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What proportion of childhood asthma is attributable to atopy?
J ALLERGY CLIN IMMUNOL VOLUME 111, NUMBER 2
77 is Rhinitis a Risk Factor for Severe Asthma in Children? D. SoI~, I. C. Camelo-Nunes, G. F. Wandalsen, K. C. Melo, C. K. Naspitz; Pediatrics/Allergy, Universidade Federal de Silo Paulo, Silo Paulo, BRAZIL. OBJECTIVE: To evaluate the role of rhinitis on asthma severity among active asthmatic (AA) schoolchildren identified by the International Study of Asthma and Allergies in Childhood (ISAAC) written questionnaire (WQ). METHODS: WQ was applied to parents of 6-7 years-old schoolchildren (SC, n=3,033), and to adolescents (AD, 13-14 years-old, n=3,487), living in Silo Paulo, Brazil. An affirmative response to "Has your child/have you had wheezing/whistling in the last year?" identified those with AA, and an affirmative response to "...the last 12 months has your child/have you had sneezing/runny/blocked nose when he/she/you did not have a cold/flu?" identified those with rhinitis (R). Subjects who had R associated with AA were identified as AA+R. RESULTS: 22.1% AD and 24.3% SC were identified as AA. 56.9% of those AD and 54.6% SC had AA+R. Considering AA and AA+R groups, speech disturbance during an acute episode of asthma was significantly higher among AA+R AD (14.1% vs 8.7% p=0.03) and AA+R SC (15.8% vs 10.5% p=0.0435) in comparison to AA. Likewise, more than 4 acute attacks in the last year was significantly higher among AA+R AD ( 15.7% vs 10.5% p=0.046) and AA+R SC (22.6% vs 12.8% p=0.0009) as the frequency of sleep disturbance due to wheezing, for AD (18.5% vs 12.3% p=0.027) and SC (70.0% vs 58.1% p=0.0012), and for "wheezing associated to exercise" for AD (51.7% vs 40.0% p=0.0015) and SC (32.7% vs 14.1% p<0.0001). CONCLUSIONS: In patients with AA+R, the presence of R is a risk factor for asthma severity.
Funding: Universidade Federal de S6o Puulo
78 Validation of a New Lung Function Method in Orally Intubated Mice Using a Model of Fungal Asthma A. B r a u n t, M. Rott ~, T. Glaab 2, J. M. Hohlfeld I, N. Krug ], H. G. Hoymann1; IFraunhofer Institut Toxikologie und Aerosolforschung, Pharmaforschang und Klinische Inhalation, Hannover, GERMANY, 2Medizinische Hochschule Hannover, Pneumologie, GERMANY. RATIONALE: The aim of the study was to compare a novel system for invasive lung function measurements in mice with standard lung function measurements in conscious mice. Therefore, airway hyperresponsiveness (AHR) was measured in a model of fungal asthma. METHODS: Female BALB/c mice were sensitized with Aspergillus fumigatus extract (AF) systemically (s.c. and i.p.) on day 0, boosted intranasally on day 14 and challenged intratracheally on day 21 (AF groups). Negative controls (NEG) received the vehicle alone. Lung function was measured 48 h after allergen challenge and AHR was tested by provocation with increasing doses of methacholine (MCh) aerosol. Two groups (AF, NEG) were anesthetized, intubated orally and placed into a novel whole-body plethysmograph in supine position to measure lung resistance, dynamic compliance and midexpiratory flow (EF50). For comparison, two additional groups (AF, NEG) were placed consciously in a head-out plethysmograph to measure EF50. RESULTS: The conscious AF animals showed a marked hyperresponsiveness: the MCh dose needed to induce a 50% decrease in EF50 was 3.3 times lower compared to NEG. In comparison, the intubated AF animals showed also a marked hyperresponsiveness: the MCh dose needed to induce a 50% decrease of EF50 was 3.1 times lower, and to induce a 100% increase in resistance was 3.2 times lower than compared to NEG. CONCLUSIONS: The new technique is a valid method to measure airway hyperresponsiveness precisely without injuring the animals.
