While asthma and rhinitis are more common in boys compared to girls in childhood, whether this trend persists after puberty or not is not yet clear. Authors inspected the European Commission funded MeDALL (Mechanisms of the Development of ALLergy) to assess the effects of sex, age and puberty on prevalence of rhinitis and other allergy-related health problems. The study included 19,013 participants from birth to age 14-20 years. Girls continue to be less affected by rhinitis compared to boys during and after puberty. Sex-puberty interaction was found to be not significant. However, when allergic multimorbidities (concurrent asthma and rhinitis) were considered, a significant sex-puberty interaction was found with tendency to more equal prevalence between sexes after onset of puberty. The authors point towards hormonal changes, anatomical differences and immune response profile differences as possible reasons for shifts in sex prevalence. They also mentioned that the immunity-enhancing female sex steroids as opposed to the anti-inflammatory effects of testosterone might further explain these shifts. Further confounding factors include possible differences in symptom reporting between sexes and differences between teenagers completing their own questionnaires and parents filling them in for their children. This study will help in counselling parents whose children present with allergic rhinitis to ENT outpatients in terms of natural history of the disease.

The sex-shift in single disease and multimorbid asthma and rhinitis during puberty - a study by MeDALL.
Keller T, Hohmann C, Standl M, et al.
ALLERGY
2018;73:602-14.
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Hassan Mohammed

Cumberland Infirmary, Carlisle, UK.

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