After dividing household income by the square root of the number of household members, monthly income was divided into 4 quartiles from top to bottom: low, low middle, upper middle, and high. The regions of residence were divided into 2 groups: urban Seoul, Gyeonggi, Busan, Daegu, Incheon, Gwangju, Daejeon, and Ulsan and rural Gangwon, Chungbuk, Chungnam, Jeonbuk, Jeonnam, Gyeongbuk, Gyeongnam, and Jeju.

The participants were asked about their histories of allergic rhinitis, asthma, and atopic dermatitis. Participants with histories of medical diagnoses were recorded as positive. To represent the entire Korean population, each surveyed population was weighted for specific value according to factors such as age, sex, and region of residence.

The rate of differences regarding sex, BMI group, income level, and region of residence were compared using the chi-square test with the Rao-Scott correction. Two-tailed analyses were conducted, and P -values lower than 0. After applying the weighted values recommended by the KNHANES, all of the simple and multiple logistic regression analysis results were presented as weighted values.

The results were analyzed using SPSS ver. In totals, The study included 1, participants without any type of allergic diseases; participants had one type of allergic disease, while and 27 participants had two and three types of allergic diseases, respectively.

The age, sex, and income level significantly differed across the groups with regard to the presence of allergic rhinitis, asthma, and atopic dermatitis, respectively.

Other socioeconomic factors such as the number of household members and region of residence did not significantly differ across groups with regard to the presence of allergic diseases Table 1.

Among the various nutritional factors, the amounts of protein, fat, carbohydrates, thiamine, and niacin significantly differed with regard to the presence of allergic rhinitis Table 2.

Each nutritional factor was analyzed with regard to its relationship to allergic rhinitis, asthma, and atopic dermatitis. No other nutritional factor was related to asthma or atopic dermatitis. We conducted a subgroup analysis by age group and sex S1 Table.

The present study was stronger than others given that we concurrently considered various nutritional factors including total calories, protein, fat, carbohydrates, vitamin A, vitamin C, thiamine, riboflavin, and niacin by adjusting their effects.

These comprehensive considerations of various nutritional factors allowed the investigation of the adjusted contribution of each nutritional factor to allergic diseases, in contrast to previous studies, in which only a limited number of variables were considered [ 19 — 21 ].

In addition, several demographic and socioeconomic factors were adjusted to improve the reliability of the results. Fat intake was significantly and positively related to allergic rhinitis in the present study. Similar to our results, previous studies have demonstrated positive relationships between fat intake and allergic rhinitis and asthma [ 14 , 19 — 21 ].

Although no direct evidence can explain the causal relationship between fat consumption and allergic diseases, several immunologic and epidemiologic studies have come to this conclusion.

Certain types of fatty acids play an essential role in immune reactions. For instance, linoleic acid is a precursor of arachidonic acid, which is subsequently converted to prostaglandin E2 PGE2 [ 1 ].

PGE2 activates and augments the allergic immune reaction by promoting the synthesis of immunoglobulin E IgE. PGE2 inhibits the formation of interferon-r IFNr but not that of interleukin-4 IL-4 in T-lymphocytes. Because IL-4 promotes whereas IFN-r interferes with the synthesis of IgE, the net effect of linoleic acid is an increase in the formation of IgE, which in turn enhances allergic reactions.

Consistent with these findings, it has been suggested that trans fatty acids are associated with the prevalence of childhood asthma and allergies, likely due to their influence on the desaturation and chain elongation of n-6 and n-3 fatty acids into inflammatory mediators including prostaglandins and leukotrienes, thereby impairing immune reactions and contributing to atopic disease [ 22 , 23 ].

In fact, it has been observed that infants with increased trans fatty acid plasma levels show changes in the fatty acid composition of plasma lipids similar to those of atopic patients [ 24 , 25 ]. On the other hand, carbohydrates were negatively related to allergic diseases in the present study.

To our knowledge, no prior study has found a relationship between carbohydrate consumption and allergic diseases in humans; however, some animal studies provide clues regarding the effect of carbohydrates on allergic diseases.

The early supplements of specific oligosaccharides before and during pregnancy significantly mitigate acute allergic skin responses and lung resistance but increase regulatory T-cell concentrations, thereby leading to decreased sensitization and allergies in mice [ 26 , 27 ].

