소아알레르기호흡기 : 제 21 권제 1 호, pp47~55, 2011 년 1) 서울송파지역초등학생에서알레르기비염유병률과항원감작과의관련성 울산대학교의과대학서울아산병원소아과학교실소아천식아토피센터 *, 인제대학교의과대학해운대백병원소아과학교실, 인제대학교의과대학상계백병원소아과학교실, 한림대학교의과대학한림대학교성심병원소아과학교실, 인제대학교의과대학서울백병원소아과학교실, 연세대학교의과대학세브란스병원소아과학교실, 차의학전문대학원강남차병원소아과학교실 **, 연세대학교의과대학강남세브란스병원소아과학교실, 정신과학교실, 서울대학교보건대학원통계학교실 권지원 * ㆍ서주희 * ㆍ유진호 * ㆍ김병주 ㆍ김효빈 ㆍ이소연 ㆍ김우경 김경원 ㆍ지혜미 ** ㆍ김규언 ㆍ신의진 ㆍ김명희 ㆍ김호 ㆍ홍수종 * Relationship between the Prevalence of Allergic Rhinitis and Allergen Sensitization in Children of Songpa Area, Seoul Ji-Won Kwon *, Ju-Hee Seo *, Jinho Yu *, Byoung-Ju Kim, Hyo Bin Kim, So Yeon Lee, Woo Kyung Kim, Kyung Won Kim, Hye-Mi Ji **, Kyu-Earn Kim, Yee-Jin Shin, Myoung Hee Kim, Ho Kim and Soo-Jong Hong * Childhood Asthma Atopy Center, Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine *, Department of Pediatrics, Haeundae Paik Hospital, Inje University College of Medicine, Department of Pediatrics, Sanggye Paik Hospital, Inje University College of Medicine, Department of Pediatrics, Hallym University Secred Heart Hospital, Department of Pediatrics, Seoul Paik Hospital, Inje University College of Medicine, Department of Pediatrics, Severance Children s Hospital, College of Medicine, Yonsei University, Department of Pediatrics, CHA University School of Medicine **, Department of Pediatrics, Gangnam Severance Hospital, College of Medicine, Yonsei University, Department of Psychiatry, Gangnam Severance Hospital, College of Medicine, Yonsei University, Graduate School of Public Health, Seoul National University Purpose : We investigated the relationship between allergic rhinitis (AR) and allergen sensitization in students at an elementary school in Seoul. Methods : A modified International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire survey was administered to 1,376 elementary school children in the Songpa area of Seoul. Serum total IgE, blood eosinophils, and skin prick tests for 18 common allergens were performed. Results : The prevalence of AR symptoms during the last 12 months and the current AR, defined as having AR symptoms during last 12 months with a history of AR diagnosis from the doctor, This study was supported by a grant of Atopy Free Seoul Project, Seoul City. 접수 : 2010 년 12 월 21 일, 승인 : 2011 년 3 월 9 일책임저자 : 홍수종, 서울시송파구풍납 2 동울산대학교의과대학서울아산병원소아청소년과 Tel : 02)3010-3379 Fax : 02)473-3725 E-mail : sjhong@amc.seoul.kr - 47 -
