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Allergic Rhinitis and Inner-City Children–Is There a Relationship to Sleep-Disordered Breathing?
S154 Abstracts
604
SUNDAY
Ocular Allergy: A National Epidemiologic Study K. Singh, L. Bielory; UMDNJ, Newark, NJ. RATIONALE: To evaluate prevalence of ocular allergy as it relates to common allergen skin reactivity. METHODS: The National Health and Nutrition Examination Survey III database (NHANES) was evaluated to determine the relation between positive wheal reaction (WR) and report of allergy symptoms. The NHANES questions used for screening were: ‘‘During the past 12 months, have you had any episodes of watery, itchy eyes? During the past 12 months, have you had any episodes of stuffy, itchy, or runny nose?’’ The data was stratified into three populations: allergic rhinitis (AR), allergic conjunctivitis (AC) and those with both AC and AR (AR1AC). WR data was extracted for White oak, Russian thistle, perennial rye (PR), rye grass, Alternaria alternata, Bermuda grass (BG), short ragweed (RW), cat, house dust mite (HDM) and German cockroach (GC). RESULTS: 3263 individuals had positive skin testing (AR 5 1034; AC 5 300; AR1AC 5 1929) with no overlap of patients. For all three populations, the most common outdoor allergens were PR > RW > BG; indoor allergens were GC > HDM. All populations had a 60% reactivity to outdoor allergens and 40% to indoor allergens. A greater percentage of those with AC had positive skin tests to all allergens compared to those with AR (11.33-34.63% vs. 2.03-7.35%). CONCLUSIONS: The population reporting AC is a distinct population when compared to those with AR, having a higher percentage of cutaneous reactivity. In the general population, ocular allergy prevalence appears to be at least four fold greater than nasal allergy symptoms.
605
Symptoms of Allergic Rhinitis in Mothers during Early Pregnancy are Associated with Higher Prevalence of Allergic Rhinitis in their Offspring M. Shinohara1,2, H. Wakiguchi1, H. Saito2, K. Matsumoto2; 1Kochi University, Kochi Medical School, Department of Pediatrics, Kochi, JAPAN, 2 National Research Institute for Child Health and Development, Tokyo, JAPAN. RATIONALE: Epigenetic control of gene expression profiles is a ubiquitous mechanism during cell differentiation, organogenesis or chronic inflammatory reactions. Recent studies showed that allergen exposure during pregnancy increases bronchial hypersensitivity of their offspring in a murine model of bronchial asthma, however, no such phenomena were reported in humans. In the present study, the role of epigenetic control in the onset of allergic diseases was investigated. METHODS: A total of 400 pairs of mothers with physician-diagnosed allergic rhinitis (AR) and their offspring (age 1.7-18.7 months) who participated in a large scale medical checkup were enrolled in this retrospective cohort study. Family history of allergic diseases, the number of older siblings, the presence or absence of the symptoms of AR during pregnancy was asked by a self-writing questionnaire. A logistic regression model adjusted for age, gender, birth month and family history of allergic diseases was analyzed by STATA software. RESULTS: Offspring whose mothers had any symptoms of AR during early pregnancy showed significantly higher adjusted odds ratio for the onset of offspring’s AR than those whose mothers had no symptom during pregnancy (aOR: 6.262, 95%CI: 1.123-34.918, p 5 0.036). However, the symptoms of AR during late pregnancy showed no effects on the odds ratio. In contrast, the presence or absence of the symptoms of AR during early or late pregnancy showed no association with the prevalence of food allergy, atopic dermatitis or asthma in their offspring. CONCLUSIONS: Our results imply the presence of possible epigenetic mechanisms regulating the onset of AR presumably through increased organ-specific hypersensitivity. Funding: Japanese Ministry of Education, Culture, Sports, Science and Technology & ‘‘Foundation for Life’’ Charitable Trust of The Kochi Shinbun and Kochi Broadcasting
J ALLERGY CLIN IMMUNOL JANUARY 2007
