Sensitization to indigenous pollen and molds and other outdoor and indoor allergens in allergic patients from saudi arabia, United arab emirates, and Sudan.

BACKGROUND: : Airborne allergens vary from one climatic region to another. Therefore, it is important to analyze the environment of the region to select the most prevalent allergens for the diagnosis and treatment of allergic patients. OBJECTIVE: : To evaluate the prevalence of positive skin tests to pollen and fungal allergens collected from local indigenous plants or isolated molds, as well as other outdoor and indoor allergens in allergic patients in 6 different geographical areas in the Kingdom of Saudi Arabia (KSA), the United Arab Emirates, and Sudan. MATERIAL AND METHODS: : Four hundred ninety-two consecutive patients evaluated at different Allergy Clinics (276 women and 256 men; mean age, 30 years) participated in this study. The selection of indigenous allergens was based on research findings in different areas from Riyadh and adjoining areas. Indigenous raw material for pollen grains was collected from the desert near the capital city of Riyadh, KSA. The following plants were included: Chenopodium murale, Salsola imbricata, Rumex vesicarius, Ricinus communis, Artiplex nummularia, Amaranthus viridis, Artemisia monosperma, Plantago boissieri, and Prosopis juliflora. Indigenous molds were isolated from air sampling in Riyadh and grown to obtain the raw material. These included the following: Ulocladium spp., Penicillium spp., Aspergillus fumigatus, Cladosporium spp., and Alternaria spp. The raw material was processed under Good Manufacturing Practices for skin testing. Other commercially available outdoor (grass and tree pollens) and indoor (mites, cockroach, and cat dander) allergens were also tested. RESULTS: : The highest sensitization to indigenous pollens was detected to C. murale (32%) in Khartoum (Sudan) and S. imbricata (30%) and P. juliflora (24%) in the Riyadh region. The highest sensitization to molds was detected in Khartoum, especially to Cladosporium spp. (42%), Aspergillus (40%), and Alternaria spp. (38%). Sensitization to mites was also very prevalent in Khartoum (72%), as well as in Abu Dhabi (United Arab Emirates) (46%) and Jeddah (KSA) (30%). CONCLUSIONS: : The allergenicity of several indigenous pollens and molds derived from autochthonous sources was demonstrated. Prevalence studies in different regions of KSA and neighbor countries indicate different sensitization rates to these and other outdoor and indoor allergens.

Increased prevalence of asthma in Saudi Arabia.

BACKGROUND: Bronchial asthma is among the most common chronic illnesses of childhood. A number of reports in the recent past suggest that the prevalence of asthma is increasing globally. OBJECTIVE: To investigate the changing prevalence of asthma in the Kingdom of Saudi Arabia. SUBJECTS AND METHODS: Two populations of schoolchildren between the ages of 8 and 16 years were studied using an internationally designed protocol in 1986 and 1995. The questionnaire used in these studies was very similar to the one used in the International Study of Allergy and Asthma in Childhood. A total of 2,123 school-children in 1986 (Jeddah and Riyadh) and 1,008 schoolchildren in 1995 (Hail and Gizan) were enrolled in the surveys. These cross-sectional studies of randomly selected schoolchildren were statistically analyzed using ANOVA and a Z test. RESULTS: The comparison of data between Riyadh versus Hail (inland desert dry environment) and Jeddah versus Gizan (coastal humid environment) revealed that the prevalence of asthma in the similar populations increased significantly from 8% in 1986 to 23% in 1995 (P < .0001). Likewise, the prevalence of allergic rhinitis also increased from 20% to 25% (P < .003) since 1986. However, no significant change in the prevalence of eczema (from 12% to 13%) was noted between 1986 and 1995. CONCLUSIONS: The study indicates that there was a significant increase in the prevalence of bronchial asthma and, to a lesser extent, in the prevalence of allergic rhinitis in the Kingdom of Saudi Arabia during this 9-year period. The study also revealed increased exposure to environmental factors such as tobacco smoke and indoor animals in Saudi houses. It seems that the continuing changes in contemporary life may well have contributed to the increased prevalence of asthma in the country.