Ji-Won Kwon, et al. : Relationship between Prevalence of Allergic Rhinitis and Allergen Sensitization in Children were 39.0% and 24.2%, respectively. Males were more likely to have current AR than females (26.6% vs. 21.5%, P =0.04). Independent risk factors for current AR were parental allergic disease (adjusted odds ratio [aor], 3.78, 95% CI, 2.76-5.18), history of atopic dermatitis (AD; aor, 1.47; 95% CI, 1.05-2.04), history of asthma (aor, 3.48; 95% CI, 2.15-5.61), and higher maternal education (aor, 1.42; 95% CI, 1.02-1.99). The subjects with higher quartiles of serum total IgE (P value for trend ), more than 4% of eosinophil fraction (aor 1.76; 95% CI, 1.24-2.48), and allergen sensitization house dust mites [aor, 1.54; 95% CI, 1.10-2.15], dog [aor, 2.95; 95% CI, 1.38-6.28], cat [1.85; 95% CI, 1.02-3.34], Alternaria [aor, 2.37; 95% CI, 1.06-5.32] and lateblooming tree pollen mixture [aor 2.26; 95% CI, 1.12-4.57] were more likely to have current AR. Conclusion : The prevalence of AR in children has increased during the last decade. The sensitization to common allergens and increased sensitization were associated with the development of current AR. House dust mites, dog, cat, alder, and Alternaria were the important allergens for current AR. [Pediatr Allergy Respir Dis(Korea) 2011;21:47-55] Key Words : Allergic rhinitis, Prevalence, Risk factor, Atopy, Childhood 서론알레르기비염 (allergic rhinitis, AR) 은비점막이알레르겐에노출된후일어나는 IgE 매개성염증반응에의한질환으로, 수양성콧물, 재채기, 코막힘등을주증상으로한다. 1) 알레르기비염의유병률은천식과더불어최근 20 여년간전세계적으로증가하고있는추세이며소아알레르기질환의국가간의유병률비교를위해진행된 International Study of Asthma and Allergic diseases in Childhood (ISAAC) 연구에따르면 1995년제 1차조사에서알레르기질환의유병률이낮았던나라에서는 2000년제 2차, 2005년제 3차조사에서지속적으로유병률이증가하는양상을보이고 1차조사에서유병률이높았던나라에서는 2, 3차조사에서유병률이감소하거나비슷한양상을보이고있다. 2) 우리나라의경우대한소아알레르기호흡기학회역학조사연구위원회에서시행한조사에따르면지난 12개월동안알레르기비염증상의유병률은 1995년 ISAAC 조사에서 31.0%, 2000년조사에서 29.7% 로약간감소하였으나, 일생동안알레르기비염의진단유병률은 1995년 15.5% 에서 2000년 20.4% 로증가하는소견을보였으며, 최근 12개월동안알레르기비염치료유병률역시 11.8% 에서 15.1% 로역시증가하는소견을보였다. 3) 알레르기비염은다른알레르기질환과마찬가지로유전적, 환경적요인이복합적으로작용하여발생한다고알려져있다. 부모의알레르기질환외에도어린연령의산모, 쌍생아, 미숙아, 성장지연, 주산기가사등이알레르기비염의발 생에영향을미칠수있으며, 실내및실외흡입알레르겐, isocyanate 와같은직업성화학물질, 비염증상을유발하는식품알레르겐등이알려져있으나정확한인과관계를밝히기엔연구가부족한실정이다. 