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Risk Factors Associated With The Development Of Asthma and Allergic Rhinitis Among Adolescents Living In São Paulo – Brazil
Abstracts AB253
J ALLERGY CLIN IMMUNOL VOLUME 133, NUMBER 2
873A
The Effects Of Anti-Seizure Medications On Patients With Antibody Deficiency Syndrome Dr. Tatyana Gavrilova, MD, Dr. Harumi Jyonouchi, MD; Rutgers University of Medicine and Dentistry, Newark, NJ. RATIONALE: Antibody deficiency is associated with both primary and secondary immunodeficiency. Secondary immunodeficiency is often caused by medications including antiepileptic drugs (AEDs). It is unknown how AEDs affect ADS patients. This study examined whether ADS subjects treated with AEDs (test group) will reveal differences as compared to control ADS subjects. METHODS: Clinical features and laboratory findings in the test group (children N58, adults N55), were retrospectively reviewed in comparison with control ADS subjects (children N518, adults N55). In the test group, AEDs were mainly prescribed for seizure disorders (grand mal and/or partial complex seizures with variable etiology). Most of the test group subjects were prescribed multiple AEDs in the past and/or currently. RESULTS: Children in the test group had lower levels of IgM /IgA than control ADS children (IgM 57.2 6 32.2 vs 101.4 6 48.6 mg/dL, IgA 37.7625.4 vs 85.0 6 50.9 mg/dL, respectively). However, there were no differences in total and isotype switched memory B cell numbers between the test and control groups irrespective of age. In cytokine production by peripheral blood mononuclear cells (PBMCs), the test group revealed lower IL-6, IL-12, and TNF-alpha production in response to TLR7/8 agonist (p<0.05) but IL-10 production in response to T cell mitogens was higher in the test group (p<0.05). CONCLUSIONS: Lower IgM /IgA levels in the test group children may be associated with lower IL-6 production and higher IL-10 production by PBMCs in the test group, since IL-10 is a suppressive cytokine and IL-6 promotes B cell maturation.
875
874
876
Pediatric Asthma Associated With Fungal Exposure Dr. Cecilia Nguyen, MD1, Dr. Christina E. Ciaccio, MD, FAAAAI2, Dr. Charles Barnes, PhD2; 1Children’s Mercy Hospitals and Clinics, 2Children’s Mercy Hospital, Kansas City, MO. RATIONALE: Asthma severity is strongly influenced by triggers and exposures. Many homes have substantial amounts of indoor fungi (mold). To determine if fungal sensitized asthmatics had a higher severity of disease than other asthmatics, we conducted the following investigation. METHODS: A cohort of 239 asthmatic subjects enrolled in the Healthy Homes study were screened for inclusion in the dataset. Subjects had specific IgE testing for cat, dog, dust mite, cockroach, mouse, alternaria, aspergillus, claddosporium and penicillium. They also had home evaluations including presence of airborne spores, dust borne allergens or both. The subjects responded to questionnaires concerning recalled asthma symptoms and medication use. Medical records of the subjects for years 2007 to 2012 were searched for utilization including urgent care, hospitalizations and clinic visits. RESULTS: A group of 29 asthmatic children were identified who were sensitized nearly exclusively to fungal allergens. A control group of 26 asthmatic children who were sensitized exclusively to animal and arthropod allergens was also selected. Fungal-related asthmatics were more likely to be hospitalized at least once during the study (OR52.10; 95% CI 0.55,8.09) and to visit the ER (OR 1.33; CI 0.45,3.99). CONCLUSIONS: A group of children can be identified whose asthma appears to be fungal related. This group did not have significantly more health care utilization than the non-fungal related asthmatics in this study.
TUESDAY
Risk Factors Associated With The Development Of Asthma and Allergic Rhinitis Among Adolescents Living In S~ ao Paulo – Brazil Dr. Fernanda Patini Furlan1, Dr. Djanira Andrade2, Danielli Christinni Bichuete-Silva, MD3, Dr. Tessa Rachel Tranquilini Gonc¸alves, MD3, Dr. In^es Camelo Nunes2, Prof. Dirceu Sole, MD, PhD3; 1Division of Allergy and Clinical Immunology, Dept of Pediatrics, Escola Paulista de Medicina, Federal University of S~ao Paulo, S~ao Paulo, Brazil, S~ao Paulo, Brazil, 2Universidade Federal de S~ao Paulo, S~ao Paulo, Brazil, 3 Federal University of Sao Paulo, Sao Paulo, Brazil. RATIONALE: Active asthma (AA) and allergic rhinitis (rhinoconjunctivitis, RC) are frequent among adolescents (AD). Our objectives were to identify risk factors associated to AA and RC development among AD living in S~ao Paulo, Brazil. METHODS: A cross-sectional study in 567 AD (13-14 years old) using written questionnaires (standardized and complementary) of International Study of Asthma and Allergies in Childhood(ISAAC) was conducted in S~ao Paulo, Brazil, in 2012. ‘‘Have had wheezing in the last year’’ identified AD with AA. The concomitant report of ‘‘nasal and ocular symptoms in the last year’’ identified those with RC. According to the variables analyzed nonparametric tests were applied. The groups (asthmatic and no-asthmatic) were compared with respect to exposure to several factors identified by the complementary WQ, and risk factors were identified by logistic regression. RESULTS: The prevalence of AA and RC were 24.7% and 34.9%, respectively. Risk factors for AA manifestation were: to have RC: [OR5 1.97; 95%CI5 1.20-3.26; p50.008], and maternal smoking [OR5 1.87; 95%CI5 1.04-3.36; p50.037]. For RC, they were: to have AA [OR5 2.06; 95%CI 1.25-3.38; p50.004] and to have attended daycare or nursery [OR51.67; 95%CI51.07-2.60; p50.024]. CONCLUSIONS: The prevalence of AA and RC are high in this studied population and to have attended day care or nursery was identified as a risk factor for both manifestations. Exposure to maternal smoking was significantly associated with asthma presentation.
