Aeroallergen Distributions in Skin Prick Tests in Children with Asthma and Allergic Rhinitis Living in the Elazığ and Malatya Regions

Abstract

Objective: Detection of the allergens in patients diagnosed with asthma and allergic rhinitis enables them to take environmental precautions in addition to receiving medical treatments, for full control of symptoms. We aimed to evaluate the distribution of aeroallergen sensitivity in skin prick tests (SPT) of children living in the Elazığ and Malatya regions and diagnosed with asthma and/or allergic rhinitis. Materials and Method: Patients who were diagnosed with asthma and/or allergic rhinitis and applied SPT between January 2022 and June 2022 were included. Demographic characteristics, diagnoses, disease severity and control level, laboratory values, and aeroallergen sensitivities in the SPT were recorded retrospectively. Results: Sensitivity to at least one aeroallergen was detected in 229 (57%) of 401 patients who underwent SPT with the diagnosis of asthma and/or allergic rhinitis. Additionally, 41.5% of the patients with aeroallergen sensitivity were found to be sensitive to more than one aeroallergen. The median age of patients with aeroallergen sensitivity was 6 years (4-9.5), and 132 (57.6%) of them were girls. Allergic rhinitis was diagnosed in 161 (70.3%) patients, asthma+allergic rhinitis in 41 (17.9%), and asthma in 27 (11.8%) patients. Patients were most sensitive to the fungal mixture (41.5%), followed by the grass-pollen mixture (36.7%) and house dust mites (31%). House dust mite susceptibility was found most frequently (48.1%) in patients with asthma. Among the asthmatic patients, monosensitization was higher in those with uncontrolled asthma (p=0.04). Conclusion: The data obtained from our study may contribute to the application of allergen protection methods and treatment in children with asthma and allergic rhinitis living in these regions.

Keywords

• Allergen
• allergic rhinitis
• asthma
• child
• skin prick test

Elazığ ve Malatya Yörelerinde Yaşayan Astım ve Alerjik Rinit Tanılı Çocuklarda Deri Prik Testlerindeki Aeroalerjen Dağılımları

Abstract

Amaç: Astım ve alerjik rinit tanısı ile izlenen hastalarda duyarlı olunan alerjenin saptanması, hastalığa yönelik medikal tedavilere ek olarak alerjene yönelik çevresel önlemlerin alınmasını ve semptomların tam olarak kontrol altına alınabilmesini sağlamaktadır. Çalışmamızda, Elazığ ve Malatya yörelerinde yaşayan ve astım ve/veya alerjik rinit tanısı konulan çocukların deri prik testleri (DPT) ile saptanan aeroalerjen duyarlılığının dağılımının değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Ocak 2022-Haziran 2022 tarihlerinde Elazığ Fethi Sekin Şehir Hastanesi ve Malatya Eğitim ve Araştırma Hastanesi Çocuk İmmünolojisi ve Alerji Hastalıkları polikliniklerinde astım ve/veya alerjik rinit tanısı konulan ve DPT uygulanan çocuk hastalar dahil edilmiştir. Hasta dosyalarından geriye dönük olarak hastaların demografik özellikleri, tanıları, hastalık şiddeti ve kontrol düzeyi, laboratuvar değerleri ve yapılan DPT’de aeroalerjen duyarlılıkları kayıt edilmiştir. Bulgular: Astım ve/veya alerjik rinit tanısı ile DPT uygulanan 401 hastanın 229’unda (%57) en az bir aeroalerjene karşı duyarlılık tespit edildi. Aeroalerjen duyarlılığı saptanan hastaların ise %41,5’inin birden fazla aeroalerjene duyarlı olduğu saptandı. Aeroalerjen duyarlılığı saptanan hastaların ortanca yaşı 6 yaş (4-9,5) olup, hastaların 132’si (%57,6) kız idi. Hastaların 161’ine (%70,3) alerjik rinit, 41’ine (%17,9) astım+alerjik rinit ve 27’sine (%11,8) astım tanısı konulmuştu. Hastaların en sık mantar karışımına karşı duyarlı olduğu (%41,5), bunu sırası ile ot polen karışımı (%36,7) ve ev tozu akarlarının (%31) izlediği gözlenmiştir. Astım tanılı hastalarda en sık ev tozu akarı duyarlılığı (%48,1) saptanmıştır. Astım tanılı hastalar içinde kontrolsüz astımı olanlarda monosensitizasyon oranı daha fazlaydı (p=0,04). Sonuç: Çalışmamızdan elde edilen verilerin, bu yörelerde yaşayan astım ve alerjik rinitli çocuklarda alerjenden korunma yöntemlerinin uygulanmasında faydalı olabileceğini ve hastaların tedavisine katkıda bulunabileceğini düşünmekteyiz.