606
Allergic Rhinitis and Inner-City Children–Is There a Relationship to Sleep-Disordered Breathing? N. Gupta1, U. Emre1, S. Kearney2, R. A. Fermo1, B. Silverman1, A. T. Schneider1; 1Long Island College Hospital, Brooklyn, NY, 2Lehigh Valley Hospital, Allentown, PA. RATIONALE: Allergic rhinitis (AR), common in children, causes increased upper airway resistance and may lead to sleep-disordered breathing (SDB), which often goes undiagnosed. The goals of this study were to assess the pattern of aeroallergen sensitization in inner-city pediatric patients with SDB and to determine if intranasal corticosteroid treatment improves SDB, using a validated Pediatric Sleep Questionnaire (PSQ). METHODS: Patients (ages 2-18) were evaluated for AR and completed the PSQ prior to treatment. Skin prick testing (SPT) to aeroallergens, including inner-city culprits (rat, cockroach, and mouse), was performed. Patients with a history of AR, SPT evaluation, and at least one positive response on the PSQ were treated with intranasal mometasone furoate monohydrate, environmental control, (1/2) antihistamines. After six weeks of treatment, PSQ responses were reassessed. RESULTS: Of the 24 patients recruited in this ongoing study, 100% had SDB as per PSQ responses; 91% had 1 positive SPT, 75% of which were SPT-positive to cockroach, mouse, or rat. Prior to treatment, patients’ average PSQ score 5 5.96 questions; following treatment, an average PSQ score 5 2.38, indicating clinical improvement (p<0.0001 paired t test.) CONCLUSIONS: Children suffering from AR have increased nasal obstruction leading to sleep-disordered events. This study demonstrated adequate treatment, including an intranasal steroid, may significantly improve SDB, as per PSQ results. In inner-city children, elimination of indoor allergens such as cockroach, mouse, or rat may further improve SDB. Larger prospective studies are needed to further validate these preliminary results.
607
Haplotype Tagging SNPs in the Beta Adrenergic Receptor (ADRB2) Gene are Associated with Pre and Postbronchodilator Lung Function in Preschool Children A. Simpson, J. Hankinson, S. Borg-Bartolo, L. Lowe, S. John, A. Woodcock, W. Ollier, A. Custovic; University of Manchester, Manchester, UNITED KINGDOM. RATIONALE: Specific airway resistance (sRaw) is a sensitive and reproducible measure of lung function in children - higher sRaw indicating poorer lung function. Albuterol (ADRB2 agonist) is the most common treatment for wheezing illness. We investigated the relationship between five haplotype tagging SNPs in ADRB2 and pre and post albuterol lung function at age 5 years in a population based birth cohort. METHODS: Lung function was assessed using plethysmographic measurement of sRaw at baseline and after bronchodilator (400 mcg albuterol). Children (n 5 665) were genotyped for variants in the ADRB2 gene (rs1042713-Arg16Gly, rs1042714-Gln27Glu, rs1800888-Thr164Ile, rs1042718, rs1042719). Results were analysed using regression. Analysis of post-bronchodilator sRaw was adjusted for baseline value; these results are presented as estimated marginal means (EMM). RESULTS: All SNPs were in Hardy Weinberg equilibrium (P>0.01). Baseline lung function was significantly better amongst Glu27 homozygotes of rs1042714 compared to other genotypes (kPa/s, GM [95% CI] 1.13 [1.09-1.17] vs. 1.18 [1.15-1.20], p 5 0.03). Carriers of Glu27 of rs1042714 had significantly better post-bronchodilator lung function than Gln27 homozygotes (EMM [95% CI} 0.97 [0.96-0.99] vs. 1.01 [0.99-1.03], p 5 0.002). For rs1042718, common allele homozygotes had better lung function both pre- (1.15 [1.14-1.17] vs.1.20 [1.16-1.23], p 5 0.02) and post-bronchodilator (0.97 [0.96-0.99] vs. 1.01 [0.99-1.03], p 5 0.001). A five-marker haplotype was significantly associated with post-bronchodilator lung function (p 5 0.013). CONCLUSIONS: In a sample of five year old children representative of the general population, polymorphisms in the ADRB2 gene predict baseline lung function. Furthermore, lung function after maximum bronchodilation was associated with variants in the ADRB2 gene independently of baseline lung function. Funding: Moulton Charitable Trust