Funding: Self-fialded
Abstracts
$139
79 What Proportion of ChildhoodAsthma Is Attributable to Atopy? M. Mangat I, K. Williams2, E. L. Peterson 3, E. M. Zoratti I, D. R. Ownby 4, C. C. Johnson3; IDivision of Allergy & Clinical Immunology, Henry Ford Hospital, Detroit, MI, 2Division of General Medicine, Henry Ford Hospital, Detroit, MI, 3Biostatistics & Research Epidemiology, Henry Ford Hospital, Detroit, MI, 4Medical College of Georgia, Augusta, GA. RATIONALE: Knowledge about the association between atopy and asthma is evolving. The objective of this study was to determine the proportion of asthma cases attributable to atopy within a birth cohort. METHODS: Participating children were born between April 15, 1987 and August 31, 1989; 479 children underwent a thorough evaluation between 6-7 years of age. This examination included skin prick and allergen-specific IgE testing. Atopy in a child was defined as having >1 positive skin prick test or ->1 positive serologic test. A child was considered to have asthma if a physician had made that diagnosis. Current asthma was asthma that was either symptomatic or required treatment within the preceding year. RESULTS: Of the 479 children evaluated, 148 (31%) had >1 positive skin prick test, 52 (11%) had asthma, and 33 (7%) had current asthma. Of the 414 children tested for allergen-specific IgE, 149 (36%) had >1 positive test. Atopic children were more likely to have both asthma (relative risk [RR]=2.4; 95% confidence interval [CI]= 1.4-4.0) and current asthma (RR=3.4; 95% C1=1.8-6.7) when compared with non-atopic children. Using skin prick testing, the proportion of asthma cases attributable to atopy was 30%; whereas using allergen-specific IgE, it was 45%. CONCLUSIONS: Among children with asthma, the association between asthma and atopy was stronger lor those with more recently active disease. More asthma cases could be attributed to atopy using serologic tests than could with skin prick tests.
280
Pycnogeno, in the Management of Asthma
R. Farid I S. Hosseini2, R. Pishnam~ 3, R. R. Watson4; IDepartment of Allergy and Clinical Immunology, Mashad University of Medical Sciences, Mashad, IRAN (ISLAMIC REPUBLIC OF), 2The University of Arizona, Tucson, AZ, 3Department of Allergy and Clinical Immunology, Mashad, IRAN (ISLAMIC REPUBLIC OF), 4The University of Arizona, Tucson, AZ. BACKGROUND: Asthma is characterized as a inflammatory chronic eosiniphic inflammatory process in the lung. Pycnogenol, a biflavonoid mixture extracted from Pinus maritima, is known to scavenge free radicals while possessing antioxidant and anti-inflammatory properties OBJECTIVE: To evaluate the efficacy of this anti-inflammatory and antioxidant agent in a randomized double blinded, placebo-controlled cross over study in patients with different severity of asthma. METHODS: Twenty-six adult patients who fulfilled the American Thoracic Society criteria for asthma were enrolled in the study. Subjects were randomly assigned at zero week to receive pycnogenol ( 1 mg/lb/day, Max 200 mg/day) or placebo pills for a 4-week period. At week 4,a second 4week period commenced in which subjects were crossed over to alternative regimen, Patients visited 4 times for screening, enrollment, and after 4 and 8 weeks of treatment. Comprehensive physical exam and baseline spirometric values were obtained at enrollment visit and a brief physical exam, reported spirometry were performed at each following visit. Blood samples for the evaluation of serum levels of thromboxane, leukotriene and chemistry tests were obtained at each visit. RESULTS: 19 of the 26 patients completed the study. Asthma symptom score, FEVI, FEV1% predicted, FEVI/FVC, the primary efficacy variables were significantly increased by pycnogenol relative to placebo (p<.01). Serum levels of thrombaxane, leukotrienes, secondary efficacy variables, were significantly decreased relative to placebo (p<.01). The safety profile of pycnogenol was clearly demonstrated. CONCLUSION: Pycnogenol may be a new anti-inflammatory nutriceutical in the management of asthma.
