Sensitization to indoor allergens and frequency of asthma exacerbations in children

Irene Irene; Putu Siadi Purniti; Sumadiono Sumadiono

doi:10.14238/pi51.4.2011.207-12

Irene Irene Department of Child Health, Udayana University Medical School/Sanglah Hospital, Denpasar, Bali
Putu Siadi Purniti Department of Child Health, Udayana University Medical School/Sanglah Hospital, Denpasar, Bali
Sumadiono Sumadiono Department of Child Health, Gadjah Mada University Medical School/Dr. Sardjito Hospital, Yogyakarta, Central Java

DOI: https://doi.org/10.14238/pi51.4.2011.207-12

Keywords: asthma exacerbation, sensitization, indoor allergen

Abstract

Background The rapid increase in asthma incidence has implicated the importance of environmental influences over genetic influences. Sensitization to perennial indoor allergens has been associated with increased asthma symptoms.

Objective To examine the correlation between sensitization to indoor allergens and frequency of asthma exacerbations in children.

Methods A cross-sectional study was carried out on asthmatic children aged 6 to 12 years in the Department of Child Health, Udayana University Medical School /Sanglah Hospital, Denpasar. Degree of sensitization was assessed by mean wheal diameter (positive defined as 3 mm greater than negative control) for seven common indoor allergens. Frequency of asthma exacerbation for three consecutive months prior to data collection was retrospectively reviewed.

Results Positive skin test results for one or more allergens were found in 84 of 89 (94%) asthmatic children. Higher frequency of asthma exacerbations weakly correlated with the number of allergens with positive sensitization (r=0.284; P=0.007). Mean wheal diameter of each allergen did not correlate to the frequency of asthma exacerbations. In addition, the frequency of asthma exacerbations was independent for parental and sibling atopic history, preceding respiratory infections, use of asthma controllers and passive environmental tobacco smoke exposure.

Conclusions Sensitization to common indoor allergens correlates weakly with frequency of asthma exacerbations.Â

