.7 0.8 0.01 (0.03) 8.7 26.1 2.49 (0.43)
Klang Valley 1995 6069 2001 3025 9.3 9.2 20.02 (0.28) 0.6 0.9 0.05 (0.05) 3.1 4.0 0.15 (0.17)

WILLIAMS ET AL 954.e7
Kota Bharu 1995 3075 2001 2989 7.2 8.5 0.22 (0.35) 0.4 1.0 0.10 (0.05) 4.2 7.1 0.48 (0.30)
Country total 1995 12442 2001 8955 8.9 9.9 0.19 (0.17) 0.6 0.9 0.04 (0.02) 4.9 12.3 0.47 (0.33)
Philippines
Metro Manila 1994 3207 2001 3658 5.2 7.8 0.37 (0.13) 1.2 1.5 0.05 (0.05) 7.1 8.4 0.18 (0.19)
Singapore
Singapore 1994 4205 2001 4217 7.4 9.2 0.25 (0.09) 0.9 1.9 0.15 (0.04) 4.0 5.5 0.22 (0.24)
South Korea
(Continued)
TABLE E1. (Continued)

954.e8 WILLIAMS ET AL
Prevalence in last 12 mo of symptoms Prevalence in last 12 mo of symptoms Prevalence of ever
Phase One Phase Three of flexural eczema of severe eczema having had eczema
Phase Phase Percentage change Phase Phase Percentage change Phase Phase Percentage change
Center Year N Year N One Three per year (SE) One Three per year (SE) One Three per year (SE)
Provincial Korea 1995 6975 2000 7375 3.5 5.7 0.46 (0.09) 0.0 1.2 0.24 (0.03) 7.3 12.2 0.98 (0.14)
Seoul 1995 2990 2000 2888 4.6 5.7 0.23 (0.15) 0.0 1.5 0.30 (0.05) 7.7 13.1 1.09 (0.17)
Country total 1995 9965 2000 10263 3.8 5.7 0.39 (0.08) 0.0 1.3 0.26 (0.03) 7.4 12.4 1.02 (0.11)
Taiwan
Taipei 1995 11,003 2001 6378 1.4 4.1 0.45 (0.05) 0.2 0.5 0.04 (0.02) 12.2 17.0 0.80 (0.18)
Thailand
Bangkok 1995 3712 2001 4669 6.8 10.4 0.60 (0.18) 0.6 1.3 0.11 (0.05) 25.4 31.3 0.98 (0.35)
Chiang Mai 1995 3927 2001 3538 9.6 8.6 20.16 (0.30) 1.2 1.2 0.00 (0.06) 27.1 24.7 20.39 (0.46)
Country total 1995 7639 2001 8207 8.2 9.6 0.39 (0.17) 0.9 1.2 0.06 (0.04) 26.3 28.5 0.48 (0.30)
Region total 1995 63,395 2001 54,869 4.7 6.3 0.17 (0.07) 0.4 0.9 0.04 (0.01) 11.0 14.7 0.68 (0.15)

Eastern Mediterranean
Iran
Rasht 1995 3181 2002 3004 3.1 4.5 0.21 (0.13) 1.4 1.3 20.01 (0.05) 10.5 17.5 1.01 (0.28)
Tehran 1995 2691 2001 3119 2.1 4.3 0.36 (0.11) 1.1 1.6 0.09 (0.05) 6.4 22.6 2.70 (0.32)
Country total 1995 5872 2002 6123 2.6 4.4 0.30 (0.09) 1.3 1.5 0.04 (0.03) 8.6 20.1 1.74 (0.23)
Kuwait
Kuwait 1995 1051 2001 2882 8.4 6.1 20.38 (0.26) — — — 13.0 10.9 20.36 (0.30)
Malta
Malta 1995 4183 2002 4136 7.7 5.4 20.33 (0.14) 1.3 0.7 20.09 (0.04) 8.8 11.5 0.38 (0.26)
Pakistan
Karachi 1995 1829 2001 2999 9.6 13.2 0.61 (0.37) 1.3 1.8 0.09 (0.10) 16.2 13.9 20.39 (0.46)
Sultanate of Oman
Al-Khod 1995 3174 2001 3747 4.7 7.1 0.39 (0.14) 0.9 2.3 0.23 (0.06) 14.4 14.4 0.00 (0.24)
Region total 1995 16,109 2001 19,887 5.5 6.7 0.17 (0.10) 1.2 1.5 0.02 (0.03) 11.0 15.0 0.55 (0.14)

