Duyarlılığının Klinik Özellikleri Allerjik Solunum Yolu Hastalıkları Olan Çocuklarda Küf Mantarı

Year 2016, Volume: 17 Issue: 2, 74 - 82, 01.08.2016

Pınar Uysal Duygu Erge Ayşe Yenigün

Abstract

Amaç: Çalışmanın amacı polikliniğimize başvuran okul çağındaki allerjik solunum yolu hastalıkları olan çocuklarda küf mantarı duyarlılığının sıklığının araştırılması ve duyarlılığın hastalığın ağırlığındaki öneminin tespit edilmesidir.Gereç ve Yöntemler: Küf mantarı sezonunda allerjik semptomları olan çocuklardan polikliniğimize Ocak 2014-Ağustos 2015 tarihleri arasında başvuranlar allerjik solunum yolu hastalıkları açısından değerlendirildi. Küf mantarı ve ticari standardizeedilmiş aeroallerjenler ile deri prik testi yapıldı. Astımlı çocuklara spirometri uygulandı. Serum total immünoglobulin E (IgE) düzeyine
bakıldı ve spesifik IgE (sIgE) düzeyleri ölçüldü.
Bulgular: Çalışmaya 112 çocuk alındı. Küf mantarı duyarlılığının sıklığı %6,4 bulundu. Alternaria alterna hem mono hem de
polisensitize çocuklarda en sık küf mantarı allerjeni idi (sırasıyla, p=0,002, p=0,004). Alternaria alterna duyarlılığı persistan allerjik
riniti olanlarda intermittan olanlara göre belirgin yüksekti (p=0,002). Hafif astımı olan hastalar daha çok monosensitize (p=0,003)
iken, ağır astımı olanlar polisensitize (p=0,007) idi. Polisensitize olanlarda Alternaria alterna ve Cladosporium spp. birlikteliği diğer
küf mantarlarına göre daha sıktı (p<0,001). sIgE’nin sensitivitesi %88 bulundu. Spirometrik değerlendirmede, sadece polisensitize
çocuklarda zorlu ekspirasyon hacmi 1/zorlu vital kapasite değerleri astımı ve astıma eşlik eden allerjik riniti olanlarda tek başına
allerjik riniti olanlara göre daha düşük saptandı (sırasıyla, p=0,004, p=0,001).
Sonuç: Mono ve polisensitize olan çocuklarda en sık rastlanan küf mantarı allerjeni Alternaria alterna idi. Küf mantarı ile
polisensitizasyon ağır astım ve düşük spirometrik değerler ile ilişkili gibi gözükmektedir.

Keywords

Astım, allerji, allerjik rinit, küf mantarı, duyarlanma, pediatri

Clinical Characteristics of Fungal Sensitization in Children with Allergic Respiratory Diseases

Abstract

Objective: The aim of the study was to evaluate the prevelance of fungal sensitization among school-aged children with allergic respiratory diseases who attended our outpatient clinic and to evaluate its clinical impact on disease severity. Materials and Methods: Children with allergic symptoms during mould season, who attended our outpatient clinic between January 2014 and August 2015, were evaluated for allergic respiratory diseases. Skin prick testing with fungal and other commercial standardized solutions of aeroallergens was performed in all children. Spirometry was performed in children with asthma. Serum total immunoglobulin E (IgE) and aeroallergen specific IgE (sIgE) levels were measured. Results: A total of 112 children were included in the study. The prevelance of fungal sensitization was 6.4%. Alternaria alterna was the most common fungal allergen in both mono and polysensitized groups (p=0.002, p=0.004, respectively). Alternaria alterna sensitization was significantly higher in patients with persistent allergic rhinitis compared to those with intermittant allergic rhinitis (p=0.002). The patients with mild asthma were mostly monosensitized (p=0.003), but cases with severe asthma (SA) were polysensitized (p=0.007). In polysensitized cases, Alternaria alterna and Cladosporium spp. coexistance was the most common combination compared to other fungal combinations (p<0.001). The sensitivity rate of sIgE was found to be 88%. In spirometric analysis, forced expiratory volume in 1 second (FEV1) and FEV1/forced vital capacity values were lower in polysensitized children with asthma and in children with asthma coexisting allergic rhinitis compared to children with allergic rhinitis only (p=0.004, p=0.001, respectively). Conclusion: The most common fungal allergen was Alternaria alterna in children with mono or polysensitization. Polysensitization with fungal allergens was closely associated with SA and lower spirometric parameters.

