Demographic, laboratory and clinical characterisation of adult portuguese asthmatic patients

BackgroundAsthma is a heterogeneous chronic inflammatory condition characterised by reversible airway obstruction and hyperresponsiveness associated with underlying bronchial inflammation and structural changes. It represents an increasing health problem and is a huge burden on the patients, their families and society. The aim of the study was to characterise the adult asthmatic population attending a Hospital Allergy Clinic between the years of 2003 and 2006.MethodsClinical files from the Allergy Outpatient Clinic of Cova da Beira Hospital were sequentially studied. The total population analysed included 335 female and 130 male asthmatic patients. Bronchial asthma was characterised by clinical history, skin prick testing to aeroallergens, determination of total and specific IgE and lung function testing, and classified according to international guidelines.ResultsOf the patients studied, 70 % had allergic asthma, and 30 % had non-allergic asthma. When compared to allergic asthma, non-allergic asthma was more frequently associated with older age, perennial symptoms and female gender. More allergic than non-allergic asthma patients also had rhinitis and the reverse was true regarding drug allergy and oesophageal reflux. Grass pollen and mites were the major sensitisers for allergic asthmatics. The sensitization profile was significantly different between urban- and rural-based asthmatic patients regarding tree pollen, fungi and moulds.ConclusionsIn this population, rhinitis was more frequently associated with allergic than with non-allergic asthma. The two types of asthma did not differ in clinical severity or changes in lung function. Sensitisation profiles were different between the urban and rural patients.     

A relatively high prevalence and severity of asthma,allergic rhinitis and atopic eczema in schoolchildren in the Sultanate of Oman

OBJECTIVES: Although asthma, allergic rhinitis and eczema are among the most common chronic diseases in children worldwide, there is very limited information about the burden of these conditions in Oman. The aim of this study was to determine the prevalence and severity of symptoms of asthma, allergic rhinitis and eczema in Omani schoolchildren using the International Study of Asthma and Allergies in Childhood (ISAAC) Phase I questionnaire. METHODS: An Arabic version of the ISAAC Phase I questionnaire was completed by parents of 3893 children aged 6-7 years and self-completed by 3174 children aged 13-14 years, randomly selected from a nationwide sample of public schools. RESULTS: The prevalence rates of reported diagnoses of asthma, allergic rhinitis and eczema were higher in older children (20.7%, 10.5% and 14.4% compared with 10.5%, 7.4% and 7.5%, respectively, in young children). In young children, 277 were current wheezers and of these 40.8% had sleep-disturbing wheeze at least once a week and 45.1% had speech-limiting wheeze during the past year. Similarly, 283 older children were current wheezers, and of these 30.0% had sleep-disturbing wheeze at least once a week and 37.5% had speech-limiting wheeze during the past year. Exercise-induced wheeze was higher in older children (19.2% vs 6.9%; P < 0.001). Allergic rhinitis and eczema were also associated with significant sleep disturbance and limitation of activity in both age groups. CONCLUSION: Allergic conditions in Omani schoolchildren are common and associated with significant morbidity. Further research is required to identify the local risk factors for allergy to allow better understanding and management of these conditions.     

Coexistence of asthma and allergic rhinitis in adult patients attending allergy clinics: ONEAIR study.

BACKGROUND: Several studies have shown links between the upper and lower airways in allergic patients. OBJECTIVES: This study aimed to evaluate the prevalence of rhinitis in patients with allergic asthma attending allergy outpatient clinics and to examine the interrelationship between both conditions. METHODS: An epidemiological prospective study was carried out during the period 2004-2005 and 170 allergists from all over the country participated. After obtaining written informed consent, we collected clinical and demographic data, a personal and family history of allergic diseases, and data on the duration and severity of asthma and rhinitis. These data were classified according to the criteria of the Global Initiative for Asthma and the Allergic Rhinitis and its Impact on Asthma guidelines, respectively. RESULTS: A total of 968 subjects were screened and 942 were enrolled in the study. Mean (SD) age was 35.5 (14) years and 63% were female. Of these patients, 89.5% presented with allergic rhinitis. The duration of the disease was 12.6 (8.9) years for rhinitis and 11.4 (9.6) years for asthma (P < .0001). The severity of asthma was classified as intermittent (39%), mild persistent (30%), moderate persistent (27%), and severe persistent (4%). Rhinitis was classified as mild intermittent (24%), moderate/severe intermittent (22%), mild persistent (19%) and moderate/severe persistent (35%). A significant correlation was found (P < .0001) between the severity of rhinitis and asthma. The prevalence of allergic rhinitis was inversely correlated with the age of the patients (P < .0001) and the severity of asthma (P < .05). CONCLUSION: This study reinforces the high prevalence of allergic rhinitis in patients with asthma, which can affect as many as 89.5%.     