Indian Subcontinent
India
Borivali 1995 3878 2003 1004 1.7 0.9 20.09 (0.11) 0.1 0.0 20.02 (0.02) 5.4 4.2 20.16 (0.26)
Chandigarh 1995 3138 2001 3122 3.5 3.6 0.02 (0.17) 0.3 0.1 20.04 (0.03) 3.0 3.9 0.16 (0.19)
Chennai (3) 1995 3079 2002 2181 1.6 1.2 20.05 (0.07) 0.4 0.1 20.04 (0.03) 4.8 6.4 0.23 (0.28)
Jodhpur 1994 1080 2003 2341 6.2 2.7 20.39 (0.35) 0.9 0.3 20.07 (0.04) 4.9 12.4 0.84 (0.26)
Kottayam 1995 2047 2002 3685 20.5 9.3 21.61 (0.35) — — — 22.1 11.2 21.55 (0.36)
Mumbai (18) 1995 3177 2002 2982 1.8 1.4 20.06 (0.20) 0.2 0.3 0.01 (0.03) 2.9 8.1 0.75 (0.29)
New Delhi (7) 1995 3025 2001 3469 5.5 3.5 20.33 (0.14) 0.3 0.5 0.03 (0.03) 5.1 4.6 20.08 (0.13)
Pune 1994 2696 2001 1983 0.6 2.1 0.22 (0.08) 0.1 0.2 0.02 (0.02) 3.5 9.5 0.86 (0.21)
Region total 1995 22,120 2002 20,767 4.3 3.7 20.03 (0.12) 0.3 0.2 20.01 (0.01) 5.9 7.7 0.17 (0.13)
Latin America

J ALLERGY CLIN IMMUNOL

Argentina
Córdoba 1997 3042 2002 3445 7.4 6.3 20.23 (0.22) 1.2 0.9 20.07 (0.07) 11.1 9.6 20.31 (0.47)
Brazil
Curitiba 1995 3004 2001 3628 3.9 3.7 20.04 (0.10) 0.6 0.4 20.04 (0.03) 10.0 4.1 20.98 (0.31)

APRIL 2008
(Continued)
TABLE E1. (Continued)

VOLUME 121, NUMBER 4

J ALLERGY CLIN IMMUNOL
Prevalence in last 12 mo of symptoms Prevalence in last 12 mo of symptoms Prevalence of ever
Phase One Phase Three of flexural eczema of severe eczema having had eczema
Phase Phase Percentage change Phase Phase Percentage change Phase Phase Percentage change
Center Year N Year N One Three per year (SE) One Three per year (SE) One Three per year (SE)
Porto Alegre 1994 3195 2003 3007 4.8 4.1 20.08 (0.07) 0.9 0.7 20.03 (0.03) 12.6 11.7 20.10 (0.16)
Recife 1994 3086 2002 2865 4.6 4.8 0.03 (0.09) 0.6 1.0 0.05 (0.03) 11.4 12.2 0.10 (0.15)
Salvador 1995 3162 2002 3020 9.2 5.1 20.58 (0.13) 2.0 1.0 20.14 (0.07) 3.7 2.2 20.22 (0.10)
São Paulo 1995 3007 2002 3161 3.7 3.5 20.02 (0.09) 0.3 0.2 20.02 (0.02) 14.0 12.7 20.19 (0.20)
Country total 1995 15,454 2002 15,681 5.3 4.2 20.08 (0.05) 0.9 0.6 20.01 (0.02) 10.3 8.4 20.17 (0.12)
Chile
Punta Arenas 1994 3050 2001 3044 6.4 13.2 0.97 (0.17) 0.7 1.3 0.09 (0.04) 9.0 8.1 20.12 (0.15)
South Santiago 1995 3050 2001 3026 10.9 22.0 1.86 (0.31) 1.6 3.0 0.23 (0.07) 6.9 31.9 4.16 (0.45)
Valdivia 1994 3231 2001 3105 11.4 13.1 0.25 (0.21) 1.0 1.7 0.09 (0.04) 9.0 12.6 0.51 (0.21)
Country total 1994 9331 2001 9175 9.6 16.1 0.86 (0.16) 1.1 2.0 0.11 (0.03) 8.3 17.5 0.36 (0.24)
Costa Rica
Costa Rica 1994 3200 2002 2436 7.2 6.3 20.11 (0.11) 1.4 1.3 20.01 (0.04) 4.5 7.6 0.38 (0.10)
Mexico
Cuernavaca 1994 3102 2002 1431 4.4 2.8 20.20 (0.09) 0.4 0.3 20.01 (0.03) 3.9 9.5 0.70 (0.16)
Panama
David-Panamá 1995 2885 2001 3183 7.8 14.5 1.11 (0.17) 1.2 1.7 0.09 (0.05) 7.2 35.5 4.70 (0.30)

Paraguay
Asunción 1997 2966 2002 3000 10.8 17.7 1.38 (0.35) 1.3 2.6 0.26 (0.10) 16.3 23.2 1.39 (0.55)
Peru
Lima 1995 3157 2001 3022 8.2 10.5 0.38 (0.21) 0.9 1.0 0.02 (0.05) 16.1 20.7 0.77 (0.22)
Uruguay
Montevideo 1994 3072 2002 3177 7.2 5.2 20.25 (0.14) 1.1 1.2 0.01 (0.05) 7.4 9.4 0.26 (0.22)
Region total 1995 46,209 2002 44,550 7.2 9.0 0.01 (0.07) 1.0 1.2 0.01 (0.01) 9.5 14.2 0.28 (0.11)
North America
Barbados
Barbados 1996 3533 2001 2498 5.0 7.0 0.40 (0.19) 1.0 1.3 0.07 (0.06) 6.4 8.8 0.50 (0.20)
United States
Seattle 1995 2330 2003 2422 8.5 8.3 20.03 (0.11) 1.0 1.4 0.06 (0.04) 8.2 10.6 0.30 (0.28)
Region total 1996 5863 2002 4920 6.4 7.6 0.08 (0.10) 1.0 1.4 0.06 (0.03) 7.1 9.7 0.43 (0.15)
Northern and Eastern Europe
Albania
Tiranë 1995 2957 2001 2983 0.8 2.0 0.19 (0.06) 0.1 0.2 0.01 (0.02) 1.3 2.9 0.28 (0.07)
Estonia
Tallinn 1994 3506 2001 3603 6.6 8.7 0.29 (0.13) 0.3 0.3 0.00 (0.02) 15.1 7.7 21.05 (0.20)
Finland

