Background: Aeroallergen sensitization is related to the coexistence of allergic diseases, but the nature of this relationship is poorly understood. The aim of this study was to clarify the relationship of polysensitization with allergic multimorbidities and the severity of allergic diseases. Methods: This study is a cross-sectional analysis of 3,368 Korean children aged 6-7 years-old. We defined IgE-mediated allergic diseases based on structured questionnaires, and classified the sensitivity to 18 aeroallergens by logistic regression and the Ward hierarchical clustering method. The relationship of polysensitization (positive IgE responses against 2 or more aeroallergens classes) with allergic multimorbidities (coexistence of 2 or more of the following allergic diseases: asthma, rhinitis, eczema, and conjunctivitis) and severity of allergic diseases was determined by ordinal logistic regression analysis. Results: The rate of polysensitization was 13.6% (n = 458, 95% CI 12.4-14.8) and that of allergic multimorbidity was 23.5% (n = 790, 95% CI 22.0-24.9). Children sensitized to more aeroallergens tended to have more allergic diseases (rho = 0.248, p < 0.001), although the agreement between polysensitization and multimorbidity was poor (kappa = 0.11, p < 0.001). The number allergen classes to which a child was sensitized increased the risk of wheezing attacks (1 allergen: adjusted odds ratio [aOR] 2.22, 4 or more allergens: aOR 9.39), absence from school (1 allergen: aOR 1.96, 3 allergens: aOR 2.08), and severity of nasal symptoms (1 allergen: aOR 1.61, 4 or more allergens: aOR 4.38). Conclusion: Polysensitization was weakly related to multimorbidity. However, the number of allergens to which a child is sensitized is related to the severity of IgE-mediated symptoms.

Bousquet J, Anto JM, Wickman M, Keil T, Valenta R, Haahtela T, et al: Are allergic multimorbidities and IgE polysensitization associated with the persistence or re-occurrence of foetal type 2 signalling? The MeDALL hypothesis. Allergy 2015;70:1062-1078.
Pinart M, Benet M, Annesi-Maesano I, von Berg A, Berdel D, Carlsen KC, et al: Comorbidity of eczema, rhinitis, and asthma in IgE-sensitised and non-IgE-sensitised children in MeDALL: a population-based cohort study. Lancet Respir Med 2014;2:131-140.
Ballardini N, Kull I, Lind T, Hallner E, Almqvist C, Ostblom E, et al: Development and comorbidity of eczema, asthma and rhinitis to age 12: data from the BAMSE birth cohort. Allergy 2012;67:537-544.
Wang XS, Shek LP, Ma S, Soh SE, Lee BW, Goh DY: Time trends of co-existing atopic conditions in Singapore school children: prevalence and related factors. Pediatr Allergy Immunol 2010;21:e137-141.
Ballardini N, Bergstrom A, Wahlgren CF, van Hage M, Hallner E, Kull I, et al: IgE antibodies in relation to prevalence and multimorbidity of eczema, asthma, and rhinitis from birth to adolescence. Allergy 2016;71:342-349.
Pearce N, Pekkanen J, Beasley R: How much asthma is really attributable to atopy? Thorax 1999;54:268-272.
Arshad SH, Tariq SM, Matthews S, Hakim E: Sensitization to common allergens and its association with allergic disorders at age 4 years: a whole population birth cohort study. Pediatrics 2001;108:E33.
Valero A, Pereira C, Loureiro C, Martinez-Cocera C, Murio C, Rico P, et al: Interrelationship between skin sensitization, rhinitis, and asthma in patients with allergic rhinitis: a study of Spain and Portugal. J Investig Allergol Clin Immunol 2009;19:167-172.
Bousquet J, Heinzerling L, Bachert C, Papadopoulos NG, Bousquet PJ, Burney PG, et al: Practical guide to skin prick tests in allergy to aeroallergens. Allergy 2012;67:18-24.
Migueres M, Davila I, Frati F, Azpeitia A, Jeanpetit Y, Lheritier-Barrand M, et al: Types of sensitization to aeroallergens: definitions, prevalences and impact on the diagnosis and treatment of allergic respiratory disease. Clin Transl Allergy 2014;4:16.
Westman M, Stjarne P, Asarnoj A, Kull I, van Hage M, Wickman M, et al: Natural course and comorbidities of allergic and nonallergic rhinitis in children. J Allergy Clin Immunol 2012;129:403-408.
Bousquet J, Becker WM, Hejjaoui A, Chanal I, Lebel B, Dhivert H, et al: Differences in clinical and immunologic reactivity of patients allergic to grass pollens and to multiple-pollen species. II. Efficacy of a double-blind, placebo-controlled, specific immunotherapy with standardized extracts. J Allergy Clin Immunol 1991;88:43-53.
Kim KW, Kim EA, Kwon BC, Kim ES, Song TW, Sohn MH, et al: Comparison of allergic indices in monosensitized and polysensitized patients with childhood asthma. J Korean Med Sci 2006;21:1012-1016.
de Jong AB, Dikkeschei LD, Brand PL: Sensitization patterns to food and inhalant allergens in childhood: a comparison of non-sensitized, monosensitized, and polysensitized children. Pediatr Allergy Immunol 2011;22:166-171.
Kang H, Yu J, Yoo Y, Kim DK, Koh YY: Coincidence of atopy profile in terms of monosensitization and polysensitization in children and their parents. Allergy 2005;60:1029-1033.