1) 그중흡입알레르겐은잘알려진알레르기비염및천식의위험인자로서 4) 전통적으로화분, 곰팡이와같은실외알레르겐은계절성알레르기비염에, 5) 집먼지진드기, 애완동물, 바퀴벌레등과같은실내알레르겐은통년성알레르기비염의위험요인으로주로작용한다고알려져있었으나, 6) 2008년개정된 Allergic Rhinitis and its Impact on Asthma (ARIA) 가이드라인 1) 에서는화분에감작된환자의 50% 이상이지속적인비염증상을보이며, 반대로집먼지진드기에감작된환자의많은수가간헐성비염증상을보이므로, 7) 증상조절및치료의관점에서계절성, 통년성비염대신간헐성 (IAR; intermittent AR), 지속성 (PER; persistent AR) 비염의개념이등장하게되었다. 흡입알레르겐은출생이후나이, 성별에따라다른감작양상을보이며각각의연령에서알레르기비염의위험인자로작용할수있는데, 지역및인종에따라감작률이달라질수있기때문에각나라의감작률분포는질병예방및치료에있어매우중요한기초자료가되나아직우리나라에서는흡입알레르겐감작에따른알레르기비염의유병률에대해기술한보고는없다. 따라서본연구에서는서울지역 1개초등학교에서 ISAAC 설문지를통해알레르기비염의유병률을분석하고 20 종의알레르기피부반응검사를시행하여알레르겐감작과현증알레르기비염의연관성을알아보고자하였다. - 48 -
권지원들 : 초등학생알레르기비염유병률과항원감작 대상및방법 1. 대상 2008 년 5-10 월에걸쳐서울시송파구소재 1개초등학교학생 1,393명을대상으로신체계측와설문조사를시행하여총 1,376명이설문에참여하였으며설문지회수율은 98.3% 였다. 설문에답한소아중남아는 746명 (53.8%), 여아는 636명 (46.2%) 이었다. 2. 방법 1) 설문조사설문지는크게 3가지항목으로구성되었다. 첫째는이름, 생년월일, 성별, 키, 몸무게등의일반적인사항, 둘째는천식, 알레르기비염, 아토피피부염, 알레르기결막염, 식품알레르기증상에대한설문으로 ISAAC 연구의설문지내용과동일하게구성되었으며, 셋째는알레르기질환과관련된환경요인에대한항목이열거되어있다. 사전에부모나보호자에게안내문을배포하여설문내용에대하여설명한후동의서를받았으며설문지를배포후회수하는방식으로조사를진행하였다. 모든설문조사과정은서울아산병원임상연구심의위원회의승인후진행되었다. 2) 혈청총 IgE 농도, 총호산구분율전체학생중 83.8% (1,153/1,376) 에서혈액을채취하여혈청총 IgE 농도는 UniCAP 검사 (Pharmacia and Upjohn Diagnostics, Uppsala, Sweden) 로, 말초혈액내호산구분율 (peripheral eosinophil fraction) 은자동혈구계산기인 Coulter STKS (Coulter Electronics Inc., Hialeah, Flor., USA) 를이용하여측정하였다. 3) 피부단자시험알레르기피부시험은전체의 84.2% (1159/1376) 에서시행되었다. 집먼지진드기 2종 (Dermatophagoides pteronyssinus; Der p, Dermatophagoides farina; Der f), pet dander (cat fur, dog hair), pollens (grass mixture, early-and late-blooming tree pollen mixture, ragweed, mugwort), fungus (Aspergillus, Alternaria) 등을포함한우리나라에서흔한흡입항원 16 종과 egg white, milk, peanut, soybean 등의식품항원 4종 (Allergopharma, Reinbek, Germany) 을이용하였다. 검사대상자의팔에항원용액을점적한후소독된주사침을사용하여시행 하였으며, 단자시험 15분후에팽진의장축과그수직축의평균값을각항원의팽진의크기로하였으며팽진의크기가 3 m 이상이면서히스타민 (1 mg/ml) 에의한팽진의크기보다같거나큰경우를양성반응으로하였으며, 하나이상의항원에양성반응을보일때를아토피 (atopy) 로정의하였다. 4) 현증알레르기비염의정의설문조사에서일생동안알레르기비염진단을받은적이있으면서최근 12개월이내에감기나독감을앓고있지않은데도재채기또는콧물또는코막힘증상이있었던경우를현증알레르기비염 (current AR) 으로정의하였다. 또한알레르기비결막염 (allergic rhinoconjunctivitis) 은알레르기비염의증상을가지고있으면서눈이가렵거나눈물이나는증상이동반된경우로정의하였다. 3. 통계분석알레르기비염의유병률은 95% 신뢰구간의모비율추정치를사용하였으며, 위험인자분석에는카이제곱검정및로지스틱회귀분석을사용하여비차비 (odd ratio, OR) 와 95% 신뢰구간 (95% confidence interval, 95% CI) 을구하였다. 모든통계분석은 SPSS 14.0 (SPSS Inc., Chicago, IL, USA) 을이용하였으며 P value가 0.05 미만일때통계학적으로유의하다고판정하였다. 결과 1. 연구대상자수및특성 1,393명을중 1,376명이설문에참여하였으며설문지회수율은 98.3% 였다. 대상자의평균연령은 9.43±1.76세였고남아가 746명, 여아가 636명으로남녀의비율은 53.8%, 46.2% 였다. 부모의알레르기질환의병력은 35.8 %, 부모의알레르기비염의병력은 32.8% 이었으며간접흡연율은 36.9% 였다.(Table 1) 2. 서울지역초등학생알레르기비염의유병률태어나서지금까지알레르기비염증상을한번이라도경험한유병률은 42.5% 였고, 최근 12개월내에알레르기비염증상을경험한유병률은 39.0% 였으며, 최근 12개월내알레르기비결막염증상을경험한경우는 13.1%, 태어나서지금까지의사에게알레르기비염진단을받았던경우는 - 49 -