Prevalence of Allergic Diseases and Influencing Factors in Primary-School Children in the Ankara Region of Turkey

We have studied the prevalence of atopic disease, by questionnaire, in 3024 primary-school children from three different socioeconomic levels in Ankara. Physical examinations were also performed on these children. The cumulative prevalence of asthma, allergic rhinitis, allergic conjunctivitis, and atopiceczema was 6.9%, 11.7%, 4.6%, and 2.6%, respectively. Allergic rhinitis was more common in children older than 10 years. Most of the symptoms of asthmatic patients began in the first 3 years of life. The cumulative prevalence of allergic diseases was 23.4%. This study has estimated the prevalence of allergic diseases, including asthma, allergic rhinitis, allergic conjunctivitis, and allergic dermatitis, in the Ankara region of Turkey.     

Prevalence and comorbidity of allergic eczema, rhinitis, and asthma in a city in western Turkey.

BACKGROUND: Allergic diseases co-occur in many patients. There is no published population-based epidemiologic study about allergic diseases in Turkey. OBJECTIVE: The aim of this population-based study was to investigate the prevalence of allergic eczema, allergic rhinitis, and asthma and their co-occurence in Manisa. METHODS: The sample size was calculated using an estimated prevalence of ever wheezing for the analyzed age group. Interviews were conducted with 725 children. The survey instrument consisted of a set of sociodemographic questions plus the questionnaire of the International Study of Asthma and Allergies in Childhood. RESULTS: The mean (SD) age of the children studied was 8.94 (5.16) years. The prevalence of ever having allergic eczema was 4.7% whereas that of current allergic eczema was 3.2%. Current allergic rhinitis and allergic conjunctivitis were present in 14.5% and 13%, respectively. Asthma was reported in 14.7% of the children older than 3 years of age while the prevalence of physician-diagnosed asthma was 7.9%. The burden of allergy was 27.1%. The prevalence of concomitant eczema and rhinitis was 1.9%. Among children aged between 3 and 17 years, 1.5% and 4.7% had asthma along with eczema and rhinitis respectively. Asthma was significantly more common in children with rhinitis (31.5% vs 11.8%; P < .01; odds ratio [OR], 3.45). Asthma was diagnosed in 28.1% of children with eczema and 14% of children without eczema (P = .03; OR, 2.41). CONCLUSIONS: Atopic diseases seem to significantly increase the risk of developing another atopic disease with ORs that range from 2.4 to 3.4.     

Mechanisms of IgE Inflammation

The prevalence of diseases such as allergic asthma and rhinitis continues to increase in the United States, affecting millions of people. It is well-established that allergy contributes to the pathogenesis of most asthma, especially in children and young adults. Despite current therapy (eg, inhaled corticosteroids, anti-leukotrienes, and bronchodilators), patients with moderate to severe asthma remain symptomatic and experience frequent exacerbations of disease requiring oral corticosteroids, emergency department treatments, and hospitalizations. Allergic diseases are traditionally referred to as immediate or type 1 hypersensitivity reactions, with IgE as a critical factor. IgE is involved in allergic inflammation, especially in early-phase response, but it may also be involved in the late-phase allergic response. A direct correlation between serum IgE levels and asthma exists. As logarithm IgE values increase, asthma prevalence increases linearly, even in patients who are categorized as having nonallergic asthma. In addition, there is a significant, although low association in allergic rhinitis with IgE levels and positive skin test reactivity to pollens. Recent advances in our understanding of the role of IgE in allergic inflammation have led to the development of a monoclonal antibody to IgE that reduces IgE levels, thereby reducing allergic inflammation. This review aims to provide an overview of the basic science of the IgE molecule and the clinical efficacy of anti-IgE therapy in allergic and asthmatic diseases.     

