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Asthma Prevalence and Morbidity Among Urban and Rural School Children in Arkansas
S210 Abstracts
807
Performance Evaluation of Allergen Exposure Assessment using Fluorescent Multiplex Array Technology: - A MultiCenter Ring Trial E. M. King1, S. Filep1, B. Smith1, N. Metwali2, P. S. Thorne2, S. Versteeg3, R. van Ree3, S. Arbes4, A. Calatroni4, H. Mitchell4, M. D. Chapman1; 1INDOOR Biotechnologies Inc., Charlottesville, VA, 2Dept Occupational and Environmental Health, University of Iowa, Iowa City, IA, 3Academic Medical Center, Amsterdam, Netherlands, 4Rho, Inc, Chapel Hill, NC. RATIONALE: Standardization of allergen exposure measurements is important to ensure reproducibility of results obtained by different laboratories. We evaluated reproducibility and inter-laboratory variability of a Multiplex Array for Indoor Allergens (MARIA), including Der p 1, Der f 1, Mite Group 2, Fel d 1, Can f 1, Rat n 1, Mus m 1 and Bla g 2. METHODS: For evaluation of the 8-plex MARIA, we used a multi-center ring trial. Ten laboratories across the US and Europe were recruited and trained to use the technology. All reagents required for the trial, as well as aliquots of an identical set of 151 dust extract samples, were sent to each of the 10 participating centers and analyzed by each laboratory on three separate occasions at three dilutions. A hierarchical model was applied to the nested data structure (repeat nested within laboratories, laboratories nested within samples). RESULTS: Complete results for 3 of the 10 participating laboratories were available at time of submission. The current results are based on more than 10,000 individual allergen measurements. More than 36,000 tests will eventually be completed. Allergens levels covered a wide range from below detection limit to greater than 100ug/g (Mus m 1 < 35ug/g). Results were highly reproducible within as well as between the three laboratories, with correlation coefficients generally greater than 0.95. CONCLUSIONS: The data indicate that the MARIA produces results that are reproducible within and between laboratories, which will improve standardization of allergen exposure assessment.
808
MONDAY
Asthma Prevalence and Morbidity Among Urban and Rural School Children in Arkansas R. D. Pesek1, P. A. Vargas2, S. M. Jones1, A. M. Scurlock1, A. McCracken1, T. T. Perry1; 1University of Arkansas for Medical Sciences/Arkansas Children’s Hospital Research Institute, Little Rock, AR, 2 Arizona State University, Glendale, AZ. RATIONALE: To compare asthma prevalence and morbidity between urban and rural schoolchildren in Arkansas. METHODS: We analyzed completed asthma screener data between urban (Little Rock, n 5 5,417) and rural (Marvell and Eudora, n 5 964) schoolchildren to compare asthma prevalence in each region. Data were analyzed to compare symptoms severity, medication use, and healthcare utilization among at-risk children in each group. RESULTS: Both populations were predominately African American [91% rural vs. 69% urban, p 5 0.001] with significantly more rural children having state-issued medical insurance [78% vs. 37%, p < 0.001]. Physician-diagnosed asthma was similar between rural (20%) and urban (21%) children. Among the at-risk population, rural children were more likely to fit symptoms criteria for moderate-to-severe asthma compared to urban children [46% vs. 36%, p < 0.001]. Rural children were also more likely to be diagnosed with bronchitis [OR 3.4; 95% CI 2.5-4.6], had more recurrent breathing problems [OR 1.8; 95% CI 1.5-2.2], recurrent cough [OR 2.2; 95% CI 1.9-2.6], repeated episodes of bronchitis [OR 2.2; 95% CI 1.7-2.8] and recurrent chest tightness [OR1.8; 95% CI 1.5-2.2] in the preceding 2 years. Rural children were more likely to miss school due to asthma [p 5 0.001], have exercise-induced symptoms [p 5 0.001], and use rescue medications [p 5 0.001] in the preceding 4 weeks. There were no differences in emergency healthcare utilization between groups. CONCLUSIONS: Although asthma remains a significant public health concern for children living in all regions of Arkansas, these data suggest rural children in Arkansas have significantly more morbidity due to asthma.