Ji-Won Kwon, et al. : Relationship between Prevalence of Allergic Rhinitis and Allergen Sensitization in Children 38.5%, 최근 12개월내에알레르기비염으로치료를받은경우는 29.5% 였다. 현증알레르기비염 ( 알레르기비염진단의병력이있으면서최근 12개월내비염증상이있는경우 ) 의유병률은 24.2% 였다.(Table 2) 현증알레르기비염은남아 (26.6%) 에서여아 (21.5%) 보다의미있게높았으며 (P =0.040, data not shown), 연령에따라서는만 7세에서 27.9% 로가장높은유병률을, 만 10세에서 19.5% 로가장낮은유병률을보였으나연령간에통계적으로유의한차이는없었다.(P =0.464, data not shown) 3. 알레르기비염의위험인자 현증알레르기비염의독립적인위험인자로는아토피피 Table 1. Characteristics of Subjects Number Age, Year mean±sd Sex, M/F BMI, mean±sd Parental history of allergic diseases Parental history of AR Economic state, monthly income Low, 2,999 USD) Middle, 3,000-4,990 USD High, 5,000 USD Environmental tobacco smoking Atopy * Allergen sensitization No. 0 1 2 3 4 1,376 9.43±1.76 740/636 18.57±3.17 371/1,037 (35.8%) 331/1,008 (32.8%) 362 (31.0%) 685 (58.7%) 120 (10.2%) 454/1,232 (36.9%) 495/1,159 (42.7%) 664 (57.3%) 331 (28.6%) 83 (7.2%) 42 (3.6%) 39 (3.4%) Abbreviations : BMI, body mass index; AR, allergic rhinitis * defined as at least 1 positive skin prick test (allergen wheal diameter is greater than 3 mm and histamine wheal diameter) 부염진단의병력 (aor=1.47, 95% CI 1.05-2.04), 천식진단의병력 (aor=3.48, 95% CI 2.15-5.61), 부모의알레르기질환 (aor=3.78, 2.76-5.18), 어머니의대졸이상학력 (aor=1.42, 95% CI 1.02-1.99) 등이있었다.(Table 3) 4. 호산구, IgE 농도, 알레르겐감작에따른현증알레르기비염의위험도 혈액내호산구가 4% 이상인경우 (aor=1.76, 95% CI 1.24-2.48), 혈청총 IgE 값이 100 ku/l 이상인경우 (aor=1.80, 95% CI 1.29-2.52), 한가지이상의알레르겐에감작된경우 (aor=1.47, 95% CI 1.06-2.04) 에현증알레르기비염의위험도가높았으며,(Table 4) 혈중호산구분율이높을수록 (aor=1.29, 95% CI.1.11-1.50, P value for trend=0.001), 혈청총 IgE의농도가높을수록 (aor=1.39, 95% CI.1.20-1.62, P value for trend= 0.001), 알레르겐감작수가많을수록 (aor=1.47, 95% CI 1.06-2.04) 위험도가높았다.(Fig. 1-3) 5. 특이알레르겐감작 집먼지진드기 (aor=1.54, 95% CI 1.10-2.15), 개항원 (aor=2.95, 95% CI 1.38-6.28), 고양이항원 (aor= 1.85, 95% CI 1.02-3.34), 오리나무화분 (aor=2.71, 95% CI 1.09-6.71) 및 Alternaria (aor=2.37, 95% CI 1.06-5.32) 감작은서울지역초등학생현증알레르기비염의독립적인위험인자였다.