Relation of indoor heating with asthma, allergic sensitisation, and bronchial responsiveness: survey of children in South Bavaria

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Abstract
Objective: To investigate the relation between different types of heating and the prevalence of atopic diseases, skin test reactivity, and bronchial hyperresponsiveness. Design: Cross sectional survey among schoolchildren aged 9-11 years. Skin prick tests, pulmonary function tests, and bronchial challenge in the children and self completion of a written questionnaire by the children's parents. Subjects: 1958 children in a rural area in southern Bavaria, Germany. Main outcome measures: Prevalence of asthma, hay fever, and atopic dermatitis as determined by parents' answers to a questionnaire; the atopic status of the child assessed by skin prick tests; and bronchial responsiveness to cold air challenge in the children. Results: After possible confounders were controlled for, the risk of developing hay fever (odds ratio=0.57; 95% confidence interval 0.34 to 0.98), atopy defined as at least one positive reaction to a panel of common aeroallergens (0.67; 0.49 to 0.93), sensitisation to pollen (0.60; 0.41 to 0.87), and of bronchial hyperresponsiveness (0.55;0.34-0.90) was significantly lower in children living in homes where coal or wood was used for heating than in children living in homes with other heating systems. Conclusions: Factors directly or indirectly related to the heating systems used in rural Bavarian homes decrease the susceptibility of children to becoming atopic and to developing bronchial hyperresponsiveness. This study shows that in a rural population children of families using wood or coal for heating and cooking had a significant lower prevalence of hay fever, atopy, and bronchial hyperresponsiveness than children living in homes with other heating systems Factors directly related to home wood or coal combustion may explain these findings Alternatively, using coal and wood burning stoves indoors may be related to a more traditional life style with unknown protective factors that have been lost in families using other sources of energy such as gas, oil, or a central heating system