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Early manifestations of near-fatal asthma newly diagnosed in children
Abstracts S71
J ALLERGY CLIN IMMUNOL VOLUME 115, NUMBER 2
Fungi—the Most Frequent Cause of Severe Chronic Bronchial Asthma T. Hofman, A. M. Hofman, A. Urbanowicz; Center Of Allergology, Poznan, POLAND. RATIONALE: The aim of this study was to establish the role of fungi on pathogenesis of severe chronic bronchial asthma. METHODS: 22 patients with severe chronic bronchial asthma, aged 2268, were examined. Diagnosis of bronchial asthma was performed along ATS definition. Following tests were made: spirometry, reversibility test, level of chlorides in sweat, skin prick test with inhalant allergens (among them molds such as: Aspergillus fumigatus(Asp.f.), Candida albicans(Can.al.), Fusarium moniliforme(Fus.m.), Penicillium notatum(Pen.n.) et al.), mycological culture of sputum, detection and identification of fungi in sputum by molecular technique PCR, and specific IgG against Asp.f., Fus.m., Pen.n. and Can.al RESULTS: Skin prick tests with inhalant allergens were negative. Levels of chlorides in sweat were normal. Mycological culture was positive with Candida albicans in 19 ( 86,4%) patients. In general IgG against fungi were increased in 19 ( 86,4%) of patients. Among all patients IgG against Candida albicans was increased in 19 ( 86,4%), IgG against Aspergillus fumigatus in 12 (54,4%), IgG against Fusarium moniliforme in 19 (86,4%), and against Penicillium notatum in 9 ( 40,9%). In 20 (90,0%) patients fungi DNA in sputum was found. Among them in 16 (72,7%) Aspergillus fumigatus DNA was found, in 4 (18,2%)- Candida albicans DNA, in 4( 18,2%)- Fusarium moniliforme DNA and in 2 (9,09%) Penicillium chrysogeum DNA. Only in 2 patients (9,09%) fungi DNA was not found.
283
CONCLUSIONS: The most often cause of severe bronchial asthma is fungi infection, especially Aspergillus fumigatus. The best method for fungi detection and identification is molecular technique PCR and specific IgG against fungi. Early Manifestations of Near-Fatal Asthma Newly Diagnosed in Children H. B. Lee, S. A. Shin, J. W. Oh; Department of Pediatrics, Hanyang University Medical Center, Seoul, REPUBLIC OF KOREA. RATIONALE: Asthma prevalence is increasing over the world. Moreover, near-fatal asthma is more likely in children with past history of sudden severe exacerbations and caregiver’s difficulty perceiving airflow obstruction or its severity (GINA 2002). Asthma should be correctly diagnosed, its severity assessed and appropriate treatments to reduce morbidity and mortality of asthma as early as possible. METHODS: Newly diagnosed nine asthmatic children (mean age 5.5 years) who admitted to an intensive care unit were analyzed retrospectively. RESULTS: The mean duration of asthma symptoms prior to admission and intensive care in hospital were 1.9±2.4 (Mean±SD) and 7±2.9 days, respectively. Of these nine subjects, six children had atopy and/or allergy (66.7%). The main initial symptoms were dyspnea (88.9%) and cough (44.4%). Five asthmatics had high serum IgE ( > 500 IU/mL), increased numbers of sensitization to common aeroallergens (Dp, Df, Cockroach, Alternaria, etc.) by skin prick test and/or IgE RAST, and high eosinophil count ( > 300/mm2) in peripheral blood, respectively. Respiratory viral infections including influenza A (2 cases) and influenza B (1 case) had proven in three children with asthma. Also, pneumomediastinum was observed in three asthmatics. All of these children with asthma recovered completely with successful management. CONCLUSIONS: Atopy is one of the early manifestations of near-fatal asthma in children. Early diagnosis and appropriate management for asthma are very important to prevent serious outcome in children.
