{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T05:07:42Z","timestamp":1788930462542,"version":"build-2803163510"},"reference-count":54,"publisher":"Elsevier BV","issue":"1","license":[{"start":{"date-parts":[[2020,1,1]],"date-time":"2020-01-01T00:00:00Z","timestamp":1577836800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2020,1,1]],"date-time":"2020-01-01T00:00:00Z","timestamp":1577836800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"}],"funder":[{"DOI":"10.13039\/501100001322","name":"South African Medical Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001322","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","jacionline.org","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Journal of Allergy and Clinical Immunology"],"published-print":{"date-parts":[[2020,1]]},"DOI":"10.1016\/j.jaci.2019.07.048","type":"journal-article","created":{"date-parts":[[2019,10,10]],"date-time":"2019-10-10T18:58:03Z","timestamp":1570733883000},"page":"415-426","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":126,"title":["Environmental factors associated with allergy in urban and rural children from the South African Food Allergy (SAFFA) cohort"],"prefix":"10.1016","volume":"145","author":[{"given":"Michael E.","family":"Levin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maresa","family":"Botha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wisdom","family":"Basera","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heidi E.","family":"Facey-Thomas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ben","family":"Gaunt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia L.","family":"Gray","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wanjiku","family":"Kiragu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jordache","family":"Ramjith","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Watkins","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jon","family":"Genuneit","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.jaci.2019.07.048_bib1","doi-asserted-by":"crossref","first-page":"1259","DOI":"10.1136\/bmj.299.6710.1259","article-title":"Hay fever, hygiene, and household size","volume":"299","author":"Strachan","year":"1989","journal-title":"BMJ"},{"key":"10.1016\/j.jaci.2019.07.048_bib2","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1136\/gut.2004.053785","article-title":"Microbes, immunoregulation, and the gut","volume":"54","author":"Rook","year":"2005","journal-title":"Gut"},{"key":"10.1016\/j.jaci.2019.07.048_bib3","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1186\/s40413-017-0160-5","article-title":"The skin microbiome: impact of modern environments on skin ecology, barrier integrity, and systemic immune programming","volume":"10","author":"Prescott","year":"2017","journal-title":"World Allergy Organ J"},{"key":"10.1016\/j.jaci.2019.07.048_bib4","doi-asserted-by":"crossref","first-page":"1099","DOI":"10.1016\/j.jaci.2017.02.007","article-title":"The microbiome in allergic disease: current understanding and future opportunities\u20142017 PRACTALL document of the American Academy of Allergy, Asthma & Immunology and the European Academy of Allergy and Clinical Immunology","volume":"139","author":"Huang","year":"2017","journal-title":"J Allergy Clin Immunol"},{"issue":"suppl\u00a05","key":"10.1016\/j.jaci.2019.07.048_bib5","doi-asserted-by":"crossref","first-page":"S348","DOI":"10.1513\/AnnalsATS.201702-139AW","article-title":"The hygiene hypothesis in the age of the microbiome","volume":"14","author":"Ege","year":"2017","journal-title":"Ann Am Thorac Soc"},{"key":"10.1016\/j.jaci.2019.07.048_bib6","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1159\/000318704","article-title":"Food allergy in Ghanaian schoolchildren: data on sensitization and reported food allergy","volume":"155","author":"Obeng","year":"2011","journal-title":"Int Arch Allergy Immunol"},{"key":"10.1016\/j.jaci.2019.07.048_bib7","first-page":"472","article-title":"Associations between asthma and bronchial hyper-responsiveness with allergy and atopy phenotypes in urban black South African