The plausible mechanism for these immune modulations away from the allergic reaction remains somewhat elusive; however, specific carbohydrate epitopes, such as galactose-a-1,3-galactose and galacto-oligosaccharides, can induce acute allergic reactions during ingestion [ 28 ].

Although carbohydrates are rarely immunogenic compared with protein, they can induce allergic reactions through cross-reactive carbohydrate determinants or specific epitopes [ 29 ].

Based on the hygiene hypothesis, less exposure to carbohydrates might have made our participants susceptible to carbohydrate allergies because of the lack of immunity to these epitopes [ 30 ].

Several types of nutritional factors, including protein, thiamine, and niacin, showed slight but significant correlations with allergic rhinitis.

These proteins or micronutrients might play unknown but essential roles in allergic reactions. The very large sample sizes in the present study enabled us to detect these small but statistically significant effects at the population level.

Therefore, our results might not assess the effects of the low intake of these nutrients. Further studies based on children with deficiencies of each nutrient will delineate clear associations between these nutrient factors and allergic diseases. Although asthma, atopic dermatitis, and allergic rhinitis are related to allergic immune reactions, the first two conditions did not manifest any relationship with the studied nutritional factors.

This lack of a relationship might explain why allergic rhinitis was more prevalent than asthma and atopic dermatitis and potentiate statistical power in the present study.

Furthermore, various factors other than the allergic immune response might influence the pathogenesis of asthma and atopic dermatitis. Because asthma is a lower airway disease, many factors other than allergic immune reactions might contribute to its pathogenesis.

For instance, wheezing in children is associated with various respiratory diseases, especially respiratory viruses such as respiratory syncytial virus RSV [ 31 ]. Atopic dermatitis is an allergic skin disease caused by cutaneous barrier malfunction and inflammation as well as the interaction of the allergic immune system and skin microorganisms [ 32 ].

Compared with these allergic diseases, allergic rhinitis is an upper airway disease without lower airway or cutaneous pathophysiology effects.

The present study provided valuable epidemiologic evidence demonstrating the significant correlations between allergic rhinitis and both high-fat and low-carbohydrate diets by considering many nutritional, demographic, and socioeconomic factors in a large and representative sample of Korean children.

Moreover, we confined the age groups of the children, who have different physiological characteristics than adults. We also conducted subgroup analyses by age. The attenuation of these statistical significance values might be due to the limited study population resulting from the subgrouping strategy.

However, the present study has some unavoidable limitations. Its cross-sectional study design was unable to determine a causal relationship between allergic diseases and nutritional factors. Furthermore, although we considered numerous confounders in our models, others such as home environment, lifestyle, and exercise habits might remain [ 33 ].

In terms of independent variables, we concurrently analyzed numerous nutritional factors, thereby enhancing the value of the present study over others; however, we did not considered subtypes of fat e.

In addition, the KNHANES was based on retrospective self-reports; therefore, recall bias remains an issue. The presence of allergic diseases was surveyed without objective tests such as skin tests.

Because the KNHNES database only contained serum IgE levels in participants older than 9 years in , we could not objectively determine the presence of allergic diseases in younger children in the present study. Furthermore, the complete hour recall method may better represent dietary habits on a population level than on an individual level.

A dietary history or a semi-qualitative food frequency questionnaire would be a better method for assessing associations between diet and diseases.

Nevertheless, the complete hour recall method remains one of the most commonly used tools among retrospective nutritional surveys.

Additional studies with prospective, longitudinal designs are warranted to address these problems. Allergic rhinitis was significantly correlated with both high-fat and low-carbohydrate diets among children.

Although making thorough adjustments for numerous confounders in a large, representative sample reinforced the reliability of our results, these relationships must be considered with regard to the dietary habits and other characteristics of the population i.

Because diet is a modifiable factor, the relationships between allergic rhinitis and both fat and carbohydrate intake likely have significant clinical implications, especially with regard to preventive medicine.

We gratefully acknowledge the participants and examiners of the Division of Chronic Disease Surveillance at the Centers for Disease Control and Prevention of Korea for participating in this survey and for the dedicated work they provided.

