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606 Exposure and sensitisation of children admitted to hospital with asthma to house dust mite allergen (Derp I)
VOLUME NUMBER
605
506
Abstracts
87 1, PART 2
ALLERGEN EXPOSURE AND SERUM Ab IN MITE ALLERGIC ASTHMATIC CHILDREN COMPARED TO NON-ASTHMATIC NON-ATOPIC CONTROLS. Rizzo MC. Ar& LK Femandez-Caldas F. Chap a MD. Platts-Mills TAE. Na&tz CI$. Sat0 Paula, I&E Charlottesville VA; Tampa FL. We compared exposure to allergens and IgE and IgG ab of 20 children with asthma and positive skin test to D. pteronyssinus, living in Sea Paulo, to 20 control children, without history of asthma or allergy, and negative prick tests to D. pteronyssinur and B. tropic& extracts. In 16120 patients’ houses and in 11/20 controls’ houses at least one dust sample was obtained which contained > 1OpgDer p I/g of dust. The highest levels of Derp I were found in bedding (GM 22.4pg/g and 16.2pg/g, respectively), followed by bedroom floor and TV room (GM >2pg/g) and kitchen (GM < lpg/g). Levels of Fe1 d I >&g/g of dust were found in 3 houses, of these all reported cats present in the house. Cockroach allergen Blu g I was ~0.6 units/g of dust in all houses. Serum IgE ab to D. pteronyssimu and to B. tropicah were >200 RAST units/ml in 19120 and in 16/20 asthmatic children (GM 1,410 units/ml and 590 units/ml, respectively). In the control group, IgE to D. pteronyssinus and to B.tropicalis was >40 units/ml but ~200 units/ml in only 3120 and l/20 subjects, respectively. IgE ab to cat and cockroach were <40 units/ml in most cases. IgG ab to Der p I or to Der f I were measured by antigen binding RIA. 17/20 asthmatic children had IgG to both allergens, whereas 17/20 controls had no detectable IgG ab. Although exposure to high levels of mite allergens was common in Sao Paulo, significant IgE and IgG ab response to those allergens was detected only in children with asthma.
607
EXPOSURE AND SENSITISATION OF CHILDREN ADMI-ITED TO HOSPITAL WITH ASTHMA TO HOUSE DUST MITE ALLERGEN (Derd I). R Sporik MRCP. TAE Platts-Mills MD PhD . JJ Coeswell MD FRcp. Dept. of Paediatrics, Poole’ General Hospital UK, * University of Virginia, Charlottesville, VA. In order to determine how many children admitted to hospital with asthma were both sensitised and exposed to house dust mites we undertook a case study of 50 admissions in September 1988 and 44 in March / April 1989. Sensitisation was judged by skin testing and RAST. The concentration of Derp I was measured in the childs’ mattress, bedroom floor and living room floor on admission. Forty one (82%) children admitted in September and 30 (70%) admitted in March, had been exposed to > 1OpgDer p I/g, a previously proposed threshold level above which there is an increased risk of wheeze. The mean levels of exposure were 29.5 and 16.1 rg/g: 38 (81%) and 37 (84%) of the children were sensitised (RAST > 1, or wheal >3mrn): 31 (69%) and 26 (62%) were both exposed and sensitised. Seventy three homes were revisited during a one month period 6 months after the initial admission. During this period 9 children were readmitted, 7 were both sensitised and exposed to > 1Opg Der p I/g. In contrast of the remaining 64 children who were not readmitted only 22 were both sensitised and exposed (p
608
291
AS~C~uTIONCUTS HCSPITAUZBTION. . Amherst, Nassaehmetta. E l *, We wanted to demonstrate that our oroeram for the care of children with asthma coi?d be successfully replicated elsewhere. We consulted with two Kaieer HMOshaving a total of 8,400 enrollees under 15 years of age starting in October 1988. The intervention focused on the physician and nursing staff. It emphasized the early diagnosis of asthwa. the early use of sreroids, the use of eoepressordriven nebulisers and peak flow meters in the office and the home. Children with Asthma: A Manual for Parents served as the text for the intervention. Aethma Rates per Thousand Admissions 1988 1988 1989
U.S. two HMO8 two HMOS
Hospital
Days
8.6 9.5 2.7
3.1 3.2 0.8
The rate of hospital discharges and hospital bed days per thousand children dropped by wore than JO percent during rhe first year of intervention. The replication was a success.
BANDfl[lMIDTryINrnHDME: KFFEmcNFmKFLay-m~c
‘IHEIR
CliIIDREN. J. Oliver. B.Sc.. F. camwell. Fh ., an3 J. F. Chavarria. M.D., Eiristol, Engti The
study
was
designed
tc
relate
the
dcmestic climatic conditions to variation in psek fitxphtcry flaw (PEF). Ninec!hildm~sufferingf?m~ perennialatter&rqthe&thmaClinicatttxEristol Children~sIimpitalam@etedal-mnthdiary cardrecmdiqtheirlXFthmeti.msaday using a calibrated mini-Wright Feak Flow Meter. In this period relative humidity and tzl3pemtureweremeasured usi.ngaPmtimeter atthetimeofthePE!Freadkjs. A positive correlation coefficient was famdhetVm2ntenperatureatldmeanm (M.7; prO.05). A negative cormlatim was demonstrated between temperature and anplitude of PEP (I==-0.7; ~~0.05). The ?rqreseicn quation (53.6 - 1.83 teqerature) explains 49.7% of the variation in pEF amplitude. llleanalysisofvarianceslluZd F = 6.92: p CO.05. No significant axrelaticmwas faud betmen either relative hmidityoraksolutehmidity andIEF. Climatic ax-ditions in the bane m to affect PEF in asthm&ic children. lkxperature ratherthanhmidityappearedtobethemajor factor.
