Asthma, allergy and atopy in Asian immigrants in Melbourne

To compare the prevalence of asthma, hay fever and atopy in Asian immigrants in Melbourne with that in Australian-born non-Asians and Australian-born Asians, and to investigate the association of these conditions with atopic status, length of stay in Australia and IgE levels in Asian immigrants.

We performed a cross-sectional study by telephone interviews, using standard questionnaire items on respiratory and allergic symptoms. A random sample of 636 recent Asian immigrants of ethnic Chinese origin, 109 Australian-born Asians and 424 Australian-born non-Asians were selected from the 1991 Melbourne Telephone Directory, using a presumptive surname list. Skin tests to determine atopic status were performed on 269 Asian immigrants and 167 of these also had serum levels of total and specific IgE estimated.

In the under 20 years age group the prevalence of wheeze or asthma ever was higher in Australian-born non-Asians and Australian-born Asians than in Asian immigrants (P < 0.001), and the prevalence of hay fever was higher in Asian immigrants and Australian-born Asians than in Australian-born non-Asians. In those older than 20 years, hay fever was almost twice as common in Asian immigrants as in Australian-born non-Asians (P < 0.001 for 20-40 years age group; P < 0.01 for > 40 years). The prevalence of hay fever and, to a lesser degree, asthma in Asian immigrants increased significantly with length of stay in Australia, independent of age at arrival, sex and atopic status (trend test: P < 0.001 for hay fever; P = 0.05 for asthma). Atopy was more common in Asian immigrants and Australian-born Asians than in Australian-born non-Asians (P < 0.001) and was very strongly associated with both hay fever and asthma, irrespective of length of stay. Pollen and mite sensitivities were more common in Asian subjects (twice as common for Asian-born and 1.5 times for Australian-born) than non-Asian subjects (P < 0.01). Among Asian immigrants, elevated total IgE level (> 100 IU/mL) was strongly associated with a history of hay fever (P < 0.01) and wheeze or asthma ever (P < 0.05), atopy (P < 0.001) and the presence of specific IgE antibodies to grass pollen, dust mite, cockroach and Ascaris antigens (P < 0.05 for all).

We found substantial differences in the prevalence of asthma, hay fever and atopy between Asian immigrants, Australian-born Asians and non-Asians. The prevalence of hay fever and asthma in Asian immigrants was strongly associated with length of stay in Australia, suggesting that environmental factors are important in the pathogenesis of these diseases.