teenagers","volume":"101","author":"Levin","year":"2011","journal-title":"South African Med J"},{"key":"10.1016\/j.jaci.2019.07.048_bib8","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1007\/s40124-016-0104-5","article-title":"Food allergy: international and developing world perspectives","volume":"4","author":"Levin","year":"2016","journal-title":"Curr Pediatr Rep"},{"key":"10.1016\/j.jaci.2019.07.048_bib9","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1136\/archdischild-2015-309770","article-title":"Modifying the infant\u2019s diet to prevent food allergy","volume":"102","author":"Grimshaw","year":"2017","journal-title":"Arch Dis Child"},{"key":"10.1016\/j.jaci.2019.07.048_bib10","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1097\/ACI.0000000000000385","article-title":"Do advanced glycation end-products cause food allergy?","volume":"17","author":"Smith","year":"2017","journal-title":"Curr Opin Allergy Clin Immunol"},{"key":"10.1016\/j.jaci.2019.07.048_bib11","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1016\/j.anai.2015.06.003","article-title":"The South African Food Sensitisation and Food Allergy population-based study of IgE-mediated food allergy: validity, safety, and acceptability","volume":"115","author":"Basera","year":"2015","journal-title":"Ann Allergy Asthma Immunol"},{"key":"10.1016\/j.jaci.2019.07.048_bib12","doi-asserted-by":"crossref","first-page":"662","DOI":"10.1016\/j.jaci.2018.07.023","article-title":"Rural and urban food allergy prevalence from the South African Food Allergy (SAFFA) study","volume":"143","author":"Botha","year":"2019","journal-title":"J Allergy Clin Immunol"},{"key":"10.1016\/j.jaci.2019.07.048_bib13","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1111\/pai.13058","article-title":"Nutrition and allergic diseases in urban and rural communities from the South\u00a0African Food Allergy (SAFFA) cohort","volume":"30","author":"Botha","year":"2019","journal-title":"Pediatr Allergy Immunol"},{"key":"10.1016\/j.jaci.2019.07.048_bib14","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1016\/j.jaad.2013.10.010","article-title":"Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis Work Group","volume":"70","author":"Eichenfield","year":"2014","journal-title":"J Am Acad Dermatol"},{"key":"10.1016\/j.jaci.2019.07.048_bib15","doi-asserted-by":"crossref","first-page":"680","DOI":"10.1016\/j.jaci.2015.12.1301","article-title":"The microbial environment and its influence on asthma prevention in early life","volume":"137","author":"Von Mutius","year":"2016","journal-title":"J Allergy Clin Immunol"},{"key":"10.1016\/j.jaci.2019.07.048_bib16","doi-asserted-by":"crossref","first-page":"1030","DOI":"10.1016\/j.chest.2015.12.028","article-title":"Associations of early life exposures and environmental factors with asthma among children in rural and urban areas of Guangdong, China","volume":"149","author":"Feng","year":"2016","journal-title":"Chest"},{"key":"10.1016\/j.jaci.2019.07.048_bib17","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1056\/NEJMoa1508749","article-title":"Innate Immunity and asthma risk in Amish and Hutterite farm children","volume":"375","author":"Stein","year":"2016","journal-title":"N Engl J Med"},{"key":"10.1016\/j.jaci.2019.07.048_bib18","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1111\/cea.12895","article-title":"Significant disparities in allergy prevalence and microbiota between the\u00a0young people in Finnish and Russian Karelia","volume":"47","author":"Ruokolainen","year":"2017","journal-title":"Clin Exp Allergy"},{"key":"10.1016\/j.jaci.2019.07.048_bib19","first-page":"1080","article-title":"Different use of medical terminology and culture-specific models of disease affecting communication between Xhosa-speaking patients and English-speaking doctors at a South African paediatric teaching hospital","volume":"96","author":"Levin","year":"2006","journal-title":"S Afr Med J"},{"key":"10.1016\/j.jaci.2019.07.048_bib20","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1046\/j.1365-2222.1999.00479.x","article-title":"Prevalence of hay fever and