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AIRIAP 2: Childhood Asthma Control in Asia According to the Global Initiative for Asthma (GINA) Criteria
Abstracts S95
J ALLERGY CLIN IMMUNOL VOLUME 121, NUMBER 2
AIRIAP 2: Childhood Asthma Control in Asia According to the Global Initiative for Asthma (GINA) Criteria G. Wong1, K. Gunasekera2, J. Hong3, J. Hsu4; 1Chinese University of Hong Kong, Hong Kong, HONG KONG, 2Central Chest Clinic, Colombo, SRI LANKA, 3Shanghai Jiaotong University, Shanghai, CHINA, 4 Taichung Veterans General Hospital, Taichung, TAIWAN. RATIONALE: Poor assessment of asthma control and under-treatment are the major causes for the sub-optimal management of asthma worldwide. The 2006 revised GINA guideline emphasizes the importance of assessing control. The study aims were to: (1) assess asthma control in Asia based on all the GINA criteria (daytime and nighttime symptoms, need for rescue medications, activity limitation and exacerbations), except lung function, and (2) evaluate the validity of the Childhood Asthma Control Test (C-ACT) in predicting level of asthma control. METHODS: A questionnaire based on asthma symptoms, health care utilization and management was administered in a face-to-face setting in the respondent’s language of choice. Children aged <16 years with diagnosed asthma and current asthma symptoms or taking medications for their asthma were recruited from China, Hong Kong, India, Indonesia, Korea, Malaysia, Philippines, Singapore, Sri Lanka, Taiwan, Thailand and Vietnam. RESULTS: A total of 988 respondents were identified by screening 172,364 households. Twenty-five (2.5%) had controlled, 435 (44.0%) partly controlled and 528 (53.4%) uncontrolled asthma. Even in the uncontrolled group, only 99 (18.8%) patients were taking inhaled corticosteroid. A total of 162 children completed the C-ACT. Receiver operating characteristic (ROC) analyses revealed the best cut-off score was 19 in identifying uncontrolled asthma (sensitivity: 0.61; specificity: 0.84). CONCLUSIONS: An overwhelming majority (97.5%) of asthmatic children in Asia had sub-optimal control. The C-ACT is a valid tool in predicting uncontrolled asthma, as defined by the GINA criteria. Use of simple assessment tools like the ACT may help clinicians to identify patients with uncontrolled asthma requiring appropriate anti-inflammatory therapy. Funding: GlaxoSmithKline
367
The Seasonal Variation of Asthma Hospitalization was Associated with Air Pollution among Children K. Yeh, M. Chen, J. Huang; Chang Gung Children’s Hospital, Taoyuan, TAIWAN. RATIONALE: To evaluate the association of seasonal variation of air pollution and asthma hospitalization in children within two year periods. METHODS: The National Health Insurances covered health care for more than 96% of whole populations in Taiwan. By using the database, we investigated the seasonal variation of hospitalization trend with primary diagnosis of asthma (International Classification of Disease 9th revision, code 493.xx) below age of 18 during 2001 and 2002. There were 71 stations of air quality monitor distributed in whole country. The data on average concentration of nitrogen dioxide (NO2), carbon monoxide (CO), ozone (O3), sulphur dioxide (SO2), and particles with aerodynamic diameter <10 mm (PM10) in each month were from Environmental Protection Department. The PSI value (pollutants standard index) above 100 was a reflection of poor air quality. We compare the association of seasonal variation of asthma admission and air pollution quality by using Pearson’s correlation. RESULTS: It had two peak seasons of asthma admission within one year, one was in autumn into winter (14.1/100000) and the other was during early spring (10.0/100000). The prevalence of asthma hospitalization had no relation to days that PSI above 100 in each month (r5-.266 p 5 .209) during this period. However, it was associated with the concentration change of each pollutant. The most related air pollutant variables was O3 (r 5 .570, p 5 .004) followed by PM10 (r 5 .546, p 5 .006) and NO3 (r 5 .534, p 5 .007). CONCLUSIONS: The seasonal variations of asthma hospitalization of children were not associated with days of poor air quality in each month, but associated with air pollutants concentration.
