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Factors associated with the development of asthma and allergic diseases among residents Singapore schoolchildren: Increased risk among Singapore-born compared to non-Singapore-born children
S256 Abstracts
J ALLERGY CLIN IMMUNOL FEBRUARY 2003
53 AdvairPreventsAlcohol-InducedAsthma
55
A. E. Varner; Allergy Diagnostic, Beachwood, OH. RATIONALE: Many patients experience asthma symptoms after ingesting alcohol, the mechanisms and treatment are unclear. METHODS: Case reports o r No patients with alcohol induced asthma that benefitted from treatment with Advair. RESULTS: Patient I : DS is a 29 year old male chemist with lifeong ARC, nasal polyposis without ASA sensitivity, wheezing with cat exposure, and alcohol induced hives, flushing, and wheezing. Prick skin tests reveal cat, dog, and dust mite sensitivity. FEV1 104% predicted. Prophylactic treatment with loratadine, albuterol, and montelukast prior to alcohol ingestion failed to prevent symptoms. However, Advair 100/50 one puff prior to alcohol ingestion completely prevented all symptoms. Patient 2: DP is a 27 year old salesman with ARC, nocturnal and exercise induced asthma, and alcohol induced wheezing and chest tightness. No history of polyposis or ASA sensitivity. Prick skin tests reveal pollen, animal,and mold sensitivity. FEV1 67% predicted with 40% improvement after albuterol. Prophylactic treatment with loratadine and albuterol did not prevent alcohol induced symptoms. However, daily treatment with Advair 100/50 one puff BID completely prevented alcohol induced chest symptoms. C O N C L U S I O N S : After failures with other prophylactic medications, Advair prevented alcohol induced asthma. Whether the beneficial effect is due to inhaled steroids or LABA is unclear and may provide insight into the mechanism of alcohol induced asthma.
Funding: Se!f-funded
754
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G. Roberts I , C, Peckitt 2, D. Strachan 3, G. Lack4, J. GoldingS; ZPaediatric Allergy, Asthma and Immunology, Imperial College at St. Mary's, London, UNITED KINGDOM, 2Department of Public Health Sciences, Georges's Hospital Medical School, London, UNITED KINGDOM, 3Department of Public Health Sciences, St. Georges's Hospital Medical School, London, UNITED KINGDOM, 4pediatric Allergy, Asthma and Immunology, Imperial College at St. Mary's, London, UNITED KINGDOM, 5Unit of Paediatric and Perinatal Epidemiology, University of Bristol, London, UNITED KINGDOM. RATIONALE: Previous studies measuring the prevalence of allergen sensitization have been relatively small and used a small number of allergens. This study addresses these issues enabling associations between sensitization to different allergens to be examined. METHODS: This study was part of the Avon Longitudinal Study of Parents and Children, a population-based birth cohort of 14000 children born 1991-2 to mothers resident in Avon, All were invited at 7 years of age for skin testing to Dermatophagoides pteronyssinus, grass pollens, cat, peanuts, mixed tree nuts and egg. Additionally, they were tested to one of three other panels: animal danders, foods and aeroallergens. Data were only included if there were valid positive and negative controls. Sensitization was defined as a weal diameter of >_3 mm. The strength of association between sensitization to each allergen was expressed as an odds ratio (adjusted for grass and D pteronyssinus weal sizes, and sex). RESULTS: 6412 children provided valid data out of 8299 who attended. Sensitization was commonest to: grass pollens (8.5%), D pteronyssinus (7.8%), cat (4.9%), D~rinae (3.6%), dog (2.7%), horse (1.4%), rabbit (1.4%), peanut (I .4%) and tree nuts (1.0%). Strong associations (OR_>I0) were seen for sensitization within the pollens, animal danders and nuts. Additionally, there was an association between sensitization to egg and the aeroallergens. CONCLUSIONS: 7-year-old children in the UK are primarily sensitized to aeroallergens, but also to peanuts and tree nuts. There are strong associations between sensitization within allergen groups as well as between allergen groups, even after controlling for atopy.