Atopic Associations In Asthmatic Patients Readmitted Within 30 Days To The Hospital Dr. Larisa Buyantseva, MD, MS, Dr. Melissa Rossi, Prof. Jason Liao, PhD, Dr. Timothy Craig, DO; Penn State University, Hershey, PA. RATIONALE: Allergy is an important trigger in 50% adults and 60-90% of children with asthma. Twelve-month readmission rate for asthma in Pennsylvania was 15.1% in 2006-2010. Quality metrics are focusing on readmission in a month as an important variable. The aim of this study is to assess if history of atopy increases the likelihood of 30-day asthma readmission. METHODS: Retrospective chart review of all adult patients with primary diagnosis of asthma who were readmitted within 30 days after the index admission was performed. Patients were identified from billing database by asthma ICD 9 code (493.9). RESULTS: We identified 37 patients readmitted within 30 days of the index admission for asthma. Sixty-five percent were females, age 41 + 28, 84% were Caucasians, and 24% had ‘‘severe’’ asthma documented in their records. Majority of patients had 1.0 + 1.8 ICU admissions in the past. Twenty-two percent of patients were tested for allergies, but only 16% reported that they have allergies. Cats, dogs and molds were the most common allergens. Fifty-one percent were on inhaled corticosteroids (ICS) and leukotriene receptor antagonists (respectively), 64% were on combined ICS and long-acting beta agonists, 38% on antihistamines and 8% on omalizumab. Of the above variables only asthma severity and history of ICU admissions were associated with a 30-day readmission (p<0.05). CONCLUSIONS: History of atopy was not associated with 30-day readmission in our asthmatic population. Significant associations for readmission were found with asthma severity and a history of ICU admissions.
J ALLERGY CLIN IMMUNOL VOLUME 133, NUMBER 2
873A
The Effects Of Anti-Seizure Medications On Patients With Antibody Deficiency Syndrome Dr. Tatyana Gavrilova, MD, Dr. Harumi Jyonouchi, MD; Rutgers University of Medicine and Dentistry, Newark, NJ. RATIONALE: Antibody deficiency is associated with both primary and secondary immunodeficiency. Secondary immunodeficiency is often caused by medications including antiepileptic drugs (AEDs). It is unknown how AEDs affect ADS patients. This study examined whether ADS subjects treated with AEDs (test group) will reveal differences as compared to control ADS subjects. METHODS: Clinical features and laboratory findings in the test group (children N58, adults N55), were retrospectively reviewed in comparison with control ADS subjects (children N518, adults N55). In the test group, AEDs were mainly prescribed for seizure disorders (grand mal and/or partial complex seizures with variable etiology). Most of the test group subjects were prescribed multiple AEDs in the past and/or currently. RESULTS: Children in the test group had lower levels of IgM /IgA than control ADS children (IgM 57.2 6 32.2 vs 101.4 6 48.6 mg/dL, IgA 37.7625.4 vs 85.0 6 50.9 mg/dL, respectively). However, there were no differences in total and isotype switched memory B cell numbers between the test and control groups irrespective of age. In cytokine production by peripheral blood mononuclear cells (PBMCs), the test group revealed lower IL-6, IL-12, and TNF-alpha production in response to TLR7/8 agonist (p<0.05) but IL-10 production in response to T cell mitogens was higher in the test group (p<0.05). CONCLUSIONS: Lower IgM /IgA levels in the test group children may be associated with lower IL-6 production and higher IL-10 production by PBMCs in the test group, since IL-10 is a suppressive cytokine and IL-6 promotes B cell maturation.
