The Burden of Early-Childhood Atopic Disease: Prevalence and Risk Factors for Allergic Rhinitis in an Informal Settlement in South Africa

Background/Objectives: Allergic rhinitis (AR) is increasingly recognized in early childhood; however, its prevalence and environmental determinants within urban informal settlements remain under-researched. This study investigated the prevalence and risk factors associated with allergic rhinitis among children under five years old attending preschools in Alexandra Township, Johannesburg. Methods: A cross-sectional study was conducted involving 3265 children. Data were collected through self-reported surveys with caregivers, designed to assess demographic, clinical, and environmental variables. Multivariate logistic regression analysis was employed to determine adjusted odds ratios (AORs) and p-values for potential environmental and clinical risk factors. Results: The findings show a prevalence of 37.3% (n = 1214) for allergic rhinitis, 47.3% (n = 1544) for rhinitis, and 42.7% (n = 1394) for rhinoconjunctivitis. Exposure to open sewerage pipelines was associated with the highest risk (AOR: 4.85, p < 0.001), followed by prolonged residence in the township (greater than 24 months; AOR: 2.74, p < 0.001) and proximity to local waterways (AOR: 1.89, p < 0.001). Additional significant factors included frequent paracetamol consumption and walking to school, while asthma and eczema exhibited an association with the presence of AR. Conclusions: The elevated prevalence of allergic symptoms within this cohort is linked to localized macro-environmental hazards, suggesting that infrastructural challenges in informal urban settings may influence early respiratory health outcomes. Protecting pediatric respiratory health may necessitate multisectoral interventions, with a specific emphasis on ensuring safe sanitation and clean household energy, to complement traditional clinical management in these vulnerable communities.