Article

Association of pediatric asthma severity with exposure to common household dust allergens

Yale Center for Perinatal, Pediatric and Environmental Epidemiology, Department of Epidemiology and Public Health, Yale University School of Medicine, One Church Street, 6th Floor, New Haven, CT 06510, USA.
Environmental Research (Impact Factor: 3.95). 06/2009; 109(6):768-74. DOI: 10.1016/j.envres.2009.04.010
Source: PubMed

ABSTRACT Reducing exposure to household dust inhalant allergens has been proposed as one strategy to reduce asthma.
To examine the dose-response relationships and health impact of five common household dust allergens on disease severity, quantified using both symptom frequency and medication use, in atopic and non-atopic asthmatic children.
Asthmatic children (N=300) aged 4-12 years were followed for 1 year. Household dust samples from two indoor locations were analyzed for allergens including dust mite (Der p 1, Der f 1), cat (Fel d 1), dog (Can f 1), cockroach (Bla g 1). Daily symptoms and medication use were collected in monthly telephone interviews. Annual disease severity was examined in models including allergens, specific IgE sensitivity and adjusted for age, gender, atopy, ethnicity, and mother's education.
Der p 1 house dust mite allergen concentration of 2.0 microg/g or more from the main room and the child's bed was related to increased asthma severity independent of allergic status (respectively, OR 2.93, 95% CI 1.37, 6.30 for 2.0-10.0 microg/g and OR 2.55 95% CI 1.13, 5.73 for 10.0 microg/g). Higher pet allergen levels were associated with greater asthma severity, but only for those sensitized (cat OR 2.41 95% CI 1.19, 4.89; dog OR 2.06 95% CI 1.01, 4.22).
Higher levels of Der p 1 and pet allergens were associated with asthma severity, but Der p 1 remained an independent risk factor after accounting for pet allergens and regardless of Der p 1 specific IgE status.

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    • "Moreover, HDM sensitization is a major risk factor for asthma (Platts-Mills et al. 2011; Shek et al. 2010; Trakultivakorn et al. 2002). IgE responses to allergens from HDMs can significantly contribute to the total serum IgE which influences asthma pathogenesis and severity (Erwin et al. 2007; Gent et al. 2009]. Increased eosinophils in peripheral blood and airway secretion are vital features of asthma, and its severity. "
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    • "Moreover, HDM sensitization is a major risk factor for asthma (Platts-Mills et al. 2011; Shek et al. 2010; Trakultivakorn et al. 2002). IgE responses to allergens from HDMs can significantly contribute to the total serum IgE which influences asthma pathogenesis and severity (Erwin et al. 2007; Gent et al. 2009]. Increased eosinophils in peripheral blood and airway secretion are vital features of asthma, and its severity. "
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    • "Dust samples were collected once at the time of the home visit from the floor and furniture of the main living area following a protocol described previously (Gent et al., 2002, 2009; Belanger et al., 2003). Samples were assayed by enzymelinked immunosorbent assay (ELISA) for allergens including Der p1, Der f 1, Fel d 1, Can f 1, and Bla g 1 (Gent et al., 2009). Results were recorded as micrograms per gram (mg/g) for dust mite and pet allergens, and as units of allergen per gram (U/g) for cockroach allergen. "
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    ABSTRACT: Few studies address concurrent exposures to common household allergens, specific allergen sensitization and childhood asthma morbidity. To identify levels of allergen exposures that trigger asthma exacerbations in sensitized individuals. We sampled homes for common indoor allergens (fungi, dust mites (Der p 1, Der f 1), cat (Fel d 1), dog (Can f 1) and cockroach (Bla g 1)) for levels associated with respiratory responses among school-aged children with asthma (N=1233) in a month-long study. Blood samples for allergy testing and samples of airborne fungi and settled dust were collected at enrollment. Symptoms and medication use were recorded on calendars. Combined effects of specific allergen sensitization and level of exposure on wheeze, persistent cough, rescue medication use and a 5-level asthma severity score were examined using ordered logistic regression. Children sensitized and exposed to any Penicillium experienced increased risk of wheeze (odds ratio [OR] 2.12 95% confidence interval [CI] 1.12, 4.04), persistent cough (OR 2.01 95% CI 1.05, 3.85) and higher asthma severity score (OR 1.99 95% CI 1.06, 3.72) compared to those not sensitized or sensitized but unexposed. Children sensitized and exposed to pet allergen were at significantly increased risk of wheeze (by 39% and 53% for Fel d 1>0.12μg/g and Can f 1>1.2μg/g, respectively). Increased rescue medication use was significantly associated with sensitization and exposure to Der p 1>0.10μg/g (by 47%) and Fel d 1>0.12μg/g (by 32%). Asthmatic children sensitized and exposed to low levels of common household allergens Penicillium, Der p 1, Fel d 1 and Can f 1 are at significant risk for increased morbidity.
    Environmental Research 08/2012; 118:86-93. DOI:10.1016/j.envres.2012.07.005 · 3.95 Impact Factor
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