284
A 17-Year Study of the Prevalence of Asthma and Allergic Diseases Among Children in Saudi Arabia a. S. Al-Frayh; Pediatrics, King Saud Uni., Riyadh 11461, SAUDI ARABIA. RATIONALE: The study aimed to determine the prevalence of asthma and allergic diseases among children in Saudi Arabia. METHODS: A total of 1678 randomly selected schoolchildren comprising of 51.6% males (mean age 11.62 + 3.08 years) and 48.4% females (mean age 11.79 + 3.21) was recruited in a questionnaire-based crosssectional study during the year 2002 in three regions. Results of the present study were compared with the previously published data from two similar surveys conducted in 1986 and 1995 to establish the prevalence trend for asthma and atopic disorders in the Kingdom over a period of 17 years. RESULTS: Significantly higher prevalence rates (p ≤ 0.0001) for asthma, rhinitis and eczema were noted in the eastern region (Hofuf) (33.7%, 48.2% and 43.5%) compared to central region (Riyadh) (17.7%, 29% and 32.6%) and western region (Jeddah) (14.1%, 24.3% and 31.9%), respectively. A comparison of the present cumulative prevalence rates for childhood asthma (21.7%), rhinitis (33.8%) and eczema (36%) with those of the past shows that after an initial sharp rise between 1986 and 1995 asthma has reached a plateau. Allergic rhinitis, on the other hand, shows a steady upward course, however, eczema for the first time, has shown a dramatic increase over a period of 17 years. CONCLUSIONS: Prevalence of childhood atopic diseases like asthma, rhinitis and eczema was exceptionally high in the eastern. Although a strong association among allergic diseases is well known, yet long-term prevalence trend for each disorder is variable among atopic children. Funding: King Khalid University Hospital
285
SUNDAY
Airway Inflammation and Methacholine Hyperresponsiveness in Athletes With Asthma-Like Symptoms and Asthmatic Patients A. Moreira1, L. Delgado1, M. Capão-Filipe2, J. Fonseca3, M. CastelBranco4; 1Serviço de Imunoalergologia, Serviço Imunologia Faculdade de Medicina Universidade do Porto, Porto, PORTUGAL, 2Serviço de Imunoalergologia, Hospital de S Joao, Porto, Porto, PORTUGAL, 3Serviço de Imunoalergologia, Serviço Bioestatística e Informática Médica Faculdade de Medicina Universidade do Porto, Porto, PORTUGAL, 4Serviço de Imunoalergologia, Hospital de São João, Porto, PORTUGAL. Asthma-like symptoms, use of asthma medication and methacholine hyperresponsiveness (BHR) are prevalent in athletes.Whether these features in athletes are caused by airways inflammation similar to asthma remains uncertain. Respiratory function, BHR to methacholine and nitric oxide concentration in exhaled air were investigated in 3 groups of nonsmoking subjects less than 36 years: athletes with asthma like symptoms; intermittent asthma patients (IAs); and persistent asthma patients (PAs) according to GINA classification. Of the 104 included subjects, 57 were athletes, 14 from IAs group and 33 from PAs group. Mean ages (sd) were 21(7), 22(5) and 26(6) respectively. Twenty seven methacholine bronchial challenges, all from athletes, were negative (PC20>16 mg/mL or PD20>7.8 mmol); 13 athletes, 9 IAs and 27 PAs subjects had marked BHR (PC20≤1.0 mg/mL or PD20≤0.1 mmol) (p<0.001). There was a significative difference between predicted FEV1 between athletes (103±17) and IAs (90±103; p<0.004) and PAs (91±12; p<0.001) subjects. We did not found any significant difference between the groups in exhaled NO for the 55 subjects assessed (8 athletes, 14 IAs:, 33 PAs), although IAs patients (without corticosteroid treatment) had slightly higher values. Median (range) FeNO was 37.3 (10.0 to 237.50), 44.7 (5.9 to 221.4), and 39.3 (8.3 to 188.7) respectively for athletes, IAs and PAs. In conclusion, in this study, responsiveness to methacholine increased in order of magnitude from athletes with asthma like symptoms to intermittent asthma to persistent asthma patients. Athletes had higher predicted FEV1 and less marked BHR to methacholine but similar levels of exhaled NO than asthmatic non-athletes subjects.