J ALLERGY CLIN IMMUNOL FEBRUARY 2009
809
Allergen and Endotoxin Exposure, Infection, and Breastfeeding in Early Life, and Recurrent Wheezing in Children: 48-month Follow-up of a Cohort Study V. E. V. Rullo1, L. K. Arruda2,1, V. Valente1, A. S. Zampolo2,1, M. R. Cardoso3,1, F. J. No´brega4,1, C. S. K. La Scala1, L. C. L. Oliveira1, C. K. Naspitz1, D. Sole´1; 1Federal University of Sa˜o Paulo, Sa˜o Paulo, Brazil, 2 Medicine, School of Medicine of Ribeira˜o Preto-USP, Ribeira˜o Preto, Brazil, 3School of Public Health-USP, Sa˜o Paulo, Brazil, 4Pediatrics, Albert Einstein Hospital, Sa˜o Paulo, Brazil. RATIONALE: Exposure to environmental factors early in life may have a critical role in subsequent development of sensitization and asthma. METHODS: One-hundred and four newborns were enrolled at birth in this cohort study. Children belonged to low-income families and were at high risk for asthma. Recurrent wheezing was defined as three or more wheezing episodes in the past year. Infection of the upper or lower respiratory tract requiring antibiotics was recorded. Dust samples were collected from bedding and floor of the infants’ bedroom within six months after birth. Endotoxin content was determined by Limulus Amebocyte Lysate assay, and major allergens from mites, cockroach, cat, dog, mouse and rat were quantitated by ELISA in dust extracts. Serum IgE antibodies were quantitated by ImmunoCAP. RESULTS: At age 48 months, 35/98 (35.7%) children presented with recurrent wheezing. Multivariate analysis revealed that respiratory infection in the first 12 months of life was associated with recurrent wheezing, OR (95% CI) 3.94 (1.29-11.98), p 5 0.016, whereas allergen exposure, exclusive breast feeding for at least four months, male gender, and high levels of exposure to endotoxin had no effect. Sensitization to D. pteronyssinus (CAP score2) was found in 25/90 (27%) children, with no association with recurrent wheezing. CONCLUSIONS: Respiratory infection in the first 12 months of life was associated with recurrent wheezing at age 4, whereas exposure to allergen and high levels of endotoxin in early life and exclusive breastfeeding for at least four months showed no effect in development of asthma.
810
Specific Oral Tolerance Induction In Children With Systemic Cow Milk Allergy. M. Reche1, T. Valbuena1, A. Fiandor2, M. A. Padial1, M. Martı´n-Esteban2, C. Pascual1; 1Hospital Infanta Sofı´a, San Sebastian de los Reyes, Madrid, Spain, 2Hospital La Paz, Madrid, Spain. RATIONALE: The aim of this study was to evaluate the safety and efficacy of specific oral tolerance induction (SOTI) in children with severe cow’s milk allergy (CMA) induced reactions. METHODS: A group of patients with diagnosis of CMA (positive SPT and sIgE to milk and/or milk proteins), underwent a double-blind, placebo-controlled food challenge. Oral desensitization was performed with increasing doses starting with 0.01 mg of cow’s milk proteins in order to enable the child to assume 200 ml of cow’s milk (CM) daily, or to induce tolerance of the highest possible CM dose. RESULTS: Sixteen children older than 3 years, (mean 3.5 years), and a diagnosis of CMA were included. All the challenges performed were positive, 9 patients developed anaphylaxis and 7 generalized urticaria. Overall, 13 of 16 patients (81.2%) achived the daily intake of 200 ml in a mean period of 4.2 months, one of the 16 patients (6.2%) tolerated 80 ml/ day of undiluted CM; all of them maintain clinical tolerance after one year. Two of the 21 (12.4%) failed the desensitization because they presented anaphylactic reactions after the intake of minimal amounts of diluted CM. CONCLUSIONS: We successfully desensitized 13 of 16 patients with systemic IgE-mediated CMA. Total or partial tolerance improves the quality of live of these patients, and reduces the risk of severe reactions after accidental ingestion of low quantities of CM.
