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Atopic disease in Indians from Tamil Nadu
PuhL Hlth. Lond. (1982) 96. 145-147
A t o p i c Disease in Indians f r o m Tamil Nadu A. Mitchell, Charlotte Manoharan, J. F. Mayberry, 3. Rhodes and R. G. Newcombe
Introduction It is occasionally said that Indians who move to Brtain experience more atopic illness.. In this s~tudy we have attempted to record the prevalence o f atopie disease in Tamil-speaking Indians in Southern India and compared them with an age- and sex-matched group of .Britor~s. Method One hundred Indians completed a questionnaire about atopic disease. The questionnaire was administered by six Tamil-speaking assistants; subjects were asked whether they had ever suffered from asthma, hayfever, allergic rhinitis, eczema or atopic dermatitis. Asthma was defined as "'breathlessness and wheezing"; allergic rhinitis w::~glikened to"hayfever with features o f recurrent sneezing and a watery nasal discharge"; eczema was described as "'patches o f dry red, inflamed, itchy skin". Questions were also asked about skin reactions to drugs, soaps, powders, plasters and tapes to establish cases of atopic dermatitis. A family history of atopic illness amongst parents or siblings of the subjects were also recorded. The subjects came from Tamil Nadu, in South India, and half of the group interviewed were women and included nurses and expectant mothers from Bethesda Christian Hospital, Ambur. The men"included members of staff and those accompanying wives who were attending the medical out-patient department. About half o f the subjects were Moslems, including tannery workers and farmers, while the Hindus were mostly of the Hajarian or untouchable cast. One hundred British controls were chosen from patients attending a fracture clinic a~ ll~~ Cardiff Royal Infirmary and their relatives. No Asian families were included. The controls from Britain were matched with the Indian subjects for age and sex. They complet,:d ~.= similar questionnaire in English, using the same definitions of atopic disease. Re:~uits were compared using X~ on one degree of freedom.
Results The mean a g e o f the 50 Indian men was 34 years (+__I1 years) and of the 50 women 26 years (+_ 9 years). The prevalence o f asthma, hayfever and eczema was similar in the Indian and British populations studied. Allergic rhinitis was commoner in the Indian group, but the difference failed to reach conventional levels o f statistical significance. Atopic dermatitis was significantly more c o m m o n in the BritiSh group, as was a family history o f atopic disease.
0033-3506/82/030145+03 $02.00/0
© 1982The Societyof Community Medicine
146
A. M i t c h e l l et aL
Txl~t£ 1. The prevalence of atopic disease in 100 Indians from Tan,il Nadu compared with 100 Britons residenl in Wales
Asthma Hayfever Rhinilis Eczema Alopic dermatilis Family history, of atopy
Indians (n = 100)
British (n = 100)
X~
p values
• 20 19 12 10 21
10 12 9 9 34 55
0.61 1-82 3.36 0.22 15.41 23-11
NS NS 0-05 < p < 0-I NS < 0-00 I < 0-001
Discussion
Atopic dermatitis appears to occur more frequently in Europeans than in Indians. However, other atopic disease has a similar frequency in both groups; the higher frequency with which British individuals reported a family history may reflect cultural differences. There are few studies of atopic disease in Indian populations. In 1965 Viswanathan et aL compared the prevalence of asthma in urban and rural areas. ~ One thousand people in a suburb of Patna in Bihar State in North East India were compared with 920 living in the rural village of Pahari. Of the urban group, 1"6~ (16) had asthma compared with 2.7~ (25) of the rural population. This difference was not significant. Both figures are lower than the 6 ~ reported in this paper. Viswanathan et aL also reviewed the frequency with which asthma occurred in relatives of affected and healthy individuals.J Thirty-four per cent of patients with asthma had a relative who was also affected, but surprisingly 16.3~ of healthy individuals had an affected relative. In the combined population of 1920 individuals, 321 (17~) had a family history of asthma. In our study 21~o of the Indian population reported that at least one member of the family was affected by an atopic.illness. In a subsequent study Viswanathan e t al. reviewed a 5 ~ sample of the population of Patna. 2 Of 15,805 people who completed a questionnaire, 1-8 ~ showed a prevalence for asthma, which was similar to their earlier pilot study. Again 11.6~ of the sample had a family history of asthma. Sethi et aL s reviewed 600 patients with asthma from Jaipur, the capital of Rajasthan in North West India, and noted that although inhaled, allergens were responsible for asthmatic attacks in 74% of the groul~, food sensitivity played an important part it, 9.4°~. of cases. Foods which were important included eggs, pulses, milk, cabbage, rice, potatoes, lemons, bananas and oranges. The Indian diet varies considerably and both previous studies were from the north, whereas Tamil Nadu is in the south. There have been no previous attempts to document the frequency of other atopic diseases in India. It is interesting that there are few differences between Indian and British communities, whereas a similar study in Hong Kong4 demonstrated some striking differences between Chinese and British populations. The Chinese appear to have significantly less atopic disease than Europeans. It is likely that the British have a greater and more varied exposure to potential allergens in soaps, powders and similar products than an Indian population and therefore atopic dermatitis is more common in the European group. The role of heredity or environment in the development of atopic dermatitis in Indians may be eliminated by further studies of Tamil-speaking Indians who have emigrated to Britain in search of work or education.