(Table 4) 고 본연구에서는서울시내송파지역 1개초등학교에서보호자를대상으로설문조사를통해학동기소아알레르기비 찰 Table 2. Prevalence of Allergic Rhinitis in Primary School Children of Seoul AR symptoms, ever AR symptoms, last 12 months AR symptoms with itchy watery eyes, last 12 months AR diagnosis, ever Current AR * Treatment of AR, last 12 months Number 474/1,116 453/1,163 164/1,255 446/1,159 292/1,208 339/1,151 Prevalence (95% CI) 42.5% (39.6-45.4) 39.0% (36.2-41.8) 13.1% (11.2-15.0) 38.5% (35.7-41.3) 24.2% (21.7-26.7) 29.5% (26.9-32.1) Abbreviation : AR, allergic rhinitis * Current AR; diagnosis ever plus symptoms within last 12 months - 50 -
권지원들 : 초등학생알레르기비염유병률과항원감작 Table 3. Risk Factors for Current Allergic Rhinitis Current AR Univariate Analysis Adjusted Analysis * Numbers % OR (95% CI) P Value aor (95% CI) P Value Personal characteristics Sex, male BMI 85percentile Past history of AD diagnosis Past history of asthma diagnosis Genetic factors Parental allergic diseases Socioeconomic factors Maternal education graduate Biologic markers Eosinophil fraction 4% Total IgE 100 ku/l Sensitization to common allergens 169/636 59/251 122/378 49/108 145/361 207/747 108/341 126/372 140/465 26.6 23.5 32.3 45.4 40.2 27.7 31.7 33.9 30.1 1.32 (1.01-1.72) 0.96 (0.69-1.33) 1.84 (1.40-2.42) 3.05 (2.03-4.58) 3.85 (2.85-5.21) 1.63 (1.22-2.17) 1.71 (1.28-2.28) 2.00 (1.51-2.67) 1.68 (1.27-2.22) 0.043 0.868 0.001 1.16 (0.84-1.58) 0.99 (0.68-1.44) 1.47 (1.05-2.04) 3.48 (2.15-5.61) 3.78 (2.76-5.18) 1.42 (1.02-1.99) 1.76 (1.24-2.48) 1.80 (1.29-2.52) 1.47 (1.06-2.04) 0.350 0.967 0.021 0.036 0.001 0.001 0.020 Abbreviations : AR, allergic rhinitis; BMI, body mass index; AD, atopic dermatitis * aor; adjusted odds ratio: Adjusted by age, sex, BMI, environmental tobacco smoking (ETS), parental allergic diseases and degree of maternal education Fig. 1. The odds ratios (95% CI) for current allergic rhinitis by the fraction of blood eosinophil. * aor: Adjusted by age, sex, BMI, ETS, parental allergic diseases and degree of maternal education * aor for trend=1.29 (1.11-1.50), P =0.001 Fig. 2. The odds ratios (95% CI) for current allergic rhinitis by the level of serum total IgE. * aor: Adjusted by age, sex, BMI, ETS, parental allergic diseases and degree of maternal education * aor for trend=1.39 (1.20-1.62), P - 51 -
