Exposición al humo de tabaco del niño asmático y su asociación con la gravedad del asma / Environmental tobacco smoke exposure in children and its relationship with the severity of asthma

Introducción: La exposición pasiva al humo de tabaco produce en el niño problemas respiratorios graves. El objetivo fue evaluar si la exposición al humo de tabaco del niño asmático incide sobre la gravedad del asma. Material y métodos: Estudio prospectivo multicéntrico en niños asmáticos, y sus padres, en 2007-2008, con encuesta de exposición, estudio de función pulmonar, determinación de cotinina en orina, y valoración de la gravedad del asma según la Guía GEMA. Las características de muestra se resumen empleando los estadígrafos adecuados y las comparaciones se realizan mediante las pruebas de la χ2 de Pearson, de la U de Mann-Whitney o de la t de Student, según la variable y la cantidad de grupos entre los que es comparada. Resultados: Se incluyeron 484 grupos familiares, de 7 comunidades autónomas, 61% de niños del género masculino, el 56% con conviviente fumador en su entorno, 34% padres, 31% madres y 17% ambos. El 37% de los casos estaba expuesto en el domicilio, el 11% diariamente. El 94% eran fumadores pasivos desde su nacimiento. El 20% había sido expuesto durante todo el embarazo a 5±1 cigarrillos/día. Los expuestos lo estuvieron a 6±1 cigarrillos/día, un 27% hasta 10 cigarrillos/día y un 10% a más de 10. La gravedad del asma durante la encuesta fue mayor en los expuestos (episódica-ocasional 47%, episódica-frecuente 35% y persistente-moderada 18% versus 59%, 25% y 16%, respectivamente; p=0,040). La gravedad en el último año fue mayor en los expuestos (episódica-ocasional 22%, episódica-frecuente 37% y persistente-moderada 50% versus 38%, 28% y 25%, respectivamente; p=0,037). Los valores espirométricos patológicos fueron 64% en expuestos frente a 36% en no expuestos para FEV1 (p=0,003), 63% vs 38% para FVC (p=0,038) y 54% vs 46% para el PEF (p=0,050). La cotinina era mayor en expuestos: 51 (0-524) ng/ml vs 27 (0-116) ng/ml (p=0,032). Se observó asociación entre la cotinina y el grado de exposición: 120 (0-590) ng/ml para >10 cigarrillos/día frente a 44 (0-103) ng/ml para ≤10 cigarrillos/día (p=0,035), que corrobora la consistencia de los datos recabados. Conclusión: La exposición al humo de tabaco del niño asmático incide sobre la gravedad de su asma (AU)

Introduction: Environmental tobacco smoke (ETS) exposure produces serious respiratory problems in childhood. The aim of the study was to evaluate if environmental tobacco smoke affects the severity of asthma in asthmatic children. Material and methods: A prospective, multicentre study was conducted on asthmatic children and their parents in 2007-2008, using an exposure questionnaire, pulmonary function, level of cotinine in urine, and evaluation of the severity of asthma according to GEMA guide. The characteristics of the sample are summarised using the appropriate statistical tools, and the comparisons were made using the Pearson chi2 test, Mann-Whitney U test or Student’ t, according to the variable and number of groups compared. Results: Four hundred and eighty four households in 7 Autonomous Communities were included. The population included, 61% male children with asthma, 56% with a smoking caregiver in their home, 34% fathers, 31% mothers and 17% both. Home exposure was 37%, with 11% daily and 94% passive smokers since birth. There was 20% with exposure during whole period of pregnancy of 5±1 cigarettes/day. Children exposed to 6±1 cigarettes/day, 27%, up to 10 cigarettes/day, and 10% to more than 10. Severity of asthma during the survey was worse among those exposed (episodic-occasional 47%, episodic-frequent 35% and persistent-moderate 18% versus 59%, 25% and 16%, respectively, P=.040). Severity of asthma in the last year was worse in those exposed (episodic - occasional 22%, episodic - frequent 37% and persistent - moderate 50% versus 38%, 28% and 25% respectively, P=.037). The spirometry was abnormal in 64% of the exposed against to 36% in the non-exposed for FEV1 (P=.003, 63% vs 38% for FVC (P=0.038), and 54% vs 46% for the PEF (P=0.050). The cotinine was higher in exposed: 51 (0-524) ng/ml vs 27 (0-116) ng/ml (P=0.032). A relationship was observed between cotinine and level of exposure: 120 (0-590) ng/ml for >10 cigarettes/day as opposed to 44 (0-103) ng/ml ≤10 cigarettes/day (P=0.035), which corroborates the consistency of the data collected. Conclusions: The exposure of children with asthma to environmental tobacco smoke has a highly negative effect on the severity of their asthma (AU)