Keywords

• Alerjen
• alerjik rinit
• astım
• çocuk
• deri prik testi

References

1. 1. Schoenwetter WF, Dupclay L, Appajosyula S, Botteman MF, Pashos CL. Economic impact and quality-of-life burden of allergic rhinitis. Curr Med Res Opin 2004;20(3):305-17. google scholar
2. 2. Brozek JL, Bousquet J, Agache I, Agarwal A, Bachert C, Bosnic-Anticevich S, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines-2016 revision. J Allergy Clin Immunol 2017;140:950-8. google scholar
3. 3. Aaron SD, Boulet LP, Reddel HK, Gershon AS. Underdiagnosis and overdiagnosis of asthma. Am J Respir Crit Care Med 2018;198:1012-20. google scholar
4. 4. Bergeron C, Hamid Q. Relationship between Asthma and rhinitis: Epidemiologic, pathophysiologc, and therapeutic aspects. Allergy Asthma Clin Immunol 2005;1:81-7. google scholar
5. 5. Dykewicz MS, Wallace DV, Amrol DJ, Baroody FM, Bernstein JA, Craig TJ, et al. Workgroup Contributors:, Dykewicz MS, Wallace DV, Amrol DJ, Baroody FM, Bernstein JA, Craig TJ, et al. Rhinitis 2020: A practice parameter update. J Allergy Clin Immunol. 2020;146(4):721-67. google scholar
6. 6. Dhami S, Nurmatov U, Arasi S, Khan T, Asaria M, Zaman H, et al. Allergen immunotherapy for allergic rhinoconjunctivitis: A systematic review and meta-analysis. Allergy 2017;72(11):1597-631. google scholar
7. 7. Burrows B, Martinez FD, Halonen M, Barbee RA, Cline MG. Association of asthma with serum IgE levels and skin-test reactivity to allergens. N Engl J Med 1989;320:271-7. google scholar
8. 8. Li J, Huang Y, Lin X, Zhao D, Tan G, Wu J, et al. Factors associated with allergen sensitizations in patients with asthma and/or rhinitis in China. Am J Rhinol Allergy 2012;26:85-91. google scholar