Ji-Won Kwon, et al. : Relationship between Prevalence of Allergic Rhinitis and Allergen Sensitization in Children Fig. 3. The Odds Ratios (95% CI) for Current Allergic Rhinitis by the Number of Sensitization * aor: Adjusted by age, sex, BMI, ETS, parental allergic diseases and degree of maternal education * aor for trend=1.38 (1.15-1.65), P 염의유병률을알아보고, 혈액내호산구, 총 IgE 및알레르기피부시험을통해알레르기생체지표가알레르기비염의발생에미치는영향에대해알아보고자하였다. 이번연구는우리나라초등학생알레르기비염의생체지표상위험요인을알아본첫번째연구이다. 개량된 ISAAC 설문지를통해나타난일생동안알레르기비염의진단유병률은 38.5% (95% 신뢰구간 ; 95% confidence interval (CI) 35.7-41.3) 로, 2000년에시행된 2차 ISAAC 조사때의 22.0% (95% CI 21.1-22.9), 2005년 3차 ISAAC 조사때의 26.4% (95% CI 25.4-27.3) 에비해증가하는양상을보였다. 8) 물론본연구가서울시초등학교만을대상으로진행되었으므로우리나라전체초등학생알레르기비염의유병률을모두반영한다고볼수는없지만, 본연구의응답률이높고 (98.3%), 서울시인구가전체인구에서차지하는비율이크며 1995, 2000, 2005년 ISAAC 조사에서 3, 8) 우리나라전체및서울시의유병률을각각비교했을때도의미있게증가하는양상을 Table 4. Proportion of Specific Allergen Sensitization by Current Allergic Rhinitis (Total 1,159 conducted to allergic skin prick test) Allergen Sensitization (Covariates) Current AR Univariate Analysis Adjusted Analysis * No (n=816) Yes (n=266) OR (95% CI) P value OR (95% CI) P value Any allergen Indoor allergens HDM (Der p or Der f) Der p Der f Cockroach Dog Cat Pollen Grass Tree1, early-blooming Tree2, late-blooming Alder Oak Mugwort Ragweed Mold Alternaria Aspergillus 321 (39.3%) 293 (35.9%) 275 (33.7%) 244 (29.9%) 233 (28.6%) 12 (1.5%) 20 (2.5%) 49 (6.0%) 51 (6.3%) 7 (0.9%) 23 (2.8%) 28 (3.4%) 18 (2.2%) 29 (3.6%) 10 (1.2%) 3 (0.4%) 26 (3.2%) 22 (2.7%) 4 (0.5%) 140 (52.6%) 131 (49.2%) 127 (47.7%) 113 (42.5%) 102 (38.3%) 7 (2.6%) 17 (6.4%) 28 (10.5%) 34 (12.8%) 5 (1.9%) 12 (4.5%) 20 (7.5%) 10 (3.8%) 12 (4.5%) 7 (2.6%) 2 (0.8%) 18 (6.8%) 16 (6.0%) 4 (1.5%) 1.71 (1.29-2.26) 1.73 (1.30-2.29) 1.79 (1.35-2.38) 1.73 (1.30-2.30) 1.55 (1.16-2.08) 1.81 (0.70-4.64) 2.71 (1.40-5.26) 1.84 (1.13-2.99) 2.19 (1.39-3.47) 2.21 (0.69-7.03) 1.62 (0.79-3.32) 2.28 (1.26-4.13) 1.73 (0.78-3.80) 1.28 (0.64-2.55) 2.17 (0.82-5.78) 2.05 (0.34-12.35) 2.20 (1.18-4.09) 2.31 (1.19-4.46) 3.09 (0.77-12.47) 0.003 0.211 0.002 0.013 0.001 0.167 0.175 0.005 0.166 0.478 0.109 0.602 0.010 0.011 0.107 1.47 (1.06-2.04) 1.49 (1.07-2.08) 1.54 (1.10-2.15) 1.47 (1.05-2.05) 1.39 (0.98-1.96) 2.30 (0.84-6.29) 2.95 (1.38-6.28) 1.85 (1.02-3.34) 2.22 (1.28-3.85) 2.29 (0.60-8.71) 1.91 (0.83-4.38) 2.26 (1.12-4.57) 2.71 (1.09-6.71) 1.84 (0.84-4.06) 1.83 (0.58-5.75) 1.69 (0.17-16.60) 2.28 (1.08-4.79) 2.37 (1.06-5.32) 2.37 (0.46-12.12) 0.020 0.017 0.010 0.025 0.059 0.104 0.005 0.042 0.004 0.221 0.125 0.022 0.031 0.126 0.296 0.652 0.030 0.035 0.300 Abbreviation : HMD, house dust mite * aor: Adjusted by age, sex, BMI, ETS, parental allergic diseases and degree of maternal education - 52 -