282
J ALLERGY CLIN IMMUNOL VOLUME 115, NUMBER 2
Fungi—the Most Frequent Cause of Severe Chronic Bronchial Asthma T. Hofman, A. M. Hofman, A. Urbanowicz; Center Of Allergology, Poznan, POLAND. RATIONALE: The aim of this study was to establish the role of fungi on pathogenesis of severe chronic bronchial asthma. METHODS: 22 patients with severe chronic bronchial asthma, aged 2268, were examined. Diagnosis of bronchial asthma was performed along ATS definition. Following tests were made: spirometry, reversibility test, level of chlorides in sweat, skin prick test with inhalant allergens (among them molds such as: Aspergillus fumigatus(Asp.f.), Candida albicans(Can.al.), Fusarium moniliforme(Fus.m.), Penicillium notatum(Pen.n.) et al.), mycological culture of sputum, detection and identification of fungi in sputum by molecular technique PCR, and specific IgG against Asp.f., Fus.m., Pen.n. and Can.al RESULTS: Skin prick tests with inhalant allergens were negative. Levels of chlorides in sweat were normal. Mycological culture was positive with Candida albicans in 19 ( 86,4%) patients. In general IgG against fungi were increased in 19 ( 86,4%) of patients. Among all patients IgG against Candida albicans was increased in 19 ( 86,4%), IgG against Aspergillus fumigatus in 12 (54,4%), IgG against Fusarium moniliforme in 19 (86,4%), and against Penicillium notatum in 9 ( 40,9%). In 20 (90,0%) patients fungi DNA in sputum was found. Among them in 16 (72,7%) Aspergillus fumigatus DNA was found, in 4 (18,2%)- Candida albicans DNA, in 4( 18,2%)- Fusarium moniliforme DNA and in 2 (9,09%) Penicillium chrysogeum DNA. Only in 2 patients (9,09%) fungi DNA was not found.
283
CONCLUSIONS: The most often cause of severe bronchial asthma is fungi infection, especially Aspergillus fumigatus. The best method for fungi detection and identification is molecular technique PCR and specific IgG against fungi. Early Manifestations of Near-Fatal Asthma Newly Diagnosed in Children H. B. Lee, S. A. Shin, J. W. Oh; Department of Pediatrics, Hanyang University Medical Center, Seoul, REPUBLIC OF KOREA. RATIONALE: Asthma prevalence is increasing over the world. Moreover, near-fatal asthma is more likely in children with past history of sudden severe exacerbations and caregiver’s difficulty perceiving airflow obstruction or its severity (GINA 2002). Asthma should be correctly diagnosed, its severity assessed and appropriate treatments to reduce morbidity and mortality of asthma as early as possible. METHODS: Newly diagnosed nine asthmatic children (mean age 5.5 years) who admitted to an intensive care unit were analyzed retrospectively. RESULTS: The mean duration of asthma symptoms prior to admission and intensive care in hospital were 1.9±2.4 (Mean±SD) and 7±2.9 days, respectively. Of these nine subjects, six children had atopy and/or allergy (66.7%). The main initial symptoms were dyspnea (88.9%) and cough (44.4%). Five asthmatics had high serum IgE ( > 500 IU/mL), increased numbers of sensitization to common aeroallergens (Dp, Df, Cockroach, Alternaria, etc.) by skin prick test and/or IgE RAST, and high eosinophil count ( > 300/mm2) in peripheral blood, respectively. Respiratory viral infections including influenza A (2 cases) and influenza B (1 case) had proven in three children with asthma. Also, pneumomediastinum was observed in three asthmatics. All of these children with asthma recovered completely with successful management. CONCLUSIONS: Atopy is one of the early manifestations of near-fatal asthma in children. Early diagnosis and appropriate management for asthma are very important to prevent serious outcome in children.
