Prevalence and risk factors for allergic rhinitis and atopic eczema among schoolchildren in Israel: results from a national study Yael Graif, MD*; Ben-Zion Garty, MD†; Irit Livne, MPH‡; Manfred S. Green, MD, PhD§; and Tamy Shohat, MD¶ Background: There is growing evidence that the prevalence rates of asthma and allergic diseases are increasing, especially among children. Several risk factors are under investigation. Objective: To evaluate the prevalence and risk factors for allergic diseases, including allergic rhinitis (AR) and atopic eczema (AE), among 13- to 14-year-old schoolchildren in Israel. Methods: A modified version of the International Study of Asthma and Allergies in Childhood written questionnaire was administered to a national sample of schoolchildren 13 to 14 years old in Israel. The questionnaire was completed by the schoolchildren themselves. Results: There were 10,057 complete questionnaires available for analysis. The prevalence of AR symptoms ever and current AR were 41.6% and 9.4%, respectively. Allergic rhinoconjunctivitis symptoms ever were reported by 15.8% of the children. The prevalence rates of 6 months of itchy rash ever and AE were 5.9% and 7.8%, respectively. After adjustment for demographic and environmental factors, current asthma, parental history of asthma, and population group were the most significant risk factors for current AR (odds ratio [OR], 4.47; 95% confidence interval [CI], 3.70 –5.40; OR, 1.30; 95% CI, 1.02–1.66; and OR, 1.75; 95% CI, 1.45–2.13; respectively) and AE (OR, 2.30; 95% CI, 1.80 –2.90; OR, 1.80; 95% CI, 1.40 –2.30; and OR, 1.70; 95% CI, 1.40 –2.00; respectively). Conclusions: Israeli children have a low prevalence rate of current AR and a midrange rate of AE. Arabs have lower prevalence rates of allergic diseases than Jews, and the prominent risk factors for those diseases are current asthma and parental history of asthma. Ann Allergy Asthma Immunol. 2004;92:245–249. INTRODUCTION Prevalence rates of allergic diseases, such as asthma, allergic rhinitis (AR), and atopic eczema (AE), are increasing world- wide. One of the theories proposed to explain this increase is the “hygiene hypothesis.” 1 In accordance with this theory, the increase in allergic diseases is associated with the significant decrease in the incidence of several childhood infectious diseases in developed countries as a result of vaccinations, antibiotics, improved hygiene, and better socioeconomic con- ditions. This decrease has resulted in the shifting of regula- tory cytokines in the immune response and the loss of pro- tection against the development of allergic diseases. 2 Due to the increasing prevalence and the new immunologic theories, there is growing interest in the epidemiology of allergic diseases, especially in children. The International Study of Asthma and Allergies in Child- hood (ISAAC) protocol established a standardized method to maximize the value of epidemiologic studies in asthma and allergic diseases and enabled international comparisons. 3 This protocol had been used in more than 56 countries in 155 collaborating centers and allowed worldwide evaluation of the self-reported symptoms of asthma, AR, and AE. 4,5 In this study, we used for the first time in Israel the ISAAC written protocol to investigate the prevalence of AR and AE in a national sample of schoolchildren aged 13 to 14 years. We also studied risk factors such as current asthma, parental history of asthma, ethnic origin, and others. This study is part of the previously published ISAAC protocol that investigated the prevalence of asthma in Israel. 6 MATERIALS AND METHODS Sampling Strategy The data were collected as part of a national study. A detailed description of the study methods is given elsewhere. 6 To obtain a representative sample of 13- to 14-year-old school- children, 141 schools were chosen at random from a Ministry of Education list of schools by district. For each school sampled, all eighth grade children were included in the study. * Allergy and Pulmonary Clinic, Israel Defense Forces, Tel-Aviv, Israel. † Pediatric Department B and Kipper Institute of Allergy and Immunology, Schneider Children’s Medical Center, and the Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. ‡ Israel Ministry of Education, Jerusalem, Israel. § The Israel Center for Disease Control, Israel Ministry of Health, Tel- Hashomer, and the Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Tel-Aviv University, Israel. ¶ Tel-Aviv Health District, Israel Ministry of Health, Tel-Aviv, and the Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Tel-Aviv University, Israel. Received for publication June 29, 2003. Accepted for publication in revised form September 4, 2003. VOLUME 92, FEBRUARY, 2004 245