Aeroallergen sensitization patterns among patients with chronic rhinitis with or without concomitant asthma

Abstract Objectives The aim of this study was to explore the differences in the pattern of allergen sensitization in CR individuals without or with asthma, according to asthma severity. Methods A total of 1066 adults were evaluated. Asthma and chronic⁄allergic rhinits were identified by specialists, questionnaries and skin-prick test. The phenotypic characterization was avaliable from skin-prick test to an aeroallergen extended panel, total IgE and pulmonary function. Using questionnaires and clinical evaluation, participants were classified into the groups: chronic rhinitis alone (CRA) and chronic rhinitis + asthma, the latter subdivided into CR + mild asthma (CRMA) and CR + moderate to severe asthma (CRMSA). Aerollergen sensitization was defined by a positive prick test to one or more allergens associated with nasal symptoms and/or asthma. The association between CR and asthma was evaluated by multivariable logistic regression. The evidence of effect modification of pattern of sensitization in CR on the association with asthma severity and outcomes was examined by introducing interactions terms in the logistic regression models adjusting for confounders. Results Frequency of sensitization to aeroallergens was higher in association with asthma in comparison to CRA (CRMA 70.4%; CRMSA 65.0%; CRA 47.0%; p= 0.000). Similarly, the presence of asthma was associated to aeroallergen multiple sensitization (51.5%) (OR = 2.10, 95% CI 1.27-3.50). Additionally, the sensitization to mites, cockroaches, animal epithelium, grasses, and molds, were higher in asthma (56.8%, 24.3%, 12%, 7.13% and 10.3%, respectively). Sensitization to Alternaria alternata, Cladosporium herbarum and dog epithelium was exclusive in asthma groups. A concomitant asthma diagnosis was directly associated with a positive allergen sensitization at least one allergen (62.7%, OR = 2.45, 95% CI 1.80-3.34) and polissensitization (51.5%, OR = 2.10, 95% CI 1.27-3.50). Conclusion Asthma is associated with multiple allergen sensitization among patients with CR. Some unique profiles of aeroallergen sensitization were observed in patients with CR and asthma. Nevertheless, no difference was found in the sensitization in relation to asthma severity, which suggest atopy is not the main underlying mechanism for asthma severity among patients with CR. Level of evidence: Level 3.

Levels of indoor allergens in public hospitals in Thailand.

Objective: To determine levels of indoor allergens in five public hospitals in Thailand. Methods: A total of 90 dust samples were collected from five public hospitals in Bangkok, Thailand, during March 2002 to October 2003. These hospitals provide both adult and pediatric care to over 500 patients daily. Each dust sample was collected at 12.00-13.00 pm during the years 2002-2003. The total amount of dust was weighed and one hundred milligram of fine dust from each sample was extracted. A commercialized two-site monoclonal antibody-based immunoassay (Indoor Biotechnologies, Ltd., Manchester, UK) was used to quantify the levels of Der p1, Der f1, Can f1 and Fel d1. Results: Fifty-one out of 90 dust samples were positive for indoor allergens. Four common groups of allergens were analyzed and detected; Der p 1 8/90 (8.89%), Der f 1 1/90 (1.11%), Fel d 1 39/90 (43.33%) and Can f 1 3/90 (3.33%)(of total samples). The arithmetic mean and standard deviation were 0.06 ug/g±0.26, 0.08 x 10-2 ug/g ± 0.001, 0.39 ug/g± 0.71 and 0.06 ug/g±0.30 for Der p 1, Der f 1, Fel d 1 and Can f 1, respectively (p =0.004). Fel d 1, the highest density allergen extracted from dust samples from hospital no. 5 and it showed a statistical difference compared with hospitals no.1,2,3,4 was observed; p < 0.05.* Conclusion: Our findings indicated that cat allergen can be found in a hospital setting where no cat is present.

Pharaoh Ant (Monomorium pharaonis): Newly Identified Important Inhalant Allergens in Bronchial Asthma

The nonstinging house ant, Monomorium pharaonis (pharaoh ant), was recently identified as a cause of respiratory allergy. This study was performed to evaluate the extent of sensitization to pharaoh ant, and its clinical significance in asthmatic patients. We carried out skin prick tests in 318 patients with asthma. Specific IgE (sIgE) to pharaoh ant was measured by ELISA, and cross-reactivity was evaluated by ELISA inhibition tests. Bronchial provocation testing was performed using pharaoh ant extracts. Fifty-eight (18.2%) of 318 patients showed positive skin responses to pharaoh ant, and 25 (7.9%) had an isolated response to pharaoh ant. Positive skin responses to pharaoh ant were significantly higher among patients with non-atopic asthma than among those with atopic asthma (26.0% vs. 14.9%, p<0.05). There was significant correlation between sIgE level and skin responses to pharaoh ant (rho=0.552, p<0.001). The ELISA inhibition tests indicated that pharaoh ant allergens had various pattern of cross-reactivity to house dust mites and cockroaches. Bronchial provocation tests to pharaoh ant were conducted for 9 patients, and eight showed typical asthmatic reactions. In conclusion, pharaoh ant is an important source of aeroallergens, and it should be included in the skin test battery for screening the causative allergens in patients with asthma.

A Case of Factitious Urticaria Strongly Responded to Cockroach Extracts / 대한피부과학회지

The impact of indoor allergens is greater than that of outdoor or occupational environments. Cockroaches have been demonstrated to be an etiologic factor in allergic diseases, especially in patients with lower socioeconomic classes in large urban areas. Infestations of cockroaches are largely dependent on housing conditions, and hypersensitivity is dependent on exposure. We herein report a 38-year-old man with factitious urticaria revealed strong positive reactions to crude extracts of American cockroach and German cockroach at a skin pinprick test and Western blot analysis.