604
SUNDAY
Ocular Allergy: A National Epidemiologic Study K. Singh, L. Bielory; UMDNJ, Newark, NJ. RATIONALE: To evaluate prevalence of ocular allergy as it relates to common allergen skin reactivity. METHODS: The National Health and Nutrition Examination Survey III database (NHANES) was evaluated to determine the relation between positive wheal reaction (WR) and report of allergy symptoms. The NHANES questions used for screening were: ‘‘During the past 12 months, have you had any episodes of watery, itchy eyes? During the past 12 months, have you had any episodes of stuffy, itchy, or runny nose?’’ The data was stratified into three populations: allergic rhinitis (AR), allergic conjunctivitis (AC) and those with both AC and AR (AR1AC). WR data was extracted for White oak, Russian thistle, perennial rye (PR), rye grass, Alternaria alternata, Bermuda grass (BG), short ragweed (RW), cat, house dust mite (HDM) and German cockroach (GC). RESULTS: 3263 individuals had positive skin testing (AR 5 1034; AC 5 300; AR1AC 5 1929) with no overlap of patients. For all three populations, the most common outdoor allergens were PR > RW > BG; indoor allergens were GC > HDM. All populations had a 60% reactivity to outdoor allergens and 40% to indoor allergens. A greater percentage of those with AC had positive skin tests to all allergens compared to those with AR (11.33-34.63% vs. 2.03-7.35%). CONCLUSIONS: The population reporting AC is a distinct population when compared to those with AR, having a higher percentage of cutaneous reactivity. In the general population, ocular allergy prevalence appears to be at least four fold greater than nasal allergy symptoms.
605
Symptoms of Allergic Rhinitis in Mothers during Early Pregnancy are Associated with Higher Prevalence of Allergic Rhinitis in their Offspring M. Shinohara1,2, H. Wakiguchi1, H. Saito2, K. Matsumoto2; 1Kochi University, Kochi Medical School, Department of Pediatrics, Kochi, JAPAN, 2 National Research Institute for Child Health and Development, Tokyo, JAPAN. RATIONALE: Epigenetic control of gene expression profiles is a ubiquitous mechanism during cell differentiation, organogenesis or chronic inflammatory reactions. Recent studies showed that allergen exposure during pregnancy increases bronchial hypersensitivity of their offspring in a murine model of bronchial asthma, however, no such phenomena were reported in humans. In the present study, the role of epigenetic control in the onset of allergic diseases was investigated. METHODS: A total of 400 pairs of mothers with physician-diagnosed allergic rhinitis (AR) and their offspring (age 1.7-18.7 months) who participated in a large scale medical checkup were enrolled in this retrospective cohort study. Family history of allergic diseases, the number of older siblings, the presence or absence of the symptoms of AR during pregnancy was asked by a self-writing questionnaire. A logistic regression model adjusted for age, gender, birth month and family history of allergic diseases was analyzed by STATA software. RESULTS: Offspring whose mothers had any symptoms of AR during early pregnancy showed significantly higher adjusted odds ratio for the onset of offspring’s AR than those whose mothers had no symptom during pregnancy (aOR: 6.262, 95%CI: 1.123-34.918, p 5 0.036). However, the symptoms of AR during late pregnancy showed no effects on the odds ratio. In contrast, the presence or absence of the symptoms of AR during early or late pregnancy showed no association with the prevalence of food allergy, atopic dermatitis or asthma in their offspring. CONCLUSIONS: Our results imply the presence of possible epigenetic mechanisms regulating the onset of AR presumably through increased organ-specific hypersensitivity. Funding: Japanese Ministry of Education, Culture, Sports, Science and Technology & ‘‘Foundation for Life’’ Charitable Trust of The Kochi Shinbun and Kochi Broadcasting
J ALLERGY CLIN IMMUNOL JANUARY 2007
606
