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Ectoparasite Induced Elevations of alpha-gal Specific IgE are Associated with Increased Total Serum IgE and Cat Sensitization but not with Asthma
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Asthma Phenotypes in School-aged Children from the Population Study: Cluster Analysis J. Kwon1, J. Seo2, H. Kim2, B. Kim3, H. Kim4, S. Lee5, K. Park6, S. Hong2; 1Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, REPUBLIC OF KOREA, 2Department of Pediatrics, Asan Medical Center, Seoul, REPUBLIC OF KOREA, 3Department of Pediatrics, Haeundae Paik Hospital, Inje University College of Medicine, Busan, REPUBLIC OF KOREA, 4Department of Pediatrics, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, REPUBLIC OF KOREA, 5Department of Pediatrics, Hallym University Secred Heart Hospital, Suwon, REPUBLIC OF KOREA, 6Department of Pediatrics, Presbyterian Medical Center, Jeonju, REPUBLIC OF KOREA. RATIONALE: We evaluate the childhood asthma phenotypes from the population study using cluster analysis. METHODS: A questionnaire survey, blood tests for total IgE and eosinophil fraction, skin prick test, spirometry and methacholine bronchial challenge test were performed in 2,491 primary school children. Among the various factors affecting to childhood asthma, representative variables were extracted by principle component analysis. And we performed two step cluster analysis in the subjects with a history of doctor-diagnosed asthma. We then compared differences in demographic characteristics, lung functions, atopic status and bronchial hyperresponsiveness between clulsters. RESULTS: In the questionnaire survey, 235 children (10.1%, 235/2,337) had a history of doctor-diagnosed asthma. After excluding subjects with missing values, three clusters were extracted in the 193 children with asthma. The first cluster (atopic asthma, n577) was more likely to have atopy (77/77, 100%), higher total IgE (380.8063.89 IU/mL, geometric _16mg/mL in methacholine mean6SD) and BHR (47/77, 61.0%, PC20< challenge). In the second cluster (male-dominant eosinophilic, n526), 23 (88.5%) were male and higher blood eosinophil % (7.7867.76 %, mean6SD) was found. The third cluster (non-atopic, n590) was less likely to have atopy (0%) and had low IgE and blood eosinophil. CONCLUSIONS: Three phenotypes were classified among subjects with childhood asthma in Korea. Cluster analysis can be a useful statistical method for identifying asthma phenotypes.
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Ectoparasite Induced Elevations of alpha-gal Specific IgE are Associated with Increased Total Serum IgE and Cat Sensitization but not with Asthma L. A. Kelly, S. L. Pochan, H. R. James, L. J. Workman, P. W. Heymann, S. P. Commins, T. A. E. Platts-Mills; University of Virginia, Charlottesville, VA. RATIONALE: In the southeastern United States, IgE antibodies to galactose-alpha-1,3-galactose (alpha-gal) are common. Induced by ectoparasitic ticks, these antibodies can cause anaphylaxis both to the monoclonal antibody cetuximab and red meat. In keeping with the distribution of alpha-gal amongst non-primate mammals, these IgE antibodies also bind extracts derived from mammals, including cats. Despite elevated total IgE and cat specific IgE, these patients describe relatively few symptoms of bronchial hyperreactivity. METHODS: Sera from 208 subjects presenting to central Virginia allergy clinics with symptoms of urticaria, angioedema, or anaphylaxis, 68 asthmatics, and 59 controls were assayed for total serum IgE and IgE to a-gal and several inhalant allergens. Spirometry and eNO were performed as markers of asthma. RESULTS: The mean total serum IgE amongst those in the anaphylaxis group was not different from that of asthmatics (177IU/mL vs. 166IU/mL, p50.63), and markedly higher than that of the control group (28IU/mL, p<0.0001). While most alpha-gal subjects have IgE to cat epithelium, living with a cat did not increase risk for asthma. Mean eNO and FEV1/ FVC amongst those living with a cat was 18ppb [C.I. 15-20] and 0.80 [0.78-0.82], respectively, and 24ppb [17-31] and 0.79 [0.77-0.81] for those not living with cats; mean eNO and FEV1/FVC for our asthmatics were 51ppb [38-64] and 0.70 [0.68-0.73], and controls 20ppb [13-27] and 0.80 [0.78-0.83].
