Synergistic effect of multiple indoor allergen sources on atopic symptoms in primary school children

Accumulating data show that the complex modern indoor environment contributes to increasing prevalence of atopic diseases. However, the dose–response relationship between allergic symptoms and complexity of indoor environmental allergen sources (IEAS) has not been clearly evaluated before. Therefore, we designed this study to investigate the overall effect of multiple IEAS on appearance of asthma (AS), allergic rhinitis (AR), and eczema (EC) symptoms in 1472 primary school children. Among various IEAS analyzed, only stuffed toys, cockroaches, and mold patches fit the model of ‘more IEAS, higher odds ratio (OR) of association’. The association of IEAS and AR increased stepwise as more IEAS appeared in the environment (1.71, 2.47, to 2.86). In AS and EC, the association was significant only when all three IEAS were present (1.42, 1.98, to 4.11 in AS; 1.40, 1.76, to 2.95 in EC). These results showed that different IEAS had a synergistic effect on their association with atopic symptoms and also suggest that there is a dose–response relationship between kinds of IEAS and risk of appearance of atopic diseases.