Allergic Rhinitis and Inner-City Children–Is There a Relationship to Sleep-Disordered Breathing? N. Gupta1, U. Emre1, S. Kearney2, R. A. Fermo1, B. Silverman1, A. T. Schneider1; 1Long Island College Hospital, Brooklyn, NY, 2Lehigh Valley Hospital, Allentown, PA. RATIONALE: Allergic rhinitis (AR), common in children, causes increased upper airway resistance and may lead to sleep-disordered breathing (SDB), which often goes undiagnosed. The goals of this study were to assess the pattern of aeroallergen sensitization in inner-city pediatric patients with SDB and to determine if intranasal corticosteroid treatment improves SDB, using a validated Pediatric Sleep Questionnaire (PSQ). METHODS: Patients (ages 2-18) were evaluated for AR and completed the PSQ prior to treatment. Skin prick testing (SPT) to aeroallergens, including inner-city culprits (rat, cockroach, and mouse), was performed. Patients with a history of AR, SPT evaluation, and at least one positive response on the PSQ were treated with intranasal mometasone furoate monohydrate, environmental control, (1/2) antihistamines. After six weeks of treatment, PSQ responses were reassessed. RESULTS: Of the 24 patients recruited in this ongoing study, 100% had SDB as per PSQ responses; 91% had 1 positive SPT, 75% of which were SPT-positive to cockroach, mouse, or rat. Prior to treatment, patients’ average PSQ score 5 5.96 questions; following treatment, an average PSQ score 5 2.38, indicating clinical improvement (p<0.0001 paired t test.) CONCLUSIONS: Children suffering from AR have increased nasal obstruction leading to sleep-disordered events. This study demonstrated adequate treatment, including an intranasal steroid, may significantly improve SDB, as per PSQ results. In inner-city children, elimination of indoor allergens such as cockroach, mouse, or rat may further improve SDB. Larger prospective studies are needed to further validate these preliminary results.
607
Haplotype Tagging SNPs in the Beta Adrenergic Receptor (ADRB2) Gene are Associated with Pre and Postbronchodilator Lung Function in Preschool Children A. Simpson, J. Hankinson, S. Borg-Bartolo, L. Lowe, S. John, A. Woodcock, W. Ollier, A. Custovic; University of Manchester, Manchester, UNITED KINGDOM. RATIONALE: Specific airway resistance (sRaw) is a sensitive and reproducible measure of lung function in children - higher sRaw indicating poorer lung function. Albuterol (ADRB2 agonist) is the most common treatment for wheezing illness. We investigated the relationship between five haplotype tagging SNPs in ADRB2 and pre and post albuterol lung function at age 5 years in a population based birth cohort. METHODS: Lung function was assessed using plethysmographic measurement of sRaw at baseline and after bronchodilator (400 mcg albuterol). Children (n 5 665) were genotyped for variants in the ADRB2 gene (rs1042713-Arg16Gly, rs1042714-Gln27Glu, rs1800888-Thr164Ile, rs1042718, rs1042719). Results were analysed using regression. Analysis of post-bronchodilator sRaw was adjusted for baseline value; these results are presented as estimated marginal means (EMM). RESULTS: All SNPs were in Hardy Weinberg equilibrium (P>0.01). Baseline lung function was significantly better amongst Glu27 homozygotes of rs1042714 compared to other genotypes (kPa/s, GM [95% CI] 1.13 [1.09-1.17] vs. 1.18 [1.15-1.20], p 5 0.03). Carriers of Glu27 of rs1042714 had significantly better post-bronchodilator lung function than Gln27 homozygotes (EMM [95% CI} 0.97 [0.96-0.99] vs. 1.01 [0.99-1.03], p 5 0.002). For rs1042718, common allele homozygotes had better lung function both pre- (1.15 [1.14-1.17] vs.1.20 [1.16-1.23], p 5 0.02) and post-bronchodilator (0.97 [0.96-0.99] vs. 1.01 [0.99-1.03], p 5 0.001). A five-marker haplotype was significantly associated with post-bronchodilator lung function (p 5 0.013). CONCLUSIONS: In a sample of five year old children representative of the general population, polymorphisms in the ADRB2 gene predict baseline lung function. Furthermore, lung function after maximum bronchodilation was associated with variants in the ADRB2 gene independently of baseline lung function. Funding: Moulton Charitable Trust