Global allergy research during : a scientometric study

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1 Annals of Library and Information Studies Vol. 63, March 2016, pp Global allergy research during : a scientometric study Sandhya Dwivedi Post Doctoral Fellow, Department of Library & Information Sciences, Banaras Hindu University, Varanasi, sandhpandey79@gmail.com Received 19 March 2015; revised 17 September 2015; accepted 30 January 2016 An analysis of papers published by countries on different aspects of allergy during as indexed by Science Citation Index-Expanded indicates that the output generally increased over the years with maximum publications in The highest number of publications came from USA, followed by Germany. The publication activity increased significantly for Poland, Turkey and South Korea and went down for Finland, Sweden and Japan in the second block. Data indicates that total output is concentrated in 8 sub-disciplines. Highest output (38.9%) is in the sub-discipline of immunology followed by food allergy (23.9%). During the period of study citations were received by papers and the average rate of citations per paper is England followed by Sweden, Netherlands and Finland has made the highest impact and Thailand has the lowest impact as seen by the values of Citation per Paper (CPP) and Relative Citation Impact (RCI). Harvard University of USA had published highest 872 papers. Keywords: allergy research; scientometrics; Citation Per Paper (CPP); Relative Citation impact; Transformative Activity Index (TAI); activity profile. Introduction Allergic diseases are complex inflammatory conditions with an increasing prevalence and incidence 1. They play a major role in environmental and occupational medicine and encompass allergic bronchial asthma 2, allergic rhinitis 3, atopic dermatitis 4, food allergy 5 and allergic eye diseases 6. Allergic diseases can cause a variety of symptoms such as a runny nose, itching, sneezing, rashes, swelling, or asthma. When a person has allergies, immune system makes immunoglobulin antibodies E (IGE) that identify a particular allergen as harmful, even though it isn t. These antibodies travel to cells that release histamine and other chemicals, causing an allergic reaction. When a person comes in contact with allergen, immune system s reaction can inflame skin, sinuses, airways or digestive system. The severity of allergies varies from person to person and can range from minor irritation to anaphylaxis- a potentially lifethreatening emergency. While most allergies can t be cured, a number of treatments can help relieve allergy symptoms. An allergy is not usually passed down through families. However, if both parents have allergies, the children are also likely to have allergies. The chance is greater if the mother has allergies. The direct medical costs on from allergic diseases are increasing over the past decades 7,8. Due to the great socioeconomic burden of allergic diseases, research in this field is important for environmental medicine and is currently increasing. In the past, studies dealing with bibliometric assessment of different fields like arthritis 9, rheumatology 10, public health research 11, parasitology 12, cardiology 13 and other medical fields have been published. Scutaru et al 14 analysed three different meetings of the European Academy of Allergy and Clinical Immunology and examined scientific contributions in European allergy research between 2001 and 2007 and found research had increased during the period. They showed that the most productive countries in 2001 were Germany (159 items) followed by Spain (122 items) and Italy (74 items) while in 2006 Spain was the most productive country with 226 published items followed by Germany (169 items) and Austria (114 items) and in 2007 Spain was again the most productive country (243 items). The current study makes a detailed scientometric investigation of the global output on allergy related research during using electronic database of Science Citation Index- Expanded published by Thomson Reuters. Objectives of the study To estimate the global output in allergy research and to examine the pattern of growth of publication output during ;