Funding: British Lung Foundation and Food Standards Agency
FactorsAssociated with the Developmentof Asthmaand Allergic Diseases among Resident Singapore Schoolchildren: Increased Risk Among Singapore-Born Comparedto Non-Singapore-Born Children
X, S. Wang, T. N. Tan, L. P. C. Shek, D. Y. T. Goh, B. W. Lee, Iz. T. Chew; National University of Singapore, Singapore, SINGAPORE. RATIONALE: Previous studies suggest that environment factors, particularly those associated with developed nations, play an important role in influencing the development of asthma and allergic disorders, This study aims to examine the influence of several factors (socioeconomic status, breast feeding, cat ownership, smoking, being sedentary and lack of physical fitness, and birth place) on the prevalence of asthma and allergic diseases among resident Singapore schoolchildren. METHODS: In a phase-Ill ISAAC survey, conducted in 2001, students from randomly-chosen primary (5-8 years-old, 5305 children) and secondary (12-15 years-old, 4058 students) schools were invited to participate. Questions regarding environmental factors were asked following the ISAAC core questions. RESULTS: A parental history of atopy was strongly associated with childhood atopic diseases. After controlling for age, gender, ethnic group, socioeconomic status and related parental history, Singapore-born primary schoolchildren were at significantly higher risk of developing asthma compared to non-Singapore born children: adjusted OR was 3.78 (95% CI 2.41-5.94) for ever wheezing; 2.78 (95% CI 1.51-5.13) for 12-month period wheezing, and 2.56 (95% C1 1.56-4.20) for ever diagnosed asthma. Singapore-born children had also higher risk of rhinitis symptoms. Similar association can be seen in secondary student population. There was no association between the other factors evaluated and asthma or allergic disorders after controlling for the same potential confounders. CONCLUSIONS: Being born and raised in Singapore seem to be an independent risk factor for childhood asthma and allergy. Further studies are nevertheless required to elucidate the relationship between birth origin and asthma and atopy among Singapore children.
Funding: Biomedical Research Council, Singapore
756 Asthma Hospital Discharge Rates in Delaware for Children Aged 0-17 years, 1994-2000 A. Lateef I, R. A. Ruggiero 2. C. A. Morales-Mateluna3, S. Dowshen4. E. Yousef5, S. J. McGeadyS; 1Allergy and Immunology, A. I. duPont Hospital for Children and Thomas Jefferson University, Wilmington, DE, 2Delaware Department of Health, Dover, DE, 3Thomas Jefferson University, Philadelphia, PA, 4A. 1. duPont Hospital for Children, Wilmington, DE, 5A. I. duPont Hospital for Children and Thomas Jefferson University, Wilmington, DE. RATIONALE: Pediatric asthma discharge rates may be one indicator of asthma care quality. We have considered the effect of NIH Guidelines I1 and the transition of the state medicaid program (MA) to managed care on 1/1/97 upon hospital pediatric asthma discharge rates tbr the entire state of Delaware. METHODS: The Delaware Office of Healthcare Statistics collected data on all asthma discharges in Delaware between the years 1994 to 2000. We have reviewed these on children aged 0-17 years. RESULTS: (1) No significant change occurred in overall pediatric asthma discharge rate in Delaware during study period despite the release of 1997 revised N1H asthma guidelines (1994-96 discharge rate=3.2 vs. 1998-2000=2.9; p=NS). (2) A significant decrease occurred in the rate of MA asthma discharges following transition of MA system to managed care on I/1/97 (1994-96=7.7 vs. 1998-2000=5,9; p<0.05). (3) Rate of pediatric asthma discharges for African American (AA) patients is significantly higher than for non-AA irrespective of insurance type (19942000=3.42 for AA non-MA vs. 1.24 for white non-MA; p<0.05). CONCLUSIONS: (1) NIH guidelines II have not affected pediatric asthma discharge rates in Delaware. (2) Transition of Delaware MA to managed care significantly decreased MA asthma discharge rate. (3) AA children have a higher discharge rate Ibr asthma than non-AA population with comparable insurance coverage suggesting inherently more severe disease in AA children.
