Allergy Asthma Respir Dis.  2013 Mar;1(1):67-72. 10.4168/aard.2013.1.1.67.

The association between sibling and allergic rhinitis in adolescents

  • 1Department of Pediatrics, Korea Cancer Center Hospital, Seoul, Korea.
  • 2Department of Pediatrics, Kosin University Gospel Hospital, Busan, Korea.
  • 3Department of Pediatrics, Childhood Asthma Atopy Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
  • 4Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
  • 5Department of Pediatrics, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.
  • 6Department of Pediatrics, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.
  • 7Department of Pediatrics, Inje University Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea.
  • 8Department of Pediatrics, Hallym Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea.
  • 9Department of Pediatrics, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea.
  • 10Department of Pediatrics, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
  • 11Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University College of Medicine, Seoul, Korea.
  • 12Department of Immunology and Pathology, Allergy TF, Korea National Institute of Health, Cheongwon, Korea.


We investigated the effect of siblings on the development of allergic rhinitis (AR) in Korean adolescents.
A cross-sectional study of adolescents (n=3,271) aged 12 to 15 years was conducted at three middle schools in Seoul. Demographic and disease-related information was obtained through a questionnaire.
The mean age of the subjects was 13.9+/-0.8 years comprising 48.7% males and 51.3% females. The percentage of the subjects who had ever been diagnosed with AR by physician was 30.7%. Subjects who had older sibling and who had younger sibling were 45.3% and 44.2% respectively. Subjects with older sibling were less likely to diagnose AR than subjects without older sibling (adjusted odds ratio [aOR], 0.69; 95% confidence interval [CI], 0.57 to 0.84). Subjects with older sibling, even though with family history of allergic disease had protective effect compared to subjects without older sibling (aOR, 0.62; 95% CI, 0.45 to 0.84). Subjects with younger sibling were more likely to diagnose AR than subjects without younger sibling (aOR, 1.23; 95% CI, 1.02 to 1.49).
These findings suggest that having older sibling is one of the important protective factor for the development of allergic rhinitis and having younger sibling is risk factor for allergic rhinitis in adolescents.


Allergic rhinitis; Adolescent; Sibling

MeSH Terms

Cross-Sectional Studies
Odds Ratio
Rhinitis, Allergic, Perennial
Risk Factors

Cited by  1 articles

Research on pediatric allergic rhinitis in Korea
Kyung Suk Lee, Yeong Ho Rha
Allergy Asthma Respir Dis. 2018;6(Suppl 1):S58-S65.    doi: 10.4168/aard.2018.6.S1.S58.


1. Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy. 2008. 63:Suppl 86. 8–160.
2. Hong SJ, Ahn KM, Lee SY, Kim KE. The prevalences of asthma and allergic diseases in Korean children. Korean J Pediatr. 2008. 51:343–350.
3. Ahn K, Kim J, Kwon HJ, Chae Y, Hahm MI, Lee KJ, et al. The prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in Korean children: Nationwide cross-sectional survey using complex sampling design. J Korean Med Assoc. 2011. 54:769–778.
4. Strachan DP. Hay fever, hygiene, and household size. BMJ. 1989. 299:1259–1260.
5. Gibbs S, Surridge H, Adamson R, Cohen B, Bentham G, Reading R. Atopic dermatitis and the hygiene hypothesis: a case-control study. Int J Epidemiol. 2004. 33:199–207.
6. Strachan DP, Harkins LS, Golding J. Sibship size and self-reported inhalant allergy among adult women. ALSPAC Study Team. Clin Exp Allergy. 1997. 27:151–155.
7. Ohfuji S, Miyake Y, Arakawa M, Tanaka K, Sasaki S. Sibship size and prevalence of allergic disorders in Japan: the Ryukyus Child Health Study. Pediatr Allergy Immunol. 2009. 20:377–384.
8. Bernsen RM, de Jongste JC, van der Wouden JC. Birth order and sibship size as independent risk factors for asthma, allergy, and eczema. Pediatr Allergy Immunol. 2003. 14:464–469.
9. Goldberg S, Israeli E, Schwartz S, Shochat T, Izbicki G, Toker-Maimon O, et al. Asthma prevalence, family size, and birth order. Chest. 2007. 131:1747–1752.
10. Ponsonby AL, Couper D, Dwyer T, Carmichael A. Cross sectional study of the relation between sibling number and asthma, hay fever, and eczema. Arch Dis Child. 1998. 79:328–333.
11. Lee SL, Wong W, Lau YL. Increasing prevalence of allergic rhinitis but not asthma among children in Hong Kong from 1995 to 2001 (Phase 3 International Study of Asthma and Allergies in Childhood). Pediatr Allergy Immunol. 2004. 15:72–78.
12. Midodzi WK, Rowe BH, Majaesic CM, Saunders LD, Senthilselvan A. Early life factors associated with incidence of physician-diagnosed asthma in preschool children: results from the Canadian Early Childhood Development cohort study. J Asthma. 2010. 47:7–13.
13. von Mutius E. The environmental predictors of allergic disease. J Allergy Clin Immunol. 2000. 105(1 Pt 1):9–19.
14. Yang HJ, Hong YH, Jeon YH, Pyun BY. Risk factors for persistent wheezing in infants with recurrent wheezing. Pediatr Allergy Respir Dis. 2007. 17:17–26.
15. Lee SY, Kwon JW, Seo JH, Song YH, Kim BJ, Yu J, et al. Prevalence of atopy and allergic diseases in Korean children: associations with a farming environment and rural lifestyle. Int Arch Allergy Immunol. 2012. 158:168–174.
16. Zekveld C, Bibakis I, Bibaki-Liakou V, Pedioti A, Dimitroulis I, Harris J, et al. The effects of farming and birth order on asthma and allergies. Eur Respir J. 2006. 28:82–88.
17. Schmitz R, Atzpodien K, Schlaud M. Prevalence and risk factors of atopic diseases in German children and adolescents. Pediatr Allergy Immunol. 2012. 23:716–723.
18. Westergaard T, Rostgaard K, Wohlfahrt J, Andersen PK, Aaby P, Melbye M. Sibship characteristics and risk of allergic rhinitis and asthma. Am J Epidemiol. 2005. 162:125–132.
19. Matricardi PM, Franzinelli F, Franco A, Caprio G, Murru F, Cioffi D, et al. Sibship size, birth order, and atopy in 11,371 Italian young men. J Allergy Clin Immunol. 1998. 101(4 Pt 1):439–444.
20. Miyake Y, Tanaka K, Arakawa M. Sibling number and prevalence of allergic disorders in pregnant Japanese women: baseline data from the Kyushu Okinawa Maternal and Child Health Study. BMC Public Health. 2011. 11:561.
21. Mattes J, Karmaus W, Moseler M, Frischer T, Kuehr J. Accumulation of atopic disorders within families: a sibling effect only in the offspring of atopic fathers. Clin Exp Allergy. 1998. 28:1480–1486.
22. Karmaus W, Botezan C. Does a higher number of siblings protect against the development of allergy and asthma? A review. J Epidemiol Community Health. 2002. 56:209–217.
23. Karmaus W, Arshad H, Mattes J. Does the sibling effect have its origin in utero? Investigating birth order, cord blood immunoglobulin E concentration, and allergic sensitization at age 4 years. Am J Epidemiol. 2001. 154:909–915.
24. Piccinni MP, Giudizi MG, Biagiotti R, Beloni L, Giannarini L, Sampognaro S, et al. Progesterone favors the development of human T helper cells producing Th2-type cytokines and promotes both IL-4 production and membrane CD30 expression in established Th1 cell clones. J Immunol. 1995. 155:128–133.
25. Piccinni MP, Bani D, Beloni L, Manuelli C, Mavilia C, Vocioni F, et al. Relaxin favors the development of activated human T cells into Th1-like effectors. Eur J Immunol. 1999. 29:2241–2247.
26. Vaz R, Slorach SA, Hofvander Y. Organochlorine contaminants in Swedish human milk: studies conducted at the National Food Administration 1981-1990. Food Addit Contam. 1993. 10:407–418.
27. Reichrtova E, Ciznar P, Prachar V, Palkovicova L, Veningerova M. Cord serum immunoglobulin E related to the environmental contamination of human placentas with organochlorine compounds. Environ Health Perspect. 1999. 107:895–899.
28. Zutavern A, von Klot S, Gehring U, Krauss-Etschmann S, Heinrich J. Pre-natal and post-natal exposure to respiratory infection and atopic diseases development: a historical cohort study. Respir Res. 2006. 7:81.
29. Ponsonby AL, Couper D, Dwyer T, Carmichael A, Kemp A. Relationship between early life respiratory illness, family size over time, and the development of asthma and hay fever: a seven year follow up study. Thorax. 1999. 54:664–669.
30. Matheson MC, Walters EH, Simpson JA, Wharton CL, Ponsonby AL, Johns DP, et al. Relevance of the hygiene hypothesis to early vs. late onset allergic rhinitis. Clin Exp Allergy. 2009. 39:370–378.
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