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Keller, T.; Hohmann, C.; Standl, M.; Wijga, A. H.; Gehring, U.; Melen, E.; Almqvist, C.; Lau, S.; Eller, E.; Wahn, U.; Christiansen, E. S.; Berg, A. von; Heinrich, J.; Lehmann, I.; Maier, D.; Postma, D. S.; Anto, J. M.; Bousquet, J.; Keil, T.; Roll, S. (2018): The sex‐shift in single disease and multimorbid asthma and rhinitis during puberty ‐ a study by MeDALL. In: Allergy, Vol. 73, No. 3: pp. 602-614
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Background: Cross-sectional studies suggested that allergy prevalence in childhood is higher in boys compared to girls, but it remains unclear whether this inequality changes after puberty. We examined the sex-specific prevalence of asthma and rhinitis as single and as multimorbid diseases before and after puberty onset in longitudinal cohort data. Methods: In six European population-based birth cohorts of MeDALL, we assessed the outcomes: current rhinitis, current asthma, current allergic multimorbidity (ie, concurrent asthma and rhinitis), puberty status and allergic sensitization by specific serum antibodies (immunoglobulin E) against aero-allergens. With generalized estimating equations, we analysed the effects of sex, age, puberty (yes/no) and possible confounders on the prevalence of asthma and rhinitis, and allergic multimorbidity in each cohort separately and performed individual participant data meta-analysis. FindingsWe included data from 19013 participants from birth to age 14-20years. Current rhinitis only affected girls less often than boys before and after puberty onset: adjusted odds ratio for females vs males 0.79 (95%-confidence interval 0.73-0.86) and 0.86 (0.79-0.94), respectively (sex-puberty interaction P=.089). Similarly, for current asthma only, females were less often affected than boys both before and after puberty onset: 0.71, 0.63-0.81 and 0.81, 0.64-1.02, respectively (sex-puberty interaction P=.327). The prevalence of allergic multimorbidity showed the strongest sex effect before puberty onset (female-male-OR 0.55, 0.46-0.64) and a considerable shift towards a sex-balanced prevalence after puberty onset (0.89, 0.74-1.04);sex-puberty interaction: P<.001. InterpretationThe male predominance in prevalence before puberty and the sex-shift towards females after puberty onset were strongest in multimorbid patients who had asthma and rhinitis concurrently.