F~tnding: Self-funded
J ALLERGY CLIN IMMUNOL FEBRUARY 2003
53 AdvairPreventsAlcohol-InducedAsthma
55
A. E. Varner; Allergy Diagnostic, Beachwood, OH. RATIONALE: Many patients experience asthma symptoms after ingesting alcohol, the mechanisms and treatment are unclear. METHODS: Case reports o r No patients with alcohol induced asthma that benefitted from treatment with Advair. RESULTS: Patient I : DS is a 29 year old male chemist with lifeong ARC, nasal polyposis without ASA sensitivity, wheezing with cat exposure, and alcohol induced hives, flushing, and wheezing. Prick skin tests reveal cat, dog, and dust mite sensitivity. FEV1 104% predicted. Prophylactic treatment with loratadine, albuterol, and montelukast prior to alcohol ingestion failed to prevent symptoms. However, Advair 100/50 one puff prior to alcohol ingestion completely prevented all symptoms. Patient 2: DP is a 27 year old salesman with ARC, nocturnal and exercise induced asthma, and alcohol induced wheezing and chest tightness. No history of polyposis or ASA sensitivity. Prick skin tests reveal pollen, animal,and mold sensitivity. FEV1 67% predicted with 40% improvement after albuterol. Prophylactic treatment with loratadine and albuterol did not prevent alcohol induced symptoms. However, daily treatment with Advair 100/50 one puff BID completely prevented alcohol induced chest symptoms. C O N C L U S I O N S : After failures with other prophylactic medications, Advair prevented alcohol induced asthma. Whether the beneficial effect is due to inhaled steroids or LABA is unclear and may provide insight into the mechanism of alcohol induced asthma.
Funding: Se!f-funded
754
,o O,,e,..,
,.
G. Roberts I , C, Peckitt 2, D. Strachan 3, G. Lack4, J. GoldingS; ZPaediatric Allergy, Asthma and Immunology, Imperial College at St. Mary's, London, UNITED KINGDOM, 2Department of Public Health Sciences, Georges's Hospital Medical School, London, UNITED KINGDOM, 3Department of Public Health Sciences, St. Georges's Hospital Medical School, London, UNITED KINGDOM, 4pediatric Allergy, Asthma and Immunology, Imperial College at St. Mary's, London, UNITED KINGDOM, 5Unit of Paediatric and Perinatal Epidemiology, University of Bristol, London, UNITED KINGDOM. RATIONALE: Previous studies measuring the prevalence of allergen sensitization have been relatively small and used a small number of allergens. This study addresses these issues enabling associations between sensitization to different allergens to be examined. METHODS: This study was part of the Avon Longitudinal Study of Parents and Children, a population-based birth cohort of 14000 children born 1991-2 to mothers resident in Avon, All were invited at 7 years of age for skin testing to Dermatophagoides pteronyssinus, grass pollens, cat, peanuts, mixed tree nuts and egg. Additionally, they were tested to one of three other panels: animal danders, foods and aeroallergens. Data were only included if there were valid positive and negative controls. Sensitization was defined as a weal diameter of >_3 mm. The strength of association between sensitization to each allergen was expressed as an odds ratio (adjusted for grass and D pteronyssinus weal sizes, and sex). RESULTS: 6412 children provided valid data out of 8299 who attended. Sensitization was commonest to: grass pollens (8.5%), D pteronyssinus (7.8%), cat (4.9%), D~rinae (3.6%), dog (2.7%), horse (1.4%), rabbit (1.4%), peanut (I .4%) and tree nuts (1.0%). Strong associations (OR_>I0) were seen for sensitization within the pollens, animal danders and nuts. Additionally, there was an association between sensitization to egg and the aeroallergens. CONCLUSIONS: 7-year-old children in the UK are primarily sensitized to aeroallergens, but also to peanuts and tree nuts. There are strong associations between sensitization within allergen groups as well as between allergen groups, even after controlling for atopy.