Funding: Self-fimded
77 is Rhinitis a Risk Factor for Severe Asthma in Children? D. SoI~, I. C. Camelo-Nunes, G. F. Wandalsen, K. C. Melo, C. K. Naspitz; Pediatrics/Allergy, Universidade Federal de Silo Paulo, Silo Paulo, BRAZIL. OBJECTIVE: To evaluate the role of rhinitis on asthma severity among active asthmatic (AA) schoolchildren identified by the International Study of Asthma and Allergies in Childhood (ISAAC) written questionnaire (WQ). METHODS: WQ was applied to parents of 6-7 years-old schoolchildren (SC, n=3,033), and to adolescents (AD, 13-14 years-old, n=3,487), living in Silo Paulo, Brazil. An affirmative response to "Has your child/have you had wheezing/whistling in the last year?" identified those with AA, and an affirmative response to "...the last 12 months has your child/have you had sneezing/runny/blocked nose when he/she/you did not have a cold/flu?" identified those with rhinitis (R). Subjects who had R associated with AA were identified as AA+R. RESULTS: 22.1% AD and 24.3% SC were identified as AA. 56.9% of those AD and 54.6% SC had AA+R. Considering AA and AA+R groups, speech disturbance during an acute episode of asthma was significantly higher among AA+R AD (14.1% vs 8.7% p=0.03) and AA+R SC (15.8% vs 10.5% p=0.0435) in comparison to AA. Likewise, more than 4 acute attacks in the last year was significantly higher among AA+R AD ( 15.7% vs 10.5% p=0.046) and AA+R SC (22.6% vs 12.8% p=0.0009) as the frequency of sleep disturbance due to wheezing, for AD (18.5% vs 12.3% p=0.027) and SC (70.0% vs 58.1% p=0.0012), and for "wheezing associated to exercise" for AD (51.7% vs 40.0% p=0.0015) and SC (32.7% vs 14.1% p<0.0001). CONCLUSIONS: In patients with AA+R, the presence of R is a risk factor for asthma severity.
Funding: Universidade Federal de S6o Puulo
78 Validation of a New Lung Function Method in Orally Intubated Mice Using a Model of Fungal Asthma A. B r a u n t, M. Rott ~, T. Glaab 2, J. M. Hohlfeld I, N. Krug ], H. G. Hoymann1; IFraunhofer Institut Toxikologie und Aerosolforschung, Pharmaforschang und Klinische Inhalation, Hannover, GERMANY, 2Medizinische Hochschule Hannover, Pneumologie, GERMANY. RATIONALE: The aim of the study was to compare a novel system for invasive lung function measurements in mice with standard lung function measurements in conscious mice. Therefore, airway hyperresponsiveness (AHR) was measured in a model of fungal asthma. METHODS: Female BALB/c mice were sensitized with Aspergillus fumigatus extract (AF) systemically (s.c. and i.p.) on day 0, boosted intranasally on day 14 and challenged intratracheally on day 21 (AF groups). Negative controls (NEG) received the vehicle alone. Lung function was measured 48 h after allergen challenge and AHR was tested by provocation with increasing doses of methacholine (MCh) aerosol. Two groups (AF, NEG) were anesthetized, intubated orally and placed into a novel whole-body plethysmograph in supine position to measure lung resistance, dynamic compliance and midexpiratory flow (EF50). For comparison, two additional groups (AF, NEG) were placed consciously in a head-out plethysmograph to measure EF50. RESULTS: The conscious AF animals showed a marked hyperresponsiveness: the MCh dose needed to induce a 50% decrease in EF50 was 3.3 times lower compared to NEG. In comparison, the intubated AF animals showed also a marked hyperresponsiveness: the MCh dose needed to induce a 50% decrease of EF50 was 3.1 times lower, and to induce a 100% increase in resistance was 3.2 times lower than compared to NEG. CONCLUSIONS: The new technique is a valid method to measure airway hyperresponsiveness precisely without injuring the animals.