Keywords

Asthma, allergy, allergic rhinitis, mould, sensitization, pediatrics

References

• 1. D’Amato G, Chatzigeorgiou G, Corsico R, Gioulekas D, Jäger L, Jäger S, et al. Evaluation of the prevalence of skin prick test positivity to Alternaria and Cladosporium in patients with suspected respiratory allergy. A European multicenter study promoted by the Subcommittee on Aerobiology and Environmental Aspects of Inhalant Allergens of the European Academy of Allergology and Clinical Immunology. Allergy 1997; 52: 711-6.
• 2. Chen YC, Tsai CH, Lee YL. Early-life indoor environmental exposures increase the risk of childhood asthma. Int J Hyg Environ Health 2011; 215: 19-25.
• 3. Erkara IP, Asan A, Yilmaz V, Pehlivan S, Okten SS. Airborne Alternaria and Cladosporium species and relationship with meteorological conditions in Eskisehir City, Turkey. Environ Monit Assess 2008; 144: 31-41.
• 4. Kilic M, Ufuk Altintas D, Yilmaz M, Güneşer Kendirli S, Bingöl Karakoc G, Taskin E, et al. The effects of meteorological factors and Alternaria spore concentrations on children sensitised to Alternaria. Allergol Immunopathol (Madr) 2010; 38: 122-8.
• 5. Vicencio AG, Santiago MT, Tsirilakis K, Stone A, Worgall S, Foley EA, et al. Fungal sensitization in childhood persistent asthma is associated with disease severity. Pediatr Pulmonol 2014; 49: 8-14.
• 6. Castanhinha S, Sherburn R, Walker S, Gupta A, Bossley CJ, Buckley J, et al. Pediatric severe asthma with fungal sensitization is mediated by steroid-resistant IL-33. J Allergy Clin Immunol. 2015; 136: 312-22.
• 7. Tischer CG, Hohmann C, Thiering E, Herbarth O, Müller A, Henderson J, et al. Meta-analysis of mould and dampness exposure on asthma and allergy in eight European birth cohorts: an ENRIECO initiative. Allergy 2011; 66: 1570-9.
• 8. Global Initiative for Asthma (GINA): Global Strategy for Asthma Management and Prevention: Revised 2014.
• 9. Brozek JL, Bousquet J, Baena-Cagnani CE, Bonini S, Canonica GW, Casale TB, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines: 2010 revision. J Allergy Clin Immunol 2010; 126: 466- 76.
• 10. Bousquet J, Heinzerling L, Bachert C, Papadopoulos NG, Bousquet PJ, Burney PG, et al. Practical guide to skin prick tests in allergy to aeroallergens. Allergy 2012; 67: 18-24.
• 11. Heinzerling LM, Burbach GJ, Edenharter G, Bachert C, BindslevJensen C, Bonini S, et al. GA(2)LEN skin test study I: GA(2)LEN harmonization of skin prick testing: novel sensitization patterns for inhalant allergens in Europe. Allergy 2009; 64: 1498-506.
• 12. 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.
• 13. Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, et al. Standardisation of spirometry. Eur Respir J 2005; 26: 319-38.
• 14. Moghtaderi M, Aleyasin S, Amin R, Kashef S. Skin test reactivity to fungal aeroallergens in asthmatic children in southern iran. Iran J Pediatr. 2010; 20: 242-3.
• 15. Pendino P, Agüero C, Cavagnero P, Lopez K, Kriunis I, Molinas J. Aeroallergen sensitization in wheezing children from rosario, Argentina. World Allergy Organ J. 2011; 4: 159-63.
• 16. Fereidouni M, Hossini RF, Azad FJ, Assarehzadegan MA, Varasteh A. Skin prick test reactivity to common aeroallergens among allergic rhinitis patients in Iran. Allergol Immunopathol (Madr) 2009; 37: 73-9.
• 17. Sharpe RA, Bearman N, Thornton CR, Husk K, Osborne NJ. Indoor fungal diversity and asthma: a meta-analysis and systematic review of risk factors. J Allergy Clin Immunol 2015; 135: 110-22.