WILLIAMS ET AL 954.e9
Kuopio County 1994 2876 2001 3051 13.2 15.6 0.34 (0.17) 0.8 0.9 0.02 (0.04) 22.8 24.4 0.23 (0.16)
Georgia
Kutaisi 1996 3297 2003 2650 2.8 1.8 20.14 (0.08) 0.6 0.3 20.04 (0.03) 1.8 1.6 20.03 (0.08)
Latvia
Riga 1994 3004 2004 1283 5.2 3.4 20.19 (0.09) 0.5 0.3 20.02 (0.02) 5.4 7.3 0.19 (0.15)
(Continued)
TABLE E1. (Continued)

954.e10 WILLIAMS ET AL
Prevalence in last 12 mo of symptoms Prevalence in last 12 mo of symptoms Prevalence of ever
Phase One Phase Three of flexural eczema of severe eczema having had eczema
Phase Phase Percentage change Phase Phase Percentage change Phase Phase Percentage change
Center Year N Year N One Three per year (SE) One Three per year (SE) One Three per year (SE)
Lithuania
Kaunas 1995 1600 2001 2723 1.7 1.8 0.02 (0.07) 0.0 0.2 0.04 (0.02) 1.8 2.2 0.07 (0.10)
Poland
Kraków 1995 2786 2002 2545 4.6 8.9 0.61 (0.13) 0.3 0.7 0.05 (0.03) 14.7 15.6 0.13 (0.23)
Poznan 1994 3625 2002 1875 5.3 8.1 0.34 (0.10) 0.2 0.7 0.07 (0.03) 13.2 20.8 0.95 (0.17)
Country total 1995 6411 2002 4420 5.0 8.5 0.44 (0.08) 0.2 0.7 0.06 (0.02) 13.8 17.8 0.67 (0.17)
Romania
Cluj 1994 3396 2001 3019 6.3 5.4 20.13 (0.17) 0.9 1.1 0.03 (0.04) 3.7 3.0 20.10 (0.10)
Russia
Novosibirsk 1996 3654 2002 3769 4.9 3.8 20.18 (0.12) 0.3 0.3 0.01 (0.02) 7.3 4.4 20.49 (0.20)
Sweden
Linköping 1994 2496 2002 2679 15.8 12.9 20.37 (0.13) 1.0 0.7 20.04 (0.04) 48.0 48.3 0.04 (0.24)
Ukraine
Kharkiv 1998 3311 2002 2428 5.3 5.7 0.11 (0.23) 0.1 0.2 0.02 (0.03) 6.5 6.8 0.08 (0.25)
Region total 1995 36,508 2002 32,608 6.0 6.6 0.06 (0.07) 0.4 0.5 0.01 (0.01) 11.4 11.7 0.09 (0.20)
Oceania
New Zealand
Auckland 1993 3206 2001 2870 12.4 8.9 20.43 (0.21) 1.9 1.9 0.00 (0.06) 23.5 20.6 20.37 (0.22)
Bay of Plenty 1993 2813 2002 1976 13.8 8.1 20.62 (0.20) 2.4 1.0 20.16 (0.05) 25.3 21.1 20.48 (0.33)
Christchurch 1993 3186 2003 3116 12.3 7.0 20.52 (0.11) 1.7 1.3 20.04 (0.03) 24.9 27.8 0.30 (0.23)
Nelson 1993 1838 2003 2305 12.8 7.5 20.53 (0.15) 1.5 0.7 20.08 (0.05) 26.2 26.8 0.05 (0.28)
Wellington 1993 4417 2001 3050 13.2 12.1 20.13 (0.14) 2.1 1.5 20.06 (0.04) 27.9 32.2 0.54 (0.26)
Region total 1993 15,460 2002 13,317 12.9 8.8 20.44 (0.08) 2.0 1.3 20.07 (0.02) 25.7 26.1 0.03 (0.13)
Western Europe
Austria
Urfahr-Umgebung 1995 1511 2003 1439 5.3 7.5 0.28 (0.13) 0.5 0.7 0.02 (0.05) 6.1 11.7 0.71 (0.14)
Belgium
Antwerp 1995 1515 2002 3250 6.7 7.2 0.07 (0.11) 1.1 0.9 20.04 (0.05) 21.5 23.8 0.33 (0.24)
Channel Islands
Guernsey 1996 1170 2001 1248 15.1 11.2 20.78 (0.29) 0.9 2.6 0.34 (0.12) 21.5 23.1 0.32 (0.39)
Jersey 1996 1135 2002 773 18.9 10.7 21.37 (0.33) 1.8 1.2 20.10 (0.13) 22.3 23.8 0.25 (0.46)
Country total 1996 2305 2002 2021 17.0 11.0 21.04 (0.23) 1.3 2.1 0.14 (0.09) 21.9 23.4 0.30 (0.29)
Germany
Münster 1994 4000 1999 4132 7.1 7.7 0.12 (0.12) 0.6 0.9 0.08 (0.04) 10.0 13.6 0.73 (0.23)
Isle of Man
Isle of Man 1995 1467 2001 1716 15.6 11.1 20.76 (0.23) 2.1 1.7 20.07 (0.10) 18.4 22.1 0.61 (0.29)
Italy

