{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T02:20:08Z","timestamp":1779934808219,"version":"3.53.1"},"reference-count":39,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2016,12,28]],"date-time":"2016-12-28T00:00:00Z","timestamp":1482883200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Prince Meshaal bin Abdulaziz Chair for Endemic Diseases, Najran University"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>The aim here was to study the possible environmental and dietary determinants of asthma among school-aged children in Southwestern Saudi Arabia. In a cross-sectional study on a representative sample in Najran in Southwestern Saudi Arabia using an Arabic version of the modified ISAAC Phase III, parent-administered questionnaire data were collected. Skin prick tests (SPTs) were performed. The study included 1700 school children, out of them 468 (27.5%) were diagnosed with, cases of bronchial asthma and 20.8% (353) reported a 12-month nocturnal cough (as a proxy of severe asthma). In multivariable analysis, the study identified the following risk factors for having asthma or severe asthma: having dogs in the house, being male, being exposed to dense truck traffic on the street, using wood as a cooking fuel, conducting vigorous exercise, consuming eggs, consuming vegetables, having an allergic sensitization to dog hair, and being exposed to Cladosporium, pigweed, and Bermuda grass. On the other hand, the following food stuffs were found to be protective: seafood, fruit, and dairy products. Comprehensive school educational programs for both children and their parents should be adopted to prevent the use of wood in cooking and heating, to ensure that house pets are properly cared for, and to encourage proper dietary habits. Physicians should be informed of the patterns of allergens in order to improve asthma diagnosis and management.<\/jats:p>","DOI":"10.3390\/ijerph14010022","type":"journal-article","created":{"date-parts":[[2016,12,28]],"date-time":"2016-12-28T11:22:14Z","timestamp":1482924134000},"page":"22","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Environmental Determinants of Bronchial Asthma among Saudi School Children in Southwestern Saudi Arabia"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3198-7576","authenticated-orcid":false,"given":"Jobran","family":"Alqahtani","sequence":"first","affiliation":[{"name":"Department of Pediatrics, College of Medicine, Najran University, Najran 1988, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Asaad","sequence":"additional","affiliation":[{"name":"Department of Clinical Microbiology, College of Medicine, Najran University, Najran 1988, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5687-6621","authenticated-orcid":false,"given":"Nabil","family":"Awadalla","sequence":"additional","affiliation":[{"name":"Department of Family and Community Medicine, College of Medicine, King Khalid University, Abha 61421, Saudi Arabia"},{"name":"Department of Community Medicine, College of Medicine, Mansoura University, Mansoura 35516, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4974-6431","authenticated-orcid":false,"given":"Ahmed","family":"Mahfouz","sequence":"additional","affiliation":[{"name":"Department of Family and Community Medicine, College of Medicine, King Khalid University, Abha 61421, Saudi Arabia"},{"name":"Department of Epidemiology, High Institute of Public Health, Alexandria University, Alexandria 21511, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2016,12,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"513","DOI":"10.3109\/02770901003615778","article-title":"Home environmental factors associated with poor asthma control in montreal children: A population-based study","volume":"47","author":"Plante","year":"2010","journal-title":"J. Asthma"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1155\/2005\/478764","article-title":"Urgent care costs of uncontrolled asthma in Canada, 2004","volume":"12","author":"Seung","year":"2005","journal-title":"Can. Respir. J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1111\/j.1399-3038.2005.00211.x","article-title":"Changing prevalence of asthma in Taiwanese adolescents: Two surveys 6 years apart","volume":"16","author":"Lee","year":"2005","journal-title":"Pediatr. Allergy Immunol."