• 18. Bayram A, Oymak S, Gülmez İ, Demir R, Büyükoğlan H. Astımda atopi ve allerjik rinit sıklığı. Erciyes Tıp Dergisi 2010; 32: 27-34.
• 19. Mirici A, Girgiç M, Tutar Ü. Erzurum’da astımlı hastalarda atopi sıklığı. Akciğer Arşivi 2001; 2: 64-8.
• 20. Torres-Rodríguez JM, Pulido-Marrero Z, Vera-García Y. Respiratory allergy to fungi in Barcelona, Spain: clinical aspects, diagnosis and specific treatment in a general allergy unit. Allergol Immunopathol (Madr) 2012; 40: 295-300.
• 21. Kashef S, Kashef MA, Eghtedari F. Prevalence of aeroallergens in allergic rhinitis in shiraz. Iran J Allergy Asthma Immunol 2003; 2: 185-8.
• 22. Küçükosmanoğlu E, Tanıdır C, Demir F, Coşkun Ş, Hafızoğlu T, Şeşeoğulları Y, ve ark. İstanbul’da çocuklarda solunum allerjenleri duyarlılığı. Gaziantep Tıp Dergisi 2009; 15: 10-3.
• 23. Mallol J, Raby P, Cambiazo D, Peñaloza C, Palma R, De Orúe M. Prevalence of atopy in 1,199 asthmatic children from southern Santiago, Chile. Rev Med Chil 2014; 142: 567-73.
• 24. Randriamanantany ZA, Annesi-Maesano I, Moreau D, Raherison C, Charpin D, Kopferschmitt C, et al. Alternaria sensitization and allergic rhinitis with or without asthma in the French Six Cities study. Allergy 2010; 65: 368-75.
• 25. Kim JH, Oh JW, Lee HB, Kim SW, Kang IJ, Kook MH, et al. Changes in sensitization rate to weed allergens in children with increased weeds pollen counts in Seoul metropolitan area. J Korean Med Sci 2012; 27: 350-5.
• 26. Roberts G, Zhang H, Karmaus W, Raza A, Scott M, Matthews S, et al. Trends in cutaneous sensitization in the first 18 years of life: results from the 1989 Isle of Wight birth cohort study. Clin Exp Allergy 2012; 42: 1501-9.
• 27. Chiu CY, Huang YL, Tsai MH, Tu YL, Hua MC, Yao TC, et al. Sensitization to food and inhalant allergens in relation to atopic diseases in early childhood: a birth cohort study. PLoS One 2014; 9: e102809.
• 28. Hwang BF, Liu IP, Huang TP. Molds, parental atopy and pediatric incident asthma. Indoor Air 2011; 21: 472-8.
• 29. Nguyen T, Lurie M, Gomez M, Reddy A, Pandya K, Medvesky M. The National Asthma Survey – New York State: association of the home environment with current asthma status. Public Health Rep 2010; 125: 877-87.
• 30. Govaere E, Van Gysel D, Massa G, Verhamme KM, Doli E, De Baets F. The influence of age and gender on sensitization to aero-allergens. Pediatr Allergy Immunol 2007; 18: 671-8.
• 31. Feliu A, González-de-Olano D, González E, Rodriguez B, Ruiz-Hornillos J, Jimeno L, et al. A multicenter study of sensitization profiles in an allergic pediatric population in an area with high allergenexposure. J Investig Allergol Clin Immunol 2013; 23: 337-44.
• 32. Zou H, Su L, Fang QH, Ma YM. Correlation between fungal sIgE and bronchial asthma severity. Exp Ther Med 2013; 6: 537-41.
• 33. Vicencio AG, Santiago MT, Tsirilakis K, Stone A, Worgall S, Foley EA, et al. Fungal sensitization in childhood persistent asthma is associated with disease severity. Pediatr Pulmonol 2014;49:8- 14.
• 34. Feliu A, González-de-Olano D, González E, Rodriguez B, RuizHornillos J, Jimeno L, et al. A multicenter study of sensitization profiles in an allergic pediatric population in an area with high allergen exposure. J Investig Allergol Clin Immunol 2013; 23: 337-44.
• 35. Zou H, Su L, Fang QH, Ma YM. Correlation between fungal sIgE and bronchial asthma severity. Exp Ther Med 2013; 6: 537-41.
• 36. Katotomichelakis M, Anastassakis K, Gouveris H, Tripsianis G, Paraskakis E, Maroudias N et al. Clinical significance of Alternaria alternata sensitization in patients with allergic rhinitis. Am J Otolaryngol 2012; 33 :232-8.