Horizontal versus vertical transmission of human immunodeficiency virus type 1 (HIV-1). Experience from southwestern Saudi Arabia.

Twenty-five confirmed cases of human immunodeficiency virus type 1 (HIV-1) infection due to blood transfusion have been documented at King Fahad Hospital (KFH) in Al-Baha, southwestern Saudi Arabia since 1986, but complete follow-up was only possible on 19 of these cases and their contacts. Seventeen cases were diagnosed as having acquired immunodeficiency syndrome (AIDS) or AIDS-related complex (ARC) after admission to the hospital due to the deterioration of their health status. Two cases were found to be anti-HIV-1 positive on routine screening for blood donation. This cluster of HIV-1 infected patients through blood transfusion allowed us to study the efficiency of sexual transmission of HIV-1 infection between spouses, the rate of perinatal transmission of HIV-1 infection, and to see whether intrafamilial transmission is a possible route of spread of the virus. Firstly, the present results confirm our earlier observation that transmission of HIV-1 infection was more efficient from the infected husband to his wife(s) in contrast to the inefficient transmission of the infection from the infected wife to her husband. Secondly, by the age of 16 months, all nine newborns to HIV-1 infected mothers became HIV-1 infected. This highlights the importance of medical advice to those mothers regarding conception and/or breast-feeding, particularly as breast-feeding up to 2 years is not an uncommon practice among Saudi women. Finally, none of the household contacts of the 19 cases was infected until now, indicating that intrafamilial spread of HIV-1 did not occur among the population studied.

PIP: In June 1986, screening for anti-HIV using enzyme immunoassay (EIA) started on all donated blood at King Fahad Hospital (KFH) in Al-Baha, southwestern Saudi Arabia. In December 1988, an HIV clinic was established at KFH and 25 adult cases were identified as HIV-1 positive who had a history of blood transfusion between 1982 and 1986. Follow-up was only possible in 19 of these cases and their contacts. When a person was found to be anti-HIV-1 positive, all family members were called for HIV testing. Contacts of HIV-1 positive patients were followed-up on a monthly basis, and those who were anti-HIV-1 positive were started on zidovudine therapy. Serum testing for anti-HIV and for HIV-Ag was done by enzyme-linked immunosorbent assays (ELISA) and confirmed by Western blot. The majority of cases were diagnosed as having AIDS (10/19) or ARC (5/19) after admission to the hospital. All AIDS cases died within 2 months after diagnosis, while those with ARC died within 1-2 years after the diagnosis. Two of the cases (cases 1 and 2) were found anti-HIV-1 positive on routine screening for blood donation, and 3 cases (cases 11, 17 and 18) were detected when their respective children were admitted and diagnosed as having AIDS. In case 6, as in case 7, the husband infected both wives. All children born before the mother had the blood transfusion and hence the infection were anti-HIV-1 negative and were still negative after 3-7 years of follow-up. In contrast, all 9 children born to HIV-1-positive mothers became infected. Although some of the infants had no evidence of infection up to 9 months of age or more, all became anti-HIV-1 positive and HIV-Ag positive by 16 months of age. These children had no blood transfusion during the 16 months period.

Reduction in the prevalence of antibody to hepatitis A virus among young Saudi adults: implications for hepatitis A vaccine.

