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[Identification of the allergenic taxa of pollen in patients with pollinosis to determine the risk season].

BACKGROUND: Determining the risk season for the presence of pollen in the atmosphere aids primary care physicians in the diagnosis and treatment of allergic diseases. Our objective was to identify the taxa of pollen that cause allergic rhinoconjunctivitis in a sample of patients from a health center who presented seasonal symptoms. METHODS: We designed an observational, cross-sectional, non-randomized study to be carried out in the Cazoña Health Center in Santander, Spain. We selected 30 volunteers of both sexes, aged between 13 and 69 year old, who suffered seasonal rhinoconjunctivitis symptoms and who had always lived in Santander. Patients underwent skin-prick tests with the 25 pollen extracts routinely used in Spain, house dust mite (HDM), cat dander and Alternaria extracts by means of the Prick-Film system. The test result was expressed as the percentage of the papule area caused by histamine. Measurement was performed by scanning the copied papule area with the Prick-Scan program for PC. RESULTS: All patients were positive to grass pollen, 26 % were sensitized to grass pollen only and 23 % were also sensitized to other non-pollen allergens. Twenty-seven percent tested positive to Plantago, 20 % to Quercus and 13 % to Morus; the remaining pollen extracts were positive in less than 10 %. Fifty-six percent of the patients were positive to HDM and 6 % to cat dander. CONCLUSIONS: A warning period for pollinosis patients in the city of Santander can be defined. In our case, the important period is the grass pollen season, since the remaining pollen taxa sensitized few patients. Most of our patients were also sensitized to HDM.

Adolescent↗

PubMed2006

Occupational respiratory allergy to roe deer.

BACKGROUND: Although scattered reports have been published on roe deer allergenicity, no systematic studies of allergenicity or possible cross-reactions have appeared. OBJECTIVES: To describe 2 patients with occupational roe deer allergy, demonstrated by positive skin and conjunctival provocation test results, and to note cross-reactions to other animal (mainly cow) allergens. METHODS: Two workers at animal rehabilitation centers were sensitized to roe deer. One patient had a history of rhinoconjunctivitis and the other a history of rhinoconjunctivitis and probable asthma. Both patients underwent skin testing with a standard battery of inhaled and epithelial allergens and with roe deer hair and dander extract and conjunctival provocation tests with roe deer hair extract. Immunodetection for IgE (both patients) and IgE immunoblot inhibition tests to determine inhibitory effect (1 patient) were also performed. RESULTS: The results of skin tests and conjunctival provocation tests showed that both patients were sensitized to roe deer allergens. In one patient specific IgE to roe deer extract was detected, and this extract completely inhibited IgE binding to cow hair and dander extract in immunoblotting tests. Specific IgE to roe deer proteins could not be demonstrated in the other patient. CONCLUSIONS: Our results suggest that roe deer epidermal derivatives can cause occupational respiratory disease in exposed workers and that allergy to this species should be considered in individuals who present with similar symptoms and exposure histories. Immunoblot inhibition studies suggested the possibility of cross-reaction between roe deer proteins and cow proteins.

Adult↗

PubMed2004

The determinants of bronchial hyperresponsiveness in patients with allergic rhinitis.

BACKGROUND: Patients with allergic rhinitis and bronchial hyperresponsiveness (BHR) may be at higher risk of developing asthma. OBJECTIVE: To investigate whether reactivity to aeroallergens in skin prick testing (SPT) and serum eosinophil cationic protein levels can be used to predict BHR in allergic rhinitis patients. METHODS: Fifty-nine consecutive patients with allergic rhinitis underwent SPTs using grass, tree, weed, parietaria, Alternaria, Aspergillus, mites, and cat and dog dander extracts. Methacholine challenge tests were performed using spirometry. RESULTS: Methacholine-induced BHR was detected in 23 patients (39%). Of 59 patients, 14 had 1 positive SPT response, 35 had 2 to 4 positive responses, and 10 had more than 4 positive responses. There was a significant inverse correlation between methacholine provocation concentration that caused a decrease in forced expiratory volume in 1 second of 20% (PC20) and the number of positive SPT responses (r = -0.28; P = .03). The BHR-positive patients had a mean of 4 positive SPT responses, whereas BHR-negative patients had a mean of 2.6 (P = .04). Nine BHR-positive patients (39%) and only 1 BHR-negative patient (3%) had more than 4 positive SPT responses (P < .001). There was no correlation between serum eosinophil cationic protein levels and methacholine PC20 doses. There was a strong association between hyperresponsiveness to methacholine and both cat and dog dander sensitivity (P < .001 and P = .001, respectively). CONCLUSIONS: Allergic rhinitis patients with SPT responses to a higher number of allergens are more likely to have BHR. Whether the number of positive SPT responses correlates with the risk of developing asthma in allergic rhinitis patients remains to be determined.

