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How Often Do Allergy Symptoms Precede Allergen Sensitization?
AB174 Abstracts
663
Cockroach Exposure, Independent of Sensitization Status, is Associated with Hospitalization for Asthma in Inner-city Children J. C. Carlson, F. A. Rabito; Tulane University, New Orleans, LA. RATIONALE: Asthmatic children living in urban environments suffer disproportionately high asthma hospitalization rates; exposure to perennial allergens have been implicated, including cockroach and house dust mite (HDM), but data are limited. METHODS: Participants consisted of 86 atopic, asthmatic children living in New Orleans, Louisiana. Sensitization status was determined by serum specific-IgE testing and vacuum dust samples were collected from homes for allergen analysis. Logistic regression analysis was used to assess the odds of a history of persistent wheezing, emergency room visits and hospital admissions in those with high versus low levels of allergen exposure. RESULTS: Forty-four and 40% of children were exposed to Bla g 1 > 2U/ g and Der 1 > 2 mg/dL respectively; 24% reported at least one asthma hospitalization in the previous four months. Median Bla g 1 was significantly higher in homes of hospitalized children (7.2 U/g vs 0.8 U/g). In multivariable analysis, children hospitalized for asthma were significantly more likely to have been exposed to Bla g 1 levels > 2 U/g independent of sensitization status (odds ratio, 4.2; 95% CI, 1.24-14.17). Exposure to HDM was not associated with any measure of asthma morbidity. CONCLUSIONS: Cockroach exposure may be the factor driving high rates of asthma hospitalization of inner-city children. Differences in morbidity associated with exposure to cockroach versus HDM proteins have been described previously. Patterns of exposure may be important; longitudinal studies should examine whether consistent exposure to HDM in bedrooms induces immune tolerance. Controlled interventional trials are needed to determine whether isolated cockroach abatement improves asthma control.
664
MONDAY
Maternal Diet during Pregnancy and Wheeze and Eczema in Infants; the Japanese Birth Cohort (T-CHILD) Study M. Narita1, D. Qiu2, M. Hamaguchi1, M. Doi1, M. Futamura1, N. Sakamoto2, Y. Ohya1,3; 1Division of Allergy, National Center for Child Health and Development, Tokyo, JAPAN, 2Division of Epidemiology, National Research Institute for Child Health and Development, Tokyo, JAPAN, 3 Tokyo-Children’s Health, ILlness and Development (T-CHILD) study group, Tokyo, JAPAN. RATIONALE: This prospective birth cohort study examined the effect of maternal diet during pregnancy on the emergence of wheeze and eczema in infants. METHODS: A total of 1344 Japanese mother-infant pairs from a prospective birth cohort (Tokyo-Children’s Health, ILlness and Development; TCHILD) study, who responede to a diet history questionnaires in the second trimester and health event questionnaires at 6-8 months, 12 months, 18 months, and 2 years of age were investigated. Health event questionnaires include items of the International Study of Asthma and Allergies in Childhood (ISAAC). RESULTS: Cumulative incidence of wheeze and eczema at 6-8 months was 12.6% and 62.1%, respectively. Maternal intake volume of calcium was positively associated with eczema up to 6-8 months (Odds ratio (OR) between extreme quartiles was 0.632, 95%confidence interval (CI) 0.429-0.932), but not with wheeze. The prevalence of current wheeze was 16.2% at 12 months, 16.6% at 18 months, and 5.2% at 2 years of age, respectively. Point prevalance of current eczema was reported 60.1% at 12 months, 45.3% at 18 months, and 34.7% at 2 years, respectively. There were no evident relationships between maternal consumption of dairy food, fish, and vitamin D during pregnancy and the risk of wheeze and eczema in the infants up to 2 years of age. CONCLUSIONS: Maternal consumption of calcium during pregnancy may have the protective effect on eczema in early infancy.
665
How Often Do Allergy Symptoms Precede Allergen Sensitization? S. Mela, J. Spahn, M. Krawiec; National Jewish, DENVER,
CO. RATIONALE: We sought to determine how many pre-school-aged children with symptoms consistent with respiratory allergy and negative skin tests will develop subsequent allergen sensitization.
