The Prevalence of Allergies

and Atopy in Indonesia

Heru Sundaru

Division of Allergy and Clinical Immunology

Department of Internal Medicine, Fac. of Medicine
Univ. Indonesia / Cipto Mangunkusumo General Hospital
Jakarta

Distribution of Asthma Prevalence

among Young Adult from Publication

Percentage

100
10

0.1
0.01
1920

1940

1960

year

1980

2000

2020

Increase Prevalence of asthma

Countries

Age

Sample of
study

year

Prevalence
(%)

England

4 - 12

5806
6056

1973
1986

2.0
4.1

Scotlandia

8 - 13

3403
4034

1989
1994

10.2
19.6

Japan

Children

Taiwan

55388
45675

1982
1992

3.3
4.6

7 - 15

23678
92471

1974
1991

1.3
5.8

22268
2457

1967
1992

3 - 5.5
19.5

Singapore

4 - 17
6 - 14

The rolee of Th1 and Th2 in Asthma and Allergic

diseases

Prevalence(%) of Allergy in West and East Germany

West Jerman
(n=5030)

East Jerman
(n=2623)

OR

CI 95%

Asthma ever

9.3 +

7.2

1.3

1.1;1.6

current Asthma

5.9

3.9

1.5

1.2;1.9

Bronchitis

15.9

33.7

0.4

0.3;0.4

Atopic Rhinitis

8.6

2.7

3.4

2.6;4.4

17.0

26.8

0.6

0.5;0.6

8.7

9.6

0.9

0.8;1.1

- Night cough

3.4

6.1

0.5

0.4;0.7

- exercise cough

11.7 +

14.2

0.8

0.7;0.9

- SO2

14g/m3

150 g/m3

- PM10

47g/m3

80 g/m3

The Doctors diagnosis

Symptoms
- Wheezing
- Short of breath

Poluted

+ : p<0,005 compare to East Jerman, : p<0,0005 compare to east Jerman

von Mutius dkk. Am J Respir Crit Care Med 1994;149:358-64

The asthma prevalence in adults based on repeated

wheezing symptom, dyspnea accompanied by
wheezing and doctors diagnosis
Utan Kayu, Central Jakarta
N = 473
Repeated wheezing
Dyspnea and wheezing
The doctors diagnosis

Current
prevalence

Cumulative
prevalence

8.9%
6.9%
3.4%

10.9%
7.6%
3.8%

Heru et al. 1990

ISAAC Phase 1 in Indonesia 1996

ISAAC Phase 1
children
13-14 years
Medan
N=250
Palembang
N=762
Jakarta
N=361
Bandung
N=2249
Bali
N=258
Manado
N=578
Ujung Pandang
N=799
Indonesia
N=5277

Wheeze in the past

year
N
%

Nose symptoms

Rash 12 months

11

4.4

97

38.8

47

18.8

27

3.54

274

35.96

43

5.64

22

5.77

86

22.57

1.84

47

2.09

733

32.59

54

2.4

19

7.36

88

34.11

0.39

24

17.47

358

61.94

101

17.47

72

9.01

420

52.56

97

12.14

222

4.21

2056

38.96

350

6.63

ISAAC Phase 3 in Indonesia 2003

ISAAC Phase 1
children
13-14 years
Bandung
N=2850
Bali
N=2576
Jakarta
N=1385
Semarang
N=3526
Indonesia
N=10337

Wheeze in the past

year
N
%

Nose symptoms

Rash 12 months

147

5.16

550

19.3

90

3.16

111

4.31

828

32.14

164

6.37

107

7.73

370

26.71

97

7.00

193

5.47

619

17.56

191

5.42

558

5.40

2367

22.40

542

5.24

Karnen et al. 2004

Asthma and atopy : Urban vs. Rural

Ciater, Subang

Pegaden, Subang

Pagaden, Subang

Cijambe, Subang

Central Jakarta

The prevalence of allergic symptoms in Jakarta

(urban) and Subang (rural) among school children
age 13-14 years old
Jakarta (urban)