J ALLERGY CLIN IMMUNOL

Cosenza 1994 1068 2002 925 4.4 3.6 20.10 (0.11) 0.7 0.3 20.04 (0.05) 4.1 2.8 20.16 (0.14)
Emilia-Romagna 1994 3961 2002 1347 6.9 8.8 0.23 (0.13) 0.4 0.3 20.01 (0.03) 11.1 8.5 20.33 (0.14)
Empoli 1994 1046 2002 1229 4.9 5.2 0.04 (0.15) 0.4 0.4 0.00 (0.05) 8.7 4.6 20.51 (0.27)
Firenze 1994 1171 2002 1383 5.9 8.0 0.27 (0.18) 0.3 0.4 0.02 (0.03) 4.4 6.0 0.21 (0.13)
Milano 1994 3373 2002 1410 7.0 8.4 0.18 (0.11) 0.4 0.5 0.01 (0.04) 11.8 13.7 0.24 (0.28)

APRIL 2008
Roma 1994 3323 2002 1325 4.9 7.8 0.37 (0.11) 0.4 0.5 0.01 (0.03) 5.1 4.8 20.04 (0.12)
Siena 1994 1181 2002 1082 7.4 10.0 0.33 (0.27) 0.7 0.6 0.00 (0.05) 9.2 16.5 0.90 (0.32)
(Continued)
TABLE E1. (Continued)

VOLUME 121, NUMBER 4

J ALLERGY CLIN IMMUNOL
Prevalence in last 12 mo of symptoms Prevalence in last 12 mo of symptoms Prevalence of ever
Phase One Phase Three of flexural eczema of severe eczema having had eczema
Phase Phase Percentage change Phase Phase Percentage change Phase Phase Percentage change
Center Year N Year N One Three per year (SE) One Three per year (SE) One Three per year (SE)
Torino 1994 1242 2002 1180 9.4 10.3 0.10 (0.23) 0.6 0.4 20.03 (0.06) 12.7 10.0 20.34 (0.25)
Trento 1995 4426 2002 1311 5.6 6.7 0.16 (0.12) 0.2 0.1 20.01 (0.02) 9.9 10.0 0.02 (0.15)
Country total 1994 20,791 2002 11192 6.2 7.7 0.16 (0.05) 0.4 0.4 0.00 (0.01) 9.1 8.6 20.05 (0.09)
Portugal
Funchal 1995 3531 2002 3161 5.4 4.5 20.13 (0.13) 1.2 1.1 20.02 (0.05) 15.0 13.6 20.20 (0.24)
Lisbon 1993 3030 2002 3024 4.0 5.6 0.17 (0.07) 0.6 1.1 0.06 (0.03) 10.3 12.9 0.30 (0.14)
Portimao 1994 1058 2002 1109 1.8 4.9 0.38 (0.12) 0.4 0.9 0.07 (0.05) 9.4 11.0 0.21 (0.27)
Porto 1995 3131 2002 3336 4.4 5.3 0.13 (0.08) 0.9 1.1 0.04 (0.04) 9.2 10.9 0.24 (0.18)
Country total 1994 10,750 2002 10,630 4.4 5.1 0.16 (0.05) 0.9 1.1 0.04 (0.02) 11.4 12.3 0.19 (0.11)
Republic of Ireland
Republic of Ireland 1995 3147 2003 3089 13.6 8.6 20.62 (0.11) 1.9 1.3 20.07 (0.06) 9.4 14.3 0.62 (0.14)
Spain
Barcelona 1993 3031 2002 3066 3.9 2.6 20.14 (0.06) 0.4 0.3 20.01 (0.02) 12.6 12.3 20.04 (0.21)
Bilbao 1994 3211 2001 3401 4.5 4.0 20.07 (0.08) 0.3 0.4 0.00 (0.02) 8.3 10.8 0.36 (0.17)
Cartagena 1993 3017 2002 3998 5.8 4.0 20.20 (0.08) 1.2 0.6 20.06 (0.03) 7.7 13.5 0.65 (0.10)
Castellón 1994 3094 2002 4024 2.9 4.1 0.15 (0.07) 0.5 0.2 20.03 (0.02) 6.8 12.0 0.65 (0.13)
Madrid 1997 3221 2002 2652 3.8 5.2 0.30 (0.13) 0.5 0.9 0.08 (0.05) 12.4 12.3 20.01 (0.26)
Pamplona 1994 3040 2001 2932 4.2 4.0 20.02 (0.08) 0.4 0.3 20.01 (0.02) 8.4 9.0 0.09 (0.13)
Valencia 1994 3174 2002 3132 3.3 4.1 0.10 (0.06) 0.1 0.5 0.05 (0.02) 15.0 16.0 0.12 (0.18)
Valladolid 1994 3177 2002 2944 4.6 4.5 20.01 (0.07) 0.6 0.5 20.01 (0.02) 10.1 13.9 0.47 (0.14)
Country total 1994 24,965 2002 26,149 4.1 4.0 20.01 (0.03) 0.5 0.5 0.00 (0.01) 10.2 12.5 0.40 (0.06)
United Kingdom
North Thames 1995 2220 2002 2356 16.0 11.2 20.69 (0.30) 1.6 1.3 20.04 (0.06) 23.1 26.4 0.48 (0.35)
Scotland 1995 4444 2002 4662 16.7 11.8 20.71 (0.16) 2.8 1.8 20.13 (0.06) 20.6 24.9 0.62 (0.21)
South Thames 1995 2297 2002 2432 16.6 10.4 20.88 (0.20) 1.6 1.2 20.05 (0.06) 20.9 25.2 0.62 (0.28)
Sunderland 1995 2092 2001 2193 10.9 10.3 20.09 (0.22) 1.9 0.7 20.19 (0.07) 21.6 28.9 1.23 (0.29)
Surrey/Sussex 1992 2114 2002 5082 10.5 9.5 20.10 (0.10) 1.0 1.2 0.02 (0.03) 23.1 27.3 0.42 (0.12)
Wales 1995 2351 2002 2501 15.3 10.6 20.67 (0.19) 2.5 2.6 0.01 (0.10) 21.1 23.8 0.38 (0.29)
Country total 1995 15,518 2002 19,226 14.7 10.6 20.39 (0.08) 2.0 1.5 20.03 (0.03) 21.5 26.1 0.54 (0.10)
Region total 1994 85,969 2002 82,844 7.7 7.1 0.00 (0.04) 0.9 0.9 0.00 (0.01) 12.7 16.1 0.29 (0.07)