368
Indicators Of IgE-Mediated Clinical Reactivity To Peanut In Children J. A. Pongracic1, C. L. Sullivan2, H. Tsai2, X. Liu2, X. Wang2; 1Children’s Memorial Hospital, Chicago, IL, 2The Mary Ann and J Milburn Smith Child Health Research Program, Children’s Memorial Hospital and Children’s Memorial Research Center, Chicago, IL. RATIONALE: Diagnosis of peanut allergy is primarily based upon history. Prick skin tests (PST) and allergen specific IgE (sIgE) are sometimes obtained without a clear history of clinical reactivity (CR). This study evaluates the relationship between PST, sIgE, atopic dermatitis (AD), multiple food allergies (MFA) and parental atopy (PA) with CR to peanut. METHODS: Children enrolled in a family-based food allergy study underwent standard questionnaire interview, PST (Multi-Test II, Lincoln Diagnostics) and sIgE analysis (ImmunoCAP, Phadia). CR was defined as typical symptoms of IgE-mediated reactions affecting 2 organ systems within 30 minutes of peanut ingestion. Multiple logistic regression models were utilized to examine the associations with adjustment for age, gender, and intrafamilial correlation. Odds ratios (OR) for continuous wheal size were for a 5 mm increase over 3 mm and for continuous log10IgE, an increase to log10 of 15 klU/L from log10 of detectable. RESULTS: Among 499 study children, 33 (7%) had CR to peanut. Including both PST and log10sIgE resulted in the best model for CR (PST: OR 5 1.8; 95%CI: 1.1-2.8, p 5 0.01; log10sIgE: OR 5 5.5; 95%CI: 2.114.5, p 5 0.0006). AD and MFA were associated with CR in separate models (AD: OR 5 5.3; 95%CI: 2.1-13.0, p 5 0.001; MFA: OR 5 6.3; 95%CI: 3.0-13.7, p < 0.0001) but became insignificant when including PST and log10sIgE in the models. PA was not associated with CR. CONCLUSIONS: Both PST and log10sIgE were independently associated with CR to peanut but other variables did not add predictive value. Our findings suggest that using both tests may better indicate CR to peanut than using either one alone. Funding: The Food Allergy Project and Children’s Memorial Hospital’s General Clinical Research Center supported by the National Center for Research Resources, National Institutes of Health (M01 RR-00048)
369
Self-Reported Allergic Reactions to Peanuts and Tree Nuts Occurring in Schools and Child Care Facilities M. J. Greenhawt1, M. S. McMorris1, T. J. Furlong2; 1University of Michigan Health System, Ann Arbor, MI, 2Food Allergy & Anaphylaxis Network (FAAN), Fairfax, VA. RATIONALE: Since publication of the first self-reported surveys of peanut and tree nut allergic individuals, limited follow-up data of venue specific reactions is available. METHODS: An internet-based, self-report survey was openly advertised on the FAAN website. RESULTS: Age for onset of peanut allergy was 1.59 years and 2.25 years for tree nut (n 5 109). 96% were peanut allergic, 63% tree nut allergic, and 59% reported both. 41% reported multiple school/child care reactions. 77% of reactions occurred in facilities without nut-restricting policies. 67.5% occurred in locations without nursing, including child care (44%), pre-school (28%), and kindergarten (16%). Implicated nuts included peanut (85%), hazelnut (4%), pistachio (4%), and cashew (2.6%). 68% of cases involved known nut-allergic individuals. 25% reported severe symptoms, 24% moderate, and 51% mild. 63% had an allergy action plan on file at the time of the reaction, which was followed in only 20% of cases. 60% had a source of self-injectable epinephrine available, but was administered in only 33% of cases. 50% reported delay in receiving epinephrine beyond 10 minutes. 80% received H-1 antihistamines. Since the reaction an additional 47% now maintain an action plan and 41% have changed facilities. Only 42% report their school/facility made any changes in response to the reaction. CONCLUSIONS: Since the first report of reactions occurring in school, more students are being treated with epinephrine, but delay in treatment is still evident. Ongoing education about food allergy in schools and child care facilities is needed to protect susceptible individuals from nut allergen exposure on-site.