2 DWIVEDI: GLOBAL ALLERGY RESEARCH DURING : A SCIENTOMETRIC STUDY 17 To study the geographical distribution of the research output and the change in their outputs during and ; To examine the pattern of citations of the research output and to identify highly cited papers; and To examine citation impact of different countries using different bibliometric indicators. Methodology Science Citation Index Expanded (SCI-E), a product of Thomson Reuters (formerly institute Scientific Information, USA) was used for the present assessment of world allergy research. To be included in the study, the journal must be listed in the allergy category of SCI. There were 21 journals covered by SCI-E under the field allergy. Data were downloaded for these 21 journals for the years from SCI-E. Downloaded data were transferred to Microsoft Excel and then arranged country-wise according the first author s affiliation. The search yielded 76,119 records that dealt with different aspects of allergy research. Bibliographic details for each record included document type, title of the paper, author(s) and their affiliation, name of the journal with its place of publication and the number of citations received by each paper. From these downloaded records, 40,364 records that included biographies, corrections, news items, editorial materials, notes, and reprints were removed. Of the remaining 35,755 records, 972 records did not contain sufficient information like author name, affiliation, country and hence were not included in the analysis. Thus, the total number of papers included in the analysis was 34,783 including articles, article proceedings, reviews, and letters. Different approaches are available in scientometrics for count of authors and the most widely used is the first author approach (straight count), though it sometimes leads to bias as it under represents co-authors. However, author of the present paper have used the first author approach. Analysis Pattern of research output During a period of 20 years ( ), a total 34,783 papers were published on different aspects of allergy research. Figure 1 shows the growth pattern of publication output during the years A continuous rising trend from the year and is seen but indicates a decrease in the years 2000 and In the year 2003 and 2004, it remained constant with slight increase in 2005 and again decreases in It is observed that the highest number of publications are in the year 2013 with 2269 papers and publications are lowest (1032) in the year It is also seen that the publications increased more than double in the twenty year span, i.e., from 1994 to Geographical distribution of research output The research output of the period originated from 95 countries. Table 1 lists 19 prolific countries that produced minimum 400 publications (1%) or more of the output. The share of these countries was about Country Table 1 Allergy research output No. of papers during (TAI) No. of papers during (TAI) Change in TAI No. of papers during USA 3598(95) 5121(104) (+9) 8719 Germany 1564(110) 1704(93) (-17) 3268 Japan 1300(125) 1086(81) (-44) 2386 England 1185(127) 960(90) (-37) 2145 Italy 948(112) 989(91) (-21) 1937 Spain 748(95) 1059(104) (+9) 1807 France 587(82) 1046(114) (+32) 1633 Sweden 642(129) 497(78) (-51) 1139 Netherland 499(105) 594(97) (-8) 1093 Canada 460(101) 583(99) (-2) 1043 Switzerland 400(116) 390(88) (-28) 790 Denmark 340(104) 413(97) (-7) 753 Poland 83(26) 652(158) (+132) 735 Austria 367(117) 349(87) (-30) 716 Finland 404(141) 254(69) (-72) 658 South Korea 142(57) 434(134) (+77) 576 Turkey 111(48) 425(141) (+93) 536 Belgium 243(108) 272(94) (-14) 515 Thailand 213(111) 227(92) (-19) 440 Others (76) 1355 (69) 2539 (104) (+35) 3894 Total Fig. 1 Growth pattern of world publication output

3 18 ANN. LIB. INF. STU., MARCH % of the total output. Remaining 11% was scattered among 76 countries. Among the most prolific countries, US produced about one-fourth (25%) of publications, followed by Germany (9.4%), Japan (6.8%), England (6.2%), and Italy (5.6). These five countries together accounted for more than half (53%) of the total output. Rest of the 47% were spread across countries like Spain, France, and Sweden etc. India holds 27 th rank with 203 (0.6%) papers. Table 1 shows the publications for different countries in two blocks of and Table 1 indicates that publications increased for USA, Germany, Italy, Spain, France, Netherland, Canada, Denmark, South Korea, Turkey Belgium and Thailand in second block. Whereas, publications decreased for Japan, England, Sweden, Austria and Finland in second block compared to first bock. It is also seen that publications increased about eight times for Poland in the second block. In order to study the change in the output in two blocks among prolific countries, Transformative Activity Index (TAI) suggested by Guan and Ma 18 was used. The methodology to calculate TAI is similar to what has been used by Garg et al 17 in their studies on Japanese encephalitis. The formula used for calculating TAI is as follows: TAI= {(C i /C o )/(W i /W o )} 100 where C i = Number of publications of the specific country in the i th block; C o = Total number of publications of the specific country during the period of study; W i = Number of publications of all countries in the i th block; W o = Total number of publication of all countries during the period of study. Fig. 2 shows the change in the values of TAI for the prolific countries. From Fig. 2, it is clear that the activity has