Allergy Express - Issue 8

Food- Induced Hypersensitivity Impact Asthma Control: Results from a Study in School Children

Recent data suggests that there is a possible link between the presence of food allergy and the development of asthma. This study aimed to evaluate the prevalence and clinical impact of IgE mediated food allergy in school children with asthma.

Food hypersensitivity was assessed in asthmatic school going children, using questionnaires, sIgE analysis and by using a double blind placebo controlled food challenge (DBPCFC). The severity of asthma and asthma control was also evaluated in these subjects.

About 49% of children reported complaints to the food consumed. Out of these, 19.3% were sensitized to food allergens. IgE-mediated food hypersensitivity was confirmed in 6.6% of children, while 3% demonstrated respiratory symptoms. Food-induced asthma exacerbations were observed in 2.5% of children. These children demonstrated significantly greater severity, poorer controls, and worse morbidity of their asthma as compared to those without. Severe food reactions occurred mostly in children with moderate/severe or partially controlled or non-controlled asthma, and asthmatic children with food allergy were more frequently hospitalized.

The results of this study showed that even though food-induced respiratory reactions in children with asthma were rare, the clinical impact on the asthma severity was associated with worse morbidity and poor control. Hence, a proper diagnosis of food allergy in children with asthma is essential for improving the management of both clinical conditions.

Allergy Asthma Immunol Res.  2015; 7(6):547-56

Increased Risk of Herpes zoster in Children with Asthma

Recent data highlights the significant morbidity due to the increased risk of common and serious microbial infections associated with asthma. This study aimed to evaluate the association between asthma and the risk of Herpes Zoster (HZ) in children.

This was an epidemiological, population-based case-control study conducted on paediatric patients with HZ. The diagnosis of asthma was confirmed using the Asthma Predictive Index criteria, which was operationalized by two or more wheezing episodes in a year for the first 3 years of life plus one of the major (physician-diagnosed asthma for a parent or physician-diagnosed eczema for a patient) or two of the minor criteria (physician-diagnosed allergic rhinitis for a patient, wheezing apart from cold, or eosinophilia [≥4%]). It was seen that the risk of HZ was increased in children with asthma defined by the API controlling for a varicella vaccine history and atopic status (adjusted odds ratio 2.56 [95% confidence interval, 1.08-6.56]).

The study results helped affirm the association between asthma and an increased risk of HZ. Hence, clinicians should be aware of early detection and treatment of HZ infection in children with asthma.

Allergy Asthma Proc.  2015; 36(5):372-8.

High Prevalence of Allergic Rhinitis and Co-morbid Asthma: A Community based Study in Delhi, India

Allergic rhinitis is the most common type of chronic rhinitis, affecting 10 to 20% of the population, and evidence suggests that the prevalence of the disorder is increasing. Severe allergic rhinitis has been associated with significant impairments in quality of life, sleep and work performance. However, there is paucity of Indian data on this disease in India. This study aimed to assess the prevalence of allergic rhinitis in adults, the proportion of asthmatics among them, risk factors associated and treatment seeking behaviour among the patients.

The study was a community based cross sectional study conducted in Mehrauli, South Delhi involving 1200 adults, aged 30 years. Information of the patients regarding symptoms, risk factors and treatment seeking behaviour was collected using a pre-tested questionnaire. The subjects were considered positive for Allergic Rhinitis as per ARIA (Allergic Rhinitis and its Impact on Asthma) guidelines. Spirometry was used as a tool for the diagnosis of asthma among them. Multivariate logistic regression analysis was done to find the association of risk factors with disease.

The prevalence of allergic rhinitis was found to be 11% (132 subjects). Amongst these 33.3% (44 patients) had concomitant asthma. Overcrowding (aOR = 6.4), absence of cross-ventilation (aOR = 2.5), occupational exposure to dust/ smoke (aOR = 2.1), tobacco smoking (aOR = 2.1), family history of allergic diseases (aOR = 2.7) and clinical allergy (aOR = 10.2) were found to be independent risk factors associated with rhinitis. About 75% of patients of rhinitis with asthma took treatment, whereas only 40% took treatment amongst those without asthma.  These patients with only rhinitis majorly relied on home remedies (42%) or, did not seek any treatment (18%) (P = 0.031).

Thus, according to this study, the burden of allergic rhinitis is quite high with a considerable overlap of asthma in Indian patients. The high prevalence emphasizes on early detection and treatment for this disease.

J Postgrad Med. 2015; 61(3):169-75.

Rhinitis During Pregnancy is Associated with Poor Asthma Control

Rhinitis and asthma are common medical conditions which may complicate pregnancy. In general, 30% of pregnant women have significant nasal symptoms and rhinitis can affect up to 80% of people with asthma. This study aimed to determine the pattern and severity of rhinitis in pregnancy and its impact on asthma control and quality of life (QoL) in pregnant women with asthma.

A total of 218 non-smoking pregnant women with asthma were included in this study. Visual analogue scale (VAS) was used to assess rhinitis. The presence of rhinitis was classified as current, mild/moderate/severe, atopic/non-atopic and pregnancy rhinitis. At baseline, the 20-Item Sino Nasal Outcome Test (SNOT20), asthma-specific (AQLQ-M) quality of life questionnaires and the Six-Item Short-Form State Trait Anxiety Inventory (STAI-6) were administered. Asthma control questionnaire (ACQ) was used to assess the asthma control.

65% women reported the presence of current rhinitis, amongst which 20% developed pregnancy rhinitis. Women with current rhinitis had higher scores for ACQ (p=0.004), SNOT20 (p<0.0001) and AQLQ-M (p<0.0001) as compared those with no rhinitis. Presence of current rhinitis was linked to increased anxiety symptoms (p=0.002). The severity of rhinitis was associated with higher ACQ score (p=0.004) and atopic rhinitis was associated with poor lung function (p=0.037).

Thus, the authors conclude that rhinitis is commonly present in pregnant women with asthma, and is associated with poorer asthma control, impairment of sino-nasal and asthma specific QoL. On active management of asthma, there was significant improvement in rhinitis symptoms and its severity as well as of the overall QoL.

Journal of Asthma; doi: 10.3109/02770903.2015.1054403

Comparision of Allergen Specific Sige Detection System: Protia™ Allergy-Q® VS. Immunocap®

Allergen avoidance is vital in the management of atopic diseases. There are various sophisticated methods used to determine the causative allergens. Amongst them, the PROTIA™ Allergy-Q® enzyme immunoassay (EIA) is a novel screening assay for specific immunoglobulin E (sIgE) for multiple allergens. The ImmunoCAP® fluorescent EIA (FEIA) system is the most widely used method for sIgE detection. This study compared the performance of the Allergy-Q® system to the ImmunoCAP® system.

The 2 systems were compared using sera from 260 Korean allergy patients suffering from asthma (26.5%), allergic rhinitis (42.3%), atopic dermatitis (67.7%), and food allergy (18.1%). The sIgE-measurement results for 7 inhalant allergens, 5 food allergens, and 4 microorganism allergens were compared in the 2 systems.

A total of 1,799 paired assay results were analyzed. Inter-assay class associations were reliable for most allergens (gamma=0.858-0.987, P<0.001). The inter-method concordance was moderate to substantial for most allergens (?=0.713-0.898, P<0.001).

Thus, the results of this comparison showed that the PROTIA™ Allergy-Q® EIA system showed good detection performance compared to the ImmunoCAP® FEIA system. However, due to differences in methods between the 2 assays, careful clinical implication is required for the interpretation of results from the Allergy-Q® EIA system.

Allergy Asthma Immunol Res. 2015; 7(6):565-72.