Global total 1995 32,0187 2002 30,2159 7.0 7.6 0.06 (0.03) 1.0 1.2 0.01 (0.01) 11.8 14.7 0.28 (0.05)

WILLIAMS ET AL 954.e11
 954.e12 WILLIAMS ET AL
TABLE E2. Summary of changes in prevalence of eczema symptoms for 6- and 7-year-old participants in the ISAAC Phase One and Phase Three surveys
Prevalence in last 12 mo of symptoms Prevalence in last 12 mo of symptoms Prevalence of ever
Phase One Phase Three of flexural eczema of severe eczema having had eczema
Phase Phase Percentage change Phase Phase Percentage change Phase Phase Percentage change
Center Year N Year N One Three per year (SE) One Three per year (SE) One Three per year (SE)

Africa (English speaking)

Nigeria
Ibadan 1995 1696 2002 2396 4.5 5.0 0.07 (0.13) 0.6 1.1 0.06 (0.07) 9.4 6.8 20.38 (0.21)
Region total 1995 1696 2002 2396 4.5 5.0 0.07 (0.13) 0.6 1.1 0.06 (0.07) 9.4 6.8 20.38 (0.21)
Asia-Pacific
Hong Kong
Hong Kong 1995 3618 2001 4448 3.9 4.6 0.12 (0.09) 0.4 0.0 20.06 (0.02) 27.2 30.7 0.59 (0.28)
Malaysia
Alor Setar 1995 2978 2002 3786 9.6 12.7 0.45 (0.21) 1.1 0.8 20.05 (0.04) 2.8 1.8 20.13 (0.09)
Klang Valley 1995 3109 2001 3044 8.7 12.0 0.55 (0.15) 1.0 0.8 20.03 (0.04) 3.8 4.9 0.19 (0.19)
Kota Bharu 1995 3819 2001 3110 10.2 12.9 0.46 (0.16) 1.2 1.1 20.02 (0.04) 1.4 1.8 0.06 (0.06)
Country total 1995 9906 2001 9940 9.5 12.6 0.49 (0.10) 1.1 0.9 20.04 (0.02) 2.5 2.8 0.02 (0.07)
Singapore
Singapore 1994 2353 2001 5389 2.8 8.9 0.87 (0.18) 0.3 1.2 0.12 (0.03) 1.3 8.2 0.98 (0.14)
South Korea
Provincial Korea 1995 5527 2000 4258 8.0 10.9 0.60 (0.13) 0.0 2.2 0.43 (0.05) 18.5 28.6 2.02 (0.23)
Seoul 1995 2582 2000 1760 10.7 12.0 0.28 (0.24) 0.0 2.0 0.41 (0.09) 23.5 30.4 1.37 (0.56)
Country total 1995 8109 2000 6018 8.8 11.3 0.52 (0.13) 0.0 2.1 0.43 (0.04) 20.1 29.1 1.93 (0.24)
Taiwan
Taipei 1994 4806 2001 4832 3.5 6.7 0.46 (0.08) 0.6 1.2 0.09 (0.03) 23.9 26.3 0.34 (0.21)
Thailand
Bangkok 1995 3629 2001 4209 12.5 16.9 0.73 (0.20) 1.3 1.6 0.05 (0.05) 22.5 24.7 0.37 (0.25)
Chiang Mai 1995 3828 2001 3106 11.4 16.3 0.82 (0.15) 1.5 2.4 0.15 (0.06) 20.5 26.0 0.92 (0.27)
Country total 1995 7457 2001 7315 11.9 16.7 0.79 (0.13) 1.4 2.0 0.09 (0.04) 21.5 25.3 0.63 (0.19)
Region total 1995 36,249 2001 37,942 8.1 11.0 0.47 (0.09) 0.8 1.3 0.04 (0.02) 15.6 18.3 0.23 (0.20)