Adolescent↗

PubMed1999

Allergy prevalence and causal factors in the domestic environment: results of a random population survey in the United Kingdom.

BACKGROUND: Surveys of the prevalence of allergic diseases associated with domestic allergens (eg, asthma, rhinitis, hay fever, eczema, and dermatitis) are usually undertaken in restricted geographic areas. They are often based on specific demographic subgroups (eg, children) or are derived from treatment data (eg, GP consultations). Causal factors are seldom quantified in these reports. OBJECTIVE: This study was designed to quantify the prevalence of allergic disease among a representative cross-section of population in the United Kingdom. It was also designed to quantify the reported causal factors in terms of domestic allergen and irritant sources and activities leading to exposure. METHODS: Two thousand respondents were selected from across the UK. These respondents were interviewed using a short series of questions that formed part of a larger, more general omnibus questionnaire. The questions required respondents to report on diagnosed allergic disease and causal factors within their household, giving a total sample base of 5,609 people. RESULTS: Asthma and hay fever account for the majority of reported cases of allergic disease in the UK (12% and 10% of total household, respectively). Pollen, house dust mite excreta (HDM allergen), and pet dander are the three most common allergic triggers (42%, 27%, and 17% respectively). Dusting and being near pets each account for about 20% of the reported domestic activities triggering an allergic response. CONCLUSION: The feedback from the general population indicates asthma and hay fever to be the predominant allergic conditions, with dust and pet dander the most common sources of allergen/irritant. Key tasks such as changing bed linen and vacuuming were not perceived as being as important as dusting in terms of activities leading to reaction.

Activities of Daily Living↗

PubMed2001

Nasal polyposis: a study of its association with airborne allergen hypersensitivity.

BACKGROUND: Despite the frequent presence of clinical symptoms such as sneezing and itching, elevated histamine and IgE in extracellular polyp fluids, tissue eosinophilia, and degranulated mast cells, allergy is not considered an important cause of nasal polyposis. OBJECTIVE: To investigate the prevalence of immediate skin reactivity to airborne allergens in patients with nasal polyposis. METHODS: Sixty-eight patients with nasal polyposis and 36 controls with chronic sinusitis were submitted to skin prick tests (SPTs) with a large series of seasonal and perennial airborne allergens including: grass, mugwort, ragweed, pellitory, plantain, birch, hazel, olive, cypress, house dust mites, cat and dog dander, and thirteen molds (Alternaria, Aspergillus, Cladosporium, Penicillium, Candida, Trichophyton, Fusarium, Curvularia, Botrytis, Pullularia, Rhizopus, Mucor, Helminthosporium). RESULTS: Forty-three of 68 (63%) patients with nasal polyposis versus 6 of 35 (17%) controls were positive on SPT with airborne allergens (P < .001). A comparison with 1,128 subjects with respiratory allergy seen from 1996 to 1999 showed a markedly higher prevalence of sensitivity to Candida albicans (19 of 43 [44%] vs 8 of 1,128 [1%]; P < .001) and to house dust mites (12 of 43 [28%] vs 154 of 1,128 [14%]; P < .05) among allergic patients with polyps. Altogether, 30 of 43 (70%) patients versus 215 of 1,128 (19%) controls were sensitive to at least one perennial airborne allergen (ie, mold, mite, or animal dander) on SPT (P < .001); in contrast, 26 of 43 (60%) patients versus 942 of 1,128 (84%) controls were sensitive to seasonal airborne allergens (P < .005). A review of the clinical histories of SPT-positive patients revealed the presence of obstructive rhinitis and chronic rhinorrhea only in most cases, whereas acute symptoms, such as sneezing and itching, were reported only by a minority of subjects. CONCLUSIONS: A clinically slight respiratory allergy, particularly to perennial airborne allergens, might play a relevant role in the pathogenesis of nasal polyposis, probably through the induction of a long-lasting inflammation of the nasal mucosa.