Funding: British Lung Foundation and Food Standards Agency
FactorsAssociated with the Developmentof Asthmaand Allergic Diseases among Resident Singapore Schoolchildren: Increased Risk Among Singapore-Born Comparedto Non-Singapore-Born Children
X, S. Wang, T. N. Tan, L. P. C. Shek, D. Y. T. Goh, B. W. Lee, Iz. T. Chew; National University of Singapore, Singapore, SINGAPORE. RATIONALE: Previous studies suggest that environment factors, particularly those associated with developed nations, play an important role in influencing the development of asthma and allergic disorders, This study aims to examine the influence of several factors (socioeconomic status, breast feeding, cat ownership, smoking, being sedentary and lack of physical fitness, and birth place) on the prevalence of asthma and allergic diseases among resident Singapore schoolchildren. METHODS: In a phase-Ill ISAAC survey, conducted in 2001, students from randomly-chosen primary (5-8 years-old, 5305 children) and secondary (12-15 years-old, 4058 students) schools were invited to participate. Questions regarding environmental factors were asked following the ISAAC core questions. RESULTS: A parental history of atopy was strongly associated with childhood atopic diseases. After controlling for age, gender, ethnic group, socioeconomic status and related parental history, Singapore-born primary schoolchildren were at significantly higher risk of developing asthma compared to non-Singapore born children: adjusted OR was 3.78 (95% CI 2.41-5.94) for ever wheezing; 2.78 (95% CI 1.51-5.13) for 12-month period wheezing, and 2.56 (95% C1 1.56-4.20) for ever diagnosed asthma. Singapore-born children had also higher risk of rhinitis symptoms. Similar association can be seen in secondary student population. There was no association between the other factors evaluated and asthma or allergic disorders after controlling for the same potential confounders. CONCLUSIONS: Being born and raised in Singapore seem to be an independent risk factor for childhood asthma and allergy. Further studies are nevertheless required to elucidate the relationship between birth origin and asthma and atopy among Singapore children.
Funding: Biomedical Research Council, Singapore
756 Asthma Hospital Discharge Rates in Delaware for Children Aged 0-17 years, 1994-2000 A. Lateef I, R. A. Ruggiero 2. C. A. Morales-Mateluna3, S. Dowshen4. E. Yousef5, S. J. McGeadyS; 1Allergy and Immunology, A. I. duPont Hospital for Children and Thomas Jefferson University, Wilmington, DE, 2Delaware Department of Health, Dover, DE, 3Thomas Jefferson University, Philadelphia, PA, 4A. 1. duPont Hospital for Children, Wilmington, DE, 5A. I. duPont Hospital for Children and Thomas Jefferson University, Wilmington, DE. RATIONALE: Pediatric asthma discharge rates may be one indicator of asthma care quality. We have considered the effect of NIH Guidelines I1 and the transition of the state medicaid program (MA) to managed care on 1/1/97 upon hospital pediatric asthma discharge rates tbr the entire state of Delaware. METHODS: The Delaware Office of Healthcare Statistics collected data on all asthma discharges in Delaware between the years 1994 to 2000. We have reviewed these on children aged 0-17 years. RESULTS: (1) No significant change occurred in overall pediatric asthma discharge rate in Delaware during study period despite the release of 1997 revised N1H asthma guidelines (1994-96 discharge rate=3.2 vs. 1998-2000=2.9; p=NS). (2) A significant decrease occurred in the rate of MA asthma discharges following transition of MA system to managed care on I/1/97 (1994-96=7.7 vs. 1998-2000=5,9; p<0.05). (3) Rate of pediatric asthma discharges for African American (AA) patients is significantly higher than for non-AA irrespective of insurance type (19942000=3.42 for AA non-MA vs. 1.24 for white non-MA; p<0.05). CONCLUSIONS: (1) NIH guidelines II have not affected pediatric asthma discharge rates in Delaware. (2) Transition of Delaware MA to managed care significantly decreased MA asthma discharge rate. (3) AA children have a higher discharge rate Ibr asthma than non-AA population with comparable insurance coverage suggesting inherently more severe disease in AA children.
F~tnding: Self-funded