J ALLERGY CLIN IMMUNOL FEBRUARY 2011
METHODS: Retrospective chart review of 299 children age 0 - 3 years who underwent evaluation for respiratory allergy (cough, wheeze, rhinorrhea, and congestion) from 1/2007 to 8/2010. All children underwent skin testing to a select panel of seasonal and perennial aeroallergens. RESULTS: Mean age at evaluation was 18.061.7 months. 115 of 299 _1 positive skin test (ST). A minority, 35 (20%) had a repeat (38%) had > ST at a mean age of 40.063.1 months. 67% developed allergic sensitization with the most common allergen being grass pollen (43%), dog dander (35%) and cat dander (30%). Trends for subsequent sensitization included a diagnosis of eczema (p50.08) and a positive parental history of atopy (p50.14). Food allergy was the only significant risk factor (p50.03) at the initial evaluation. The most common symptom on initial evaluation was cough; while wheeze was the most common complaint at the second evaluation. CONCLUSION: The majority of pre-school children who were not sensitized at the initial evaluation developed subsequent allergen sensitization. Children with food allergy, eczema, and a parental history of atopy were most likely to become sensitized over time. This suggests that in many preschool children, allergic symptoms precede sensitization. As such, repeat skin testing should be performed more regularly in young children who are not sensitized, yet have persistent allergic symptoms.
666
Risks for asthma at age 7 differ by neighborhood and socioeconomic status in New York City L. M. Acosta1, R. L. Miller2, I. F. Goldstein3, A. G. Rundle3, R. B. Mellins4, A. G. Cornell4, L. Hoepner1, H. Andrews5, S. Lopez-Pintado6, J. W. Quinn7, G. L. Chew1, J. S. Jacobson3, F. P. Perera1, M. S. Perzanowski1; 1Columbia University, Mailman School of Public Health, Department of Environmental Health Sciences, New York, NY, 2Columbia University, Department of Medicine, Division of Pulmonary, Allergy, Critical Care Medicine, New York, NY, 3Columbia University, Mailman School of Public Health, Department of Epidemiology, New York, NY, 4Columbia University, College of Physicians and Surgeons, Department of Pediatrics, New York, NY, 5Columbia University, Mailman School of Public Health, Data Coordinating Center, New York, NY, 6Columbia University, Mailman School of Public Health, Department of Biostatistics, New York, NY, 7Columbia University, Institute for Social and Economic Research and Policy, New York, NY. RATIONALE: Pediatric asthma prevalence varies dramatically (3-19%) among neighborhoods in New York City (NYC). We hypothesized that risks for asthma also vary among these neighborhoods. METHODS: Children from 3 groups participating in 2 studies were compared. NYC Neighborhood Asthma and Allergy case-control study recruited MIDDLE-INCOME children from the same employer-based health insurance who lived in low (LAPN) (Group A) and high (HAPN) (Group B) asthma prevalence neighborhoods. Columbia’s Center for Children’s Environmental Health birth cohort study recruited LOW-INCOME mothers living in HAPN (Group C). At age 7/8 years, children were classified as asthma cases or controls based on current symptoms and medication use. There were 64, 71 and 100 cases and 59, 53 and 180 controls in groups A, B, and C, respectively. Odds ratios (OR) were calculated by logistic regression, adjusting for ethnicity/race, sex and maternal asthma. Effect modification by study group (A,B,C) was tested using interaction terms to compare OR. RESULTS: There were several risks that differed between study groups. For example, reported household income was inversely associated with asthma in A (OR50.84, P50.032) but not in B (OR50.94, P50.48) or C (OR51.01, P50.85) (Pinteraction50.025). Similarly, reported local drug dealer activity was associated with asthma in A but not in B or C (Pinteraction50.002). Having an unmarried mother (Pinteraction50.001) and reporting that the neighborhood was not a good place to raise children were significantly associated with asthma in B but not C (Pinteraction50.014). CONCLUSIONS: Associations between demographic and social environment related risks and asthma differed by neighborhood and socio-economic status in NYC.
