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Do aeroallergen sensitization and immunoglobulin E levels correlate with severity of asthma in Malaysian children?
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Posters / Paediatric Respiratory Reviews 13S1 (2012) S51–S85
summer was significantly lower than the percentage of positive results during the rest of the year in children (58.5% vs 75.4% respectively p = 0.046). By contrast there was no difference between the seasons in adults (39% vs 38% respectively p = 0.92). Conclusion: There is a significant difference in the percentage of positive tests in the summer months compared to the rest of the year in children suggesting a reduction in sensitivity of 22.4% of the MCH test in the hot season. We view this decrease as clinically significant and suggest that it should be taken into account when scheduling and interpreting metacholine studies. A04-56 Do aeroallergen sensitization and immunoglobulin E levels correlate with severity of asthma in Malaysian children? K.P. Eg, A.M. Nathan, J. deBruyne, F. Khalid. University Malaya Medical Center, Selangor, Malaysia Introduction: The aim of this study was to determine (1) aeroallergen sensitization, (2) total serum Immunoglobulin E (IgE) levels and (3) if there is an association between aeroallergen sensitization and IgE levels with asthma severity in Malaysian children with asthma. Methods: This was a cross-sectional study of 82 children who were part of another study, a case-control study on the risk of asthma in children delivered via caesarean section. This study was conducted in University Malaya Medical Centre, Malaysia from 1st September 2009 till 31st December 2010. The children were seen by either the paediatric respiratory specialist or trainee paediatric specialist and had a diagnosis of asthma based on a history of recurrent episodes of doctor-diagnosed wheezing. Asthma severity was categorized into intermittent, mild, moderate to severe persistent asthma as per GINA 2000. A simple demographic form was administered by the investigator, blood for total Ig E was taken and skin prick tests to 6 common aeroallergens i.e. dog, cat, house-dust mite mix(Dermatophagoides pteronyssinus and Dermatophagoides farinae, HDM), Blomia tropicalis (Bt) and cockroach (Blattela germanica) were done on each child. The skin prick test was considered positive if the resultant wheal (induration) was ≥3 mm larger than the negative control. Results: The median age of the patients was 8 years (IQR 5 years). The female:male ratio was 1:1.2. The median age of diagnosis of asthma was 3 years old. Only twenty-nine children (35.4%) were exclusively breast-fed for at least 4 months. Thirty-five children (42.7%) were exposed to post-natal environmental tobacco smoke. Most of the children (n = 70, 79.5%) had persistent asthma. The median FEV1 (n = 30) = 92% (IQR 15), the median FVC (n = 30) = 85.50% (IQR 18.5) and FEF25–75 (n = 28) = 97.71% (IQR 134). Frequency of aeroallergen sensitization was as follows: HDM mix = 84%, Bt = 72%, dog = 21.4%, cat = 32.9%, and cockroach = 17.1%. Seventy-three children (89%) were sensitized to at least one aeroallergen. The median IgE = 1240 iu/l (IQR 1436). There was no significant difference in IgE levels (z = −1.039, p = 0.299) or SPT positivity (p = 0.743) between children with intermittent and persistent asthma. Sensitization to ≥2 aeroallergens was significantly associated with higher IgE levels (z = −2.79, p = 0.005). Only house-dust mite sensitization was significantly associated with increase in severity of asthma (p = 0.018). Conclusion: Eighty-nine percent of Malaysian children were sensitized to one aeroallergen. The commonest aeroallergens were HDM and Bt. Bt is unique in the tropical environment and an aeroallergen associated with asthma. Neither IgE or SPT positivity correlated with asthma severity. Only sensitization to HDM was associated with severity of asthma.
