Background. In Mexico, several studies have been conducted under the ISAAC methodology; nevertheless, no validation studies of the ISAAC questionnaire based on objective clinical testing in our country have been published. Aims of the Study. To validate the ISAAC questionnaire, used in a study of prevalence of allergic diseases, based on medical, respiratory, and allergic evaluations of schoolchildren being 11 to 16 years old in Mexicali, Mexico. Material and Methods. We conducted a cross-sectional study to validate the ISAAC questionnaire through the generation of an index (considered as gold standard) using pre- and postbronchodilator spirometry test, exhaled nitric oxide measurements, and atopic evaluations. 114 schoolchildren were included (23 asthmatics with respiratory symptoms and 91 nonasthmatics without respiratory symptoms) and we evaluated the sensitivity, specificity, and positive and negative predictive value of the questionnaire using discriminant analysis. Results. We observed sensitivity of 35.2% and specificity of 93.3% and the positive and negative predictive values were 82.6% and 61.5%, respectively. Conclusions. Our findings indicate that the ISAAC Mexican version questionnaire was less sensitive and more specific when compared to the gold standard; however, it is adequate and able to discriminate children with and without asthma and a useful tool to use in epidemiological studies. 1. Introduction Asthma, allergic rhinitis, and atopic dermatitis are three of the allergic diseases that most affect children worldwide [1–3]. Asthma is a multifactor disease characterized by chronic inflammation of the airways and a reversible obstruction of air flow. Concern about these diseases has arisen because of their increase over the years, with prevalence and mortality rates having increased worldwide [4]. The International Study of Asthma and Allergies in Childhood (ISAAC) methodology was established in 1990s [4]. This methodology is a useful and practical strategy to most effectively identify these types of affections in children. It has been used in many countries where different languages are spoken, as well as in countries where the language does not have a way to describe asthma symptoms. The ISAAC is designed with three phases. Phase I is designed to assess the basic prevalence and severity of asthma and other allergic diseases by administering target questionnaires. Phase II investigates possible risk factors related to these diseases and those suggested in phase I. Phase III repeats phase I to assess the prevalence tendency of these
References
[1]
A. Arnedo-Penaa, L. García-Marcosb, G. García Hernándezc et al., “Tendencia temporal y variaciones geográficas de la prevalencia de síntomas de rinitis alérgica en escolares de 6-7 a？os de ocho áreas espa？olas, según ISAAC,” Anales de Pediatría, vol. 62, no. 3, pp. 229–236, 2005.
[2]
S. T. Holgate, “The epidemic of allergy and asthma,” Nature, vol. 402, no. 6760, pp. B2–B4, 1999.
[3]
R. L. Smyth, “Asthma: a major pediatric health issue,” Respiratory Research, vol. 3, supplement 1, pp. S3–S7, 2002.
[4]
The International Study of Asthma and Allergies in Childhood Steering Committee, “Worldwide variations in the prevalence of asthma symptoms: the International Study of Asthma and Allergies in Childhood (ISAAC),” European Respiratory Journal, vol. 12, no. 2, pp. 315–335, 1998.
[5]
Coordination Committee for the International Study of Asthma and Allergies in Childhood (ISAAC), “Manual for the International Study for Asthma and Allergies in Childhood (ISAAC),” InBochum, FRG, 1992, http://isaac.auckland.ac.nz/phases/phaseone/phaseonemanual.pdf.
[6]
E. Yamada, A. T. Vanna, C. K. Naspitz, and D. Solé, “International study of asthma and allergies in childhood (ISAAC): validation of the written questionnaire (eczema component) and prevalence of atopic eczema among Brazilian children,” Journal of Investigational Allergology and Clinical Immunology, vol. 12, no. 1, pp. 34–41, 2002.
[7]
A. T. Vanna, E. Yamada, L. K. Arruda, C. K. Naspitz, and D. Solé, “International study of asthma and allergies in childhood: validation of the rhinitis symptom questionnaire and prevalence of rhinitis in schoolchildren in S？o Paulo, Brazil,” Pediatric Allergy and Immunology, vol. 12, no. 2, pp. 95–101, 2001.
[8]
P. G. Gibson, R. Henry, S. Shah et al., “Validation of the ISAAC video questionnaire (AVQ3.0) in adolescents from a mixed ethnic background,” Clinical and Experimental Allergy, vol. 30, no. 8, pp. 1181–1187, 2000.