권지원들 : 초등학생알레르기비염유병률과항원감작 보였으므로본연구의결과는학동기알레르기비염의기초통계자료로유용하게쓸수있을것이라생각된다. 본연구에서는알레르기비염의진단병력이있는아동중최근 12개월내에알레르기비염의증상이있는경우를현증알레르기비염으로정의하고그위험인자를분석한결과아토피피부염및천식의병력, 부모의알레르기질환병력, 어머니의학력이대졸이상인경우위험도가높았다. 아토피피부염을가지고있는아이들에서천식발생의위험도가높고, 천식을가지고있는아동중많게는 80% 까지알레르기비염을가지는것으로미루어 하나의기도질환 의개념이나 알레르기행진 의개념에의해상호동반될가능성이높음을확인할수있었으며, 부모의알레르기질환병력이자녀알레르기질환발생의중요한위험요인중하나임을확인할수있었다. 사회경제적수준에따라알레르기질환의유병률이다르다는것은잘알려진사실이다. 미국에서진행된연구에따르면천식의유병률, 그중에서도심한천식은빈곤층에서많고, 알레르기비염및아토피피부염은상대적으로선진국또는개발도상국에서많은것으로알려져있으나 9-11), 최근연구에서는사회경제적수준이낮은계층에서천식및알레르기비염유병률의증가가가장많은것으로알려져있어 10), 그추세가변화될수있음을시사한다. 또한부모의교육수준이증가할수록아토피피부염및알레르겐감작의위험도가커진다는연구 12) 와같이본연구에서도모친의교육수준이대졸이상인경우가현증알레르기비염의위험도가 1.42(95% CI 1.02-1.99) 배높았다. 그러나부친의교육수준은알레르기비염발생에영향을미치지않았으며, 이는모친의교육수준만이알레르기질환의위험도를증가시키고부친의교육수준과는상관없다는다른연구와동일한결과이다. 12) 현증알레르기비염과알레르기생체지표와의연관성분석을통해초등학생에서호산구분율이높을수록, 혈청총 IgE 농도가높을수록, 알레르기감작수가많을수록현증비염의위험도가증가하는것을알수있었다. 피부시험상한가지이상의알레르겐에양성반응을보인경우는 42.7% (495/1,159) 였으며, 집먼지진드기, 개또는고양이항원, 오리나무, Alternaria 에양성반응을보인경우에현증알레르기비염의위험도가높았다. 집먼지진드기의항원감작률이현증알레르기비염아동에서 47.7% 로가장높았으나위험도는다변량분석에서 1.49(1.07-2.08) 로나와, 개항원 (OR 2.95, 95% CI 1.38-6.28), 고양이항원 (OR 1.85, 95% CI 1.02-3.34), 오리나무항원 (OR 2.71, 95% CI 1.09-6.71), Alternaria (OR 2.37, 95% CI 1.06-5.32) 가상대적으로위험도가높은것을알수있었는데, 이는각항원에대한양성반응수의차이로인한현상일수있으나, 집먼지진드기항원에비해개, 오리나무, Alternaria 항원의비염증상유발강도가높을수있음을시사한다. 외국자료에서도집먼지진드기의감작률 (36.0%) 이가장높았으나비염증상에대한위험도는 2.7(95% CI 1.8-3.7) 로고양이항원의위험도가 4.9(95% CI 2.3-10.2) 로더높은것을알수있다. 13) 이러한결과는지역에따른항원노출정도나항원종류에따라서영향을받겠지만한국서울지역에서는집먼지진드기나개 / 고양이, 그리고 Alternaria 감작이비염발생의중요원인항원임을확인할수있었고, 오리나무항원은송파지역의특성을고려하여야할것으로생각된다. 특히본연구에서는감작된항원수가증가할수록현증알레르기비염의위험도가높아져서, 이는외국의단면분석 13) 및출생코호트연구 14) 와같은결과를보여주었으며, 이결과는여러항원에감작될수록알레르기비염발생위험성이증가함을시사한다. 알레르겐에대한감작률은성별, 연령, 인종, 거주지역, 측정계절에따라달라질수있으므로감작률을비교할때는측정시기가비슷하고대상군의특성이차이가나지않는군에서비교해야선택오류 (selection bias) 를줄일수있다. 최근국내에서보고된알레르기항원감작률을살펴보면, 1997년에발표된서울및충주지역 7-19세소아청소년 3,219 명을대상으로한조사에서아토피유병률은 35.0 % 였고 15), 2003년여천, 여수, 남원등에서 10-13 세아동 670 명을대상으로한조사 16) 에서는 23.3-35.6% 의감작률을보였다. 2008년제주도서귀포시에서 1,343명의초, 중학교소아청소년을대상으로한조사 17) 에서는 51.9% (550/1,060), 2006년서울지역고등학생 724명을대상으로한조사 18) 에서는 52.1%, 2006 년서울지역대학생 537 명을대상으로시행한조사 19) 에서는 36.9% 의감작률을보였다. 일반적으로알레르기항원의감작률이초기성인기까지연령이많아짐에따라증가하다 30 대이후부터감소하는것을고려하고 20), 본연구가서울지역 1개초등학교를대상으로시행한단점을고려하더라도본연구에서조사된 42.7% 의감작률은전체서울지역초등학생의감작률을예상하는데도움이될것이라고사료된다. 설문지상현증알레르기비염으로정의된아동중 52.6%(140/266) 가아토피성향을보였으며, 일생동안알레르기비염으로진단받은적이있는아동중 52.1%(211/405) 에서, 알레르기비염으로진단받은적이없는아동중 37.2%(238/639) 에서아 - 53 -