increased significantly for Poland, Turkey and South Korea in second block and it went down significantly for Finland, Sweden and Japan. The rise is substantial in case of Poland, South Korea and Turkey. Focus of research Based on the journal classification used by SCI-E, it is observed that global research efforts on allergy are scattered in eight sub-disciplines. There are 21 journals covered by SCI-E under the subject category Allergy. Table 2 shows that 25,997 (38.9%) articles fall in the sub-categories immunology, followed by food allergy 15,984 (24%), atopic eczema with 7,278 (10.9%) allergy rhinitis with 7,130 (10.7%) dermatology with 3,835 (5.8%) allergic asthma with 3,139 (4.7%) respiratory system with 2,084 (3.1%) and allergic eye diseases with 1,238 (1.9%) of total 66,685 publications. Fig. 2 Change in transformative activity index

4 DWIVEDI: GLOBAL ALLERGY RESEARCH DURING : A SCIENTOMETRIC STUDY 19 Table 2 Scatter of publication output in major sub-disciplines Subject code Subject Papers(%) S1 Immunology 25997(38.9) S2 Food Allergy 15984(24) S3 Atopic Eczema 7278(10.9) S4 Allergy Rhinitis 7130((10.7) S5 Dermatology 3835(5.8) S6 Allergic Asthma 3139(4.7) S7 Respiratory System 2084(3.1) S8 Allergic Eye Disease 1238(1.9) 66685* *The total output is more than the actual output as several journals are classified in more than one sub-discipline Table 3 Distribution of citations Number of citations Number of papers Total citations > Total papers Total citations Citation per paper 20.7 Citation pattern of the research output Citation analysis measures the impact of each article by counting the number of times they were cited by other articles. High levels of citations to a scientific publication are interpreted as signs of scientific influence, impact and visibility. An author s visibility can be measured through a determination of how often their publications have been cited in other author s publications. Citation pattern of papers published is given in Table 3. Citations were examined from 1994-October 31, 2014 on which the data was downloaded. During this period 718,546 citations were received by 34,783 papers and the average rate of citation per paper is Highly cited papers Top 20 highly cited papers are listed in Appendix 1. Bousquet J et al., (2001) have highly cited paper with 1106 citations, followed by Bosquet J et al., (2008) with 1038 citations. Highly cited paper published in journal of Allergy and Clinical Immunology. Among 20 highly cited papers, 16 papers are published in journal of Allergy and Clinical Immunology. Leading countries and their citation impact The scientific impact of leading countries was examined by using two relative indicators, namely Citations per paper (CPP), and Relative Citations Impact (RCI). Citations per Paper (CPP) is a relative indicator computed as the average number of citation per paper. It has been widely used in bibliometric studies as it normalizes a large disparity in volumes of published output among prolific countries and small nations for a meaningful comparison of research performance. Citation per paper = (Total number of citations for a country or an institution/total number of papers for that country or institution). Relative Citation Impact (RCI) was developed by the Institute of Scientific Information (now Thomson Reuters, USA) and has been used by Joshi 19 et al. to examine the impact of different countries and institutions in the field of forest fungal research. RCI measures both the influence and visibility of nation s research in global context. Relative Citation Impact (RCI) = (A Country s share of world citations/country s share of world publications). RCI = 1 indicates that country s citation rate is equal to world s citation rate; RCI> 1 indicates that country s citation rate is higher than world s citation rate and RCI < 1 indicates that country s citation rate is less than world s citation rate. Table 4 list 19 prolific countries with their total number of publication (TNP), total number of citations (TNC), share of world publications and citations as well as the values of CPP and RCI. The average value of CPP is 21 and is highest for England followed by Finland. CPP is considerably less than average for Germany, Japan, Spain, France, Poland, South Korea, Turkey, and Thailand. It is lowest for Thailand (5). The standing of different countries as judged by the values of RCI indicates that it is more than world average for England, Sweden, Netherland, Finland, USA, Canada, Switzerland, Austria, Denmark and Belgium. It is highest for England closely followed by Sweden and Netherland. The value of RCI is less than world average for remaining countries listed in Table 4. For Italy the value of CPP and RCI is just equal to the world average. The ranking of countries on these two parameters follow almost the similar trend.