Atopic disease in hldians
13,7
References 1. 2. 3. 4.
Viswanathan. R., Mody, R. K., Prasad, S. S. & Sinha,S. P. (I 965). Bronchial asthma and chronic bronchilis. A pilot survey. Journal of the Indian 34edical Association 45, 480--3. Viswanathan. R., Prasad, M., Thakur, A. K., Sinha, S. P., Prakash, N., Mody, R . K . , Singh, T. R. B, P, ?q. & Prasad, S. N. (1966). EpidemioIogy of asthma in an urban population, A random morbidity survey. Journal of the Indian ~Icdieal Association 46, 480--3. Sethi, J. P., Mathur, D. P., Baldwa, V. S.. Mathur, U. S. & Sogani, I. C. (1969). Natural history of bronchial asthma in India. Journal~fAsthma Research 6. 187-97. Fung, Y. M,, Mayberry. J. F.. Rhodes. J.&Newcombe, R. G.(1982).Alopicdiseasein the Hong Kong Chinese. Postgraduate Medical Journal (In press).
A t o p i c Disease in Indians f r o m Tamil Nadu A. Mitchell, Charlotte Manoharan, J. F. Mayberry, 3. Rhodes and R. G. Newcombe
Introduction It is occasionally said that Indians who move to Brtain experience more atopic illness.. In this s~tudy we have attempted to record the prevalence o f atopie disease in Tamil-speaking Indians in Southern India and compared them with an age- and sex-matched group of .Britor~s. Method One hundred Indians completed a questionnaire about atopic disease. The questionnaire was administered by six Tamil-speaking assistants; subjects were asked whether they had ever suffered from asthma, hayfever, allergic rhinitis, eczema or atopic dermatitis. Asthma was defined as "'breathlessness and wheezing"; allergic rhinitis w::~glikened to"hayfever with features o f recurrent sneezing and a watery nasal discharge"; eczema was described as "'patches o f dry red, inflamed, itchy skin". Questions were also asked about skin reactions to drugs, soaps, powders, plasters and tapes to establish cases of atopic dermatitis. A family history of atopic illness amongst parents or siblings of the subjects were also recorded. The subjects came from Tamil Nadu, in South India, and half of the group interviewed were women and included nurses and expectant mothers from Bethesda Christian Hospital, Ambur. The men"included members of staff and those accompanying wives who were attending the medical out-patient department. About half o f the subjects were Moslems, including tannery workers and farmers, while the Hindus were mostly of the Hajarian or untouchable cast. One hundred British controls were chosen from patients attending a fracture clinic a~ ll~~ Cardiff Royal Infirmary and their relatives. No Asian families were included. The controls from Britain were matched with the Indian subjects for age and sex. They complet,:d ~.= similar questionnaire in English, using the same definitions of atopic disease. Re:~uits were compared using X~ on one degree of freedom.
Results The mean a g e o f the 50 Indian men was 34 years (+__I1 years) and of the 50 women 26 years (+_ 9 years). The prevalence o f asthma, hayfever and eczema was similar in the Indian and British populations studied. Allergic rhinitis was commoner in the Indian group, but the difference failed to reach conventional levels o f statistical significance. Atopic dermatitis was significantly more c o m m o n in the BritiSh group, as was a family history o f atopic disease.