9. 9. Thomsen SF. Epidemiology and natural history of atopic diseases. Eur Clin Respir J. 2015 Mar 24;2. google scholar
10. 10. Yan YR, Xu YH, Zheng Q, Guo YS. The prevalence and sex difference of allergen sensitization among adult patients with allergic diseases in Shanghai, China. Asian Pac J Allergy Immunol 2019;37:147-53. google scholar
11. 11. Johansson SG, Bieber T, Dahl R, Friedmann PS, Lanier BQ, Lockey RF, et al. Revised nomenclature for allergy for global use: Report of the Nomenclature Review Committee of the World Allergy Organization, October 2003: J Allergy Clin Immunol 113:832-6, 2004. google scholar
12. 12. Drebog S, Frew A. The European Academy of Allergology and Clinical Immunology: Position paper: Immunotherapy. Allergy 1993;48(Supply 14):7-35. google scholar
13. 13. Global Strategy for Asthma Management and Prevention, 2020 Update, Global Initiative for Asthma (GINA) Available from http:// www.ginasthma.org google scholar
14. 14. Brozek JL, Bousquet J, Agache I, Agarwal A, Bachert C, Bosnic-Anticevich S, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines-2016 revision. J Allergy Clin Immunol 2017;140:950-8. google scholar
15. 15. Heinzerling L, Mari A, Bergmann KC, Bresciani M, Burbach G, Darsow U, et al. The skin prick test - European standards. Clin Transl Allergy 2013;3:3. google scholar
16. 16. Zuberbier T, Bachert C, Bousquet PJ, Passalacqua G, Walter Canonica G, Merk H et al. GA (2) LEN/EAACI pocket guide for allergen-specific immunotherapy for allergic rhinitis and asthma. Allergy 2010;65:1525-30. google scholar
17. 17. Canonica GW, Bousquet J, Casale T, Lockey RF, Baena-Cagnani CE, Pawankar R, et al. Sublingual immunotherapy:World Allergy Organization PoSCITion Paper 2009. Allergy 2009;64:1-5. google scholar
18. 18. Duman Senol H, Topyildiz E, Ekici B, Gulen F, Demir E. Effectiveness and adverse reactions to subcutaneous immunotherapy in children with allergic rhinitis/asthma. Int J Pediatr Otorhinolaryngol 2022;162:111292. google scholar
19. 19. Madonini E, Agostinis F, Barra R, et al. Long-term and preventive effects of sublingual allergen-specific immunotherapy: a retrospective, multicentric study. Int J Immunopathol Pharmacol 2003;16:73-9. google scholar
20. 20. Pajno GB, Barberio G, Luca F D E, Morabito L, Parmiani S. Prevention of new sensitizations in asthmatic children monosensitized to house dust mite by specific immunotherapy. A sixyear follow-up study. Clin Exp Allergy 2001;31:1392-7. google scholar
21. 21. Karaman S, Yavas HF, Erdem SB, et al. Monosensitize hastalarda alerjen immünoterapinin yeni duyarlılık gelişimine etkisi. İzmir Dr. Behçet Uz Çocuk Hast Dergisi 2018;8(3):205-2. 10 google scholar
22. 22. Çekiç Ş, Canıtez Y, Çiçek F, Ocakoğlu G, Sapan N. The effect of allergen immunotherapy on the development of new sensitization in children. Turk Arch Pediatr 2021;56(4):374-379. google scholar
23. 23. Raulf M, Buters J, Chapman M, Cecchi L, de Blay F, Doekes G, et al. European Academy of Allergy and Clinical Immunology. Monitoring of occupational and environmental aeroallergens-- EAACI Position Paper. Concerted action of the EAACI IG Occupational Allergy and Aerobiology & Air Pollution. Allergy 2014;69(10):1280-99. google scholar
24. 24. Topal E, Çatal F, Ermiştekin H, Özdemir R, Karadağ A, Sinanoğlu MS, et al. Malatya yöresinde astım ve alerjik rinit tanısı konulan çocukların deri prik testlerindeki aeroalerjen dağılımları. Abant Tıp Dergisi 2014;3(3):215-9. google scholar