Subang (rural)

Variable
N = 3840

N = 3019

WHEZEV

389

10.1

399

13.2

WHEZ12

288

7.5

290

9.6

ASTHMAEV

298

7.8

353

11.7

PNOSEEV

1023

26.6

1619

53.6

PNOSE12

843

22.0

1046

34.6

RASHEV

220

5.7

406

13.4

RASH12

178

4.6

303

10.0

ECZEMAEV

182

4.7

475

15.7
Heru et al. 2005

Perbandingan suhu, kelembaban (humidity), dan

polusi udara di Jakarta dan Subang
Jakarta Pusat

(min-max)

Subang
Kalijati

Lapangan Bintang

Temp air (oC)

27.98
(23.39-33.22)

26.43
(21.10-33.62)

26.10
(22.49-31.09)

Hum air (%)

59.91
(27.12-78.24)

69.17
(26.96-95.42)

67.59
(24.24-91.54)

PM10 (g/m3 )

89.37
(46.71-276.13)

85.76
(44.79-165.81)

72.73
(39.75-148.56)

SO2 (g/m3)

30.75
(16.54-50.46)

114.08
(110.10-118.59)

111.76
(108.23-121.30)

CO (mg/m3 )

1.56
(0.50-3.67)

0.62
(0.14-2.88)

0.33
(0.11-0.72)

O3 (g/m3 )

86.81
(39.44-301.15)

33.17
(9.90-75.93)

54.17
(25.77-99.75)

NO2 (g/m3 )

60.31
(13.57-128.56)

16.98
(7.08-38.49)

13.87
(2.38-44.54)

Crude prevalence ratios (with 95% confidence

intervals) of symptom groups by district and year,
for the study cohort, in 1989, 1990 and 1991
Respiratory symptoms and
asthma

Year
1989 (baseline)

1990 (preintervention)

1991 (postintervention)

Cough or sore throat

S
KT

16,1 (14,2-18,0)
19,8 (18,0-21,6)

13,9 (12,1-15,7)
16,8 (15,1-18,5)

11,7 (10,0-13,4)
11,1 (9,7-12,5)

Phlegn

S
KT

16,8 (14,9-18,7)
19,2 (17,4-21,0)

13,2 (11,4-15,0)
14,2 (12,6-15,8)

9,4 (7,9-10,9)
8,1 (6,9-9,3)

Wheezing or
asthmatic diagnosis

S
KT

11,3 (9,7-12,9)
12,7 (11,2-14,2)

10,5 (8,9-12,1)
11,2 (9,8-12,6)

9,2 (7,7-10,7)
9,3 (8,0-10,6)

Wheezing

S
KT

7,8 (6,4-9,2)
10,5 (9,1-11,9)

9,5 (8,0-11,0)
9,9 (8,6-11,2)

6,9 (5,6-8,2)
7,2 (6,0-8,4)

Asthma

S
KT

7,4 (6,0-8,8)
7,1 (6,0-8,2)

6,9 (5,6-8,2)
6,9 (5,8-8,0)

5,8 (4,6-7,0)
6,3 (5,2-7,4)

Nasal symptoms, allergic

rhinitis or sinitis

S
KT

35,6 (33,1-38,1)
38,1 (35,9-40,3)

31,0 (28,6-33,4)
31,4 (29,3-33,5)

32,6 (30,2-35,0)
32,4 (30,2-34,5)

S : Southern
KT : Kwai Tsing
Peters J, Hedley AJ, Wong CM, Lam TH, Ong SG, International Journal of Epidemiology 1996;25:821-828

Prevalence(%) of Allergy in West and East Germany

West Jerman
(n=5030)

East Jerman
(n=2623)