Viral etiology was investigated in 133 Saudi patients with acute hepatitis seen in King Khalid University Hospital, Riyadh. between July 1993-May 1994. Out of the 133 patients, 51 (38.3%) were diagnosed as having acute hepatitis due to hepatitis A virus (HAV). Hepatitis C virus (HCV) was the second most common etiological agent (20.3%). There were 35 patients with acute hepatitis (26.3%) in whom no viral marker for HAV, HBV, HCV, CMV or Epstein-Barr virus (EBV) was detected. Among the 51 patients with acute hepatitis due to HAV, the majority (88.2%) were children (1-12 years) and only 6 (11.8%) were adults (15-24 years). This is in contrast to patients with HCV or HBV infection where the majority were adults: 74.1% and 82.3% respectively. The diagnosis of acute hepatitis due to HAV in Saudi adults, an observation not seen earlier, indicated a change in the epidemiological pattern of HAV infection in the Saudi population. This change was confirmed by the significant reduction in the prevalence of anti-HAV in 630 Saudi subjects (1-30 years old) (50.2%) investigated in 1994 compared to that of 587 subjects of the same age group investigated in 1986 (76.5%) (P < 0.005). In the light of these results, a nation-wide survey is recommended to confirm this pattern in other areas. It is important that high-risk Saudi groups be identified and evaluated for their anti-HAV status as these groups are candidates for HAV vaccination.

Respiratory syncytial virus infection in young children hospitalized with respiratory illness in Riyadh.

The occurrence of respiratory syncytial virus (RSV) infection among young children hospitalized with lower respiratory tract illness, at King Khalid University Hospital in Riyadh, was examined during the autumn-winter season between September 1991 and February 1992. Sixty-nine cases were diagnosed by immunofluorescent antibody staining of viral antigen in nasopharyngeal aspirates from 127 children, constituting 54 per cent of these patients. Virus culture was attempted only in a few cases, yielding two isolates. Most children were < 1 year of age (median 2 months). Bronchiolitis and bronchopneumonia were the major diagnoses on admission. Hospitalization was for an average of 5 days (range 1-36 days). Treatment was supportive but most children received antibiotic therapy. There was no mortality. Few other bacterial or viral pathogens could be identified from RSV-positive or -negative patients. These results indicate that, during the season of infection, RSV may be the main pathogen of lower respiratory tract illness in hospitalized young children in this region.

IgG and IgM antibodies to human parvovirus B19 in the serum of patients with a clinical diagnosis of infection with the virus and in the general population of Saudi Arabia.

A total of 56 samples of serum from 32 patients with a clinical diagnosis of human parvovirus B19 infection were tested for specific immunoglobulin G (IgG) and M (IgM) antibodies by means of the recently available indirect enzyme-linked immunosorbent assay (ELISA) (Parvoscan-B19, Ferring Diagnostica, Sweden). The assay was also used in order to determine the age-specific prevalence of antibodies to the virus in the general population of Saudi Arabia. Specific IgM antibodies were detected in 94% specimens collected 1 week after the onset of illness and could be detected for up to 2 months. On the other hand, specific IgG antibodies were detected in 85% patients from whom acute- and convalescent-phase serum samples were collected. Saudis begin to be exposed to human parvovirus B19 early in life and prevalence of exposure increases with age in both sexes (overall prevalence 19.0%). The availability of a commercial ELISA makes it possible to diagnose infection with the virus routinely and will help in establishing the extent of exposure to it in various communities.

Acute paralytic poliomyelitis presenting as Guillain-Barré syndrome.

The initial clinical picture and CSF changes in four children with acute ascending paralysis simulated Guillain-Barré syndrome. However, diagnosis of poliomyelitis was confirmed on the basis of isolation of wild poliovirus type I and high neutralising antibody to it. The four children had received primary vaccination with live attenuated oral poliomyelitis vaccine. It is postulated that the clinical course of paralytic poliomyelitis may be altered in children who have previously been vaccinated with live oral vaccine.

Asthma patterns in Saudi Arabian children.

In a study of 2006 school children living in two urban areas of the Kingdom of Saudi Arabia, we used a questionnaire to collect details of age, sex, areas of residence, occupation, education, social class, parental history of asthma and information relating to parental smoking habit. The relative importance of these factors on the likelihood of children having bronchial asthma was assessed using a linear modelling analysis. The extent to which these factors affected the severity of bronchial asthma was also examined. A number of statistically significant associations between bronchial asthma and 'breathlessness' (P less than 0.0087), 'Father smoker' (P less than 0.0001), 'usually cough' (P less than 0.0001), 'pets' (P less than 0.0067) and 'Family history of allergy' (P less than 0.007), were found.