Ji-Won Kwon, et al. : Relationship between Prevalence of Allergic Rhinitis and Allergen Sensitization in Children 토피를가지고있었다.(data not shown) 이로미루어보아설문지상정의되는알레르기비염에는상당수에서비알레르기비염이포함되어있음을알수있어해석에주의를기울여야할것이며, 향후이에대한연구가더진행되어야할것으로생각한다. 본연구의제한점으로는서울송파지역 1개초등학교를대상으로시행된조사이므로우리나라전체의현상을대표할수는없다는점과, 병력청취및진찰과정없이설문지를통해알레르기비염을정의하였으므로회상오류, 선택오류등이일어날수있다는점이다. 하지만본연구의설문지회수율및알레르기검사시행률이상당히높고서울시자체가우리나라전체인구에서차지하는비율이상당할뿐만아니라, 기존국내 ISAAC 연구를실제로수행하였던연구자가본연구를동일하게수행하였기에과거연구결과와비교할수있을것으로생각되기에초등학생연령에서알레르기비염관련기초참고자료로유용하게사용될수있을것이다. 결론적으로서울송파지역초등학생알레르기비염진단유병률은 38.5%, 현증알레르기비염유병률은 24.2% 였으며, 이는과거에비해증가하고있는것을알수있었다. 위험인자로는아토피피부염과천식의병력, 부모의알레르기질환병력, 모친의높은교육수준등이었다. 혈액내호산구분율, 혈청 IgE, 알레르겐감작수가증가할수록현증알레르기비염과용량반응관계로위험도가높아졌으며, 집먼지진드기, 개항원, 고양이항원, 오리나무, Alternaria 항원은서울송파지역초등학생알레르기비염의주요원인항원이었다. 본연구결과는우리나라소아알레르기비염의기초자료로유용하게쓰일것으로생각되며, 출생코호트와같은전향적인연구를통해알레르기비염의발생원인을찾기위한보다다각도의노력이필요할것으로보인다. 요약목적 : 본연구는서울지역초등학생알레르기비염유병률및위험인자를확인하기위해시행되었다. 방법 : 연구대상은서울송파지역 1개초등학교학생 1,376명 ( 남아 740명, 여아 636명 ) 이었고, 개량된 ISAAC 설문지를통해알레르기비염의유병률분석을시행하였고, 알레르기피부반응검사및혈액내총 IgE, 호산구분율검사를시행하여생체지표에따른현증알레르기비염의위험도를분석하였다. 결과 : 설문지의회수율은 98.3% 였고, 대상군의연령은 9.43±1.76세였고남아가 746명, 여아가 636명으로남녀 의비율은 53.8%, 46.2% 였다. 최근 12 개월내알레르기비염증상유병률은 39.0%, 알레르기비결막염증상유병률은 13.1% 였으며, 평생동안의사에게진단받은알레르기비염의유병률은 38.5%, 최근 12개월내에알레르기비염치료유병률은 29.5% 였다. 현증알레르기비염의유병률은 24.2 % 였다. 현증알레르기비염의위험인자로는아토피피부염진단병력 (aor=1.47, 95% CI 1.05-2.04), 천식진단병력 (aor=3.48, 95% CI 2.15-5.61), 부모의알레르기질환 (aor=3.78, 2.76-5.18), 어머니의대졸이상학력 (aor=1.42, 95% CI 1.02-1.99) 등이있었다. 또한호산구분율이높을수록 (P value for trend =0.001), 혈청 IgE 가높을수록 (P value for trend ), 알레르겐감작수가많을수록 (P value for trend ) 위험도가증가하였다. 집먼지진드기 (1.54, 1.10-2.15), 개항원 (2.95, 1.38-6.28), 고양이항원 (1.85, 1.02-3.34), 오리나무 (2.71, 1.09-6.71), Alternaria 감작 (2.37, 1.06-5.32) 은현증알레르기비염의독립적인위험인자였다. 결론 : 서울초등학교알레르기비염유병률은과거자료와비교하여증가하고있으며, 아토피피부염과천식의병력, 부모의알레르기질환력, 모의높은교육수준등의경우에그위험도가높았다. 혈액내호산구분율, 혈청 IgE, 알레르겐감작수는현증알레르기비염과용량반응관계의위험도를보였으며, 집먼지진드기, 개, 고양이항원, 오리나무, Alternaria는서울송파지역초등학생알레르기비염의주요원인항원이었다. 감사의글 본연구는서울시 Atopy Free Seoul 사업의지원으로진행되었습니다. 연구에참여해주신모든학생및부모님들과서울잠전초등학교교장선생님이하여러선생님들, 대한소아알레르기호흡기학회산하 ISAAC 역학조사위원회선생님들, 송파구보건소김인국소장님및관계자분들께감사의말씀드립니다. 참고문헌 1) Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy 2008;63 Suppl 86:8-160. - 54 -
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