807
Performance Evaluation of Allergen Exposure Assessment using Fluorescent Multiplex Array Technology: - A MultiCenter Ring Trial E. M. King1, S. Filep1, B. Smith1, N. Metwali2, P. S. Thorne2, S. Versteeg3, R. van Ree3, S. Arbes4, A. Calatroni4, H. Mitchell4, M. D. Chapman1; 1INDOOR Biotechnologies Inc., Charlottesville, VA, 2Dept Occupational and Environmental Health, University of Iowa, Iowa City, IA, 3Academic Medical Center, Amsterdam, Netherlands, 4Rho, Inc, Chapel Hill, NC. RATIONALE: Standardization of allergen exposure measurements is important to ensure reproducibility of results obtained by different laboratories. We evaluated reproducibility and inter-laboratory variability of a Multiplex Array for Indoor Allergens (MARIA), including Der p 1, Der f 1, Mite Group 2, Fel d 1, Can f 1, Rat n 1, Mus m 1 and Bla g 2. METHODS: For evaluation of the 8-plex MARIA, we used a multi-center ring trial. Ten laboratories across the US and Europe were recruited and trained to use the technology. All reagents required for the trial, as well as aliquots of an identical set of 151 dust extract samples, were sent to each of the 10 participating centers and analyzed by each laboratory on three separate occasions at three dilutions. A hierarchical model was applied to the nested data structure (repeat nested within laboratories, laboratories nested within samples). RESULTS: Complete results for 3 of the 10 participating laboratories were available at time of submission. The current results are based on more than 10,000 individual allergen measurements. More than 36,000 tests will eventually be completed. Allergens levels covered a wide range from below detection limit to greater than 100ug/g (Mus m 1 < 35ug/g). Results were highly reproducible within as well as between the three laboratories, with correlation coefficients generally greater than 0.95. CONCLUSIONS: The data indicate that the MARIA produces results that are reproducible within and between laboratories, which will improve standardization of allergen exposure assessment.
808
MONDAY
Asthma Prevalence and Morbidity Among Urban and Rural School Children in Arkansas R. D. Pesek1, P. A. Vargas2, S. M. Jones1, A. M. Scurlock1, A. McCracken1, T. T. Perry1; 1University of Arkansas for Medical Sciences/Arkansas Children’s Hospital Research Institute, Little Rock, AR, 2 Arizona State University, Glendale, AZ. RATIONALE: To compare asthma prevalence and morbidity between urban and rural schoolchildren in Arkansas. METHODS: We analyzed completed asthma screener data between urban (Little Rock, n 5 5,417) and rural (Marvell and Eudora, n 5 964) schoolchildren to compare asthma prevalence in each region. Data were analyzed to compare symptoms severity, medication use, and healthcare utilization among at-risk children in each group. RESULTS: Both populations were predominately African American [91% rural vs. 69% urban, p 5 0.001] with significantly more rural children having state-issued medical insurance [78% vs. 37%, p < 0.001]. Physician-diagnosed asthma was similar between rural (20%) and urban (21%) children. Among the at-risk population, rural children were more likely to fit symptoms criteria for moderate-to-severe asthma compared to urban children [46% vs. 36%, p < 0.001]. Rural children were also more likely to be diagnosed with bronchitis [OR 3.4; 95% CI 2.5-4.6], had more recurrent breathing problems [OR 1.8; 95% CI 1.5-2.2], recurrent cough [OR 2.2; 95% CI 1.9-2.6], repeated episodes of bronchitis [OR 2.2; 95% CI 1.7-2.8] and recurrent chest tightness [OR1.8; 95% CI 1.5-2.2] in the preceding 2 years. Rural children were more likely to miss school due to asthma [p 5 0.001], have exercise-induced symptoms [p 5 0.001], and use rescue medications [p 5 0.001] in the preceding 4 weeks. There were no differences in emergency healthcare utilization between groups. CONCLUSIONS: Although asthma remains a significant public health concern for children living in all regions of Arkansas, these data suggest rural children in Arkansas have significantly more morbidity due to asthma.