CONCLUSIONS: Subjects with alpha-gal specific IgE and allergic symptoms after ingestion of red meat have elevated total IgE and cat specific IgE, but lung function that is no different from that of our control group.
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Helicobacter Pylori, A Protective Agent For Asthma Or Not? C. Camacho, J. Santiago, V. Velazquez, M. Gonzalez, A. Sepulveda, J. Ramos; Hospital Episcopal San Lucas, Ponce, PR. RATIONALE: Helicobacter pylori is a Gram-negative gastric bacillus, whose diagnosis is made by endoscopic biopsy. H. pylori has been associated to the inhibition of Th2 responses in asthmatic patients activating Th1 response. Asthma is inversely associated with serologic evidence of the presence of cagA+ H. pylori strains. We will explore the association between Helicobacter pylori status and asthma prevalence among a pediatric population, that may suggest a protective factor conferred by the bacteria. METHODS: Review of medical records of pediatric patients (N5855) that underwent an upper endoscopy on 2009 at HESLin Ponce, Puerto Rico. Study includes patients between 1 to 21 years of age. Demographic, age, gender, history of asthma and allergies were obtained. H. pylori status was obtained from gastric biopsy results. RESULTS: From 831 gastric biopsy results, 52 were positive for H. pylori. 63% were(33/52) females and 37% (19/52) males. 54% (28/52) were teenagers . Twenty-nine percent (15/52) of patients have history of asthma, 17% (9/52) have history of allergies, 10% (5/52) have history of both, and 54 % (28/52) did not have history of asthma or allergies. CONCLUSION: More females are diagnosed with H. pylori infection and teen patients suffer more infections with such bacteria. There appears to be an association between infection and the absence of asthma and allergies, since 54% of our patients with H. pylori infection did not have a history of asthma or allergies. To evaluate H pylori as a protective factor for asthma and allergies, a control population with negative cultures will be required.
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The Role of Atopy as a Predictor of Childhood Atopic Asthma S. Abbott, R. Green, C. Els; University of Pretoria, Pretoria, SOUTH AFRICA. INTRODUCTION: The diagnosis of childhood asthma remains difficult. Atopy is a surrogate marker for determining asthma in a preschool child with chronic respiratory symptoms. However, local studies have brought this relationship into question. Two studies conducted at the Children’s Chest and Allergy Clinic, Steve Biko Academic Hospital, investigated the role of atopy as a predictor of childhood atopic asthma. METHODS: Study 1 (Atopy in asthmatic children attending a tertiary hospital in Pretoria) enrolled 100 asthmatic children and an age and sexmatched control group of 50 non-atopic children. Skin prick tests to standard allergen extracts were performed. Study 2 (An investigation into maternal factors of asthmatic children for predicting the allergic basis of childhood asthma) enrolled 100 asthmatic children and their mothers. The mothers completed a questionnaire which included demographic details, a history of symptoms suggestive of allergic diseases and a history of asthma. Skin prick testing was performed on the mothers. RESULTS: In study 1, 45% of asthmatic children and 16% of the control group, had a positive skin prick test. In study 2, 14 of the 16 mothers with asthma, had atopic children (p50.045). Maternal atopy or a history suggestive of maternal allergic disease, weren’t good predictors of childhood atopic asthma. CONCLUSION: Atopy occurs less commonly in our population of asthmatic children than previously thought. Maternal asthma is the only valuable predictor of childhood asthma, suggesting that asthma must be associated with other environmental exposures. A more extensive study is suggested.