SUNDAY
366
J ALLERGY CLIN IMMUNOL VOLUME 121, NUMBER 2
AIRIAP 2: Childhood Asthma Control in Asia According to the Global Initiative for Asthma (GINA) Criteria G. Wong1, K. Gunasekera2, J. Hong3, J. Hsu4; 1Chinese University of Hong Kong, Hong Kong, HONG KONG, 2Central Chest Clinic, Colombo, SRI LANKA, 3Shanghai Jiaotong University, Shanghai, CHINA, 4 Taichung Veterans General Hospital, Taichung, TAIWAN. RATIONALE: Poor assessment of asthma control and under-treatment are the major causes for the sub-optimal management of asthma worldwide. The 2006 revised GINA guideline emphasizes the importance of assessing control. The study aims were to: (1) assess asthma control in Asia based on all the GINA criteria (daytime and nighttime symptoms, need for rescue medications, activity limitation and exacerbations), except lung function, and (2) evaluate the validity of the Childhood Asthma Control Test (C-ACT) in predicting level of asthma control. METHODS: A questionnaire based on asthma symptoms, health care utilization and management was administered in a face-to-face setting in the respondent’s language of choice. Children aged <16 years with diagnosed asthma and current asthma symptoms or taking medications for their asthma were recruited from China, Hong Kong, India, Indonesia, Korea, Malaysia, Philippines, Singapore, Sri Lanka, Taiwan, Thailand and Vietnam. RESULTS: A total of 988 respondents were identified by screening 172,364 households. Twenty-five (2.5%) had controlled, 435 (44.0%) partly controlled and 528 (53.4%) uncontrolled asthma. Even in the uncontrolled group, only 99 (18.8%) patients were taking inhaled corticosteroid. A total of 162 children completed the C-ACT. Receiver operating characteristic (ROC) analyses revealed the best cut-off score was 19 in identifying uncontrolled asthma (sensitivity: 0.61; specificity: 0.84). CONCLUSIONS: An overwhelming majority (97.5%) of asthmatic children in Asia had sub-optimal control. The C-ACT is a valid tool in predicting uncontrolled asthma, as defined by the GINA criteria. Use of simple assessment tools like the ACT may help clinicians to identify patients with uncontrolled asthma requiring appropriate anti-inflammatory therapy. Funding: GlaxoSmithKline
367
The Seasonal Variation of Asthma Hospitalization was Associated with Air Pollution among Children K. Yeh, M. Chen, J. Huang; Chang Gung Children’s Hospital, Taoyuan, TAIWAN. RATIONALE: To evaluate the association of seasonal variation of air pollution and asthma hospitalization in children within two year periods. METHODS: The National Health Insurances covered health care for more than 96% of whole populations in Taiwan. By using the database, we investigated the seasonal variation of hospitalization trend with primary diagnosis of asthma (International Classification of Disease 9th revision, code 493.xx) below age of 18 during 2001 and 2002. There were 71 stations of air quality monitor distributed in whole country. The data on average concentration of nitrogen dioxide (NO2), carbon monoxide (CO), ozone (O3), sulphur dioxide (SO2), and particles with aerodynamic diameter <10 mm (PM10) in each month were from Environmental Protection Department. The PSI value (pollutants standard index) above 100 was a reflection of poor air quality. We compare the association of seasonal variation of asthma admission and air pollution quality by using Pearson’s correlation. RESULTS: It had two peak seasons of asthma admission within one year, one was in autumn into winter (14.1/100000) and the other was during early spring (10.0/100000). The prevalence of asthma hospitalization had no relation to days that PSI above 100 in each month (r5-.266 p 5 .209) during this period. However, it was associated with the concentration change of each pollutant. The most related air pollutant variables was O3 (r 5 .570, p 5 .004) followed by PM10 (r 5 .546, p 5 .006) and NO3 (r 5 .534, p 5 .007). CONCLUSIONS: The seasonal variations of asthma hospitalization of children were not associated with days of poor air quality in each month, but associated with air pollutants concentration.