The effect of mold sensitization and humidity upon allergic asthma

Introduction: Humidity is commonly associated with increased airway hyperresponsiveness in asthma. Objective: To examine mold sensitization in patients with allergic asthma or allergic rhinitis and self‐reports of humidity as exacerbating factors of clinical symptoms. Methods: A retrospective, cross‐sectional study at a University hospital outpatient allergy and asthma clinic was performed. A total of 106 patients with either allergic asthma or allergic rhinitis completed standard prick‐puncture skin testing with 17 allergens and controls and completed standardized forms addressing trigger factors for clinical symptoms. Results: Allergic asthmatics sensitized to Cladosporium were more likely to have a more severe asthma severity class (odds ratio = 4.26, confidence interval = 1.30–16.93). Sensitization to Alternaria, Cladosporium, Helminthosporium, Aspergillus and Dermatophagoides pteronyssinus in asthma was associated with higher likelihood for previous hospitalization, while sensitization to Cladosporium, Helminthosporium, Aspergillus, Dermatophagoides pteronyssinus and cockroach in asthma was associated with higher likelihood of having reduced pulmonary function based on forced expiratory volume in 1 s. Furthermore, allergic asthmatics more commonly reported humidity as an exacerbating factor of symptoms than did patients only with allergic rhinitis (68.42% vs 42.86%, respectively; P < 0.05). Conclusion: Mold sensitization is highly associated with more severe asthma, while humidity is more of an exacerbating factor in patients with allergic asthma as compared with allergic rhinitis alone. Further delineation between mold sensitization and humidity is needed to determine whether these are independent factors in asthma. Please cite this paper as: Hayes D Jr, Jhaveri MA, Mannino DM, Strawbridge H and Temprano J. The effect of mold sensitization and humidity upon allergic asthma. Clin Respir J 2013; 7: 135–144.     

Nasal polyps in patients with rhinitis and asthma.

The objective of this study was to investigate the prevalence of nasal polyposis in Greek patients with chronic rhinitis and asthma. We studied 3817 patients (2342 men and 1385 women) who were referred for allergy evaluation during 1990-1998 and diagnosed as having chronic rhinitis and asthma. Skin-prick tests with allergens common in Greece and controls were used in all subjects. A wheal with a mean diameter > or = 3 mm was considered as positive. According to the history of symptoms and the results of skin tests, patients were divided into the following groups: patients who have allergic rhinitis (seasonal, perennial), patients who have allergic asthma (seasonal, perennial), patients who have nonallergic rhinitis, and patients who have nonallergic asthma. All patients were examined for nasal polyps by anterior rhinoscopy and endoscopic investigation with a rigid or/and flexible endoscope. We found that 4.2% of the patients with chronic rhinitis and asthma (4.4% of the men and 3.8% of the women; p > 0.05) had nasal polyps. The prevalence of nasal polyps increased with age (p < 0.001) in both sexes. The prevalence of nasal polyps was 13% in patients with nonallergic asthma, 2.4% in patients with allergic asthma, 8.9% in patients with nonallergic rhinitis, and 1.7% in patients with allergic rhinitis. Nasal polyps were found in 3.6% of the patients with rhinitis and in 4.8% of the patients with asthma (p > 0.05). Nasal polyps were present more frequently (1) in patients with nonallergic respiratory disease (rhinitis, asthma) than in patients with allergic respiratory disease (10.8% versus 2.1%; p < 0.001) and (2) in patients with perennial respiratory allergy (rhinitis, asthma) than in patients with seasonal respiratory allergy (4.8% versus 0.4%; p < 0.001). We found that 4.2% of patients with chronic rhinitis and asthma had nasal polyps. Nasal polyps were present more frequently in nonallergic patients than in allergic patients and in patients with perennial allergy than in patients with seasonal allergy.     