605
506
Abstracts
87 1, PART 2
ALLERGEN EXPOSURE AND SERUM Ab IN MITE ALLERGIC ASTHMATIC CHILDREN COMPARED TO NON-ASTHMATIC NON-ATOPIC CONTROLS. Rizzo MC. Ar& LK Femandez-Caldas F. Chap a MD. Platts-Mills TAE. Na&tz CI$. Sat0 Paula, I&E Charlottesville VA; Tampa FL. We compared exposure to allergens and IgE and IgG ab of 20 children with asthma and positive skin test to D. pteronyssinus, living in Sea Paulo, to 20 control children, without history of asthma or allergy, and negative prick tests to D. pteronyssinur and B. tropic& extracts. In 16120 patients’ houses and in 11/20 controls’ houses at least one dust sample was obtained which contained > 1OpgDer p I/g of dust. The highest levels of Derp I were found in bedding (GM 22.4pg/g and 16.2pg/g, respectively), followed by bedroom floor and TV room (GM >2pg/g) and kitchen (GM < lpg/g). Levels of Fe1 d I >&g/g of dust were found in 3 houses, of these all reported cats present in the house. Cockroach allergen Blu g I was ~0.6 units/g of dust in all houses. Serum IgE ab to D. pteronyssimu and to B. tropicah were >200 RAST units/ml in 19120 and in 16/20 asthmatic children (GM 1,410 units/ml and 590 units/ml, respectively). In the control group, IgE to D. pteronyssinus and to B.tropicalis was >40 units/ml but ~200 units/ml in only 3120 and l/20 subjects, respectively. IgE ab to cat and cockroach were <40 units/ml in most cases. IgG ab to Der p I or to Der f I were measured by antigen binding RIA. 17/20 asthmatic children had IgG to both allergens, whereas 17/20 controls had no detectable IgG ab. Although exposure to high levels of mite allergens was common in Sao Paulo, significant IgE and IgG ab response to those allergens was detected only in children with asthma.
607
EXPOSURE AND SENSITISATION OF CHILDREN ADMI-ITED TO HOSPITAL WITH ASTHMA TO HOUSE DUST MITE ALLERGEN (Derd I). R Sporik MRCP. TAE Platts-Mills MD PhD . JJ Coeswell MD FRcp. Dept. of Paediatrics, Poole’ General Hospital UK, * University of Virginia, Charlottesville, VA. In order to determine how many children admitted to hospital with asthma were both sensitised and exposed to house dust mites we undertook a case study of 50 admissions in September 1988 and 44 in March / April 1989. Sensitisation was judged by skin testing and RAST. The concentration of Derp I was measured in the childs’ mattress, bedroom floor and living room floor on admission. Forty one (82%) children admitted in September and 30 (70%) admitted in March, had been exposed to > 1OpgDer p I/g, a previously proposed threshold level above which there is an increased risk of wheeze. The mean levels of exposure were 29.5 and 16.1 rg/g: 38 (81%) and 37 (84%) of the children were sensitised (RAST > 1, or wheal >3mrn): 31 (69%) and 26 (62%) were both exposed and sensitised. Seventy three homes were revisited during a one month period 6 months after the initial admission. During this period 9 children were readmitted, 7 were both sensitised and exposed to > 1Opg Der p I/g. In contrast of the remaining 64 children who were not readmitted only 22 were both sensitised and exposed (p
608
291
AS~C~uTIONCUTS HCSPITAUZBTION. . Amherst, Nassaehmetta. E l *, We wanted to demonstrate that our oroeram for the care of children with asthma coi?d be successfully replicated elsewhere. We consulted with two Kaieer HMOshaving a total of 8,400 enrollees under 15 years of age starting in October 1988. The intervention focused on the physician and nursing staff. It emphasized the early diagnosis of asthwa. the early use of sreroids, the use of eoepressordriven nebulisers and peak flow meters in the office and the home. Children with Asthma: A Manual for Parents served as the text for the intervention. Aethma Rates per Thousand Admissions 1988 1988 1989
U.S. two HMO8 two HMOS
Hospital
Days
8.6 9.5 2.7
3.1 3.2 0.8
The rate of hospital discharges and hospital bed days per thousand children dropped by wore than JO percent during rhe first year of intervention. The replication was a success.
BANDfl[lMIDTryINrnHDME: KFFEmcNFmKFLay-m~c
‘IHEIR
CliIIDREN. J. Oliver. B.Sc.. F. camwell. Fh ., an3 J. F. Chavarria. M.D., Eiristol, Engti The
study
was
designed
tc
relate
the
dcmestic climatic conditions to variation in psek fitxphtcry flaw (PEF). Ninec!hildm~sufferingf?m~ perennialatter&rqthe&thmaClinicatttxEristol Children~sIimpitalam@etedal-mnthdiary cardrecmdiqtheirlXFthmeti.msaday using a calibrated mini-Wright Feak Flow Meter. In this period relative humidity and tzl3pemtureweremeasured usi.ngaPmtimeter atthetimeofthePE!Freadkjs. A positive correlation coefficient was famdhetVm2ntenperatureatldmeanm (M.7; prO.05). A negative cormlatim was demonstrated between temperature and anplitude of PEP (I==-0.7; ~~0.05). The ?rqreseicn quation (53.6 - 1.83 teqerature) explains 49.7% of the variation in pEF amplitude. llleanalysisofvarianceslluZd F = 6.92: p CO.05. No significant axrelaticmwas faud betmen either relative hmidityoraksolutehmidity andIEF. Climatic ax-ditions in the bane m to affect PEF in asthm&ic children. lkxperature ratherthanhmidityappearedtobethemajor factor.