A05-67 Effect of caesarean section on wheezing disorders Y.N. Li, H.J. Cheng, L. Liu, H.M. Giao. First Hospital of Jilin University Changchun, China Keywords: caesarean section, wheezing disorders, hospitalization
Background: Caesarean-section delivery has been showed associated with the subsequent development of wheezing disorders in childhood. Which maybe be the result of an altered immune system development due to altered gut microflora. Changchun is located in northeast China, where has a high incidence of wheezing disorders. Objective: To examine the association between caesarean section and development of wheezing disorders (obliterative bronchiolitis, asthma and bronchiolitis) in hospitalization children in Changchun. Methods: A retrospective study was explored, all children hospitalized in Chuangchun 1 January 2008 to 1 October 2010 were included in this study. Children born mode of delivery was categorized as vaginal (including forceps and ventouse extractions) or caesarean section (elective and emergency). All patients grouped according to disease category including cardiovascular system disease, nervous system disease, wheezing disorders (obliterative bronchiolitis, asthma and bronchiolitis), and unwheezing respiratory system disease. Results: Total 8285 patients were included in this study. Of these patients, 1748 were wheezing disorders, 3025 were unwheezing respiratory system diseases, 1065 were cardiovascular system diseases, 1129 were urinary system diseases, 1318 were nervous system disease. Of all the children, 3877 (46.8%) were delivered vaginally and 4408 (53.2%) by caesarean section. The percentage of caesarean section in different diseases were available for 1182 (67.6%) subjects for wheezing disorders; 1525 (50.4%) subjects for unwheezing respiratory system diseases; 503 (47.2%), 579 (51.3%), 668 (50.7%) for cardiovascular system diseases, urinary system diseases, and nervous system disease, respectively. Significantly increased risk of wheezing disorders was seen among children delivered by cesarean section. Findings were similar among children delivered by acute and elective cesarean section. However, cesarean section could not increase the risk of unwheezing respiratory system diseases, cardiovascular system diseases, urinary system diseases, and nervous system disease. Conclusion: Delivery by caesarean section was associated with the subsequent development of asthma, obliterative bronchiolitis, and bronchiolitis.in later childhood in this population. A06-71 Clostridium leptum-induced regulatory T cells protect against asthma Y.N. Li, H.J. Cheng. First Hospital of Jilin University Changchun, China Keywords: Clostridium leptum; asthma; regulatory T cell; immunoregulatory therapy
Background: Asthma is a chronic inflammatory disease of the airways that is driven by dysregulated immune responses. The most promising therapeutic strategies for allergic disease, which involve increasing the numbers or function of Tregs. Previous studies demonstrated that oral treatment with Clostridium leptum can expand and activate Tregs. Objectives: We tested the hypothesis that Tregs play an essential role in C. leptum-induced inflammation attenuation of asthma. Methods: Establishing OVA-sensitized mouse bronchial asthma model, treated daily with C. leptum, PBS-sensitized mice as control. The numbers of Foxp3+ CD4+ CD25+ Tregs in both spleen and mediastinal lymph node were detected. Inflammatory cell influx, cytokine levels in BALF, and airway Hyperresponsiveness of mice were also assessed. Results: Following 14 days of oral C. leptum treatment, the percentage and total number of Foxp3+ CD4+ CD25+ Tregs in spleens
Posters / Paediatric Respiratory Reviews 13S1 (2012) S51–S85
summer was significantly lower than the percentage of positive results during the rest of the year in children (58.5% vs 75.4% respectively p = 0.046). By contrast there was no difference between the seasons in adults (39% vs 38% respectively p = 0.92). Conclusion: There is a significant difference in the percentage of positive tests in the summer months compared to the rest of the year in children suggesting a reduction in sensitivity of 22.4% of the MCH test in the hot season. We view this decrease as clinically significant and suggest that it should be taken into account when scheduling and interpreting metacholine studies. A04-56 Do aeroallergen sensitization and immunoglobulin E levels correlate with severity of asthma in Malaysian children? K.P. Eg, A.M. Nathan, J. deBruyne, F. Khalid. University Malaya Medical Center, Selangor, Malaysia Introduction: The aim of this study was to determine (1) aeroallergen sensitization, (2) total serum Immunoglobulin E (IgE) levels and (3) if there is an association between aeroallergen sensitization and IgE levels with asthma severity in Malaysian children with asthma. Methods: This was a cross-sectional study of 82 children who were part of another study, a case-control study on the risk of asthma in children delivered via caesarean section. This study was conducted in University Malaya Medical Centre, Malaysia from 1st September 2009 till 31st December 2010. The children were seen by either the paediatric respiratory specialist or trainee paediatric specialist and had a diagnosis of asthma based on a history of recurrent episodes of doctor-diagnosed wheezing. Asthma severity was categorized into intermittent, mild, moderate to severe persistent asthma as per GINA 2000. A simple demographic form was administered by the investigator, blood for total Ig E was taken and skin prick tests to 6 common aeroallergens i.e. dog, cat, house-dust mite mix(Dermatophagoides pteronyssinus and Dermatophagoides farinae, HDM), Blomia tropicalis (Bt) and cockroach (Blattela germanica) were done on each child. The skin prick test was considered positive if the resultant wheal (induration) was ≥3 mm larger than the negative control. Results: The median age of the patients was 8 years (IQR 5 years). The female:male ratio was 1:1.2. The median age of diagnosis of asthma was 3 years old. Only twenty-nine children (35.4%) were exclusively breast-fed for at least 4 months. Thirty-five children (42.7%) were exposed to post-natal environmental tobacco smoke. Most of the children (n = 70, 79.5%) had persistent asthma. The median FEV1 (n = 30) = 92% (IQR 15), the median FVC (n = 30) = 85.50% (IQR 18.5) and FEF25–75 (n = 28) = 97.71% (IQR 134). Frequency of aeroallergen sensitization was as follows: HDM mix = 84%, Bt = 72%, dog = 21.4%, cat = 32.9%, and cockroach = 17.1%. Seventy-three children (89%) were sensitized to at least one aeroallergen. The median IgE = 1240 iu/l (IQR 1436). There was no significant difference in IgE levels (z = −1.039, p = 0.299) or SPT positivity (p = 0.743) between children with intermittent and persistent asthma. Sensitization to ≥2 aeroallergens was significantly associated with higher IgE levels (z = −2.79, p = 0.005). Only house-dust mite sensitization was significantly associated with increase in severity of asthma (p = 0.018). Conclusion: Eighty-nine percent of Malaysian children were sensitized to one aeroallergen. The commonest aeroallergens were HDM and Bt. Bt is unique in the tropical environment and an aeroallergen associated with asthma. Neither IgE or SPT positivity correlated with asthma severity. Only sensitization to HDM was associated with severity of asthma.
