Article open access publication

The sex‐shift in single disease and multimorbid asthma and rhinitis during puberty ‐ a study by MeDALL

Allergy, Wiley, ISSN 1398-9995

Volume 73, 3, 2018

DOI:10.1111/all.13312, Dimensions: pub.1091974958, PMC: PMC5836860, PMID: 28960325,


Melén, E. (5) (6)
Almqvist, C. (6) (7)
Lau, S. (8)
Eller, E. (9)
Wahn, U. (8)
Heinrich, J. (2) (12)
Maier, D. (14)
Antó, J. M. (16) (17) (18) (19)
Bousquet, J. (19) (20) (21) (22)
Keil, T. (1)
Roll, S. (1)



  1. (1) Charité – Universitätsmedizin Berlin Institute of Social Medicine, Epidemiology and Health Economics Berlin Germany
  2. (2) Helmholtz Zentrum München ‐ German Research Center for Environmental Health Institute of Epidemiology I Neuherberg Germany
  3. (3) National Institute for Public Health and the Environment Center for Nutrition, Prevention, and Health Services Bilthoven The Netherlands
  4. (4) Utrecht University, grid.5477.1
  5. (5) Sachs' Children and Youth Hospital, grid.416452.0
  6. (6) Karolinska Institute, grid.4714.6
  7. (7) Karolinska University Hospital, grid.24381.3c
  8. (8) Charité, grid.6363.0
  9. (9) Odense University Hospital, grid.7143.1, Southern Denmark Region
  10. (10) Hans Christian Andersen Children Hospital Odense Denmark
  11. (11) Research Institute Marien‐Hospital Wesel Department of Pediatrics Wesel Germany
  12. (12) Klinikum der Universität München, grid.411095.8
  13. (13) Helmholtz Centre for Environmental Research, grid.7492.8
  14. (14) Biomax Informatics (Germany), grid.424158.e
  15. (15) University of Groningen, grid.4830.f
  16. (16) Center for Research in Environmental Epidemiology, grid.417617.2
  17. (17) Hospital Del Mar, grid.411142.3
  18. (18) Institute of Health Carlos III, grid.413448.e
  19. (19) Pompeu Fabra University, grid.5612.0
  20. (20) European Innovation Partnership on Active and Healthy Ageing Reference Site, and INSERM VIMA: Ageing and Chronic Diseases, Epidemiological and Public Health Approaches MACVIA‐LR Paris France
  21. (21) University Hospital of Montpellier, grid.157868.5
  22. (22) Université Versailles UVSQ St‐Quentin‐en‐Yvelines France


BACKGROUND: Cross-sectional studies suggested that allergy prevalence in childhood is higher in boys compared to girls, but it remains unclear whether this inequality changes after puberty. We examined the sex-specific prevalence of asthma and rhinitis as single and as multimorbid diseases before and after puberty onset in longitudinal cohort data. METHODS: In six European population-based birth cohorts of MeDALL, we assessed the outcomes: current rhinitis, current asthma, current allergic multimorbidity (ie, concurrent asthma and rhinitis), puberty status and allergic sensitization by specific serum antibodies (immunoglobulin E) against aero-allergens. With generalized estimating equations, we analysed the effects of sex, age, puberty (yes/no) and possible confounders on the prevalence of asthma and rhinitis, and allergic multimorbidity in each cohort separately and performed individual participant data meta-analysis. FINDINGS: We included data from 19 013 participants from birth to age 14-20 years. Current rhinitis only affected girls less often than boys before and after puberty onset: adjusted odds ratio for females vs males 0.79 (95%-confidence interval 0.73-0.86) and 0.86 (0.79-0.94), respectively (sex-puberty interaction P = .089). Similarly, for current asthma only, females were less often affected than boys both before and after puberty onset: 0.71, 0.63-0.81 and 0.81, 0.64-1.02, respectively (sex-puberty interaction P = .327). The prevalence of allergic multimorbidity showed the strongest sex effect before puberty onset (female-male-OR 0.55, 0.46-0.64) and a considerable shift towards a sex-balanced prevalence after puberty onset (0.89, 0.74-1.04); sex-puberty interaction: P < .001. INTERPRETATION: The male predominance in prevalence before puberty and the "sex-shift" towards females after puberty onset were strongest in multimorbid patients who had asthma and rhinitis concurrently.


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