Occurrence and impact of sinusitis in patients with asthma and/or allergic rhinitis

Objective: The occurrence of radiological sinusitis in patients with asthma without any obvious nasal symptoms could possibly increase the severity of asthma. We investigated the occurrence and impact of sinusitis on computed tomography of the paranasal sinuses (CT-PNS) in patients with asthma and/or allergic rhinitis. Effect of sinusitis on the quality of life (QoL) was also assessed. Methods: All subjects underwent spirometry with reversibility, CT-PNS, intradermal test against common aeroallergens and responded to Symptom Severity Score and Rhinosinusitis Disability Index (RSDI). Of the 216 consecutive patients, 27 had asthma without nasal symptoms (Group 1), 58 had asthma with allergic rhinitis (Group 2) and 131 had allergic rhinitis (Group 3). Thirty normal healthy controls without atopy were also included (Group 4). Results: 20/27 (74%) patients in Group 1 had sinusitis on CT-PNS. 48/58 (82%) patients in Group 2 and 88/131 (67%) patients in Group 3 had chronic rhinosinusitis (CRS) as confirmed on CT-PNS. 6/30 (20%) healthy controls in Group 4 had mucosal thickening. Asthmatics with radiological sinusitis in Group 1 and with CRS in Group 2 had significantly lower FEV1, FEV1/FVC ratio, were more symptomatic and had a greater impairment of QoL. The mean sinus severity score was significantly higher in Group 2. In Group 3, sinusitis occurred significantly higher in “blockers” than “sneezers-runners” (41/79 versus 47/52, p = 0.045). Conclusions: Occurrence of radiological sinusitis on CT-PNS in asthmatics without nasal symptoms and CRS in allergic rhinitis with or without asthma increases the severity of the disease and affects the QoL.     

Evaluation of risk factors in patients diagnosed with bronchial asthma

Bronchial asthma is a public health problem with gradually increasing importance, affecting more than 100 million individuals worldwide and found independently of the level of development of the country. Factors related to lifestyle and the environment form the basis for the increase in the prevalence of the disease.AimTo evaluate our patients being followed-up with a diagnosis of bronchial asthma at the Allergy Clinic for risk factors and to determine their sociodemographic characteristicsMaterial and MethodThe risk factors of 3025 patients followed-up with a diagnosis of bronchial asthma at the Allergy Clinic of the Ministry of Health, Ankara Diskapi Children's Diseases Training and Research Hospital between January 1995 and March 2000 were evaluated retrospectively.ResultsA high percentage of our patients suffered from both asthma and allergic rhinitis and 45% of our asthmatic patients had allergic rhinitis while 93.5 % of those with allergic rhinitis were also asthmatic. Asthma was more common in males and those born in the summer months. 57.6 % of the patients had a history of atopy. Passive smoking was observed at a high rate and cigarette smoke was the most important factor increasing the symptoms. The symptoms increased during the winter. 92.8 % of the patients lived in the city. The average Ig E level was high and 60.9% of the patients were atopic on the skin prick test.ResultsAsthma seems to be an important health problem in our country. Recognizing the risk factors is important for the diagnosis and prevention of the disease.     

Omalizumab and the treatment of allergic rhinitis

Anti-IgE therapy affects mechanisms in the allergic response that are IgE-dependent or IgE-mediated and common to both allergic asthma and allergic rhinitis. Clinical trials of omalizumab in the treatment of patients with allergic rhinitis or comorbid allergic rhinitis and moderate to severe allergic asthma have recorded significant reductions in symptom severity scores of both conditions. This novel therapy has increased the knowledge base concerning IgE-mediated allergic responses, and, in keeping with its actions established in the treatment of asthma, appears to be useful in the treatment of moderate to severe allergic rhinitis, as well.     