[9]
H. H. Chan, A. Pei, C. Van Krevel, G. W. K. Wong, and C. K. W. Lai, “Validation of the Chinese translated version of ISAAC core questions for atopic eczema,” Clinical and Experimental Allergy, vol. 31, no. 6, pp. 903–907, 2001.
[10]
A. Barraza-Villarreal, L. H. Sanín-Aguirre, M. M. Téllez-Rojo, M. Lacasa？a-Navarro, and I. Romieu, “Prevalencia de asma y otras enfermedades alérgicas en ni？os escolares de Ciudad Juárez, Chihuahua,” Salud Pública de México, vol. 43, no. 5, pp. 433–443, 2001.
[11]
B. Del-Rio-Navarro, A. Berber, V. Blandón-Vijil et al., “Identification of asthma risk factors in Mexico City in an International Study of Asthma and Allergy in Childhood survey,” Allergy and Asthma Proceedings, vol. 27, no. 4, pp. 325–333, 2006.
[12]
M. I. Tatto-Cano, L. H. Sanín-Aguirre, V. González, S. Ruiz-Velasco, and I. Romieu, “Prevalencia del asma, rinitis, y ezcema en ni？os escolares de Cuernavaca, Morelos,” Salud Pública de México, vol. 39, pp. 497–506, 1997.
[13]
“Standardization of spirometry, 1994 update. American Thoracic Society,” American Journal of Respiratory and Critical Care Medicine, vol. 152, no. 3, pp. 1107–1136, 1995.
[14]
“Global Initiative for Asthma: global strategies for asthma management and prevention,” Global Inicitative for Asthma, 2011, http://www.ginasthma.org/guidelines-gina-report-global-strategy-for-asthma.html.
[15]
P. E. Silkoff, “Recommendations for standardized procedures for the online and offline measurement of exhaled lower respiratory nitric oxide and nasal nitric oxide in adults and children-1999,” American Journal of Respiratory and Critical Care Medicine, vol. 160, no. 6, pp. 2104–2117, 1999.
[16]
K. Alving, C. Janson, and L. Nordvall, “Performance of a new hand-held device for exhaled nitric oxide measurement in adults and children,” Respiratory Research, vol. 7, article 67, 2006.
[17]
K. Julge, S. Meriste, A. Kemp, and B. Bj？rkstén, “Atopic allergy and delayed type hypersensitivity in Estonian children,” Clinical and Experimental Allergy, vol. 32, no. 10, pp. 1420–1423, 2002.
[18]
J. P. Laaban, B. Kouchakji, M. F. Dore, E. Orvoen-Frija, P. David, and J. Rochemaure, “Nutritional status of patients with chronic obstructive pulmonary disease and acute respiratory failure,” Chest, vol. 103, no. 5, pp. 1362–1368, 1993.
[19]
J. E. Dallas, Métodos multivariados aplicados al análisis de datos, International Thomson Editores, 2002.
[20]
M. Lara, N. Duan, C. Sherbourne et al., “Differences between child and parent reports of symptoms among Latino children with asthma,” Pediatrics, vol. 102, no. 6, article E68, 1998.
[21]
R. M. Busquets, J. M. Antó, J. Sunyer, N. Sancho, and O. Vall, “Prevalence of asthma-related symptoms and bronchial responsiveness to exercise in children aged 13-14 yrs in Barcelona, Spain,” European Respiratory Journal, vol. 9, no. 10, pp. 2094–2098, 1996.
[22]
S. J. Hong, S. W. Kim, J. W. Oh et al., “The validity of the ISAAC written questionnaire and the ISAAC Video questionnaire (AVQ 3.0) for predicting asthma associated with bronchial hyperreactivity in a group of 13-14 year old Korean schoolchildren,” Journal of Korean Medical Science, vol. 18, no. 1, pp. 48–52, 2003.
[23]
M. A. Jenkins, J. R. Clarke, J. B. Carlin et al., “Validation of questionnaire and bronchial hyperresponsiveness against respiratory physician assessment in the diagnosis of asthma,” International Journal of Epidemiology, vol. 25, no. 3, pp. 609–616, 1996.