Ciprandi G, Cirillo I: Monosensitization and polysensitization in allergic rhinitis. Eur J Intern Med 2011;22:e75-e79.
Ciprandi G, Alesina R, Ariano R, Aurnia P, Borrelli P, Cadario G, et al: Characteristics of patients with allergic polysensitization: the POLISMAIL study. Eur Ann Allergy Clin Immunol 2008;40:77-83.
Cirillo I, Marseglia G, Klersy C, Ciprandi G: Allergic patients have more numerous and prolonged respiratory infections than nonallergic subjects. Allergy 2007;62:1087-1090.
Cirillo I, Vizzaccaro A, Klersy C, Baiardini I, Marseglia GL, Canonica GW, et al: Quality of life and polysensitization in young men with intermittent asthma. Ann Allergy Asthma Immunol 2005;94:640-643.
Hahm MI, Chae Y, Kwon HJ, Kim J, Ahn K, Kim WK, et al: Do newly built homes affect rhinitis in children? The ISAAC phase III study in Korea. Allergy 2014;69:479-487.
Kim J, Hahm MI, Lee SY, Kim WK, Chae Y, Park YM, et al: Sensitization to aeroallergens in Korean children: a population-based study in 2010. J Korean Med Sci 2011;26:1165-1172.
Asher MI, Keil U, Anderson HR, Beasley R, Crane J, Martinez F, et al: International Study of Asthma and Allergies in Childhood (ISAAC): rationale and methods. Eur Respir J 1995;8:483-491.
Lee SY, Kim YN, Kang YJ, Jang M, Kim J, Moon JS, et al: The methodology for developing the 2007 Korean growth charts and blood pressure nomogram in Korean children and adolescents. Korean J Pediatr 2008;51:26.
Valderas JM, Starfield B, Sibbald B, Salisbury C, Roland M: Defining comorbidity: implications for understanding health and health services. Ann Fam Med 2009;7:357-363.
Storm van's Gravesande K, Moseler M, Kuehr J: The most common phenotypes of sensitization to inhalant allergens in childhood. Clin Exp Allergy 1997;27:646-652.
Schatz M, Hsu JW, Zeiger RS, Chen W, Dorenbaum A, Chipps BE, et al: Phenotypes determined by cluster analysis in severe or difficult-to-treat asthma. J Allergy Clin Immunol 2014;133:1549-1556.
Wickman M, Asarnoj A, Tillander H, Andersson N, Bergstrom A, Kull I, et al: Childhood-to-adolescence evolution of IgE antibodies to pollens and plant foods in the BAMSE cohort. J Allergy Clin Immunol 2014;133:580-582.
Boulet LP, Turcotte H, Laprise C, Lavertu C, Bedard PM, Lavoie A, et al: Comparative degree and type of sensitization to common indoor and outdoor allergens in subjects with allergic rhinitis and/or asthma. Clin Exp Allergy 1997;27:52-59.
Bousquet PJ, Castelli C, Daures JP, Heinrich J, Hooper R, Sunyer J, et al: Assessment of allergen sensitization in a general population-based survey (European Community Respiratory Health Survey I). Ann Epidemiol 2010;20:797-803.
Kim HY, Shin YH, Yum HY, Jee HM, Jang SJ, Yoon JW, et al: Patterns of sensitisation to common food and inhalant allergens and allergic symptoms in pre-school children. J Paediatr Child Health 2013;49:272-277.
Bousquet J, Clark TJ, Hurd S, Khaltaev N, Lenfant C, O'Byrne P, et al: GINA guidelines on asthma and beyond. Allergy 2007;62:102-112.
de Groot EP, Duiverman EJ, Brand PL: Comorbidities of asthma during childhood: possibly important, yet poorly studied. Eur Respir J 2010;36:671-678.
Bousquet J, Schunemann HJ, Samolinski B, Demoly P, Baena-Cagnani CE, Bachert C, et al: Allergic Rhinitis and its Impact on Asthma (ARIA): achievements in 10 years and future needs. J Allergy Clin Immunol 2012;130:1049-1062.
Olze H, Zuberbier T: Comorbidities between nose and skin allergy. Curr Opin Allergy Clin Immunol 2011;11:457-463.
Eichenfield LF, Tom WL, Chamlin SL, Feldman SR, Hanifin JM, Simpson EL, et al: Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis. J Am Acad Dermatol 2014;70:338-351.
Gough H, Grabenhenrich L, Reich A, Eckers N, Nitsche O, Schramm D, et al: Allergic multimorbidity of asthma, rhinitis, and eczema over 20 years in the German birth cohort MAS. Pediatr Allergy Immunol 2015;26:431-437.
Guerra S, Allegra L, Blasi F, Cottini M: Age at symptom onset and distribution by sex and symptoms in patients sensitized to different allergens. Allergy 1998;53:863-869.
Gustafsson D, Sjoberg O, Foucard T: Development of allergies and asthma in infants and young children with atopic dermatitis - a prospective follow-up to 7 years of age. Allergy 2000;55:240-245.
Ciprandi G, Cirillo I, Tosca MA, Vizzaccaro A: Bronchial hyperreactivity and spirometric impairment in polysensitized patients with allergic rhinitis. Clin Mol Allergy 2004;2:3.
Prigione I, Morandi F, Tosca MA, Silvestri M, Pistoia V, Ciprandi G, et al: Interferon-gamma and IL-10 may protect from allergic polysensitization in children: preliminary evidence. Allergy 2010;65:740-742.
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