References

1. Rahajoe N, Supriyatno B, Setyanto DB. Pedoman nasional asma anak. Jakarta: Penerbit IDAI; 2004.p.1.
2. Global Initiative for Asthma-GINA. Global Strategy for asthma management and prevention. GINA Workshop Report. 2009 [cited 2010 Sept 17]. Available from: www.ginasthma.org.
3. Asma bronkial, tata laksana jangka panjang. In: Pusponegoro HD, Hadinegoro SRS, Firmanda D, Tridjaja BAAP, Pudjiadi AH, Kosim MS, et al., editors. Standar pelayanan medis kesehatan anak. 1st ed. Jakarta: Indonesian Pediatric Society; 2004.p.341-4.
4. Institute of Medicine. Major issues in understanding asthma. In: Johnston RB, Burge HA, Fisk WJ, Gold DR, Gordis R, Grunstein MM, et al., editors. Clearing the air: asthma and indoor air exposures. 1st ed. Washington DC: National Academy Press; 2002.p.31-3.
5. Timonen KL, Nielsen J, Schwartz J, Gotti A, Vonda V, Gratziou C, et al. Chronic respiratory symptoms, skin test results, and lung function as predictors of peak flow variability. Am J Respir Crit Care Med. 1997;156:776-82.
6. Holt PG. Potential role of environmental factors in the etiology and pathogenesis of atopy: a working model. Environ Health Perspec. 1999;107:485-7.
7. Platts-Mills TAE, Blumenthal K, Perzanowski M, Woodfolk JA. Determinants of clinical allergic disease: the relevance of indoor allergens to the increase in asthma. Am J Respir Crit Med. 2000;162:S128-33.
8. Gaffin JM, Phipatanakul W. The role of indoor allergens in the development of asthma. Curr Opin Allergy Clin Immunol. 2009;9:128-35.
9. Gehring U, Heinrich H, Jacob B, Richter K, Fahlbusch B, Schlenvoigt G, et al. Respiratory symptoms in relation to indoor exposure to mite and cat allergens and endotoxins. Eur Respir J. 2001;18:555-63.
10. Busse WW, Boushey HA, Camargo CA, Evans D, Foggs MB, Janson SL, et al. Definition, pathophysiology, and pathogenesis of asthma, and natural history of asthma. In: National Heart, Lung, and Blood Institute, Expert panel report 3: guidelines for the diagnosis and management of asthma. US Department of Health and Human Services; 2007.p.11-20, 165-89.
11. Sporik R, Squillace SP, Ingram JM, Rakes G, Honsinger RW, Platts-Mills TAE. Mite, cat, and cockroach exposure, allergen sensitization, and asthma in children: a case-control study of three schools. Thorax. 1999;54:675-80.
12. Akerman M, Valentine-Maher S, Rao M, Taningco G, Khan R, Tuysugoglu G, et al. Allergen sensitivity and asthma severity at an inner city asthma center. J Asthma. 2003;40:55-62.
13. Carroll WD, Lenney W, Child F, Strange RC, Jones PW, Whyte MK, et al. Asthma severity and atopy: how clear is the relationship? Arch Dis Child. 2006;91:405-9.
14. Gruchalla RS, Pongracic J, Plaut M, Evans R, Visness CM, Walter M, et al. Inner city asthma study: relationships among sensitivity, allergen exposure, and asthma morbidity. J Allergy Clin Immunol. 2005;115:478-85.
15. Tumbelaka AR, Abdoerrachman MH, Latief A, Abdulsalam M, Darwis D. Pengukuran dalam penelitian. In: Sastroasmoro S, Ismael S, editors. Dasar-dasar metodologi klinis. 3rd ed. Jakarta: Sagung Seto; 2010.p.67.
16. Sastrawan IGP, Suryana K, Rai IBN. Prevalensi asma bronkial atopi pada pelajar di Desa Tenganan. J Peny Dalam. 2008;9:47-53.
17. Misirlioglu ED, Cengizlier MR. Skin prick test results of child patients diagnosed as bronchial asthma. Allergol et Immunopathol. 2007;35:21-4.
18. Aunillah, Setyarini E, Ramadhan N, Barlianto W. Results of skin prick test sensitization in 39 children with asthma attending the allergy-immunology outpatients clinic, Saiful Anwar Hospital. Paediatr Indones. 2010;50(supp):S3.
19. Schwindt CD, Tjoa T, Floro JN, McLaren C, Delfino RJ. Association of atopy to asthma severity and medication use in children. J Asthma. 2006;43:439-46.
20. Sarpong AB, Karrison T. Skin test reactivity to indoor allergens as a marker of asthma severity in children with asthma. Ann Allergy Asthma Immunol. 1998;80:303-8.
21. Craig TJ, King TS, Lemanske RF. National Heart, Lung, and Blood Instituteâ€™s asthma clinical research network: aeroallergen sensitization correlates with PC(20) and exhaled nitric oxide in subjects with mild-to-moderate asthma. J Allergy Clin Immunol. 2008;121:671-7.
22. Wati DK. House dust mite level in asthmatic and non-asthmatic children in Denpasar. Presented in 25th International Congress of Pediatrics; 2007 Aug 25-30; Athens, Greece. 2007.
23. Boquete M, Iraola V, Fernandez-Caldas E, Villaroel LA, Carballada FJ, de la Cuesta CG. House dust mite species and allergen levels in Galicia, Spain: a cross-sectional, multicenter, comparative study. J Investig Allergol Clin Immunol. 2006;16:169-76.
24. Fernandez-Caldas E, Codina R, Ledford D, Trudeau W, Lockey R. House dust mite, cat, and cockroach allergen concentrations in day care centerss in Tampa, Florida. Ann Allergy Asthma Immunol. 2001;87:196-200.
25. Jooma OF, Weinberg EG, Berman D, Manjra AI, Potter PC. Accumulation of house dust mite (Der-p-1) levels on mattress covers. S Afr Med J. 1995;85:1002-5.
26. Custovic A, Simpson A. Environmental allergen exposure, sensitization and asthma: from whole populations to individuals at risk. Thorax. 2004;59:825-7.
27. Holloway JW, Beghe B, Holgate ST. The genetic basis of atopic asthma. Clin Exp Allergy. 1999;29:1023-32.
28. Sykes A, Johnston SL. Etiology of asthma exacerbations. J Allergy Clin Immunol. 2008;122:685-8.
29. Cobanoglu N, Kiper N, Dilber E, Gurcan N, Gocmen A, Ozcelik U, et al. Environmental tobacco smoke exposure and respiratory morbidity in children. Inhal Toxicol. 2007;19:779-85.
30. Gerald LB, Gerald JK, Gibson L, Patel K, Zhang S, McClure LA. Changes in environmental tobacco smoke exposure and asthma morbidity among urban school children. Chest. 2009;135:911-6.
31. Ronchetti R, Bonci E, Cutrera R. Enhanced allergic sensitization related to parental smoking. Arch Dis Child. 1992;67:496-500.
32. Becker AB. Is primary prevention of asthma possible? Pediatr Pulmonol. 2000;30:63-72.