25. 25. Ay S, Civelek E, Kaya EK, Güvenir H, Misirlioglu ED, Toyran M, et al. Astımlı ve Astım-Alerjik Rinit Birlikteliği Olan Çocuklarda Deri Testi Sonuçlarının Değerlendirilmesi. Türkiye Çocuk Hastalıkları Dergisi 2017;11(3):153-8. google scholar
26. 26. İğde M, İğde F, Sancak R, Oztürk F. Orta Karadeniz Bölgesindeki çocuklarda allerji deri testi sonuçları. Turkiye Klinikleri Journal of Pediatrics 2009;18(2):82-90. google scholar
27. 27. Akcakaya N, Cokugras H, Camcioglu Y, Ozdemir M. Skin test hypersensitivity for childhood asthma in Istanbul during a period of 16 years. Allergol Immunopathol (Madr) 2005;33(1):15-9. google scholar
28. 28. Rosas I, Calderon C, Escamilla B. Seasonal distribution of Aspergillus in the air of urban area: Mexico City. Grana 1992;31:315-9. google scholar
29. 29. Lintner TJ, Brame KA. The effects of season, climate, and airconditioning on the prevalence of Dermatophagoides mite allergens in household dust. J Allergy Clin Immunol 1993;91:862-7. google scholar
30. 30. Bayram N, Uyar M, Elbek O, Dikensoy Ö, Filiz A. Gaziantep’te Göğüs Hastalıkları Polikliniğinde Tespit Edilen Alerji Deri Testi Sonuçları. Gaziantep Tıp Derg 2013;19:152-4. google scholar
31. 31. İynen İ, Şan FB. Adıyaman’da Alerjik Rinitli Hastalarda Deri Prick Testi Sonuçları. Harran Univ Tip Fak Derg 2010;7:81-4. google scholar
32. 32. Turgut CŞ, Tezcan D, Uzuner N, Köse S, Karaman Ö. Sensization to allergens in Izmir and around the city. İzmir SSK Tepecik Hastanesi Dergisi 2003;13(1):19-24. google scholar
33. 33. Şaşihüseyinoğlu AŞ, Özhan AK, Serbes M, Duyuler GA, Bingöl G, Yilmaz M, et al. Çocukluk Yaş Grubunda Deri Testi ile Allerjen Duyarlılığının Dağılımı. Asthma Allergy Immunology 2017;15(1):43-8. google scholar
34. 34. Visitsunthorn N, Chaimongkol W, Visitsunthorn K, Pacharn P, Jirapongsananuruk O. Great flood and aeroallergen sensitization in children with asthma and/or allergic rhinitis. Asian Pac J Allergy Immunol 2018;36(2):69-76. google scholar
35. 35. Dai L, Liu J, Zhao Q, Li M, Zhou Y, Chen Z, et al. Investigation of Allergic Sensitizations in Children With Allergic Rhinitis and/or Asthma. Front Pediatr 2022;10:842293. google scholar
36. 36. Lau S, Illi S, Sommerfeld C, Niggemann B, Bergmann R, von Mutius E, et al. Early exposure to house-dust mite and cat allergens and development of childhood asthma:a cohortstudy. Multicentre Allergy Study Group. Lancet 2000;356(9239):1392-7. google scholar
37. 37. Can C, Altınel N, Hatipoglu S. Aeroallergen sensitisation patterns of children aged 5 years and younger with asthma and/or allergic rhinitis in Istanbul. Arch Pediatr 2021;28(1):7-11. google scholar
38. 38. Bodur M, Canıtez Y, Çekiç Ş, Ocakoğlu G, Sapan N. Güney Marmara Bölgesindeki Alerjik Rinitli Çocuklarda Mantar Alerjenlerine Duyarlılık Oranlarının Araştırılması. Çocuk Dergisi 2021;21(2):111-8. google scholar
39. 39. Yazicioglu M, Oner N, Cetlik C, Okutan O, Pala O. Sensitization to common allergens, especially pollens, among children with respiratory allergy in the Trakya region of Turkey. Asian Pac J Allergy Immunol 2004;22:183-90. google scholar
40. 40. Nagarajan S, Ahmad S, Quinn M, Agrawal S, Manilich E, Concepcion E, et al. Allergic sensitization and clinical outcomes in urban children with asthma, 2013-2016. Allergy Asthma Proc. 2018;39(4):281-8. google scholar
41. 41. Beck AF, Huang B, Kercsmar CM, Guilbert TW, McLinden DJ, Lierl MB, et al. Allergen sensitization profiles in a population-based cohort of children hospitalized for asthma. Ann Am Thorac Soc 2015;12(3):376-84. google scholar