Growth patterns in Saudi Arabian children.

The measurements of head and chest circumferences of 6623 Saudi Arabian pre-school children are presented for the first time. The data were collected through a large scale cross-sectional growth study carried out in Riyadh, the capital of the Kingdom of Saudi Arabia. The results indicate that the average head and chest circumference measurements of the girls were smaller than the boys in all age groups. The analysis of variance results confirmed that these differences were statistically significant. The date indicated that among the average-build (the 50th centile) pre-schoolers, the head circumference measurements of the newborns were larger than the chest circumference measurement by 4.5%. By one year of age, these measurements were equal. After one year, the chest circumference grew larger than the head circumference. However, among the small-build preschoolers (the 3rd centile), the chest circumference measurements did not reach the head circumference measurements until nearly 30 months after birth.

Epidemiology of asthma and allergic rhinitis in two coastal regions of Saudi Arabia.

In a study of 1953 school children living in two coastal urban areas of the Kingdom of Saudi Arabia, we used a questionnaire to collect details of age, sex, areas of residence, occupation, education, social class, parental history of asthma and information relating to parental smoking habit. The relative importance of those factors on the likelihood of children having bronchial asthma was assessed using logistic regression and a linear modelling analysis. The extent to which these factors affected the severity of bronchial asthma was also examined. A number of statistically significant associations between bronchial asthma and "breathlessness" (P less than 0.001), "Fathers smoker" (P less than 0.001), "usually cough" (P less than 0.001), "pets" (P less than 0.001), "Family history of allergy" (P less than 0.01), were found.

Effects of consanguineous matings on anthropometric measurements of Saudi newborn infants.

The effects of parental consanguinity on gestation age and anthropometric measurements of 4497 Saudi newborn infants have been evaluated. The incidence of consanguineous matings was high, about 54.3%. For purposes of statistical analysis, marriages were classified into three groups based on degree of consanguinity. The results of the study reveal no significant effects of inbreeding on gestational age. Neither were any significant differences observed by type of marriage in weight, height or head, chest and mid-arm circumference at birth. It is suggested that inbreeding does not lead to significant effects of fetal growth among Saudi newborns.

Lack of evidence for transplacental transmission of HBV infection by HBsAg-carrier mothers.

The possibility of transplacental transmission of HBV infection was investigated in 54 HBsAg-carrier Saudi mothers and their newborns. Controls were 60 Saudi mothers with previous exposure to HBV, and their newborns. Thirteen cord blood samples were HBsAg-positive by ELISA, including three from mothers with previous exposure to HBV, compared with one sample which was HBsAg- and HBeAg-positive and three samples which were only HBeAg-positive. Eight of the 13 cord blood samples which were HBsAg-positive by ELISA were haemolysed sera and were found to be HBsAg-negative by RIA and RPHA. None of the infants' sera, taken within 1-4 days of delivery, was positive for HBsAg or IgM anti-HBc. These results indicate that HBV markers in cord blood are either false-positive or due to contamination by maternal blood rather than an indication of in utero infection.

Bacterial, parasitic and viral enteropathogens associated with diarrhoea in Saudi children.

In a 2-year study of stools from Saudi children with gastro-enteritis and from controls, rotavirus was the pathogen most frequently detected, either alone (44.3%) or in combination with other enteropathogens (7%). There were two peaks for rotavirus isolates, one during the cold months and the other during the dry, hot season. Salmonella spp. and Campylobacter jejuni were the second and third most frequently isolated enteropathogens. Enteropathogenic Escherichia coli did not contribute significantly to diarrhoea. Detection of enterotoxigenic E. coli was not attempted and its role in diarrhoea remains obscure. Giardia lamblia was detected more frequently in controls than in cases of diarrhoea. Neither Entamoeba histolytica nor Schistosoma mansoni was detected in any of the children studied.

Cerebral gigantism with hydronephrosis: a case report.

A case of cerebral gigantism with hydronephrosis in a 20-month-old boy is described. Hydronephrosis is believed to be an additional association of the syndrome not hitherto reported.