Adolescent↗

PubMed1999

Bronchial allergen challenge in subjects with low levels of allergic sensitization to indoor allergens.

BACKGROUND: Low skin reactivity to common inhalant allergens is frequently found in asymptomatic individuals as well as in patients with respiratory complaints. However, most studies on bronchial allergen challenge concern patients with high levels of allergic sensitization. The present study was directed to bronchial reactions after allergen challenge in subjects with low skin reactivity to Dermatophagoides pteronyssinus or cat dander. METHODS: Titrated intracutaneous skin tests, skin prick tests, specific IgE assays, histamine release on washed leukocytes, and bronchial histamine and allergen-challenge tests were performed in 20 subjects with an intracutaneous skin test threshold for cat dander (Felis domesticus) or D. pteronyssinus above 0.1 BU/ml (mean wheal diameter in skin prick test with 10000 BU/ml: 4.4mm). Ten of the 20 patients had specific IgE below the detection limit in at least one of the three IgE assays which were done. Fifteen patients had a specific IgE level below 2 kU/I in all three tests. As a positive control group, the same parameters were studied in seven moderately sensitized patients with an intracutaneous skin test threshold below 0.1 BU/ml (mean wheal diameter with 10000 BU/ml: 7.2mm). RESULTS: The 20 subjects with low levels of allergic sensitization had an early decrease in FEV1 of 8.6% (P<0.01) and a mean late decrease of 6.3% (P<0.05). There was a trend for decrease in PC20 histamine 24h after allergen challenge (-0.4 doubling doses, P=0.09). CONCLUSIONS: In this group of subjects with low levels of allergic sensitization, a statistically significant early and late decrease in FEV1 was found. However, the decrease in lung function was small and unnoticed by most patients. The increase in nonspecific bronchial hyperresponsiveness after bronchial allergen challenge did not reach statistical significance in the study group. The results indicate that allergen exposure in patients with low levels of allergic sensitization may lead to airways changes in the absence of acute symptoms.

Adult↗

PubMed2000

Sensitivity to fungal allergens is a risk factor for life-threatening asthma.

BACKGROUND: Previous studies have suggested that sensitivity to Alternaria and Cladosporium may be risk factors for life-threatening asthma. We have investigated this by studying the relationship between skin tests for fungal spores and admission to an intensive care unit (ICU) for asthma. METHODS: Skin prick tests for fungal spores (Alternaria tenuis, Cladosporium cladosporoides, Helminthosporium maydis, and Epicoccum nigrum), cat dander, house-dust mite (Dermatophagoides pteronyssinus), and a seven-grass mix were performed in three groups of patients: patients admitted to an ICU with an attack of asthma; those who had received emergency treatment for asthma but had not been admitted to an ICU, and those who had never required emergency treatment for their asthma. RESULTS: Twenty of 37 patients (54%) admitted to the ICU had a positive skin test for one or more fungal allergens compared with 15/50 patients (30%) in each of the other groups (P=0.005). The ICU patients were no more likely to have positive skin tests for the grass mix, cat dander, or house-dust mite than the other patients. CONCLUSIONS: A positive skin test for fungal allergens is a risk factor for admission to an ICU with an acute attack of asthma.

Adolescent↗

PubMed2001

Eosinophil cationic protein (ECP) in school children living in a mountainous area of Norway: a population-based study of ECP as a tool for diagnosing asthma in children with reference values.