663
Cockroach Exposure, Independent of Sensitization Status, is Associated with Hospitalization for Asthma in Inner-city Children J. C. Carlson, F. A. Rabito; Tulane University, New Orleans, LA. RATIONALE: Asthmatic children living in urban environments suffer disproportionately high asthma hospitalization rates; exposure to perennial allergens have been implicated, including cockroach and house dust mite (HDM), but data are limited. METHODS: Participants consisted of 86 atopic, asthmatic children living in New Orleans, Louisiana. Sensitization status was determined by serum specific-IgE testing and vacuum dust samples were collected from homes for allergen analysis. Logistic regression analysis was used to assess the odds of a history of persistent wheezing, emergency room visits and hospital admissions in those with high versus low levels of allergen exposure. RESULTS: Forty-four and 40% of children were exposed to Bla g 1 > 2U/ g and Der 1 > 2 mg/dL respectively; 24% reported at least one asthma hospitalization in the previous four months. Median Bla g 1 was significantly higher in homes of hospitalized children (7.2 U/g vs 0.8 U/g). In multivariable analysis, children hospitalized for asthma were significantly more likely to have been exposed to Bla g 1 levels > 2 U/g independent of sensitization status (odds ratio, 4.2; 95% CI, 1.24-14.17). Exposure to HDM was not associated with any measure of asthma morbidity. CONCLUSIONS: Cockroach exposure may be the factor driving high rates of asthma hospitalization of inner-city children. Differences in morbidity associated with exposure to cockroach versus HDM proteins have been described previously. Patterns of exposure may be important; longitudinal studies should examine whether consistent exposure to HDM in bedrooms induces immune tolerance. Controlled interventional trials are needed to determine whether isolated cockroach abatement improves asthma control.
664
MONDAY
Maternal Diet during Pregnancy and Wheeze and Eczema in Infants; the Japanese Birth Cohort (T-CHILD) Study M. Narita1, D. Qiu2, M. Hamaguchi1, M. Doi1, M. Futamura1, N. Sakamoto2, Y. Ohya1,3; 1Division of Allergy, National Center for Child Health and Development, Tokyo, JAPAN, 2Division of Epidemiology, National Research Institute for Child Health and Development, Tokyo, JAPAN, 3 Tokyo-Children’s Health, ILlness and Development (T-CHILD) study group, Tokyo, JAPAN. RATIONALE: This prospective birth cohort study examined the effect of maternal diet during pregnancy on the emergence of wheeze and eczema in infants. METHODS: A total of 1344 Japanese mother-infant pairs from a prospective birth cohort (Tokyo-Children’s Health, ILlness and Development; TCHILD) study, who responede to a diet history questionnaires in the second trimester and health event questionnaires at 6-8 months, 12 months, 18 months, and 2 years of age were investigated. Health event questionnaires include items of the International Study of Asthma and Allergies in Childhood (ISAAC). RESULTS: Cumulative incidence of wheeze and eczema at 6-8 months was 12.6% and 62.1%, respectively. Maternal intake volume of calcium was positively associated with eczema up to 6-8 months (Odds ratio (OR) between extreme quartiles was 0.632, 95%confidence interval (CI) 0.429-0.932), but not with wheeze. The prevalence of current wheeze was 16.2% at 12 months, 16.6% at 18 months, and 5.2% at 2 years of age, respectively. Point prevalance of current eczema was reported 60.1% at 12 months, 45.3% at 18 months, and 34.7% at 2 years, respectively. There were no evident relationships between maternal consumption of dairy food, fish, and vitamin D during pregnancy and the risk of wheeze and eczema in the infants up to 2 years of age. CONCLUSIONS: Maternal consumption of calcium during pregnancy may have the protective effect on eczema in early infancy.
665
How Often Do Allergy Symptoms Precede Allergen Sensitization? S. Mela, J. Spahn, M. Krawiec; National Jewish, DENVER,
CO. RATIONALE: We sought to determine how many pre-school-aged children with symptoms consistent with respiratory allergy and negative skin tests will develop subsequent allergen sensitization.
