Impact of helminth infection on childhood allergic diseases in an area in transition from high to low infection burden

BACKGROUND: The effect of helminth infections on allergic diseases is still inconclusive. Furthermore, the effect of helminth infections on childhood allergic diseases in a tropical area where prevalence of helminth infections has undergone dramatic changes is not well documented. OBJECTIVE: To investigate the relationship between allergic diseases and helminth infection in a cohort of schoolchildren in an area that has undergone dramatic changes in intensity of helminth infections. METHODS: Children attending grade 5 were recruited from 17 schools in Western Province of Sri Lanka. They were assessed for allergic diseases using the International Study of Asthma and Allergies in Childhood questionnaire. Their serum total IgE (tIgE) and allergen-specific IgE (sIgE) for five common aeroallergens were measured by ImmunoCAP® method and stools were examined for the presence of helminth infections. RESULTS: A total of 640 children (mean age 10 years) were recruited to the study. Of them, 33.7% had evidence of allergic disease and 15.5% had helminth infections. Majority of infections (68.9%) were of low intensity. A significant relationship between allergic disease and helminth infections was not observed, however, a trend toward protective role of helminth infections against allergic diseases was noted. Multivariate analysis showed helminth infections to be an independent predictor of high tIgE levels whereas allergic disease was not. Allergic sensitization (atopy) was a significant risk factor for allergic disease only among non-infected children (odds ratio 3.025, p = 0.022) but not in infected children. The ratio of sIgE to tIgE was higher in non-infected children. CONCLUSION: Though not significant, a reduced risk of allergy in helminth-infected children was observed in this population. A Decrease in intensity of helminth infections may have contributed to the reduced capacity of immune-modulation by helminths in this paediatric population.

Impact of chronic urticaria on the quality of life in Australian and Sri Lankan populations

BACKGROUND: Chronic idiopathic urticaria (CIU) has a significant impact on patients' quality of life. OBJECTIVE: The purpose of this study is to assess that impact and to compare differences by culture, gender, age or duration of treatment. METHODS: We used the modified chronic urticaria quality of life questionnaire, consisting of 15 questions. Over the course of 6 months, patients attending Immunology clinics at Campbelltown Hospital and private rooms in Australia and at the faculty of Medicine, University of Kelaniya in Sri Lanka were asked to fill out the questionnaires. We have obtained the data from 125 patients (43 Australian vs. 82 Sri Lankan). There were significantly more female patients (P < 0.01). The data was analysed using SAS. RESULTS: Overall, patients were affected mostly by itch and wheals and least affected by the side effects of treatments. Sri Lankan populations were more affected by wheals and by interference on activities, mood and food choices but were less affected by tiredness due to sleep disturbances (P < 0.01). Females were more affected by sleep disturbance (P < 0.05) while those older than 40 years of age were more impacted by tiredness and by the side effects from medications (P < 0.05), though the complaints themselves were mild. Those who suffered from CIU for more than 1 year were more affected by wheal, tiredness and irritability (P ≤ 0.05). CONCLUSION: The questionnaire highlighted some differences between patients attending Australian versus Sri Lankan outpatients. Significant differences were found in one third of parameters which include mood, sleep, daily activities and food choices.