BACKGROUND: Most previous studies on eosinophil cationic protein (ECP) have been performed on carefully selected groups of asthmatic patients. Few studies based upon population cohorts have been reported. The primary objective of the present study was to assess the usefulness of serum eosinophil cationic protein (s-ECP) in the diagnosis of asthma in schoolchildren and determine reference values based on measurements in healthy children. METHODS: The population consisted of 216 schoolchildren (aged 7-16 years) who in a previous questionnaire had reported asthma or asthma-like symptoms and a control group. The questionnaire study comprised the entire population of schoolchildren in Upper Hallingdal. After clinical assessment, blood samples, and skin prick tests, these subjects were then reclassified into four groups: atopic and nonatopic asthmatic and nonasthmatics. S-ECP was assessed in relation to atopy, asthma severity, allergen exposure, and sex. RESULTS: The asthma group (n = 105) had significantly higher mean s-ECP level than the nonasthma group (n = 111) (13.3 vs 8.3 microg/l, P < 0.001), with no significant difference between atopic asthmatics and atopic nonasthmatics. Mean s-ECP levels in children with mild, moderate, or severe asthma were 12.1, 18.5, and 12.2 microg/l, respectively. The children with animal dander allergy demonstrated higher levels of s-ECP than children without this allergy (12.9 vs 9.1 microg/l, P = 0.001). The upper reference limit (determined as the 95th percentile in healthy children) of 19.1 microg/l, showed low sensitivity (24%) and high specificity (93%) for the diagnosis of asthma. The positive and negative likelihood ratios for the asthma diagnosis were found to be 3.2 and 0.83, respectively. CONCLUSIONS: The highest s-ECP values were found among children with moderate asthma. Animal dander allergy resulted in elevated s-ECP. However, mean values were still below the reference value of 19.1 microg/l, and the sensitivity was low, suggesting that s-ECP is not a useful parameter for diagnosing asthma in population-based studies.

Adolescent↗

PubMed2000

Asthma and allergy among schoolchildren in a mountainous, dry, non-polluted area in Norway.

The aim of this study was to assess prevalence of asthma and allergy in the non-polluted mountain area of Upper Hallingdal, Norway. All schoolchildren (7-16 years) who in a previous questionnaire survey (n = 1177) reported 'sometime' asthma were enrolled in group I (n = 80), the 59 who reported asthma-like symptoms in the past 12 months formed group II, and 77 of the healthy controls were randomly selected as group III. All 216 children underwent clinical examination, skin prick test, spirometry, bronchial provocation (PD20 metacholine) and treadmill exercise test. Subsequently they were reclassified as (1) healthy, never had asthma or symptoms, (2) symptoms not confirmed as asthma, (3) previous asthma, now healthy, (4) current asthma. Lifetime asthma prevalence was 10.2%. Based upon clinical examination, the specificity and sensitivity of the questionnaire for asthma diagnosis were 88 and 74%, respectively. Forced vital capacity was significantly higher among the asthmatics (group 4 versus 1), whereas forced expiratory volume in one second (FEV1) and forced expiratory flow at 50% of vital capacity were similar in all groups. More than 10% reduction in FEV1 following treadmill-run was found in 20% of children. Children with current asthma compared to controls had significantly; lower mean values of PD20 (9.1 versus 16.5 micromol), higher eosinophil cationic protein (13.4 versus 7.7 micromol) and more frequent sensitization to animal dander (56% versus 10%). In conclusion, despite a favorable climate, little mite sensitization and low outdoor pollution, asthma prevalence was surprisingly high in Upper Hallingdal. Sensitization to animal dander was the most important contributing factor for current asthma.

Adolescent↗

PubMed1997

The most common phenotypes of sensitization to inhalant allergens in childhood.

BACKGROUND: Atopic individuals are frequently sensitized to a limited number of certain allergens, although most of them are exposed to multiple inhalant allergens in daily life. OBJECTIVE: We investigated the hypothesis that observed common patterns of sensitization might occur with similar frequency within two independent study populations of school-children. METHODS: The results were derived from skin-prick tests conducted on two large samples of children (study 1: n = 583; study 2: n = 1099) examined with the same panel of six inhalant allergens. RESULTS: In order to ensure that the comparison was uniform, the younger subpopulation of study 1 (n = 147) was compared with the sample of study 2 (n = 374). The highest frequency for monosensitization was found for sensitization to Dermatophagoides pteronyssinus (study 1: 18.4%, study 2: 20.3%), followed by monosensitization to grass pollens (study 1: 12.2%; study 2: 8.8%). Using multiple logistic regression for each specific sensitization, a significantly increased relative risk of sensitization to hazel pollens (study 1 OR 5.9; study 2 OR: 24.3) appeared to be associated with sensitization to birch pollens. The same applied to dog dander (study 1 OR: 7.3; study 2 OR: 2.6), which showed an association with sensitization to cat dander. CONCLUSION: In summary, our data suggest that certain clusters of monosensitization and polysensitization to common inhalant allergens exist among a given population. This may well be a reflection of diversity in disposition to specific sensitization and/or antigen crossreactivity. From a practical point of view the data also might help in counselling parents of allergic children.