Eastern Mediterranean
Iran
Rasht 1995 3013 2001 3057 1.3 3.0 0.29 (0.06) 0.6 0.9 0.05 (0.04) 9.8 11.8 0.34 (0.16)
Tehran 1995 2456 2001 3008 0.8 1.1 0.04 (0.05) 0.2 0.3 0.02 (0.03) 2.2 12.3 1.68 (0.13)
Country total 1995 5469 2001 6065 1.1 2.0 0.13 (0.05) 0.4 0.6 0.03 (0.02) 6.4 12.1 1.16 (0.13)
Malta
Malta 1994 3493 2001 3795 4.2 4.0 20.03 (0.07) 0.4 0.4 0.00 (0.02) 4.4 11.3 0.98 (0.11)
Sultanate of Oman
Al-Khod 1995 3891 2001 4130 4.2 4.2 0.00 (0.08) 0.9 1.3 0.06 (0.04) 7.4 7.7 0.07 (0.12)
Region total 1995 12,853 2001 13,990 2.9 3.2 0.08 (0.04) 0.6 0.7 0.02 (0.02) 6.1 10.6 0.78 (0.08)

J ALLERGY CLIN IMMUNOL

Indian Subcontinent
India
Jodhpur 1994 1104 2003 2114 1.9 0.9 20.11 (0.05) 0.3 0.2 0.00 (0.03) 1.7 1.4 20.03 (0.06)
Kottayam 1995 2156 2002 2619 11.5 2.3 21.32 (0.16) — — — 18.7 10.1 21.22 (0.23)
Mumbai (16) 1995 3967 2003 2865 1.9 1.8 20.01 (0.06) 0.3 0.1 20.02 (0.02) 1.1 1.7 0.07 (0.04)

APRIL 2008
Mumbai (18) 1994 3568 2002 4862 0.9 2.4 0.19 (0.07) 0.1 0.2 0.01 (0.02) 1.1 2.5 0.18 (0.05)
(Continued)
TABLE E2. (Continued)

VOLUME 121, NUMBER 4

J ALLERGY CLIN IMMUNOL
Prevalence in last 12 mo of symptoms Prevalence in last 12 mo of symptoms Prevalence of ever
Phase One Phase Three of flexural eczema of severe eczema having had eczema
Phase Phase Percentage change Phase Phase Percentage change Phase Phase Percentage change
Center Year N Year N One Three per year (SE) One Three per year (SE) One Three per year (SE)
New Delhi (7) 1995 2938 2002 3706 2.8 4.2 0.21 (0.08) 0.2 0.5 0.04 (0.02) 2.6 5.1 0.36 (0.11)
Pune 1995 3248 2001 2711 1.5 2.0 0.08 (0.07) 0.1 0.2 0.01 (0.02) 2.5 3.4 0.16 (0.08)
Region total 1995 16,981 2002 18,877 3.0 2.4 0.00 (0.07) 0.2 0.2 0.01 (0.01) 3.9 4.0 0.08 (0.11)
Latin America
Brazil
São Paulo 1995 3005 2002 3047 6.8 6.8 0.00 (0.12) 0.5 0.9 0.05 (0.03) 13.2 13.1 20.02 (0.18)
Chile
Punta Arenas 1994 3060 2001 3052 9.5 12.1 0.37 (0.13) 0.9 1.3 0.05 (0.04) 15.0 30.8 2.26 (0.31)
South Santiago 1994 3182 2001 3075 10.5 14.8 0.61 (0.14) 2.2 2.0 20.02 (0.07) 4.4 18.2 1.97 (0.18)
Valdivia 1994 3138 2001 3183 12.6 11.7 20.13 (0.13) 2.3 1.3 20.14 (0.05) 10.8 11.1 0.04 (0.16)
Country total 1994 9380 2001 9310 10.9 12.9 0.26 (0.08) 1.8 1.5 20.02 (0.04) 10.0 19.9 1.09 (0.21)
Costa Rica
Costa Rica 1994 2942 2002 3234 8.7 8.9 0.02 (0.09) 1.0 1.6 0.07 (0.04) 8.2 8.6 0.06 (0.09)
Mexico
Cuernavaca 1994 3097 2002 2579 4.9 4.0 20.11 (0.08) 0.3 0.3 0.00 (0.02) 3.5 1.2 20.29 (0.06)
Panama
David-Panamá 1995 3043 2001 2942 7.9 14.4 1.09 (0.17) 0.7 1.8 0.17 (0.06) 6.3 35.1 4.81 (0.31)
Region total 1994 21,467 2001 21,112 8.7 10.5 0.13 (0.06) 1.2 1.3 0.03 (0.02) 8.7 17.0 0.10 (0.13)