875
874
876
Pediatric Asthma Associated With Fungal Exposure Dr. Cecilia Nguyen, MD1, Dr. Christina E. Ciaccio, MD, FAAAAI2, Dr. Charles Barnes, PhD2; 1Children’s Mercy Hospitals and Clinics, 2Children’s Mercy Hospital, Kansas City, MO. RATIONALE: Asthma severity is strongly influenced by triggers and exposures. Many homes have substantial amounts of indoor fungi (mold). To determine if fungal sensitized asthmatics had a higher severity of disease than other asthmatics, we conducted the following investigation. METHODS: A cohort of 239 asthmatic subjects enrolled in the Healthy Homes study were screened for inclusion in the dataset. Subjects had specific IgE testing for cat, dog, dust mite, cockroach, mouse, alternaria, aspergillus, claddosporium and penicillium. They also had home evaluations including presence of airborne spores, dust borne allergens or both. The subjects responded to questionnaires concerning recalled asthma symptoms and medication use. Medical records of the subjects for years 2007 to 2012 were searched for utilization including urgent care, hospitalizations and clinic visits. RESULTS: A group of 29 asthmatic children were identified who were sensitized nearly exclusively to fungal allergens. A control group of 26 asthmatic children who were sensitized exclusively to animal and arthropod allergens was also selected. Fungal-related asthmatics were more likely to be hospitalized at least once during the study (OR52.10; 95% CI 0.55,8.09) and to visit the ER (OR 1.33; CI 0.45,3.99). CONCLUSIONS: A group of children can be identified whose asthma appears to be fungal related. This group did not have significantly more health care utilization than the non-fungal related asthmatics in this study.
TUESDAY
Risk Factors Associated With The Development Of Asthma and Allergic Rhinitis Among Adolescents Living In S~ ao Paulo – Brazil Dr. Fernanda Patini Furlan1, Dr. Djanira Andrade2, Danielli Christinni Bichuete-Silva, MD3, Dr. Tessa Rachel Tranquilini Gonc¸alves, MD3, Dr. In^es Camelo Nunes2, Prof. Dirceu Sole, MD, PhD3; 1Division of Allergy and Clinical Immunology, Dept of Pediatrics, Escola Paulista de Medicina, Federal University of S~ao Paulo, S~ao Paulo, Brazil, S~ao Paulo, Brazil, 2Universidade Federal de S~ao Paulo, S~ao Paulo, Brazil, 3 Federal University of Sao Paulo, Sao Paulo, Brazil. RATIONALE: Active asthma (AA) and allergic rhinitis (rhinoconjunctivitis, RC) are frequent among adolescents (AD). Our objectives were to identify risk factors associated to AA and RC development among AD living in S~ao Paulo, Brazil. METHODS: A cross-sectional study in 567 AD (13-14 years old) using written questionnaires (standardized and complementary) of International Study of Asthma and Allergies in Childhood(ISAAC) was conducted in S~ao Paulo, Brazil, in 2012. ‘‘Have had wheezing in the last year’’ identified AD with AA. The concomitant report of ‘‘nasal and ocular symptoms in the last year’’ identified those with RC. According to the variables analyzed nonparametric tests were applied. The groups (asthmatic and no-asthmatic) were compared with respect to exposure to several factors identified by the complementary WQ, and risk factors were identified by logistic regression. RESULTS: The prevalence of AA and RC were 24.7% and 34.9%, respectively. Risk factors for AA manifestation were: to have RC: [OR5 1.97; 95%CI5 1.20-3.26; p50.008], and maternal smoking [OR5 1.87; 95%CI5 1.04-3.36; p50.037]. For RC, they were: to have AA [OR5 2.06; 95%CI 1.25-3.38; p50.004] and to have attended daycare or nursery [OR51.67; 95%CI51.07-2.60; p50.024]. CONCLUSIONS: The prevalence of AA and RC are high in this studied population and to have attended day care or nursery was identified as a risk factor for both manifestations. Exposure to maternal smoking was significantly associated with asthma presentation.
Atopic Associations In Asthmatic Patients Readmitted Within 30 Days To The Hospital Dr. Larisa Buyantseva, MD, MS, Dr. Melissa Rossi, Prof. Jason Liao, PhD, Dr. Timothy Craig, DO; Penn State University, Hershey, PA. RATIONALE: Allergy is an important trigger in 50% adults and 60-90% of children with asthma. Twelve-month readmission rate for asthma in Pennsylvania was 15.1% in 2006-2010. Quality metrics are focusing on readmission in a month as an important variable. The aim of this study is to assess if history of atopy increases the likelihood of 30-day asthma readmission. METHODS: Retrospective chart review of all adult patients with primary diagnosis of asthma who were readmitted within 30 days after the index admission was performed. Patients were identified from billing database by asthma ICD 9 code (493.9). RESULTS: We identified 37 patients readmitted within 30 days of the index admission for asthma. Sixty-five percent were females, age 41 + 28, 84% were Caucasians, and 24% had ‘‘severe’’ asthma documented in their records. Majority of patients had 1.0 + 1.8 ICU admissions in the past. Twenty-two percent of patients were tested for allergies, but only 16% reported that they have allergies. Cats, dogs and molds were the most common allergens. Fifty-one percent were on inhaled corticosteroids (ICS) and leukotriene receptor antagonists (respectively), 64% were on combined ICS and long-acting beta agonists, 38% on antihistamines and 8% on omalizumab. Of the above variables only asthma severity and history of ICU admissions were associated with a 30-day readmission (p<0.05). CONCLUSIONS: History of atopy was not associated with 30-day readmission in our asthmatic population. Significant associations for readmission were found with asthma severity and a history of ICU admissions.