Funding: Self-fialded
Abstracts
$139
79 What Proportion of ChildhoodAsthma Is Attributable to Atopy? M. Mangat I, K. Williams2, E. L. Peterson 3, E. M. Zoratti I, D. R. Ownby 4, C. C. Johnson3; IDivision of Allergy & Clinical Immunology, Henry Ford Hospital, Detroit, MI, 2Division of General Medicine, Henry Ford Hospital, Detroit, MI, 3Biostatistics & Research Epidemiology, Henry Ford Hospital, Detroit, MI, 4Medical College of Georgia, Augusta, GA. RATIONALE: Knowledge about the association between atopy and asthma is evolving. The objective of this study was to determine the proportion of asthma cases attributable to atopy within a birth cohort. METHODS: Participating children were born between April 15, 1987 and August 31, 1989; 479 children underwent a thorough evaluation between 6-7 years of age. This examination included skin prick and allergen-specific IgE testing. Atopy in a child was defined as having >1 positive skin prick test or ->1 positive serologic test. A child was considered to have asthma if a physician had made that diagnosis. Current asthma was asthma that was either symptomatic or required treatment within the preceding year. RESULTS: Of the 479 children evaluated, 148 (31%) had >1 positive skin prick test, 52 (11%) had asthma, and 33 (7%) had current asthma. Of the 414 children tested for allergen-specific IgE, 149 (36%) had >1 positive test. Atopic children were more likely to have both asthma (relative risk [RR]=2.4; 95% confidence interval [CI]= 1.4-4.0) and current asthma (RR=3.4; 95% C1=1.8-6.7) when compared with non-atopic children. Using skin prick testing, the proportion of asthma cases attributable to atopy was 30%; whereas using allergen-specific IgE, it was 45%. CONCLUSIONS: Among children with asthma, the association between asthma and atopy was stronger lor those with more recently active disease. More asthma cases could be attributed to atopy using serologic tests than could with skin prick tests.
280
Pycnogeno, in the Management of Asthma
R. Farid I S. Hosseini2, R. Pishnam~ 3, R. R. Watson4; IDepartment of Allergy and Clinical Immunology, Mashad University of Medical Sciences, Mashad, IRAN (ISLAMIC REPUBLIC OF), 2The University of Arizona, Tucson, AZ, 3Department of Allergy and Clinical Immunology, Mashad, IRAN (ISLAMIC REPUBLIC OF), 4The University of Arizona, Tucson, AZ. BACKGROUND: Asthma is characterized as a inflammatory chronic eosiniphic inflammatory process in the lung. Pycnogenol, a biflavonoid mixture extracted from Pinus maritima, is known to scavenge free radicals while possessing antioxidant and anti-inflammatory properties OBJECTIVE: To evaluate the efficacy of this anti-inflammatory and antioxidant agent in a randomized double blinded, placebo-controlled cross over study in patients with different severity of asthma. METHODS: Twenty-six adult patients who fulfilled the American Thoracic Society criteria for asthma were enrolled in the study. Subjects were randomly assigned at zero week to receive pycnogenol ( 1 mg/lb/day, Max 200 mg/day) or placebo pills for a 4-week period. At week 4,a second 4week period commenced in which subjects were crossed over to alternative regimen, Patients visited 4 times for screening, enrollment, and after 4 and 8 weeks of treatment. Comprehensive physical exam and baseline spirometric values were obtained at enrollment visit and a brief physical exam, reported spirometry were performed at each following visit. Blood samples for the evaluation of serum levels of thromboxane, leukotriene and chemistry tests were obtained at each visit. RESULTS: 19 of the 26 patients completed the study. Asthma symptom score, FEVI, FEV1% predicted, FEVI/FVC, the primary efficacy variables were significantly increased by pycnogenol relative to placebo (p<.01). Serum levels of thrombaxane, leukotrienes, secondary efficacy variables, were significantly decreased relative to placebo (p<.01). The safety profile of pycnogenol was clearly demonstrated. CONCLUSION: Pycnogenol may be a new anti-inflammatory nutriceutical in the management of asthma.
Funding: Self-fimded