allergic sensitization in farmer\u2019s children and\u00a0their peers living in the same rural community","volume":"29","author":"Braun-Fahrl\u00e4nder","year":"1999","journal-title":"Clin Exp Allergy"},{"key":"10.1016\/j.jaci.2019.07.048_bib21","doi-asserted-by":"crossref","first-page":"1140","DOI":"10.1016\/j.jaci.2007.01.037","article-title":"Not all farming environments protect against the development of asthma and wheeze in children","volume":"119","author":"Ege","year":"2007","journal-title":"J Allergy Clin Immunol"},{"key":"10.1016\/j.jaci.2019.07.048_bib22","doi-asserted-by":"crossref","first-page":"1129","DOI":"10.1016\/S0140-6736(01)06252-3","article-title":"Exposure to farming in early life and development of asthma and allergy: a cross-sectional survey","volume":"358","author":"Riedler","year":"2001","journal-title":"Lancet"},{"key":"10.1016\/j.jaci.2019.07.048_bib23","doi-asserted-by":"crossref","first-page":"570","DOI":"10.1046\/j.1365-2222.2001.01070.x","article-title":"Having lived on a farm and protection against allergic diseases in Australia","volume":"31","author":"Downs","year":"2001","journal-title":"Clin Exp Allergy"},{"key":"10.1016\/j.jaci.2019.07.048_bib24","doi-asserted-by":"crossref","first-page":"1171","DOI":"10.1034\/j.1398-9995.2002.t01-1-23644.x","article-title":"Farm residence and exposures and the risk of allergic diseases in New Zealand children","volume":"57","author":"Wickens","year":"2002","journal-title":"Allergy"},{"key":"10.1016\/j.jaci.2019.07.048_bib25","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1111\/j.1398-9995.2007.01279.x","article-title":"The protective effect of rural living against atopy in Mongolia","volume":"62","author":"Viinanen","year":"2007","journal-title":"Allergy"},{"key":"10.1016\/j.jaci.2019.07.048_bib26","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1002\/ppul.21061","article-title":"Very low prevalence of asthma and allergies in schoolchildren from rural Beijing, China","volume":"44","author":"Ma","year":"2009","journal-title":"Pediatr Pulmonol"},{"key":"10.1016\/j.jaci.2019.07.048_bib27","doi-asserted-by":"crossref","first-page":"1347","DOI":"10.1016\/j.jaci.2013.10.035","article-title":"Atopy and allergic respiratory disease in rural Poland before and after accession to the European Union","volume":"133","author":"Soza\u0144ska","year":"2014","journal-title":"J Allergy Clin Immunol"},{"key":"10.1016\/j.jaci.2019.07.048_bib28","doi-asserted-by":"crossref","first-page":"1671","DOI":"10.1016\/j.jaci.2012.03.016","article-title":"Amish children living in northern Indiana have a very low prevalence of allergic sensitization","volume":"129","author":"Holbreich","year":"2012","journal-title":"J Allergy Clin Immunol"},{"key":"10.1016\/j.jaci.2019.07.048_bib29","doi-asserted-by":"crossref","first-page":"1178","DOI":"10.1111\/j.1365-2222.2004.02005.x","article-title":"Farming exposure in childhood, exposure to markers of infections and the development of atopy in rural subjects","volume":"34","author":"Radon","year":"2004","journal-title":"Clin Exp Allergy"},{"key":"10.1016\/j.jaci.2019.07.048_bib30","doi-asserted-by":"crossref","first-page":"1158","DOI":"10.1111\/j.1398-9995.2007.01490.x","article-title":"Lifelong farm exposure may strongly reduce the risk of asthma in adults","volume":"62","author":"Douwes","year":"2007","journal-title":"Allergy"},{"key":"10.1016\/j.jaci.2019.07.048_bib31","doi-asserted-by":"crossref","first-page":"1470","DOI":"10.1016\/j.jaci.2012.03.013","article-title":"Protection\u00a0from childhood asthma and allergy in Alpine farm environments\u2014the GABRIEL Advanced Studies","volume":"129","author":"Illi","year":"2012","journal-title":"J Allergy Clin Immunol"},{"key":"10.1016\/j.jaci.2019.07.048_bib32","doi-asserted-by":"crossref","first-page":"1374","DOI":"10.1016\/j.jaci.2006.03.008","article-title":"Which aspects of the farming lifestyle explain the inverse\u00a0association with childhood allergy?","volume":"117","author":"Perkin","year":"2006","journal-title":"J Allergy Clin