Allergic rhinitis and sinusitis in asthma: differential effects on symptoms and pulmonary function

BACKGROUND: Allergic rhinitis and sinusitis are frequently associated with asthma. The purpose of this study was to determine the impact of self-reported allergic rhinitis and sinusitis on lower airway disease in a large cohort of participants with well-characterized asthma. METHODS: A cohort study of participants in two trials of the American Lung Association-Asthma Clinical Research Centers: 2,031 asthmatics in the Safety of Inactivated Influenza Vaccine in Asthma in Adults and Children (SIIVA) trial and 488 asthmatics in the Effectiveness of Low Dose Theophylline as Add-on Treatment in Asthma (LODO) trial. At baseline, participants reported the presence of allergic rhinitis and sinusitis, and then lung function and asthma control were measured. During the trials, participants were monitored for asthma exacerbations. RESULTS: More than 70% of participants reported either allergic rhinitis or sinusitis. Sinusitis was more common in female patients (odds ratio, 1.46 [SIIVA]), those with gastroesophageal reflux disease (odds ratio, 2.21 [SIIVA]), and those of white race (odds ratio, 1.53 [SIIVA]). Similar associations were seen for allergic rhinitis. LODO participants with allergic rhinitis and sinusitis had increased asthma symptoms and a trend toward more sleep disturbance. Participants with allergic rhinitis had higher baseline lung function than those without allergic rhinitis measured by peak flow (91.2% vs 95.8% in the SIIVA trial). Participants with sinusitis had similar lung function to those without sinusitis. Participants with and without allergic rhinitis had similar exacerbation rates. In the LODO trial only, participants with sinusitis had increased asthma exacerbations (5.68 per patient per year vs 3.72 per patient per year). CONCLUSION: Allergic rhinitis and sinusitis are associated with more severe asthmatic symptoms and, in patients with poorly controlled asthma, more exacerbations but are not associated with low lung function.     

广东惠州地区成人支气管哮喘合并过敏性鼻炎的流行病学调查分析

目的了解惠州地区支气管哮喘（简称哮喘）患者合并过敏性鼻炎的情况,分析两者在临床表现方面的相关性及调查对过敏性鼻炎认知程度和治疗现状。方法问卷调查惠州地区280例哮喘患者,详细了解其哮喘病史、严重程度分级、哮喘控制测试（asthma control test,ACT）评分、鼻炎情况包括患病情况、认知程度、相关家族遗传史及治疗现状等。建立相应个人数据档案,对数据进行统计学分析。结果 280例哮喘患者中,203例（72.50%）合并过敏性鼻炎,哮喘合并过敏性鼻炎组和单纯哮喘组在年龄、性别、病程间的差异无统计学意义（P〉0.05）。哮喘合并过敏性鼻炎组、二级（轻度持续）、三级（中度持续）、四级（重度持续）例数均高于单纯哮喘组（P〈0.05）。ACT评分,完全控制、良好控制例数均低于单纯哮喘组（P〈0.05）,未控制哮喘高于单纯哮喘组（P〈0.05）。鼻炎情况过敏性鼻炎起病早于哮喘占59.61%,两者同时起病占17.24%,鼻炎诱因依次为冷空气（82.10%）,刺激性气体（61.58%）,25.62%患者做过过敏原测验,56.65%使用药物治疗鼻炎,27.10%直系三代有哮喘或过敏性鼻炎家族史。结论惠州地区哮喘合并过敏性鼻炎发生率高,认知程度较低,治疗现状不容乐观,为今后防治措施及相关研究提供依据。     