SATURDAY
Abstracts AB7
J ALLERGY CLIN IMMUNOL VOLUME 129, NUMBER 2
Asthma Phenotypes in School-aged Children from the Population Study: Cluster Analysis J. Kwon1, J. Seo2, H. Kim2, B. Kim3, H. Kim4, S. Lee5, K. Park6, S. Hong2; 1Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, REPUBLIC OF KOREA, 2Department of Pediatrics, Asan Medical Center, Seoul, REPUBLIC OF KOREA, 3Department of Pediatrics, Haeundae Paik Hospital, Inje University College of Medicine, Busan, REPUBLIC OF KOREA, 4Department of Pediatrics, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, REPUBLIC OF KOREA, 5Department of Pediatrics, Hallym University Secred Heart Hospital, Suwon, REPUBLIC OF KOREA, 6Department of Pediatrics, Presbyterian Medical Center, Jeonju, REPUBLIC OF KOREA. RATIONALE: We evaluate the childhood asthma phenotypes from the population study using cluster analysis. METHODS: A questionnaire survey, blood tests for total IgE and eosinophil fraction, skin prick test, spirometry and methacholine bronchial challenge test were performed in 2,491 primary school children. Among the various factors affecting to childhood asthma, representative variables were extracted by principle component analysis. And we performed two step cluster analysis in the subjects with a history of doctor-diagnosed asthma. We then compared differences in demographic characteristics, lung functions, atopic status and bronchial hyperresponsiveness between clulsters. RESULTS: In the questionnaire survey, 235 children (10.1%, 235/2,337) had a history of doctor-diagnosed asthma. After excluding subjects with missing values, three clusters were extracted in the 193 children with asthma. The first cluster (atopic asthma, n577) was more likely to have atopy (77/77, 100%), higher total IgE (380.8063.89 IU/mL, geometric _16mg/mL in methacholine mean6SD) and BHR (47/77, 61.0%, PC20< challenge). In the second cluster (male-dominant eosinophilic, n526), 23 (88.5%) were male and higher blood eosinophil % (7.7867.76 %, mean6SD) was found. The third cluster (non-atopic, n590) was less likely to have atopy (0%) and had low IgE and blood eosinophil. CONCLUSIONS: Three phenotypes were classified among subjects with childhood asthma in Korea. Cluster analysis can be a useful statistical method for identifying asthma phenotypes.
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Ectoparasite Induced Elevations of alpha-gal Specific IgE are Associated with Increased Total Serum IgE and Cat Sensitization but not with Asthma L. A. Kelly, S. L. Pochan, H. R. James, L. J. Workman, P. W. Heymann, S. P. Commins, T. A. E. Platts-Mills; University of Virginia, Charlottesville, VA. RATIONALE: In the southeastern United States, IgE antibodies to galactose-alpha-1,3-galactose (alpha-gal) are common. Induced by ectoparasitic ticks, these antibodies can cause anaphylaxis both to the monoclonal antibody cetuximab and red meat. In keeping with the distribution of alpha-gal amongst non-primate mammals, these IgE antibodies also bind extracts derived from mammals, including cats. Despite elevated total IgE and cat specific IgE, these patients describe relatively few symptoms of bronchial hyperreactivity. METHODS: Sera from 208 subjects presenting to central Virginia allergy clinics with symptoms of urticaria, angioedema, or anaphylaxis, 68 asthmatics, and 59 controls were assayed for total serum IgE and IgE to a-gal and several inhalant allergens. Spirometry and eNO were performed as markers of asthma. RESULTS: The mean total serum IgE amongst those in the anaphylaxis group was not different from that of asthmatics (177IU/mL vs. 166IU/mL, p50.63), and markedly higher than that of the control group (28IU/mL, p<0.0001). While most alpha-gal subjects have IgE to cat epithelium, living with a cat did not increase risk for asthma. Mean eNO and FEV1/ FVC amongst those living with a cat was 18ppb [C.I. 15-20] and 0.80 [0.78-0.82], respectively, and 24ppb [17-31] and 0.79 [0.77-0.81] for those not living with cats; mean eNO and FEV1/FVC for our asthmatics were 51ppb [38-64] and 0.70 [0.68-0.73], and controls 20ppb [13-27] and 0.80 [0.78-0.83].