A05-67 Effect of caesarean section on wheezing disorders Y.N. Li, H.J. Cheng, L. Liu, H.M. Giao. First Hospital of Jilin University Changchun, China Keywords: caesarean section, wheezing disorders, hospitalization
Background: Caesarean-section delivery has been showed associated with the subsequent development of wheezing disorders in childhood. Which maybe be the result of an altered immune system development due to altered gut microflora. Changchun is located in northeast China, where has a high incidence of wheezing disorders. Objective: To examine the association between caesarean section and development of wheezing disorders (obliterative bronchiolitis, asthma and bronchiolitis) in hospitalization children in Changchun. Methods: A retrospective study was explored, all children hospitalized in Chuangchun 1 January 2008 to 1 October 2010 were included in this study. Children born mode of delivery was categorized as vaginal (including forceps and ventouse extractions) or caesarean section (elective and emergency). All patients grouped according to disease category including cardiovascular system disease, nervous system disease, wheezing disorders (obliterative bronchiolitis, asthma and bronchiolitis), and unwheezing respiratory system disease. Results: Total 8285 patients were included in this study. Of these patients, 1748 were wheezing disorders, 3025 were unwheezing respiratory system diseases, 1065 were cardiovascular system diseases, 1129 were urinary system diseases, 1318 were nervous system disease. Of all the children, 3877 (46.8%) were delivered vaginally and 4408 (53.2%) by caesarean section. The percentage of caesarean section in different diseases were available for 1182 (67.6%) subjects for wheezing disorders; 1525 (50.4%) subjects for unwheezing respiratory system diseases; 503 (47.2%), 579 (51.3%), 668 (50.7%) for cardiovascular system diseases, urinary system diseases, and nervous system disease, respectively. Significantly increased risk of wheezing disorders was seen among children delivered by cesarean section. Findings were similar among children delivered by acute and elective cesarean section. However, cesarean section could not increase the risk of unwheezing respiratory system diseases, cardiovascular system diseases, urinary system diseases, and nervous system disease. Conclusion: Delivery by caesarean section was associated with the subsequent development of asthma, obliterative bronchiolitis, and bronchiolitis.in later childhood in this population. A06-71 Clostridium leptum-induced regulatory T cells protect against asthma Y.N. Li, H.J. Cheng. First Hospital of Jilin University Changchun, China Keywords: Clostridium leptum; asthma; regulatory T cell; immunoregulatory therapy
Background: Asthma is a chronic inflammatory disease of the airways that is driven by dysregulated immune responses. The most promising therapeutic strategies for allergic disease, which involve increasing the numbers or function of Tregs. Previous studies demonstrated that oral treatment with Clostridium leptum can expand and activate Tregs. Objectives: We tested the hypothesis that Tregs play an essential role in C. leptum-induced inflammation attenuation of asthma. Methods: Establishing OVA-sensitized mouse bronchial asthma model, treated daily with C. leptum, PBS-sensitized mice as control. The numbers of Foxp3+ CD4+ CD25+ Tregs in both spleen and mediastinal lymph node were detected. Inflammatory cell influx, cytokine levels in BALF, and airway Hyperresponsiveness of mice were also assessed. Results: Following 14 days of oral C. leptum treatment, the percentage and total number of Foxp3+ CD4+ CD25+ Tregs in spleens