Considerable variation in the prevalence of childhood asthma and allergic conditions has been shown in previous studies. These differences may in part be attributable to methodological problems in defining childhood asthma and wheezing illnesses. However, the results of recent surveys using identical study instruments suggest that the variation in the distribution of the disease is real. In western societies serial prevalence studies have furthermore shown an increasing trend in the prevalence of childhood asthma and airway hyperresponsiveness. A concomitant increase in the prevalence of hay fever and atopic eczema has been reported by others. Moreover, hospitalization rates for childhood wheezing illnesses have increased in affluent countries suggesting that indeed the morbidity from these causes has increased in the last decades. Interestingly, areas of low prevalence of asthma and atopic conditions have recently been identified in developing countries and in Eastern Europe. In Eastern Germany where drastic changes towards westernization of living conditions have occurred after reunification an increase in the prevalence of hay fever and atopic sensitization has been documented over the last 4-5 years in children aged between 9 and 10 years of age. The prevalence of asthma and airway hyperresponsiveness, however, remained virtually unchanged in this age group. These children spent their first 3 years of life under socialist living conditions and were exposed to a western lifestyle only after their third birthday. Therefore, environmental factors may affect an individual's inherited susceptibility for the development of asthma and hay fever at different ages inducing changes in the prevalence of atopic diseases in populations in a time- and age-dependent way.