CONCLUSIONS: Subjects with alpha-gal specific IgE and allergic symptoms after ingestion of red meat have elevated total IgE and cat specific IgE, but lung function that is no different from that of our control group.
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Helicobacter Pylori, A Protective Agent For Asthma Or Not? C. Camacho, J. Santiago, V. Velazquez, M. Gonzalez, A. Sepulveda, J. Ramos; Hospital Episcopal San Lucas, Ponce, PR. RATIONALE: Helicobacter pylori is a Gram-negative gastric bacillus, whose diagnosis is made by endoscopic biopsy. H. pylori has been associated to the inhibition of Th2 responses in asthmatic patients activating Th1 response. Asthma is inversely associated with serologic evidence of the presence of cagA+ H. pylori strains. We will explore the association between Helicobacter pylori status and asthma prevalence among a pediatric population, that may suggest a protective factor conferred by the bacteria. METHODS: Review of medical records of pediatric patients (N5855) that underwent an upper endoscopy on 2009 at HESLin Ponce, Puerto Rico. Study includes patients between 1 to 21 years of age. Demographic, age, gender, history of asthma and allergies were obtained. H. pylori status was obtained from gastric biopsy results. RESULTS: From 831 gastric biopsy results, 52 were positive for H. pylori. 63% were(33/52) females and 37% (19/52) males. 54% (28/52) were teenagers . Twenty-nine percent (15/52) of patients have history of asthma, 17% (9/52) have history of allergies, 10% (5/52) have history of both, and 54 % (28/52) did not have history of asthma or allergies. CONCLUSION: More females are diagnosed with H. pylori infection and teen patients suffer more infections with such bacteria. There appears to be an association between infection and the absence of asthma and allergies, since 54% of our patients with H. pylori infection did not have a history of asthma or allergies. To evaluate H pylori as a protective factor for asthma and allergies, a control population with negative cultures will be required.
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The Role of Atopy as a Predictor of Childhood Atopic Asthma S. Abbott, R. Green, C. Els; University of Pretoria, Pretoria, SOUTH AFRICA. INTRODUCTION: The diagnosis of childhood asthma remains difficult. Atopy is a surrogate marker for determining asthma in a preschool child with chronic respiratory symptoms. However, local studies have brought this relationship into question. Two studies conducted at the Children’s Chest and Allergy Clinic, Steve Biko Academic Hospital, investigated the role of atopy as a predictor of childhood atopic asthma. METHODS: Study 1 (Atopy in asthmatic children attending a tertiary hospital in Pretoria) enrolled 100 asthmatic children and an age and sexmatched control group of 50 non-atopic children. Skin prick tests to standard allergen extracts were performed. Study 2 (An investigation into maternal factors of asthmatic children for predicting the allergic basis of childhood asthma) enrolled 100 asthmatic children and their mothers. The mothers completed a questionnaire which included demographic details, a history of symptoms suggestive of allergic diseases and a history of asthma. Skin prick testing was performed on the mothers. RESULTS: In study 1, 45% of asthmatic children and 16% of the control group, had a positive skin prick test. In study 2, 14 of the 16 mothers with asthma, had atopic children (p50.045). Maternal atopy or a history suggestive of maternal allergic disease, weren’t good predictors of childhood atopic asthma. CONCLUSION: Atopy occurs less commonly in our population of asthmatic children than previously thought. Maternal asthma is the only valuable predictor of childhood asthma, suggesting that asthma must be associated with other environmental exposures. A more extensive study is suggested.
SATURDAY
Abstracts AB7
J ALLERGY CLIN IMMUNOL VOLUME 129, NUMBER 2