0033-3506/82/030145+03 $02.00/0
© 1982The Societyof Community Medicine
146
A. M i t c h e l l et aL
Txl~t£ 1. The prevalence of atopic disease in 100 Indians from Tan,il Nadu compared with 100 Britons residenl in Wales
Asthma Hayfever Rhinilis Eczema Alopic dermatilis Family history, of atopy
Indians (n = 100)
British (n = 100)
X~
p values
• 20 19 12 10 21
10 12 9 9 34 55
0.61 1-82 3.36 0.22 15.41 23-11
NS NS 0-05 < p < 0-I NS < 0-00 I < 0-001
Discussion
Atopic dermatitis appears to occur more frequently in Europeans than in Indians. However, other atopic disease has a similar frequency in both groups; the higher frequency with which British individuals reported a family history may reflect cultural differences. There are few studies of atopic disease in Indian populations. In 1965 Viswanathan et aL compared the prevalence of asthma in urban and rural areas. ~ One thousand people in a suburb of Patna in Bihar State in North East India were compared with 920 living in the rural village of Pahari. Of the urban group, 1"6~ (16) had asthma compared with 2.7~ (25) of the rural population. This difference was not significant. Both figures are lower than the 6 ~ reported in this paper. Viswanathan et aL also reviewed the frequency with which asthma occurred in relatives of affected and healthy individuals.J Thirty-four per cent of patients with asthma had a relative who was also affected, but surprisingly 16.3~ of healthy individuals had an affected relative. In the combined population of 1920 individuals, 321 (17~) had a family history of asthma. In our study 21~o of the Indian population reported that at least one member of the family was affected by an atopic.illness. In a subsequent study Viswanathan e t al. reviewed a 5 ~ sample of the population of Patna. 2 Of 15,805 people who completed a questionnaire, 1-8 ~ showed a prevalence for asthma, which was similar to their earlier pilot study. Again 11.6~ of the sample had a family history of asthma. Sethi et aL s reviewed 600 patients with asthma from Jaipur, the capital of Rajasthan in North West India, and noted that although inhaled, allergens were responsible for asthmatic attacks in 74% of the groul~, food sensitivity played an important part it, 9.4°~. of cases. Foods which were important included eggs, pulses, milk, cabbage, rice, potatoes, lemons, bananas and oranges. The Indian diet varies considerably and both previous studies were from the north, whereas Tamil Nadu is in the south. There have been no previous attempts to document the frequency of other atopic diseases in India. It is interesting that there are few differences between Indian and British communities, whereas a similar study in Hong Kong4 demonstrated some striking differences between Chinese and British populations. The Chinese appear to have significantly less atopic disease than Europeans. It is likely that the British have a greater and more varied exposure to potential allergens in soaps, powders and similar products than an Indian population and therefore atopic dermatitis is more common in the European group. The role of heredity or environment in the development of atopic dermatitis in Indians may be eliminated by further studies of Tamil-speaking Indians who have emigrated to Britain in search of work or education.
Atopic disease in hldians
13,7
References 1. 2. 3. 4.
Viswanathan. R., Mody, R. K., Prasad, S. S. & Sinha,S. P. (I 965). Bronchial asthma and chronic bronchilis. A pilot survey. Journal of the Indian 34edical Association 45, 480--3. Viswanathan. R., Prasad, M., Thakur, A. K., Sinha, S. P., Prakash, N., Mody, R . K . , Singh, T. R. B, P, ?q. & Prasad, S. N. (1966). EpidemioIogy of asthma in an urban population, A random morbidity survey. Journal of the Indian ~Icdieal Association 46, 480--3. Sethi, J. P., Mathur, D. P., Baldwa, V. S.. Mathur, U. S. & Sogani, I. C. (1969). Natural history of bronchial asthma in India. Journal~fAsthma Research 6. 187-97. Fung, Y. M,, Mayberry. J. F.. Rhodes. J.&Newcombe, R. G.(1982).Alopicdiseasein the Hong Kong Chinese. Postgraduate Medical Journal (In press).