[Environmental tobacco smoke exposure in children and its relationship with the severity of asthma]. / Exposición al humo de tabaco del niño asmático y su asociación con la gravedad del asma.

INTRODUCTION: Environmental tobacco smoke (ETS) exposure produces serious respiratory problems in childhood. The aim of the study was to evaluate if environmental tobacco smoke affects the severity of asthma in asthmatic children. MATERIAL AND METHODS: A prospective, multicentre study was conducted on asthmatic children and their parents in 2007-2008, using an exposure questionnaire, pulmonary function, level of cotinine in urine, and evaluation of the severity of asthma according to GEMA guide. The characteristics of the sample are summarised using the appropriate statistical tools, and the comparisons were made using the Pearson chi2 test, Mann-Whitney U test or Studentis t, according to the variable and number of groups compared. RESULTS: Four hundred and eighty four households in 7 Autonomous Communities were included. The population included, 61% male children with asthma, 56% with a smoking caregiver in their home, 34% fathers, 31% mothers and 17% both. Home exposure was 37%, with 11% daily and 94% passive smokers since birth. There was 20% with exposure during whole period of pregnancy of 5±1 cigarettes/day. Children exposed to 6±1 cigarettes/day, 27%, up to 10 cigarettes/day, and 10% to more than 10. Severity of asthma during the survey was worse among those exposed (episodic-occasional 47%, episodic-frequent 35% and persistent-moderate 18% versus 59%, 25% and 16%, respectively, P=.040). Severity of asthma in the last year was worse in those exposed (episodic - occasional 22%, episodic - frequent 37% and persistent - moderate 50% versus 38%, 28% and 25% respectively, P=.037). The spirometry was abnormal in 64% of the exposed against to 36% in the non-exposed for FEV(1) (P=.003, 63% vs 38% for FVC (P=.038), and 54% vs 46% for the PEF (P=.050). The cotinine was higher in exposed: 51 (0-524) ng/ml vs 27 (0-116) ng/ml (P=.032). A relationship was observed between cotinine and level of exposure: 120 (0-590) ng/ml for >10 cigarettes/day as opposed to 44 (0-103) ng/ml ≤10 cigarettes/day (P=.035), which corroborates the consistency of the data collected. CONCLUSIONS: The exposure of children with asthma to environmental tobacco smoke has a highly negative effect on the severity of their asthma.

Skin tests and conjunctival and bronchial challenges with extracts of Blomia tropicalis and Dermatophagoides pteronyssinus in patients with allergic asthma and/or rhinoconjunctivitis.