J ALLERGY CLIN IMMUNOL FEBRUARY 2011
METHODS: Retrospective chart review of 299 children age 0 - 3 years who underwent evaluation for respiratory allergy (cough, wheeze, rhinorrhea, and congestion) from 1/2007 to 8/2010. All children underwent skin testing to a select panel of seasonal and perennial aeroallergens. RESULTS: Mean age at evaluation was 18.061.7 months. 115 of 299 _1 positive skin test (ST). A minority, 35 (20%) had a repeat (38%) had > ST at a mean age of 40.063.1 months. 67% developed allergic sensitization with the most common allergen being grass pollen (43%), dog dander (35%) and cat dander (30%). Trends for subsequent sensitization included a diagnosis of eczema (p50.08) and a positive parental history of atopy (p50.14). Food allergy was the only significant risk factor (p50.03) at the initial evaluation. The most common symptom on initial evaluation was cough; while wheeze was the most common complaint at the second evaluation. CONCLUSION: The majority of pre-school children who were not sensitized at the initial evaluation developed subsequent allergen sensitization. Children with food allergy, eczema, and a parental history of atopy were most likely to become sensitized over time. This suggests that in many preschool children, allergic symptoms precede sensitization. As such, repeat skin testing should be performed more regularly in young children who are not sensitized, yet have persistent allergic symptoms.
666
Risks for asthma at age 7 differ by neighborhood and socioeconomic status in New York City L. M. Acosta1, R. L. Miller2, I. F. Goldstein3, A. G. Rundle3, R. B. Mellins4, A. G. Cornell4, L. Hoepner1, H. Andrews5, S. Lopez-Pintado6, J. W. Quinn7, G. L. Chew1, J. S. Jacobson3, F. P. Perera1, M. S. Perzanowski1; 1Columbia University, Mailman School of Public Health, Department of Environmental Health Sciences, New York, NY, 2Columbia University, Department of Medicine, Division of Pulmonary, Allergy, Critical Care Medicine, New York, NY, 3Columbia University, Mailman School of Public Health, Department of Epidemiology, New York, NY, 4Columbia University, College of Physicians and Surgeons, Department of Pediatrics, New York, NY, 5Columbia University, Mailman School of Public Health, Data Coordinating Center, New York, NY, 6Columbia University, Mailman School of Public Health, Department of Biostatistics, New York, NY, 7Columbia University, Institute for Social and Economic Research and Policy, New York, NY. RATIONALE: Pediatric asthma prevalence varies dramatically (3-19%) among neighborhoods in New York City (NYC). We hypothesized that risks for asthma also vary among these neighborhoods. METHODS: Children from 3 groups participating in 2 studies were compared. NYC Neighborhood Asthma and Allergy case-control study recruited MIDDLE-INCOME children from the same employer-based health insurance who lived in low (LAPN) (Group A) and high (HAPN) (Group B) asthma prevalence neighborhoods. Columbia’s Center for Children’s Environmental Health birth cohort study recruited LOW-INCOME mothers living in HAPN (Group C). At age 7/8 years, children were classified as asthma cases or controls based on current symptoms and medication use. There were 64, 71 and 100 cases and 59, 53 and 180 controls in groups A, B, and C, respectively. Odds ratios (OR) were calculated by logistic regression, adjusting for ethnicity/race, sex and maternal asthma. Effect modification by study group (A,B,C) was tested using interaction terms to compare OR. RESULTS: There were several risks that differed between study groups. For example, reported household income was inversely associated with asthma in A (OR50.84, P50.032) but not in B (OR50.94, P50.48) or C (OR51.01, P50.85) (Pinteraction50.025). Similarly, reported local drug dealer activity was associated with asthma in A but not in B or C (Pinteraction50.002). Having an unmarried mother (Pinteraction50.001) and reporting that the neighborhood was not a good place to raise children were significantly associated with asthma in B but not C (Pinteraction50.014). CONCLUSIONS: Associations between demographic and social environment related risks and asthma differed by neighborhood and socio-economic status in NYC.