DIRAE study: Seasonal allergic rhinitis distribution in Spain

BackgroundNational epidemiological study to observe if among patients with pollinic seasonal allergic rhinitis (SAR), there are differences between those visited by primary care physicians (GPs) or allergists (ALs).Methods758 and 739 adults were recruited respectively by GPs and ALs. The physicians filled in a questionnaire: ARIA classification, prescribed treatment, and asthma incidence. The patient completed a visual analogical scale (VAS) to evaluate the severity of the rhinitis. Rhinitis control (controlled, partially controlled, and not controlled) was assessed by physician and patient.ResultsNo significant differences were found among patients visited by GPs or ALs concerning the ARIA classification and rhinitis severity. Treatment with oral antihistamines was 92.3% and 89.3% for GPs and ALs, respectively. The use of nasal corticosteroids was 76.7% and 60.4% for GP and AL patients, respectively. 31.9% of the patients visited by the ALs were treated with immunotherapy. The use of alternative medicine was 10.9% and 7.6% in GP and AL patients, respectively. The perception of “controlled” rhinitis was similar among patients (40.0%) and doctors (40.1%), although patients referred differences depending if they were visited by GP (44.8%) or AL (34.9%). Asthma prevalence was higher in those who suffered persistent as compared to intermittent rhinitis (OR = 1.81, 95% CI: 1.39–2.36, p < 0.001), and moderate/severe vs. mild rhinitis (OR = 1.68, 95% CI: 1.05–2.68, p = 0.029).ConclusionThe patients with pollinic SAR visited by GPs or ALs show no differences in severity. Less than half of the patients can be considered as “controlled”.     

Trends in the prevalence of asthma and allergic rhinitis in Italy between 1991 and 2010

The prevalence of asthma increased worldwide until the 1990s, but since then there has been no clear temporal pattern. The present study aimed to assess time trends in the prevalence of current asthma, asthma-like symptoms and allergic rhinitis in Italian adults from 1990 to 2010. The same screening questionnaire was administered by mail or phone to random samples of the general population (age 20-44 yrs) in Italy, in the frame of three multicentre studies: the European Community Respiratory Health Survey (ECRHS) (1991-1993; n = 6,031); the Italian Study on Asthma in Young Adults (ISAYA) (1998-2000; n = 18,873); and the Gene Environment Interactions in Respiratory Diseases (GEIRD) study (2007-2010; n = 10,494). Time trends in prevalence were estimated using Poisson regression models in the centres that repeated the survey at different points in time. From 1991 to 2010, the median prevalence of current asthma, wheezing and allergic rhinitis increased from 4.1% to 6.6%, from 10.1% to 13.9% and from 16.8% to 25.8%, respectively. The prevalence of current asthma was stable during the 1990s and increased (relative risk 1.38, 95% CI 1.19-1.59) from 1998-2000 to 2007-2010, mainly in subjects who did not report allergic rhinitis. The prevalence of allergic rhinitis has increased continuously since 1991. The asthma epidemic is not over in Italy. During the past 20 yrs, asthma prevalence has increased by 38%, in parallel with a similar increase in asthma-like symptoms and allergic rhinitis.     

Relation of perimenstrual asthma with disease severity and other allergic co-morbidities—the first report of perimenstrual asthma prevalence in Saudi Arabia

BackgroundPerimenstrual asthma (PMA) has been documented in 30–40% of asthmatic women; however, there have been few epidemiological investigations of PMA in practice.ObjectivesDetermination of the prevalence of perimenstrual asthma in a sample of female Saudi asthmatic patients, and to study the relation of PMA to asthma severity, aspirin-induced asthma and to other allergic co-morbidities.Study designData were analysed from all female asthmatic patients followed up in the unit from January 2008 to May 2009 who were not pregnant, not on oral contraceptive pills, not menopausal, nor had had a hysterectomy. They were asked about exacerbation of their asthma state regarding worsening of symptoms, need for more rescue medications and even visits to emergency room just before or in the first days of menstruation, or both. Moreover, relation with aspirin-induced asthma and other associated allergic co-morbidities recorded in their medical files with prevalence of PMA was reported.ResultsThe prevalence was found to be 8.2%. Asthma severity was found to be significantly related to PMA (p<0.0001). Aspirin-induced asthma and allergic co-morbidities were more prone to occur in cases with PMA than other studied asthmatics.ConclusionWe have found a low prevalence of PMA in Saudi women of fertile age compared to other studies published. Study findings support the hypothesis that PMA is related to asthma severity.     

Mite allergen exposure, sensitisation and clinical symptoms in Valdivia, Chile.