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Saadeh, D., Salameh, P., Caillaud, D., Charpin, D., De Blay, F., Kopferschmitt, C., Lavaud, F., Annesi-Maesano, I., Baldi, I., and Raherison, C. (2015). Prevalence and association of asthma and allergic sensitization with dietary factors in schoolchildren: Data from the french six cities study. BMC Public Health, 15.","DOI":"10.1186\/s12889-015-2320-2"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1016\/S1081-1206(10)63301-7","article-title":"Increased prevalence of asthma in Saudi Arabia","volume":"86","author":"Shakoor","year":"2001","journal-title":"Ann. Allergy Asthma Immunol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"580","DOI":"10.4067\/S0034-98872007000500005","article-title":"Changes in the prevalence of asthma in Chilean school age children between 1994 and 2002. International study of asthma and allergies in childhood (ISAAC)\u2014Chile phases I and III","volume":"135","author":"Mallol","year":"2007","journal-title":"Rev. Med. Chile"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Solis-Soto, M.T., Pati\u00f1o, A., Nowak, D., and Radon, K. (2013). Association between environmental factors and current asthma, rhinoconjunctivitis and eczema symptoms in school-aged children from Oropeza Province\u2013Bolivia: A cross-sectional study. Environ. Health, 12.","DOI":"10.1186\/1476-069X-12-95"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1590\/S0034-89102012005000008","article-title":"Time trend of asthma in children and adolescents in Brazil, 1998\u20132008","volume":"46","author":"Wehrmeister","year":"2012","journal-title":"Rev. Saude Public"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1016\/j.jaci.2004.12.003","article-title":"The epidemiology and genetics of asthma risk associated with air pollution","volume":"115","author":"Peden","year":"2005","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_10","first-page":"95","article-title":"Urban air pollution and climate change as environmental risk factors of respiratory allergy: An update","volume":"20","author":"Cecchi","year":"2010","journal-title":"J. Investig. Allergol. Clin. Immunol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1097\/ACI.0b013e32832678b0","article-title":"The role of indoor allergens in the development of asthma","volume":"9","author":"Gaffin","year":"2009","journal-title":"Curr. Opin. Allergy Clin. Immunol."},{"key":"ref_12","first-page":"57","article-title":"The role of allergen exposure and avoidance in asthma","volume":"21","author":"Baxi","year":"2010","journal-title":"Adolesc. Med. State Art Rev."},{"key":"ref_13","first-page":"133","article-title":"Risk and protective factors for the development of childhood asthma","volume":"16","author":"Ding","year":"2015","journal-title":"Paediatr. Respir. Rev."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1823","DOI":"10.1164\/ajrccm.164.10.2104061","article-title":"Dietary antioxidants and asthma in adults: Population-based case-control study","volume":"164","author":"Shaheen","year":"2001","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"137","DOI":"10.5694\/j.1326-5377.1996.tb122010.x","article-title":"Consumption of oily fish and childhood asthma risk","volume":"164","author":"Hodge","year":"1996","journal-title":"Med. J. Aust."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1875","DOI":"10.1046\/j.1365-2222.2001.01222.x","article-title":"Dietary fats and asthma in teenagers: Analyses of the first nutrition and health survey in Taiwan (NAHSIT)","volume":"31","author":"Huang","year":"2001","journal-title":"Clin. Exp. Allergy"},{"key":"ref_17","first-page":"9","article-title":"Practical issues in calculating the sample size for prevalence studies","volume":"1","author":"Naing","year":"2006","journal-title":"Arch. Orofac. Sci."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Al Ghobain, M.O., Al-Hajjaj, M.S., and Al Moamary, M.S. (2012). Asthma prevalence among 16-to 18-year-old adolescents in Saudi Arabia using the isaac questionnaire. BMC Public Health, 12.","DOI":"10.1186\/1471-2458-12-239"},{"key":"ref_19","first-page":"10","article-title":"The international study of asthma and allergies in childhood (ISAAC): Phase three rationale and methods [research methods]","volume":"9","author":"Ellwood","year":"2005","journal-title":"Int. J. Tuberc. Lung Dis."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Heinzerling, L., Mari, A., Bergmann, K.-C., Bresciani, M., Burbach, G., Darsow, U., Durham, S., Fokkens, W., Gjomarkaj, M., and Haahtela, T. (2013). The skin prick test\u2014European standards. Clin. Transl. Allergy, 3.","DOI":"10.1186\/2045-7022-3-3"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1136\/bmj.309.6947.90","article-title":"Factors in childhood as predictors of asthma in adult life","volume":"309","author":"Jenkins","year":"1994","journal-title":"BMJ"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"742","DOI":"10.1097\/EDE.0b013e318261f040","article-title":"Exposure to cats and dogs, and symptoms of asthma, rhinoconjunctivitis, and eczema","volume":"23","author":"Brunekreef","year":"2012","journal-title":"Epidemiology"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1016\/j.ccm.2012.08.003","article-title":"Indoor fuel exposure and the lung in both developing and developed countries: An update","volume":"33","author":"Sood","year":"2012","journal-title":"Clin. Chest Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1791","DOI":"10.1289\/ehp.0800467","article-title":"Self-reported truck traffic on the street of residence and symptoms of asthma and allergic disease: A global relationship in ISAAC phase 3","volume":"117","author":"Brunekreef","year":"2009","journal-title":"Environ. Health Perspect."