5 20 ANN. LIB. INF. STU., MARCH 2016 Table 4 Prolific countries and their citation impact Country TNP World s share (%) TNC World s share *CPP RCI USA Germany Japan England Italy Spain France Sweden Netherland Canada Switzerland Denmark Poland Austria Finland South Korea Turkey Belgium Thailand Others Total *CPP rounded off to the nearest whole number Table 5 Leading institutions Sl. no. Name of Institutions Number of Papers 1 Harvard University (USA) University of California (USA) Karolinska Institutet (Sweden) Institut National De LaSanke Et De La 713 Rechsrch Medical Inserm (France) 5 University of Landon (England) University of Munich (Germany) John Hopping University (USA) University of Copenhagen (Denmark) Imperial College Landon (England) Charite Medical University of Berlin (Germany) 485 Prolific institutions Table 5 indicates that the three institutions from USA, two each from Germany and England, and one each from Sweden, France and Denmark. Out of 10 institutions, 8 are academic institutions and rest 2 is research institutions. Among these institutions listed in table 5, Harvard University of USA had the highest number of papers followed by University of California (USA). Distribution of output by journal titles Total of 34,783 papers were published in 21 scholarly journals which originated from 11 different countries. Majority of these journals were Table 6 Journals used for publishing research results Title of the journal and country of publication Number of papers JIF Journal of Allergy and Clinical Immunology (USA) 2 Allergy (USA) Clinical and Experimental Allergy (USA) 4 International archieves of Allergy and Immunology (Switzerland) 5 Contact Dermititis (USA) Journal of Asthma (USA) Allergologie (Germany) Allergy and Asthma Proceeding (USA) Immunology and Allergy Clinics of North America (USA) 10 Journal of Investigational Allergology and Clinical Immunology (Spain) 11 Clinical Reviews in Allergy & Immunology (USA) 12 Current Opinion in Allergy and Clinical Immunology (USA) 13 Asian Pacific Journal of Allergy and Immunology (Thailand) 14 Current Allergy and Asthma Reports (USA) 15 Revue Francaise D Allergologie (Italy) Postepy Dermatologii I Allergologii (Poland) 17 Allergologia Et Immunopathologia (Spain) 18 Iranian Journal of Allergy Asthma and Immunology (Iran) 19 Allergy Asthma & Immunology Research (Korea) 20 Allergology International (Japan) Allergy Asthma and Clinical Immunology (Canada) 87 - published from USA (11) and Spain (2) and rest were published from Poland (1), Japan (1), Switzerland (1), Korea (1), Iran (1), Thailand (1), Italy (1) and Canada (1). Table 6 lists journals with their country of publication and impact factor for 2013 where research results on allergy were published. Journal of Allergy and Clinical Immunology had the highest impact factor among all the journals listed in Table 6. Summary of findings The research output on allergy has increased many folds since 1994 except a significant dip in Most of the papers have been published in journals that have originated from the USA. Highest number of articles were published in Journal of Allergy and Clinical Immunology. The total research output originated from 95 countries. Nineteen countries each produced

6 DWIVEDI: GLOBAL ALLERGY RESEARCH DURING : A SCIENTOMETRIC STUDY publications or more of the output. The share of these 19 countries was about 89% of the total output. The publication activity has increased significantly for Poland, Turkey and South Korea in second block and it went down significantly for Finland, Sweden and Japan. The main focus of research is spread among 8 subdisciplines of which immunology and food allergy received the maximum attention. As seen by the values of CPP and RCI, England followed by Sweden, Netherlands and Finland has made the highest impact and Thailand has the lowest impact. The average rate of citation per paper is Harvard University of USA had published highest 872 papers, followed 790 papers by University of California (USA) Conclusions The present study examined the allergy research output in world as reflected in the science citation index expanded for the period 1994 to 2013 using scientometric tools. The results have demonstrated the ongoing expansion of that literature, while also identifying the key nations and journals involved in its production