284
A 17-Year Study of the Prevalence of Asthma and Allergic Diseases Among Children in Saudi Arabia a. S. Al-Frayh; Pediatrics, King Saud Uni., Riyadh 11461, SAUDI ARABIA. RATIONALE: The study aimed to determine the prevalence of asthma and allergic diseases among children in Saudi Arabia. METHODS: A total of 1678 randomly selected schoolchildren comprising of 51.6% males (mean age 11.62 + 3.08 years) and 48.4% females (mean age 11.79 + 3.21) was recruited in a questionnaire-based crosssectional study during the year 2002 in three regions. Results of the present study were compared with the previously published data from two similar surveys conducted in 1986 and 1995 to establish the prevalence trend for asthma and atopic disorders in the Kingdom over a period of 17 years. RESULTS: Significantly higher prevalence rates (p ≤ 0.0001) for asthma, rhinitis and eczema were noted in the eastern region (Hofuf) (33.7%, 48.2% and 43.5%) compared to central region (Riyadh) (17.7%, 29% and 32.6%) and western region (Jeddah) (14.1%, 24.3% and 31.9%), respectively. A comparison of the present cumulative prevalence rates for childhood asthma (21.7%), rhinitis (33.8%) and eczema (36%) with those of the past shows that after an initial sharp rise between 1986 and 1995 asthma has reached a plateau. Allergic rhinitis, on the other hand, shows a steady upward course, however, eczema for the first time, has shown a dramatic increase over a period of 17 years. CONCLUSIONS: Prevalence of childhood atopic diseases like asthma, rhinitis and eczema was exceptionally high in the eastern. Although a strong association among allergic diseases is well known, yet long-term prevalence trend for each disorder is variable among atopic children. Funding: King Khalid University Hospital
285
SUNDAY
Airway Inflammation and Methacholine Hyperresponsiveness in Athletes With Asthma-Like Symptoms and Asthmatic Patients A. Moreira1, L. Delgado1, M. Capão-Filipe2, J. Fonseca3, M. CastelBranco4; 1Serviço de Imunoalergologia, Serviço Imunologia Faculdade de Medicina Universidade do Porto, Porto, PORTUGAL, 2Serviço de Imunoalergologia, Hospital de S Joao, Porto, Porto, PORTUGAL, 3Serviço de Imunoalergologia, Serviço Bioestatística e Informática Médica Faculdade de Medicina Universidade do Porto, Porto, PORTUGAL, 4Serviço de Imunoalergologia, Hospital de São João, Porto, PORTUGAL. Asthma-like symptoms, use of asthma medication and methacholine hyperresponsiveness (BHR) are prevalent in athletes.Whether these features in athletes are caused by airways inflammation similar to asthma remains uncertain. Respiratory function, BHR to methacholine and nitric oxide concentration in exhaled air were investigated in 3 groups of nonsmoking subjects less than 36 years: athletes with asthma like symptoms; intermittent asthma patients (IAs); and persistent asthma patients (PAs) according to GINA classification. Of the 104 included subjects, 57 were athletes, 14 from IAs group and 33 from PAs group. Mean ages (sd) were 21(7), 22(5) and 26(6) respectively. Twenty seven methacholine bronchial challenges, all from athletes, were negative (PC20>16 mg/mL or PD20>7.8 mmol); 13 athletes, 9 IAs and 27 PAs subjects had marked BHR (PC20≤1.0 mg/mL or PD20≤0.1 mmol) (p<0.001). There was a significative difference between predicted FEV1 between athletes (103±17) and IAs (90±103; p<0.004) and PAs (91±12; p<0.001) subjects. We did not found any significant difference between the groups in exhaled NO for the 55 subjects assessed (8 athletes, 14 IAs:, 33 PAs), although IAs patients (without corticosteroid treatment) had slightly higher values. Median (range) FeNO was 37.3 (10.0 to 237.50), 44.7 (5.9 to 221.4), and 39.3 (8.3 to 188.7) respectively for athletes, IAs and PAs. In conclusion, in this study, responsiveness to methacholine increased in order of magnitude from athletes with asthma like symptoms to intermittent asthma to persistent asthma patients. Athletes had higher predicted FEV1 and less marked BHR to methacholine but similar levels of exhaled NO than asthmatic non-athletes subjects.
282