Adolescent↗

PubMed2002

Atopic sensitization among children in an arctic environment.

BACKGROUND: Asthma has been reported to be rare among Inuits, but so far total and specific IgE levels have never been determined in arctic populations. OBJECTIVE: To determine the prevalence of atopy in children living in an arctic environment, and to examine whether atopy and total IgE levels were associated with parental place of birth, as a measure of ethnicity, and travel history. MATERIAL AND METHODS: All schoolchildren in Sisimiut, a community on the West coast of Greenland, were screened for atopy. Blood samples were analysed for total IgE and for specific IgE against inhalant and food allergens. Information on place of birth of children and their parents was obtained from national registries. Information on travel history was obtained from self-administered questionnaires. RESULTS: A total of 1031 schoolchildren aged 5 to 18 years had a blood sample drawn (85% of available children for the study). Of these, 151 (14.6%) children were sensitized to at least one inhalant allergen and 42 (4.1%) to at least one food allergen. Sensitization to grass was most common, whereas sensitization to mugwort, birch, animal-dander and house-dust mite was infrequent. Children whose parents were both born abroad had a higher risk of sensitization to inhalant allergens compared with children born of Greenlandic parents (OR = 8.6, 95% CI 2.8-27.1). Furthermore, children who had been abroad had a higher risk of sensitization towards pollen (OR = 1.6, 95% CI 1.0-2.5) and animal-dander (OR = 2.1, 95% CI 1.0-4.6) after adjustment for confounders. Both atopic and non-atopic children demonstrated high levels of total IgE (medians of 251 and 58 kU/L). CONCLUSIONS: Compared with European findings Greenlandic children have high levels of total IgE but a low prevalence of allergic sensitization towards inhalant allergens. This may be due to a low genetic susceptibility to atopy and less allergen exposure, as well as to living conditions in an arctic environment.

Adolescent↗

PubMed2003

Quantitative measurement of airborne allergens from dust mites, dogs, and cats using an ion-charging device.

BACKGROUND: Increasing evidence suggests that children raised with an animal(s) in the house have a decreased risk of becoming sensitized. However, it is not clear whether this phenomenon is related to airborne exposure. OBJECTIVE: To estimate airborne exposure to animal dander and dust mite allergens using a device that can sample large volumes of air silently. METHODS: The device, which uses an ion-charging technique to move air and to collect particles, was run at 1.7 m3/min for 24 h in 44 homes with and without animals. The allergen collected was measured by ELISA for Fel d 1, Can f 1, Der p 1, and Der f 1. RESULTS: Airborne Fel d 1 was present in all homes with a cat (n=27). The quantities measured, i.e. 0.5-20 microg in 24 h, represent 0.01-0.3 microg Fel d 1 inhaled/day at normal breathing rates (20 L/h). Values for houses without a cat were 0.01-0.05 microg inhaled/day. Airborne Fel d 1 correlated significantly with floor Fel d 1 (r=0.58, P<0.001). Results for Can f 1 were similar in houses with a dog, but this allergen was only detected airborne in two houses without a dog. Neither Der p 1 nor Der f 1 (i.e. <0.01 microg) was detected, which represents < or =1 ng inhaled/day during normal domestic activity. During disturbance airborne mite was detected with both the ion-charging device and a filter run in parallel. For cat and mite allergens there was a close correlation between the two techniques (r=0.84, P<0.001). CONCLUSION: Exposure to cat or dog allergen airborne in homes with an animal can be up to 100 times higher than exposure to mite allergen. The results are in keeping with a model where immunological tolerance to animal dander allergens results from high exposure.

Air Pollutants↗

PubMed2002

Threshold levels of purified natural Bos d 2 for inducing bronchial airway response in asthmatic patients.