over the study time period. The study reveals that USA leads in terms of number of publications with 25% of total output. England outperformed other countries by higher citation per paper and relative citation impact. In an era when scientometric indictors are increasingly being employed in the assessment of individual, institutional and national performance, these findings should provide useful information for those tasked with improving that performance. Acknowledgment I am thankful to Prof H. N. Prasad, Professor & Head, Department of Library & Information Science, BHU Varanasi for providing all necessary facility for the work. Financial assistance from UGC, New Delhi is thankfully acknowledged. References 1 Nauta A J, Engels F, Knippels L M, Garssen J, Nijkamp F P and Redegeld F A, Mehanism of allergy and asthma, European journal of Pharmacology, 585 (2-3) (2008) Apter A J, Advances in the care of Adults with asthma and allergy in 2007, Journal of Allergy Clinical Immunology, 121 (4) (2008) Ahmed N and Zachare M A, Allergic rhinitis and rhinosinositis, Otolarynologic Clinics of North America, 41 (2) (2008) Gianatti A and Girolomoni G, Skin diseases with high public health impact. Atopic dermatitis, European journal of Dermatology, 17 (6) (2007) Lack G, Epidemiologic risks for food allergy, Journal of Allergy and Clinical Immunology, 121 (6) (2008) Bielory L, Occular allergy overview, Immunology and Allergy Clinics of North America, 28 (1) (2008) Redd S C, Asthma in the United States: burden and current theories, Environmental Health Perspectives, 110 (4) (2002) Weiss K B, Sullivan S D and Lyttle C S, Trends in the cost of illness for Asthma in the Unied States , Journal of Allergy and Clinical Immunology, 106 (3) (2000) Lewison G and Dewey M E, Bibliometric methods for the evaluation of arthritis research, Rheumatology, 38 (1) (1999) Cheng T and Zhang G, Worldwide research productivity in the field of rheumatology from : a bibliometric analysis, Rheumatology, 52 (9) (2013) Clarke A, Gatineau M, Grimaud O, Royer-Devaux S, Wyn Roberts N, Le Bis I and Lewison A, Bibliometric overview of public health research in Europe, European Journal of Public Health, 17 (1) (2007) Falagas M E, Paraskevi A P and Bliziotis I A, A Bibliometric analysis of research productivity in parasitology by different world regions during 9 year period , BMC Infectious Diseases, 6 (3) (2006) 1-6, doi: / Yosipovitch G and Belhassen B, Bibliometric study of cardiology in Israel in 1978, 1983, and 1988, Israel Journal of Medical Sciences, 27 (4) (1991) Scutaru C, Quarcoo D, Sakr M, Shami A, Mutawakel K A, Vitzthum K, Fisher T C, Zuberbier T, Kloft B G, Density equalizing mapping and scientometric benchmarking of European allergy research, Journal of Occupational Medicine Toxicology, 5 (2) (2010) 1-8, doi: / Gupta B M, Kaur H and Kshitij A, Dimentia research in India: a scientometric analysis of research output during , Annals of Library and Information Studies, 59 (4) (2012) Ramos J M, Pdilla S, Masia M, Gutierrez F, A bibliometric analysis of tuberculosis research indexed in PubMed , International Journal of Tuberculosis and Lung Disease, 12 (12) (2008) Garg K C, Dwivedi S and Kumar S, Scientometric profile of vectorborn diseases: a case study of global Japaneses Encephelitis Research, SRELS Journal of Information Management, 50 (5) (2013) Guan J and Nan Ma, A comparative study of research performance in computer science, Scientometrics, 61 (3) (2004) Joshi K, Kshitij A and Garg K C, Scientometric profile of global forest fungal research, Annals of Library and Information Science, 57 (2) (2010)

7 22 ANN. LIB. INF. STU., MARCH 2016 Appendix 1 Highly cited papers Sl. no. Author, Bibliographic Details Intitution Citations 1 Bousquet J, Van C P, Khaltev N, Ait-khaled N, Annesi-Maesano I, Bachert C, Baena-Cagnani C, Bateman E, Bonini S, and Canonica G W et.al., Allergic rhinitis and its impact on asthma, Journal of Allergy and Clinical Immunology, 108 (2001) Hopital Amaud-de- Villeneuve, Montpellier, France Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A, Zuberbier T, Baena-Cagnani CE, Canonica GW, van Weel C et.al, Allergic rhinitis and its impact on asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen), Allergy, 63 (2008) Univ Hosp, Montpellier, France Masoli M, Fabian D, Holt S, and Beasley