North America
Barbados
Barbados 1995 3289 2001 2759 6.7 9.2 0.42 (0.12) 1.0 1.5 0.08 (0.05) 7.5 14.0 1.08 (0.16)
Canada
Saskatoon 1994 2418 2003 1255 8.7 12.0 0.36 (0.12) 0.7 1.0 0.04 (0.04) 22.1 33.4 1.25 (0.18)
Region total 1995 5707 2002 4014 7.6 10.1 0.39 (0.08) 0.9 1.4 0.05 (0.03) 13.7 20.0 1.16 (0.18)

Northern and Eastern Europe

Albania
Tiranë 1995 2981 2000 2896 2.5 3.7 0.24 (0.10) 0.5 0.7 0.04 (0.05) 1.5 1.4 20.03 (0.09)
Estonia
Tallinn 1994 3070 2001 2385 9.8 11.5 0.24 (0.12) 0.5 0.5 0.00 (0.03) 12.4 9.6 20.40 (0.13)
Georgia
Kutaisi 1996 3356 2003 2666 5.1 2.4 20.39 (0.16) 0.9 0.3 20.08 (0.04) 4.7 1.8 20.42 (0.17)
Lithuania
Kaunas 1995 1878 2002 2772 2.3 3.0 0.09 (0.08) 0.0 0.1 0.02 (0.02) 1.4 3.5 0.30 (0.07)
Poland

WILLIAMS ET AL 954.e13
Kraków 1995 2264 2001 2497 7.3 10.4 0.51 (0.14) 1.5 1.5 0.00 (0.06) 19.9 28.9 1.51 (0.22)
Poznan 1994 2710 2002 1999 5.4 12.9 0.94 (0.11) 0.6 0.9 0.04 (0.03) 19.5 34.5 1.87 (0.18)
Country total 1995 4974 2002 4496 6.3 11.5 0.77 (0.08) 1.0 1.2 0.03 (0.03) 19.7 31.4 1.72 (0.15)
Russia
Novosibirsk 1996 3637 2002 2730 9.4 6.6 20.46 (0.12) 1.0 0.6 20.06 (0.04) 11.4 9.1 20.39 (0.14)
Sweden
(Continued)
TABLE E2. (Continued)

954.e14 WILLIAMS ET AL
Prevalence in last 12 mo of symptoms Prevalence in last 12 mo of symptoms Prevalence of ever
Phase One Phase Three of flexural eczema of severe eczema having had eczema
Phase Phase Percentage change Phase Phase Percentage change Phase Phase Percentage change
Center Year N Year N One Three per year (SE) One Three per year (SE) One Three per year (SE)
Linköping 1994 1329 2002 2089 19.5 22.3 0.35 (0.18) 1.0 1.2 0.03 (0.05) 30.7 38.6 0.99 (0.22)
Ukraine
Kharkiv 1998 2971 2002 1950 6.2 5.3 20.21 (0.17) 0.3 0.0 20.08 (0.03) 5.5 3.2 20.58 (0.17)
Region total 1995 24196 2002 21984 7.0 8.2 0.18 (0.08) 0.7 0.6 20.01 (0.01) 10.6 13.4 0.15 (0.15)

Oceania
Australia
Melbourne 1993 2840 2002 2968 11.1 17.1 0.67 (0.11) 0.7 2.0 0.14 (0.03) 22.6 32.3 1.07 (0.15)
New Zealand
Auckland 1993 3526 2002 3541 14.4 14.3 0.00 (0.12) 2.6 2.5 20.01 (0.06) 22.3 26.4 0.45 (0.14)
Bay of Plenty 1993 2681 2002 2150 13.8 13.8 0.01 (0.12) 2.2 1.5 20.07 (0.05) 24.5 29.2 0.52 (0.15)
Christchurch 1993 3318 2003 3315 15.8 18.5 0.27 (0.10) 1.6 1.9 0.02 (0.04) 28.8 37.9 0.91 (0.13)
Nelson 1993 1868 2003 1867 12.0 11.6 20.05 (0.12) 0.7 0.7 0.00 (0.03) 24.4 32.5 0.82 (0.18)
Country total 1993 11,393 2003 10,873 14.3 15.0 0.08 (0.06) 1.9 1.8 20.01 (0.02) 25.0 31.5 0.68 (0.09)
Region total 1993 14,233 2002 13,841 13.6 15.5 0.21 (0.05) 1.7 1.9 0.03 (0.02) 24.6 31.7 0.75 (0.08)