This work was supported by a Research Grant funded by Hallym University Sacred Heart Hospital HURF The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

The manuscript was edited for English language, grammar, punctuation, spelling, and overall style by highly qualified native English-speaking editors at American Journal Experts. The English in this document has been checked by at least two professional editors, both native speakers of English.

For a certificate, please see:. Conceived and designed the experiments: SYS HGC. Performed the experiments: SYS HGC. Analyzed the data: SYS HGC. Wrote the paper: JHK. Browse Subject Areas? Click through the PLOS taxonomy to find articles in your field. Article Authors Metrics Comments Media Coverage Reader Comments Figures.

Abstract Background Numerous studies have suggested that nutritional intake is related to allergic diseases. Methods A total of 3, participants, aged 4 to 13 years old, were enrolled in the present study from the Korean National Health and Nutrition Examination Survey KNHANES , — Results Of the participants, Conclusion Allergic rhinitis was related to high-fat and low-carbohydrate diets.

Dileepan, University of Kansas Medical Center, UNITED STATES Received: August 27, ; Accepted: February 10, ; Published: February 26, Copyright: © Kim et al. Introduction Allergic diseases, including allergic rhinitis, asthma, and rhinoconjunctivitis, are common chronic diseases.

It can be frustrating; you do your best to eat healthy, exercise, and manage your blood sugar. But if you have trouble maintaining a healthy weight and keeping your blood sugar under control, insulin resistance may be to blame. And this can manifest as carbohydrate intolerance.

When we eat foods that contain starches and sugars carbohydrates , like breads, rice, pasta, potatoes, fruit, desserts, and sugary drinks, the body breaks them down into sugar and causes a rise in blood sugar also called glucose.

Our bodies need to keep blood sugar controlled within a narrow range - not too high and not too low. So as blood sugar rises, the body signals to the pancreas to release an important hormone, insulin.

Insulin moves blood sugar out of the bloodstream and into cells where it can be stored or used for energy. Each person has their own unique carbohydrate tolerance. These people are sensitive to insulin, which is a good thing and allows blood sugar to move efficiently from their blood into their cells.

The difficulty that the body has dealing with carbohydrates and keeping the blood sugar levels normal due to insulin resistance is carbohydrate intolerance. The body doesn't respond normally to carbohydrate intake, and higher carbohydrate intake only worsens the problem. The longer this goes on, the more likely you are to develop prediabetes, which then often progresses to type 2 diabetes.

Insulin resistance and carbohydrate intolerance often develop years before the development of prediabetes and diabetes. Without intervention, the carbohydrate intolerance gets worse over time. The pancreas tries to keep up the best it can, but it eventually falls behind.

This is when sugar levels start to rise to levels which are in the prediabetes, and eventually diabetes, range. It's unclear why some individuals handle carbohydrates better than others and why some people progress to insulin resistance, carbohydrate intolerance, and eventually to prediabetes and diabetes.

Although it's not healthy to eliminate all carbs from your diet, restricting your intake to complex carbohydrates could improve your symptoms. Carbohydrates are not known to cause sinus problems in everyone.

In fact, many people eat carbohydrates regularly with no obvious side effects. However, some people have a specific sensitivity to carbs. Similar to a food allergy, this sensitivity causes an abnormal physiologic reaction to occur when carbohydrates are consumed.

For some people, this reaction involves sinus congestion or infection. If you believe a carbohydrate sensitivity could be the cause of your sinus problems, consult with your physician for a proper treatment plan and healthy sinus diet.

In some cases, sinus problems might be caused by a problem with fungus, according to the Oasis Advanced Wellness website. The mouth and nose are common ports of entry for fungi and other bacteria. Typically, the natural body defenses protect us against the microorganisms and prevent them from harming our health.

In some cases, though, our body environment is not conducive for these protective behaviors. According to the website, carbohydrates provide a large amount of sugar for these fungi to feast on.

By eliminating carbohydrates, you can eliminate the main food source for the fungi — and hopefully eliminate them altogether. The Centers for Disease Control and Prevention acknowledges that carbohydrates can be classified into two types: simple carbohydrates and complex carbohydrates.