BACKGROUND: Provocation tests are invaluable in establishing threshold levels and a causal relationship between atopic asthma and a certain allergen source, especially in relation to work-associated exposure. Purified major allergens open possibilities for a more accurate assessment of sensitization. OBJECTIVE: To determine the threshold dose of purified major bovine dander allergen Bos d 2 in bronchial provocation in comparison with the standard allergen and a set of other parameters of allergy. METHOD: Nine consecutive patients referred to hospital for confirming the bovine origin of their occupational asthma were subjected to bronchial provocation tests with purified natural Bos d 2 and a standard bovine dander allergen. Additional tests included bronchial histamine challenge, measurements of total IgE, specific IgE antibody determinations and skin prick tests (SPT) with both allergens. RESULTS: In the provocation tests with Bos d 2, a 15% decrease in the forced expiratory volume in 1 s (FEV1) and/or peak expiratory flow (PEF) values in eight out of nine patients confirmed the predominant role of Bos d 2 in the sensitization. The threshold dose of Bos d 2 varied from 0.1 microg to > 100 microg (median +/- median absolute deviation = 4.5 +/- 3.9 microg). A positive SPT was induced by a median dose of 13.9 +/- 9.8 microg of Bos d 2. Bronchial response to histamine and IgE antibodies against Bos d 2 showed the highest correlations to the provocations results. CONCLUSIONS: The efficacy of Bos d 2 in bronchial provocation in patients with occupational cattle-associated asthma was confirmed and the range of the threshold level was determined. There were individual variations, but the response in provocation remains the reference method for identification of the cause of occupational atopic asthma. SPT and the measurement of specific IgE antibodies, preferably with purified or recombinant major allergens, increase the accuracy of the diagnosis.

Adult↗

PubMed2003

Effects of changing risk factors on increasing asthma prevalence in southern Taiwan.

The study sought to identify factors with consistent relationships with the prevalence of asthma and postulate causes for the increasing prevalence. Reduplication of prevalence surveys was conducted among children of similar ages (6-12 years) from the same area (Tainan City, Taiwan). A total of 7523 primary school children from 1993 and 7224 from 1997 participated in the study. The reported prevalence of diagnosed asthma increased from 6.46% in 1993 to 8.45% in 1997 (relative risk 1.31, 95% CI 1.16, 1.47). Among all environment- and heredity-related factors examined, only four showed consistent relationships with childhood asthma, and all appeared to be a related hereditary condition. Dander allergy is the only factor that increased correspondingly with the prevalence of childhood asthma; therefore, it seems to be the most likely key factor responsible for the increasing trend. The investigation of the interactive effects imposed by the environment- (dander exposure) and heredity-related (atopic sensitisation) factors are recommended for further studies.

Asthma↗

PubMed2002

Asthma severity, allergy and lung function during young middle life in subjects with asthma in childhood.

The further course of asthma severity lung function, bronchial hyperresponsiveness (BHR) to cold air challenge (CACh), clinical allergies and allergic sensitization in young middle adulthood was studied in a cohort of 55 subjects with childhood asthma. All subjects (27 females) have attended all five previous and the current follow-up visit, undertaken at a mean age of 35 years. Twelve subjects (22%) reported no current asthma, 28 (51%) mild/intermittent, and 15 (27%) moderate/severe asthma. Asthma severity changed little in the individual subjects over the last 5-year period. Females continued to have higher asthma severity scores than the males, but the previously noted lower resting and post-bronchodilator % predicted FEV1 in females was not confirmed now. Pathological BHR to CACh tended to be more common among the males. Forty-four subjects were still allergic to animal danders and 35 to pollens. Sensitization rates (skin prick test or RAST) were similar to those recorded 5 years earlier and there was no clear evidence of tolerance developing. Five subjects have never shown evidence of allergy or sensitization. The extent of sensitization to animal danders showed statistically significant relationships to asthma severity and BHR to CACh. Social development and professional careers continued to be good.

Adult↗

PubMed1976

[Guinea-pig asthma (author's transl)].