Immunol"},{"key":"10.1016\/j.jaci.2019.07.048_bib33","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1111\/j.1365-2222.2006.02640.x","article-title":"Inverse association of farm milk consumption with asthma and allergy in\u00a0rural\u00a0and suburban populations across Europe","volume":"37","author":"Waser","year":"2007","journal-title":"Clin Exp Allergy"},{"key":"10.1016\/j.jaci.2019.07.048_bib34","doi-asserted-by":"crossref","first-page":"766","DOI":"10.1016\/j.jaci.2011.07.048","article-title":"The protective effect of farm milk consumption on childhood asthma and atopy: the GABRIELA study","volume":"128","author":"Loss","year":"2011","journal-title":"J Allergy Clin Immunol"},{"key":"10.1016\/j.jaci.2019.07.048_bib35","doi-asserted-by":"crossref","first-page":"e007350","DOI":"10.1136\/bmjopen-2014-007350","article-title":"Farm environment during infancy and lung function at the age of 31: a prospective birth cohort study in Finland","volume":"5","author":"Lampi","year":"2015","journal-title":"BMJ Open"},{"key":"10.1016\/j.jaci.2019.07.048_bib36","doi-asserted-by":"crossref","first-page":"1636","DOI":"10.1016\/j.jaci.2018.11.034","article-title":"Effects of diet on the childhood gut microbiome and its implications for atopic dermatitis","volume":"143","author":"Mahdavinia","year":"2018","journal-title":"J Allergy Clin Immunol"},{"key":"10.1016\/j.jaci.2019.07.048_bib37","first-page":"460","article-title":"Smoking in urban pregnant women in South Africa","volume":"87","author":"Steyn","year":"1997","journal-title":"S Afr Med J"},{"key":"10.1016\/j.jaci.2019.07.048_bib38","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1111\/j.1365-3016.2006.00707.x","article-title":"The influence of maternal cigarette smoking, snuff use and passive smoking on pregnancy outcomes: the Birth To Ten Study","volume":"20","author":"Steyn","year":"2006","journal-title":"Paediatr Perinat Epidemiol"},{"key":"10.1016\/j.jaci.2019.07.048_bib40","doi-asserted-by":"crossref","first-page":"662","DOI":"10.1016\/j.jaci.2018.07.023","article-title":"Rural and urban food allergy prevalence from the South African Food Allergy (SAFFA) study","volume":"143","author":"Botha","year":"2018","journal-title":"J Allergy Clin Immunol"},{"key":"10.1016\/j.jaci.2019.07.048_bib41","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1016\/j.jaci.2012.03.033","article-title":"Ascaris sensitization is associated with aeroallergen sensitization and airway hyperresponsiveness but not allergic disease in urban Africa","volume":"130","author":"Levin","year":"2012","journal-title":"J Allergy Clin Immunol"},{"key":"10.1016\/j.jaci.2019.07.048_bib42","first-page":"202","article-title":"Ascaris infection and sensitisation in rural and urban Xhosa children with and without atopic dermatitis","volume":"29","author":"Botha","year":"2016","journal-title":"Curr Allergy Clin Immunol"},{"key":"10.1016\/j.jaci.2019.07.048_bib43","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1016\/j.jaci.2016.05.040","article-title":"The false alarm hypothesis: food allergy is associated with high dietary advanced glycation end-products and proglycating dietary sugars that mimic alarmins","volume":"139","author":"Smith","year":"2017","journal-title":"J Allergy Clin Immunol"},{"key":"10.1016\/j.jaci.2019.07.048_bib44","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1039\/c1fo10026b","article-title":"Inhibition of advanced glycation endproduct formation by foodstuffs","volume":"2","author":"Wu","year":"2011","journal-title":"Food Funct"},{"key":"10.1016\/j.jaci.2019.07.048_bib45","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1136\/thoraxjnl-2012-202285","article-title":"Do fast foods cause asthma, rhinoconjunctivitis and eczema? Global findings from the International Study of Asthma and Allergies in Childhood (ISAAC) Phase Three","volume":"68","author":"Ellwood","year":"2013","journal-title":"Thorax"},{"key":"10.1016\/j.jaci.2019.07.048_bib46","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1017\/S1368980015000865","article-title":"Intakes of apple juice, fruit drinks and soda are associated with prevalent asthma in US children aged 2-9 