368
Indicators Of IgE-Mediated Clinical Reactivity To Peanut In Children J. A. Pongracic1, C. L. Sullivan2, H. Tsai2, X. Liu2, X. Wang2; 1Children’s Memorial Hospital, Chicago, IL, 2The Mary Ann and J Milburn Smith Child Health Research Program, Children’s Memorial Hospital and Children’s Memorial Research Center, Chicago, IL. RATIONALE: Diagnosis of peanut allergy is primarily based upon history. Prick skin tests (PST) and allergen specific IgE (sIgE) are sometimes obtained without a clear history of clinical reactivity (CR). This study evaluates the relationship between PST, sIgE, atopic dermatitis (AD), multiple food allergies (MFA) and parental atopy (PA) with CR to peanut. METHODS: Children enrolled in a family-based food allergy study underwent standard questionnaire interview, PST (Multi-Test II, Lincoln Diagnostics) and sIgE analysis (ImmunoCAP, Phadia). CR was defined as typical symptoms of IgE-mediated reactions affecting 2 organ systems within 30 minutes of peanut ingestion. Multiple logistic regression models were utilized to examine the associations with adjustment for age, gender, and intrafamilial correlation. Odds ratios (OR) for continuous wheal size were for a 5 mm increase over 3 mm and for continuous log10IgE, an increase to log10 of 15 klU/L from log10 of detectable. RESULTS: Among 499 study children, 33 (7%) had CR to peanut. Including both PST and log10sIgE resulted in the best model for CR (PST: OR 5 1.8; 95%CI: 1.1-2.8, p 5 0.01; log10sIgE: OR 5 5.5; 95%CI: 2.114.5, p 5 0.0006). AD and MFA were associated with CR in separate models (AD: OR 5 5.3; 95%CI: 2.1-13.0, p 5 0.001; MFA: OR 5 6.3; 95%CI: 3.0-13.7, p < 0.0001) but became insignificant when including PST and log10sIgE in the models. PA was not associated with CR. CONCLUSIONS: Both PST and log10sIgE were independently associated with CR to peanut but other variables did not add predictive value. Our findings suggest that using both tests may better indicate CR to peanut than using either one alone. Funding: The Food Allergy Project and Children’s Memorial Hospital’s General Clinical Research Center supported by the National Center for Research Resources, National Institutes of Health (M01 RR-00048)
369
Self-Reported Allergic Reactions to Peanuts and Tree Nuts Occurring in Schools and Child Care Facilities M. J. Greenhawt1, M. S. McMorris1, T. J. Furlong2; 1University of Michigan Health System, Ann Arbor, MI, 2Food Allergy & Anaphylaxis Network (FAAN), Fairfax, VA. RATIONALE: Since publication of the first self-reported surveys of peanut and tree nut allergic individuals, limited follow-up data of venue specific reactions is available. METHODS: An internet-based, self-report survey was openly advertised on the FAAN website. RESULTS: Age for onset of peanut allergy was 1.59 years and 2.25 years for tree nut (n 5 109). 96% were peanut allergic, 63% tree nut allergic, and 59% reported both. 41% reported multiple school/child care reactions. 77% of reactions occurred in facilities without nut-restricting policies. 67.5% occurred in locations without nursing, including child care (44%), pre-school (28%), and kindergarten (16%). Implicated nuts included peanut (85%), hazelnut (4%), pistachio (4%), and cashew (2.6%). 68% of cases involved known nut-allergic individuals. 25% reported severe symptoms, 24% moderate, and 51% mild. 63% had an allergy action plan on file at the time of the reaction, which was followed in only 20% of cases. 60% had a source of self-injectable epinephrine available, but was administered in only 33% of cases. 50% reported delay in receiving epinephrine beyond 10 minutes. 80% received H-1 antihistamines. Since the reaction an additional 47% now maintain an action plan and 41% have changed facilities. Only 42% report their school/facility made any changes in response to the reaction. CONCLUSIONS: Since the first report of reactions occurring in school, more students are being treated with epinephrine, but delay in treatment is still evident. Ongoing education about food allergy in schools and child care facilities is needed to protect susceptible individuals from nut allergen exposure on-site.
SUNDAY
366