Out of 140 selected patients with bronchial asthma 24 demonstrated signs of guinea-pig hypersensitivity. Six further patients with a shorter exposure to guinea-pigs were not sensitized. The diagnosis can be established by means of history, skin test, and removal of the animal. The mean period until asthma became clinically manifest was 12.3 months, for the prodromal stage rhinitis and (or) conjunctivitis 9.8 months. Atopic symptoms may or may not be present in affected persons. A great number of accompanying false-positive skin test reactions to different animal dander antigens supports the hypothesis of an antigenic relationship between dander allergens from different animal species. The only treatment for guinea-pig asthma is removal of the guinea-pig. Other domestic animals should be avoided as well.

Allergens↗

PubMed1997

The role of cockroach allergy and exposure to cockroach allergen in causing morbidity among inner-city children with asthma.

BACKGROUND: It has been hypothesized that asthma-related health problems are most severe among children in inner-city areas who are allergic to a specific allergen and also exposed to high levels of that allergen in bedroom dust. METHODS: From November 1992 through October 1993, we recruited 476 children with asthma (age, four to nine years) from eight inner-city areas in the United States. Immediate hypersensitivity to cockroach, house-dust-mite, and cat allergens was measured by skin testing. We then measured major allergens of cockroach (Bla g 1), dust mites (Der p 1 and Der f 1), and cat dander (Fel d 1) in household dust using monoclonal-antibody-based enzyme-linked immunosorbent assays. High levels of exposure were defined according to proposed thresholds for causing disease. Data on morbidity due to asthma were collected at base line and over a one-year period. RESULTS: Of the children, 36.8 percent were allergic to cockroach allergen, 34.9 percent to dust-mite allergen, and 22.7 percent to cat allergen. Among the children's bedrooms, 50.2 percent had high levels of cockroach allergen in dust, 9.7 percent had high levels of dust-mite allergen, and 12.6 percent had high levels of cat allergen. After we adjusted for sex, score on the Child Behavior Checklist, and family history of asthma, we found that children who were both allergic to cockroach allergen and exposed to high levels of this allergen had 0.37 hospitalization a year, as compared with 0.11 for the other children (P=0.001), and 2.56 unscheduled medical visits for asthma per year, as compared with 1.43 (P<0.001). They also had significantly more days of wheezing, missed school days, and nights with lost sleep, and their parents or other care givers were awakened during the night and changed their daytime plans because of the child's asthma significantly more frequently. Similar patterns were not found for the combination of allergy to dust mites or cat dander and high levels of the allergen. CONCLUSIONS: The combination of cockroach allergy and exposure to high levels of this allergen may help explain the frequency of asthma-related health problems in inner-city children.

Allergens↗

PubMed2000

The use of standardized extracts in allergen immunotherapy.

BACKGROUND: Double-blind, placebo-controlled studies have established that injection allergen immunotherapy is clinically effective. However, it is not known to what extent the doses of allergen extract commonly used in clinical practice match those that have been used in these controlled studies. OBJECTIVE: The aim of this study was to determine by questionnaire the doses of standardized allergen extracts commonly used by board-certified allergists in the United States and to compare these with doses that have proven effective in double-blind, placebo-controlled studies. METHODS: A questionnaire containing a hypothetical case and asking for a recommended allergen prescription for maintenance immunotherapy was mailed to 500 randomly selected board-certified members of the American Academy of Allergy, Asthma and Immunology living in the United States. The recommended doses were compared with those doses of the extracts that had been proven effective by using major allergen content figures for representative standardized US allergen extracts provided by an allergy extract laboratory. RESULTS: Responses were received from 118 (23%) of the addressees. Eighty (16%) contained interpretable data on maintenance dosing for extracts. The median doses of pollen recommended were comparable with those that have been demonstrated to be clinically effective. Median doses of house dust mites were only slightly lower than those that have proven effective. Median doses of animal dander, on the other hand, were well below those used effectively in controlled studies. Although the median doses used were often in the range of proven doses, the range of doses recommended by allergists included some that were one tenth to one five hundredth those of the median doses. CONCLUSION: In the absence of useful guidance from the federal regulatory authorities, American allergists, for the most part, use doses of pollens and house dust mites that are within the proven range. Their dosing of animal dander is generally below proven effective doses. There is, however, a wide range of dosing of all extracts used, and there is use of mixes that have no botanical basis. Therefore there is need for studies defining what are effective and ineffective allergen extract doses.

Allergens↗