One hundred consecutive asthmatic paediatric patients were evaluated and skin tested with a battery of skin prick test reagents, including 8 different standardized house dust mite extracts. Asthma severity was graded according to the Global Initiative for Asthma (GINA) document in mild persistent (52 patients), moderate persistent (39) and severe persistent (9). Sixty patients had asthma and allergic rhinitis, 12 asthma and eczema, and 8 asthma, allergic rhinitis and eczema. The patient population was divided into 2 different socioeconomic groups (50 patients per group) based on a standardized, validated questionnaire. A dust sample was collected with an adapted vacuum cleaner from the mattress of each patient and analysed for Der p 1, Der f 1 and Der p 2 allergen content using monoclonal antibodies. Eighty patients were skin test positive to at least one mite species. All positive skin test patients were positive to Dermatophagoides pteronyssinus, 99% to D. farinae, 92% to Euroglyphus maynei, 80% to Lepidoglyphus destructor, 73% to Tyrophagus putrescientae, 72% to Blomia tropicalis; 70% to Acarus siro and 68% to Chortoglyphus arcuatus. All patients with severe persistent asthma had a positive skin test to mites, 85% in the moderate group, and 73% in the mild group (p < 0.01). 95% of patients with asthma and allergic rhinitis had a positive skin test to mites, 92% of patients with asthma and eczema and 100% of patients with asthma, allergic rhinitis and eczema; (p < 0.01). Mean Der p 1, Der f 1 and Der p 2 allergen concentrations were 18.3, 0.6 and 5.6 microg/g of mattress dust, respectively. Mean Der p 1 allergen levels in the middle-low socioeconomic group were significantly higher than in the middle high group (p < 0.01). There is a high rate of allergic sensitisation among pediatric asthmatic patients in Chile. More than one species are implicated, although sensitisation and exposure to D. pteronyssinus predominates. Mite allergic patients are exposed to high mite allergen concentrations, exceeding previously established risk levels for sensitisation and symptoms.     

sICAM-1 and TNF-α in Asthma and Rhinitis: Relationship with the Presence of Atopy

Background. A genetically determined overproduction of specific immunoglobulin E (IgE) underlies many diseases like asthma or allergic rhinitis. IgE as well as tumor necrosis factor-α (TNF-α), and intercellular adhesion molecule-1 (ICAM-1) play a critical role in the induction and maintenance of inflammation. While the correlation between IgE and atopy is inseparable, little is known about the correlation of atopy with markers of inflammation. Objective. We investigated the relationship between the serum concentrations of TNF-α, soluble ICAM-1 (sICAM-1), and the presence of atopy in patients with persistent rhinitis or asthma. Methods. Serum concentrations of sICAM-1, TNF-α, and total IgE were investigated in 64 adults with persistent allergic rhinitis, 17 subjects with nonatopic rhinitis, 90 patients with asthma, and 21 healthy individuals. Atopy was diagnosed on the basis of positive family history, skin prick tests, and serum IgE concentration. Results. Total IgE concentration was significantly higher in patients with atopic rhinitis or asthma when compared with nonatopic patients and healthy individuals and was the highest in patients suffering from severe atopic asthma who were not treated with systemic glucocorticosteroids. Although there were marked alterations in IgE in atopic and nonatopic patients, there were no significant differences between atopic and corresponding groups of nonatopic rhinitic and asthmatic patients in sICAM-1 and TNF-α concentrations. (sICAM-1 in rhinitis: atopic vs. nonatopic patients: 224.02 and 221.08 ng/ml, respectively, p > .05; in mild/moderate asthma: atopic vs. nonatopic: 306.22 and 326.39 ng/ml, respectively, p > .05; severe asthma without oral corticosteroids therapy: atopic vs. nonatopic: 418.03 and 468.09 ng/ml, respectively, p > .05; and severe asthma with oral corticosteroids therapy: atopic vs. nonatopic: 320.66 and 308.09 ng/ml, respectively, p > .05). Conclusions. Concentrations of sICAM-1 and TNF-α are significantly higher in patients with asthma compared with those observed in patients with rhinitis, but they are independent of the presence of atopy.