R, The global burden of asthma: Medical Research Institute of New executive summary of the GINA Dissemination Committee Report, Allergy Zealand 59 (2004) Fantuzzi G, Adipose tissue, adipokines, and inflammation, Journal of Allergy and Clinical Immunology 115 (2005) Johansson SGO, Hourihane JO, Bousquet J, Bruijnzeel-Koomen C, Dreborg S, Haahtela T, Kowalski ML, Mygind N, Ring J, van Cauwenberge P et.al., A revised nomenclature for allergy - An EAACI position statement from the EAACI nomenclature task force, Allergy 56 (2001) Johansson SGO, Bieber T, Dahl R, Friedmann PS, Lanier BQ, Lockey RF, Motala C; Martell JAO, Platts-Mills TAE, Ring J, Thien F et. al., Revised nomenclature for allergy for global use: Report of the Nomenclature Review Committee of the World Allergy Organization, October 2003, Journal of Allergy and Clinical Immunology 113 (2004) University of Illinois, Chicago, USA Karolinska University Hospital, Stockholm, Sweden Karolinska University Hospital, Stockholm, Sweden Sampson H A, Utility of food-specific IgE concentrations in predicting symptomatic food allergy, Journal of Allergy and Clinical Immunology 107 (2001) Mount Sinai School of Medicine, NY, USA Bock S A, Munoz-Furlong A, and Sampson H A, Fatalities due to anaphylactic reactions to foods, Journal of Allergy and Clinical Immunology 107 (2001) Sampson H A, Update on food allergy, Journal of Allergy and Clinical Immunology 813 (2004) Sampson H A, and Ho D G, Relationship between food-specific IgE concentrations and the risk of positive food challenges in children and adolescents, Journal of Allergy and Clinical Immunology 100 (1997) Nathan RA, Sorkness CA, Kosinski M, Schatz M, Li JT, Marcus P, Murray JJ and Pendergraft TB, Development of the asthma control test: A survey for assessing asthma control, Journal of Allergy and Clinical Immunology 113 (2004) National Jewish and Medical Research Centre, USA Mount Sinai School of Medicine, NY, USA John Hopkins University, Baltimore, MD GlaxoSmithKline, Global Hlth Outcomes, USA Moller C, Dreborg S, Ferdousi HA, Halken S, Host A, Jacobsen L, Koivikko A, Koller DY, Niggemann B et al., Pollen immunotherapy reduces the development of asthma in children with seasonal rhinoconjunctivitis (the PAT-Study), Journal of Allergy and Clinical Immunology 109 (2002) Kalliomaki M, Kirjavainen P, Eerola E, Kero P, Salminen S, and Isolauri E, Distinct patterns of neonatal gut microflora in infants in whom atopy was and was not developing, Journal of Allergy and Clinical Immunology 107 (2001) Umea University, Sweden 525 Turku University, Finland 518

8 DWIVEDI: GLOBAL ALLERGY RESEARCH DURING : A SCIENTOMETRIC STUDY 23 Highly cited papers Sl. no. Author, Bibliographic Details Intitution Citations 14 Bjorksten B, Sepp E, Julge K, Voor T and Mikelsaar M, Allergy development and the intestinal microflora during the first year of life, Journal of Allergy and Clinical Immunology 108 (2001) Karolinska Institutet, Stockholm, Sweden Dinarello CA, IL-18: A T-H1-inducing, proinflammatory cytokine and new member of the IL-1 family, Journal of Allergy and Clinical Immunology 103 (1999) University Colorado, Health Sciences Centre, USA Majamaa H, and Isolauri E, Probiotics: A novel approach in the management of food allergy, Journal of Allergy and Clinical Immunology 99 (1997) University of Tampere, Finland Sampson H A, Food allergy. Part 1: Immunopathogenesis and clinical Mount Sinai School of Medicine, 487 disorders, Journal of Allergy and Clinical Immunology 103 (1990) USA 18 Bjorksten B, Naaber P, Sepp E, and Mikelsaar M, The intestinal microflora in allergic Estonian and Swedish 2-year-old children, Clinical and Experimental Allergy 29 (1999) Linkoping University, Sweden Busse W, Corren J, Lanier BQ, McAlary M, Fowler-Taylor A, Della Cioppa G, van As A, and Gupta N, Omalizumab, anti-ige recombinant humanized monoclonal antibody, for the treatment of severe allergic asthma, Journal of Allergy and Clinical Immunology 108 (2001) University of Wisconsin, USA Williams H, Robertson C, Stewart A, Ait-Khaled N, Anabwani G, Anderson R, Asher I, Beasley R, Bjorksten B, Burr M et al. Worldwide variations in the prevalence of symptoms of atopic eczema in the international study of asthma and allergies in childhood, Journal of Allergy and Clinical Immunology 103 (1999) University Nottingham Hosp, England 448