OR

CI 95%

Asthma ever

9.3 +

7.2

1.3

1.1;1.6

current Asthma

5.9

3.9

1.5

1.2;1.9

Bronchitis

15.9

33.7

0.4

0.3;0.4

Atopic Rhinitis

8.6

2.7

3.4

2.6;4.4

17.0

26.8

0.6

0.5;0.6

8.7

9.6

0.9

0.8;1.1

- Night cough

3.4

6.1

0.5

0.4;0.7

- exercise cough

11.7 +

14.2

0.8

0.7;0.9

- SO2

14g/m3

150 g/m3

- PM10

47g/m3

80 g/m3

The Doctors diagnosis

Symptoms
- Wheezing
- Short of breath

Poluted

+ : p<0,005 compare to East Jerman, : p<0,0005 compare to east Jerman

von Mutius dkk. Am J Respir Crit Care Med 1994;149:358-64

Frequency of allergic disease among

872 hospital personnel
Place of work

Asthma

Rhinitis

Urticaria

1.
2.
3.

21 (7,0%)
17 (5,7%)
10 (3,7%)

21 (7,0%)
26 (8,7%)
14 (5,2%)

39 (13,0%)
31 (10,3%)
17 (6,3%)

Operating room nurses (n = 300)

Ward nurses (n = 300)
Administration staffers (n = 272)

Asthma is more prevalent in operating room nurses and ward nurses

compared with administration staffers (p < 0.05), while there is no
difference in rhinitis and urticaria (p > 0,05)
Huda, et al. 2005

Distribution of atopy and non atopy

among 872 hospital personnel
Place of work
Operating room nurses
Ward room nurses
Administration staff

Atopy
104 (34,7 %)
99 (33,0 %)
91 (33,5 %)

Non atopy
196 (65,3 %)
201 (67,0 %)
181 (66,5 %)

* p > 0,05 for all groups

Huda, et al. 2005

Latex sensitization among 294

atopic personnels
Latex (-)

Total

1. Operating room nurses 11 (10,6 %)

2. Ward nurses
10 (10,1 %)

93 (89,4 %)

104

89 (89,9 %)

99

3. Administrative staffers

89 (97,8 %)

91

271 (92,2 %)

294

Place of work

Total

Latex (+)

(2,2 %)

23 (7,8 %)

There were more latex sensitization in operating room and ward

nurses compared with administrative work (p < 0,01)
Huda, et al. 2005

Proportion distribution & OR of asthma

according to allergen sensitization in Jakarta
Sensitization
D.Pteronyssinus
+
D.farinae
+
Cockroach
+

Control
(N=274)
%

Asthma
(N=207)
%

216
(78.83)
58
(21.17)

47
(22.71)
160
(77.29)

225
(82.12)
49
(17.88)

63
(30.43)
144
(69.57)

239
(87.23)
35
(12.77)

114
(55.07)
93
(44.93)

Crude OR
(95% IC)

1
12.68
(7.50;21.44)

0.0000

1
10.50
(6.35;17.34)

0.0000

1
5.57
(3.44;9.01)

0.0000

Proportion distribution & OR of asthma according

to allergen sensitization in Jakarta
Sensitization
Dog
+

Control
(N=274)
%

Asthma
(N=207)
%

259
(94.53)
15
(5.47)

199
(96.14)
8
(3.86)

266
(97.08)
8
(2.92)

193
(93.24)
14
(6.76)

267
(97.45)
7
(2.55)

194
(93.72)
13
(6.28)

209
(76.28)
65
(23.72)

43
(20.77)
164
(79.23)

Crude OR
(95% IC)

1
0.69
(0.29;1.67)

0.4132

Cat
+
C.albicans
+
Atopy
+

1
2.41
(0.99;6.56)

0.0460

1
2.56
(1.00;6.56)

0.0429

1
12.26
(7.27;20.69)

0.0000

Proportion distribution & OR of asthma

according to allergen sensitization in Subang
Sensitization
D.Pteronyssinus
+
D.farinae
+
Cockroach
+

Control
(N=274)
%

Asthma
(N=207)
%

176
(71.26)
71
(28.74)

61
(50.83)
59
(49.17)

193
(78.14)
54
(21.86)

73
(60.83)
47
(39.17)

206
(83.40)
41
(16.60)