Western Europe
Austria
Kärnten 1995 5264 2002 4847 5.1 5.8 0.10 (0.07) 0.4 0.3 20.01 (0.02) 9.8 14.5 0.67 (0.11)
Urfahr-Umgebung 1995 2129 2002 2029 7.3 6.6 20.11 (0.12) 0.6 0.6 0.01 (0.04) 12.0 15.0 0.42 (0.15)
Country total 1995 7393 2002 6876 5.7 6.1 0.05 (0.06) 0.4 0.4 20.01 (0.02) 10.4 14.6 0.58 (0.09)
Belgium
Antwerp 1995 6533 2002 5645 7.7 11.6 0.56 (0.09) 0.7 0.8 0.02 (0.02) 16.8 22.1 0.76 (0.15)
Germany
Münster 1994 3739 1999 3830 6.7 7.9 0.23 (0.12) 0.7 0.5 20.05 (0.04) 13.7 14.7 0.19 (0.19)
Italy
Emilia-Romagna 1994 4472 2002 2265 5.4 10.3 0.61 (0.10) 0.1 0.4 0.04 (0.02) 14.9 17.6 0.34 (0.12)
Empoli 1994 1434 2002 1152 5.3 8.6 0.41 (0.13) 0.1 0.3 0.03 (0.03) 13.2 11.5 20.22 (0.16)
Firenze 1994 1138 2002 1036 5.5 10.0 0.56 (0.15) 0.5 0.2 20.04 (0.04) 12.7 14.8 0.25 (0.19)
Milano 1994 3616 2002 2249 6.8 10.0 0.39 (0.10) 0.1 0.2 0.01 (0.02) 16.7 18.1 0.18 (0.15)
Roma 1994 4027 2002 2224 5.5 10.2 0.58 (0.10) 0.1 0.3 0.03 (0.02) 13.0 15.8 0.36 (0.12)
Torino 1994 1429 2002 2361 5.5 10.6 0.64 (0.12) 0.2 0.3 0.01 (0.02) 15.2 17.3 0.26 (0.17)
Country total 1994 16,116 2002 11,287 5.8 10.1 0.53 (0.04) 0.1 0.3 0.02 (0.01) 14.5 16.4 0.23 (0.07)
Portugal
Funchal 1995 1797 2002 1819 12.4 10.0 20.34 (0.18) 2.6 1.9 20.10 (0.08) 13.3 11.5 20.26 (0.19)
Lisbon 1995 2143 2002 2477 11.1 10.2 20.12 (0.16) 2.5 1.2 20.19 (0.06) 11.2 15.6 0.64 (0.17)
Portimao 1994 1189 2001 1069 2.6 8.0 0.78 (0.18) 0.3 1.4 0.16 (0.07) 7.7 15.2 1.07 (0.27)
Country total 1995 5129 2002 5365 9.6 9.7 0.09 (0.12) 2.0 1.5 20.05 (0.04) 11.1 14.1 0.40 (0.11)

J ALLERGY CLIN IMMUNOL

Spain
Bilbao 1994 3019 2001 3157 4.4 6.8 0.33 (0.08) 0.4 0.4 0.01 (0.03) 16.1 31.8 2.24 (0.17)
Cartagena 1993 3335 2002 2948 2.7 4.5 0.21 (0.05) 0.4 0.6 0.02 (0.02) 15.0 27.9 1.44 (0.15)
Castellón 1994 3594 2002 3915 3.1 5.3 0.28 (0.06) 0.3 0.2 0.00 (0.02) 15.1 29.5 1.81 (0.14)
Madrid 1997 2442 2002 2347 4.1 6.0 0.38 (0.13) 0.4 0.6 0.04 (0.04) 21.4 31.2 1.96 (0.35)

APRIL 2008
Pamplona 1994 2996 2001 3176 3.2 7.0 0.54 (0.08) 0.1 0.3 0.03 (0.02) 15.4 31.7 2.32 (0.16)
(Continued)
TABLE E2. (Continued)

VOLUME 121, NUMBER 4

J ALLERGY CLIN IMMUNOL
Prevalence in last 12 mo of symptoms Prevalence in last 12 mo of symptoms Prevalence of ever
Phase One Phase Three of flexural eczema of severe eczema having had eczema
Phase Phase Percentage change Phase Phase Percentage change Phase Phase Percentage change
Center Year N Year N One Three per year (SE) One Three per year (SE) One Three per year (SE)
Valencia 1994 3940 2002 3398 3.2 5.9 0.33 (0.06) 0.2 0.2 0.01 (0.01) 18.9 30.0 1.39 (0.14)
Country total 1994 19,326 2002 18,941 3.4 5.9 0.31 (0.03) 0.3 0.4 0.01 (0.01) 16.9 30.3 1.81 (0.07)
United Kingdom
Sunderland 1996 1864 2001 1843 13.0 16.0 0.60 (0.28) 2.0 2.2 0.04 (0.11) 27.6 36.1 1.71 (0.34)
Region total 1994 60,100 2002 53,787 5.8 8.3 0.33 (0.03) 0.5 0.6 0.01 (0.01) 15.1 22.0 0.80 (0.06)
Global total 1995 193,482 2002 187,943 6.9 8.6 0.21 (0.03) 0.7 0.9 0.01 (0.01) 12.9 17.5 0.31 (0.06)

WILLIAMS ET AL 954.e15