Development and validation of the childhood allergy comprehensive screening questionnaire and Its application in a cross-sectional survey of allergic diseases among children aged 0-6 Years in Shanghai, China.

INTRODUCTION: Childhood allergic diseases constitute a substantial global health burden, with children aged 0-6 years representing a highly vulnerable population during early immunological transition. Evidence regarding the associations of lifestyle, household environments, and prenatal exposures with these conditions remains inconsistent and heterogeneous, and epidemiological data for this critical age group are still limited. This study aimed to develop and validate a standardized screening instrument and to evaluate these potential associations. METHODS: This study utilized a two-phase design: Phase I (Clinical Validation) evaluated the psychometric properties of a newly developed, culturally localized 24-item Childhood Allergy and Asthma Comprehensive Screening Questionnaire (CACSQ) against clinical gold-standard physician diagnoses in a hospital-based case-control study comprising 98 cases and 98 matched controls. Phase II (Epidemiological Survey) applied the validated CACSQ in a district-wide cross-sectional investigation. Using multi-stage stratified random cluster sampling, 3,064 children aged 0-6 years were enrolled in Minhang District, Shanghai, China. Multivariable logistic regression models were employed to identify independent perinatal, residential-environmental, and familial factors associated with childhood allergies. RESULTS: The CACSQ demonstrated high accuracy, with an AUC of 0.88 (P<0.001), sensitivity of 92%, specificity of 76%, and Kappa coefficient of 0.698. Among 3,064 children aged 0-6 years, the overall CACSQ-identified prevalence of food allergy, asthma, atopic dermatitis, and allergic rhinitis was 14.7%, 8.4%, 18.9%, and 20.0%, respectively. Male sex, higher socioeconomic status, only-child status, history of antibiotic use and pneumonia, and family history of allergy were associated with elevated risk of allergic diseases. In contrast, sleep duration ≥ 12 h/day and window-opening ventilation were associated with lower odds of allergic diseases. Age effects varied by condition; the odds of atopic dermatitis decreased with age, whereas the odds of allergic rhinitis increased. CONCLUSION: Genetic predisposition and modifiable environmental/lifestyle factors significantly associated with early childhood allergies. The validated CACSQ offers a reliable, low-cost screening tool for early detection and future longitudinal cohort studies.