96
(80.00)
24
(20.00)

Crude OR
(95% IC)

1
2.40
(1.51;3.80)

0.0001

1
2.30
(1.42;3.73)

0.0005

1
1.26
(0.72;2.20)

0.4240

Proportion distribution & OR of asthma according

to allergen sensitization in Subang
Sensitization
Dog
+

Control
(N=274)
%

Asthma
(N=207)
%

204
(97.17)
7
(2.83)

113
(94.17)
7
(5.83)

236
(95.55)
11
(4.45)

113
(93.24)
7
(5.83)

246
(99.60)
1
(0.40)

113
(94.17)
7
(5.83)

158
(63.97)
89
(36.03)

53
(44.17)
67
(55.83)

Crude OR
(95% IC)

1
2.12
(0.72;6.23)

0.1599

Cat
+
C.albicans
+
Atopy
+

1
1.33
(0.50;3.53)

0.5664

1
15.24
(1.79;129.89)

0.0008

1
2.24
(1.43;3.53)

0.0003

Atopy and asthma (Australia/Europe)

n

Atopy

asthma

DX

1. Simpson et.al 2001

5681

Adult

48.27%

9.7%

DX asma

2. Von Mutius et.al 1994

4451
(JB)

9-11 th

36.7%

5.9%

Current asma

2335
(JT)

9-11 th

18.2%

3.9%

Current asma

979

10

14.3%

8.3%

Wheezing 12
mth

1339
(Sidney)

8-11 th

42%

24%

Current asma

926
(Belmon)

8-11 th

39%

38%

Current asma

3. Riikjark et.al 2000

4. Peat et.al 1996

Atopy and asthma (Asia/Africa)

n

Atopy

Asthma

Yemaneran 1997

Rural

861

5-20 yr

12%

1%

Africa

urban

2194

5-20 yr

4%

4%

Leung 1997
(Hongkong)

Malaysia

409

12-18 yr

64%

4,9%

1062

12-18 yr

58%

3.7%

China

737

12-18 yr

49%

1.1%

Urban

350

>15 yr

35%

4.4%

Rural

286

>15 yr

22%

3,5%

Hongkong
Nyan 2001 (Gambia)

Correlation allergen sensitization and asthma

prevalence
Name of study

location

Sensitization
TDR

Asthma
prevalence (%)

Charpin, dkk

Marseille
Briancon

28,0
10,0

4
2

Faniran, dkk

Australia
Nigeria

28,2
20,7

21,9
10,2

Wieringa, dkk

Urban Antwerp
Suburb Antwero

26,0
17,0

7
4

Von Mutius

Jerman Barat
Jerman Timur

10,3
4,20

5,9
3,9

Leung, dkk

Hongkong
Kota kinibalu
San Bu

55,4
60,2
42,7

3,7
4,9
1,1

This studi

Jakarta

77,3

7,5

Subang

49,2

9,5

Comparison Der p1, Der f1 and Group I

allergen level between case and control
Jakarta (Urban)
Allergen
level
(HDM)

Subang (Rural)

Control
(n=164)

Case
(n=135)

P-value

Control
(n=138)

Case
(n=135)

P-value

Der p1
(g/g dust)

0.28
(0.23;0.35)

0.29
(0.23;0.35)

0.9501

0.28
(0.22;0.36)

0.44
(0.32;0.61)

0.0382

Der f1
(g/g dust)

1.28
(1.07;1.53)

1.49
(1.24;1.80)

0.2371

0.33
(0.26;0.43)

0.49
(0.32;0.74)

0.1139

Group I
(g/g dust)

1.85
(1.58;2.16)

2.08
(1.78;2.42)

0.3021

0.83
(0.66;1.04)

1.24
(0.89;1.72)

0.0514

* Geometric

SUMMARY
Compare to developed countries the
prevalence of asthma and allergic disease is
still low, although there are tendencies to
increase
Other factor should have a role beside atopy
in determining the prevalence of asthma and
allergy in Indonesia