J ALLERGY CLIN IMMUNOL FEBRUARY 2009
809
Allergen and Endotoxin Exposure, Infection, and Breastfeeding in Early Life, and Recurrent Wheezing in Children: 48-month Follow-up of a Cohort Study V. E. V. Rullo1, L. K. Arruda2,1, V. Valente1, A. S. Zampolo2,1, M. R. Cardoso3,1, F. J. No´brega4,1, C. S. K. La Scala1, L. C. L. Oliveira1, C. K. Naspitz1, D. Sole´1; 1Federal University of Sa˜o Paulo, Sa˜o Paulo, Brazil, 2 Medicine, School of Medicine of Ribeira˜o Preto-USP, Ribeira˜o Preto, Brazil, 3School of Public Health-USP, Sa˜o Paulo, Brazil, 4Pediatrics, Albert Einstein Hospital, Sa˜o Paulo, Brazil. RATIONALE: Exposure to environmental factors early in life may have a critical role in subsequent development of sensitization and asthma. METHODS: One-hundred and four newborns were enrolled at birth in this cohort study. Children belonged to low-income families and were at high risk for asthma. Recurrent wheezing was defined as three or more wheezing episodes in the past year. Infection of the upper or lower respiratory tract requiring antibiotics was recorded. Dust samples were collected from bedding and floor of the infants’ bedroom within six months after birth. Endotoxin content was determined by Limulus Amebocyte Lysate assay, and major allergens from mites, cockroach, cat, dog, mouse and rat were quantitated by ELISA in dust extracts. Serum IgE antibodies were quantitated by ImmunoCAP. RESULTS: At age 48 months, 35/98 (35.7%) children presented with recurrent wheezing. Multivariate analysis revealed that respiratory infection in the first 12 months of life was associated with recurrent wheezing, OR (95% CI) 3.94 (1.29-11.98), p 5 0.016, whereas allergen exposure, exclusive breast feeding for at least four months, male gender, and high levels of exposure to endotoxin had no effect. Sensitization to D. pteronyssinus (CAP score2) was found in 25/90 (27%) children, with no association with recurrent wheezing. CONCLUSIONS: Respiratory infection in the first 12 months of life was associated with recurrent wheezing at age 4, whereas exposure to allergen and high levels of endotoxin in early life and exclusive breastfeeding for at least four months showed no effect in development of asthma.
810
Specific Oral Tolerance Induction In Children With Systemic Cow Milk Allergy. M. Reche1, T. Valbuena1, A. Fiandor2, M. A. Padial1, M. Martı´n-Esteban2, C. Pascual1; 1Hospital Infanta Sofı´a, San Sebastian de los Reyes, Madrid, Spain, 2Hospital La Paz, Madrid, Spain. RATIONALE: The aim of this study was to evaluate the safety and efficacy of specific oral tolerance induction (SOTI) in children with severe cow’s milk allergy (CMA) induced reactions. METHODS: A group of patients with diagnosis of CMA (positive SPT and sIgE to milk and/or milk proteins), underwent a double-blind, placebo-controlled food challenge. Oral desensitization was performed with increasing doses starting with 0.01 mg of cow’s milk proteins in order to enable the child to assume 200 ml of cow’s milk (CM) daily, or to induce tolerance of the highest possible CM dose. RESULTS: Sixteen children older than 3 years, (mean 3.5 years), and a diagnosis of CMA were included. All the challenges performed were positive, 9 patients developed anaphylaxis and 7 generalized urticaria. Overall, 13 of 16 patients (81.2%) achived the daily intake of 200 ml in a mean period of 4.2 months, one of the 16 patients (6.2%) tolerated 80 ml/ day of undiluted CM; all of them maintain clinical tolerance after one year. Two of the 21 (12.4%) failed the desensitization because they presented anaphylactic reactions after the intake of minimal amounts of diluted CM. CONCLUSIONS: We successfully desensitized 13 of 16 patients with systemic IgE-mediated CMA. Total or partial tolerance improves the quality of live of these patients, and reduces the risk of severe reactions after accidental ingestion of low quantities of CM.