years","volume":"19","author":"DeChristopher","year":"2016","journal-title":"Public Health Nutr"},{"key":"10.1016\/j.jaci.2019.07.048_bib47","doi-asserted-by":"crossref","first-page":"742","DOI":"10.1016\/j.anai.2017.04.011","article-title":"Atopic dermatitis and food sensitization in South African toddlers: role of fiber and gut microbiota","volume":"118","author":"Mahdavinia","year":"2017","journal-title":"Ann Allergy Asthma Immunol"},{"key":"10.1016\/j.jaci.2019.07.048_bib48","first-page":"74","article-title":"Use of asthma terminology by Xhosa-speaking patients in South Africa\u2014how it affects asthma control questionnaires and questionnaire-based epidemiological studies","volume":"20","author":"Levin","year":"2007","journal-title":"Curr Allergy Clin Immunol"},{"key":"10.1016\/j.jaci.2019.07.048_bib49","series-title":"Discordant definitions of medical terminology and their impact on communication between English-speaking doctors and Xhosa-speaking parents at a paediatric hospital","author":"Levin","year":"2005"},{"key":"10.1016\/j.jaci.2019.07.048_bib50","doi-asserted-by":"crossref","first-page":"721","DOI":"10.1111\/pai.12459","article-title":"Ethnic differences in peanut allergy patterns in South African children with atopic dermatitis","volume":"26","author":"Gray","year":"2015","journal-title":"Pediatr Allergy Immunol"},{"key":"10.1016\/j.jaci.2019.07.048_bib51","doi-asserted-by":"crossref","first-page":"572","DOI":"10.1111\/pai.12270","article-title":"Food allergy in South African children with atopic dermatitis","volume":"25","author":"Gray","year":"2014","journal-title":"Pediatr Allergy Immunol"},{"key":"10.1016\/j.jaci.2019.07.048_bib52","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1111\/j.1399-3038.2007.00663.x","article-title":"Total IgE in urban Black South African teenagers: the influence of atopy and helminth infection","volume":"19","author":"Levin","year":"2008","journal-title":"Pediatr Allergy Immunol"},{"key":"10.1016\/j.jaci.2019.07.048_bib53","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1080\/0376835X.2017.1419857","article-title":"Development for children\u2019s environmental health in South Africa: past gains and future opportunities","volume":"35","author":"Mathee","year":"2018","journal-title":"Dev South Afr"},{"key":"10.1016\/j.jaci.2019.07.048_bib54","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1016\/S0140-6736(00)02491-0","article-title":"Evolutionary adaptation of inflammatory immune responses in human beings","volume":"356","author":"Le Sou\u00ebf","year":"2000","journal-title":"Lancet"},{"key":"10.1016\/j.jaci.2019.07.048_bib55","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1111\/pai.12859","article-title":"Association between pro-inflammatory alleles and allergic phenotypes in Xhosa adolescents","volume":"29","author":"Laurence","year":"2018","journal-title":"Pediatr Allergy Immunol"}],"container-title":["Journal of Allergy and Clinical Immunology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0091674919313090?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0091674919313090?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T09:23:02Z","timestamp":1758792182000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0091674919313090"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,1]]},"references-count":54,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2020,1]]}},"alternative-id":["S0091674919313090"],"URL":"https:\/\/doi.org\/10.1016\/j.jaci.2019.07.048","relation":{},"ISSN":["0091-6749"],"issn-type":[{"value":"0091-6749","type":"print"}],"subject":[],"published":{"date-parts":[[2020,1]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Environmental factors associated with allergy in urban and rural children from the South African Food Allergy (SAFFA) cohort","name":"articletitle","label":"Article Title"},{"value":"Journal of Allergy and Clinical Immunology","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.jaci.2019.07.048","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2019 American Academy of Allergy, Asthma & Immunology","name":"copyright","label":"Copyright"}]}}