BACKGROUND: Blomia tropicalis and Dermatophagoides pteronyssinus are important mite species in Tenerife, Canary Islands, Spain. Several studies have demonstrated a variable degree of allergenic cross-reactivity in vitro. However, only a few have addressed their allergenic cross-reactivity using challenge tests. OBJECTIVE: The objective of this study was to conduct conjunctival and bronchial challenge tests with B. tropicalis and D. pteronyssinus extracts in a group of 42 patients with allergic asthma and/or rhinoconjunctivitis sensitised to house dust mites (31 females, 11 males; mean age 21.7 +/- 7.02 years). METHODS: Prick tests using standardised extracts and specific IgE determinations using the CAP system were performed. Bronchial and/or conjunctival challenges were conducted using freeze-dried extracts of both mite species. A patient was considered sensitive to a mite species if she/he had a positive prick and/or CAP test result. A total of 32 conjunctival and 15 bronchial challenges were performed with both mite species. RESULTS: Prick tests were positive to B. tropicalis in 23 patients (54.7%) and to D. pteronyssinus in 41 (97.6%). One patient (2.4%) was exclusively sensitive to B. tropicalis. The CAP test was positive for B. tropicalis in 28 patients and for D. pteronyssinus in 41. Conjunctival challenges to B. tropicalis were positive in 20 patients (18 sensitised and 2 non-sensitised) and negative in 12 (5 sensitised and 7 non-sensitised patients). Conjunctival challenges with D. pteronyssinus were positive in all 31 D. pteronyssinus-sensitised patients who underwent conjunctival challenges. Bronchial challenges with B. tropicalis were positive in 9 sensitised patients and negative in 6 patients (2 sensitised and 4 non-sensitised). Bronchial challenges with D. pteronyssinus were positive in all patients except 1, who only reacted to B. tropicalis. CONCLUSIONS: Allergens of the mite species B. tropicalis induce positive conjunctival and bronchial challenges in B. tropicalis-sensitised individuals. Our results suggest that although there is a low to moderate degree of in vivo cross-reactivity between B. tropicalis and D. pteronyssinus, B. tropicalis seems to be a relevant source of allergens in areas where patients are exposed.

The natural history of Apis-specific IgG and IgG4 in beekeepers.

BACKGROUND: Most published studies on changes of specific IgG or its subclasses as a response to stimuli by allergens have been performed on patients under immunotherapy. There are few reports analysing the response to immunoglobulins in patients exposed to allergens in their natural habitats. OBJECTIVE: The aim of this work was to discover the natural history of Apis specific IgG (IgG-ap) and IgG4 (IgG4-ap) levels in beekeepers from the Canary Islands. METHODS: We studied 242 beekeepers (Bks). We used a questionnaire and measured total IgE and seric Apis specific IgE (IgE-ap), IgG-ap and IgG4-ap against Apis mellifera venom. RESULTS: All Bks had IgG-ap and IgG4-ap. IgE-ap was positive in 160 Bks (65.6%), but only 92 (37.6%) Bks were considered sensitized. IgG-ap and IgG4-ap showed significant correlation (r = 0.84); IgE did not correlate with IgG-ap or IgG4-ap. There was no seasonal variation in IgG-ap or IgG4-ap. The group of sensitized Bks had significantly lower IgG-ap and IgG4-ap levels (P < 0.05). The groups with longer beekeeping activity showed significantly higher levels of IgG-ap and IgG4-ap (P < 0.001). Bks with locals reactions had significantly higher IgG-ap and IgG4-ap than Bks who reported systemic reactions (P < 0.05). CONCLUSION: Our study showed that IgG-ap and IgG4-ap appear to increase in Bks, either according to their beekeeping experience or in subjects with local reactions after bee stings.

Epidemiology of allergic reactions in beekeepers: a lower prevalence in subjects with more than 5 years exposure.

Beekeepers (Bks) represent a high allergic risk population against Hymenoptera because of their frequent exposure to bee stings. Most published studies show different percentage of sensitization and systemic reactions with to another groups of population. With the aim to know the prevalence and type of allergic reaction in Bks from the Canary Islands, 246 subjects were studied prospectively. A questionnaire was developed and skin test and specific IgE determination against Apis mellifera, Vespula and Polistes venom were performed. One hundred and twenty eight subjects had presented at least one reaction greater than merely local. In 83.5% of these subjects subsequent stings caused reactions of lesser intensity. Specific IgE in serum for Apis mellifera was positive in 126 BKs, for Vespula in 27 and for Polistes in 9. We found that the group of BKs sensitized to Apis was significantly higher among atopics BKs (p < 0.001) and with fewest years of working experience in beekeeping (p = 0.0134). This study showed that sensitization to Hymenoptera is higher in beekeepers with less than 5 years working experience and who are sensitized to another allergens.