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1433","DOI":"10.1289\/ehp.10968","article-title":"Traffic-related air pollution and asthma onset in children: A prospective cohort study with individual exposure measurement","volume":"116","author":"Jerrett","year":"2008","journal-title":"Environ. Health Perspect."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1518","DOI":"10.1016\/j.rmed.2006.01.011","article-title":"Body mass index and physical activity in relation to asthma and atopic diseases in young adults","volume":"100","author":"Terho","year":"2006","journal-title":"Respir. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e666","DOI":"10.1542\/peds.2007-1236","article-title":"Asthmatic symptoms, physical activity, and overweight in young children: A cohort study","volume":"121","author":"Eijkemans","year":"2008","journal-title":"Pediatrics"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1048","DOI":"10.1136\/thx.2005.043034","article-title":"Diet and asthma in Dutch school children (ISAAC-2)","volume":"61","author":"Tabak","year":"2006","journal-title":"Thorax"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"516","DOI":"10.1136\/thx.2009.128256","article-title":"Effect of diet on asthma and allergic sensitisation in the international study on allergies and asthma in childhood (ISAAC) phase two","volume":"65","author":"Nagel","year":"2010","journal-title":"Thorax"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"S1505","DOI":"10.1093\/ajcn\/83.6.1505S","article-title":"n-3polyunsaturated fatty acids, inflammation, and inflammatory diseases","volume":"83","author":"Calder","year":"2006","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1111\/nure.12121","article-title":"Fruit and vegetable intake and risk of wheezing and asthma: A systematic review and meta-analysis","volume":"72","author":"Seyedrezazadeh","year":"2014","journal-title":"Nutr. Rev."},{"key":"ref_32","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":"ref_33","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1136\/thorax.55.9.775","article-title":"Diet and childhood asthma in a society in transition: A study in urban and rural Saudi Arabia","volume":"55","author":"Hijazi","year":"2000","journal-title":"Thorax"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1165","DOI":"10.1111\/j.1398-9995.2005.00860.x","article-title":"Prevalence of food allergy and its relationship to asthma and allergic rhinitis in schoolchildren","volume":"60","author":"Raherison","year":"2005","journal-title":"Allergy"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1016\/j.jaci.2007.03.037","article-title":"Exposure to dust mite allergen and endotoxin in early life and asthma and atopy in childhood","volume":"120","author":"Milton","year":"2007","journal-title":"J. Allergy Asthma Clin. Immunol."},{"key":"ref_36","first-page":"11","article-title":"Skin test reactivity to indoor allergens correlates with asthma severity in Jeddah, Saudi Arabia","volume":"2","author":"Koshak","year":"2006","journal-title":"Allergy Asthma Clin. Immunol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"675","DOI":"10.1136\/thx.54.8.675","article-title":"Mite, cat, and cockroach exposure, allergen sensitisation, and asthma in children: A case-control study of three schools","volume":"54","author":"Sporik","year":"1999","journal-title":"Thorax"},{"key":"ref_38","first-page":"183","article-title":"Aeroallergen sensitivity of thai patients with allergic rhinitis","volume":"15","author":"Pumhirun","year":"1997","journal-title":"Asian Pac. J. Allergy Immunol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1067\/mai.2002.120759","article-title":"Release of allergens as respirable aerosols: A link between grass pollen and asthma","volume":"109","author":"Taylor","year":"2002","journal-title":"J. Allergy Clin. Immunol."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/14\/1\/22\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T19:29:28Z","timestamp":1760210968000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/14\/1\/22"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,12,28]]},"references-count":39,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2017,1]]}},"alternative-id":["ijerph14010022"],"URL":"https:\/\/doi.org\/10.3390\/ijerph14010022","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,12,28]]}}}