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Allergen Skin Test Reactivity and Eosinophilia in Adult Bronchial Asthmatic Patients

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Allergen Skin Test Reactivity and Eosinophilia in Adult Bronchial Asthmatic Patients

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Asthma affects more than 100 million people worldwide. lncreased morbidrty
include increased exposure to indoor allergens and environmental pollutants
agonist, under-use of anti-inflammatory mediators and limited education about healu' care

Asthma affects more than 100 million people worldwide. lncreased morbidrty
include increased exposure to indoor allergens and environmental pollutants
agonist, under-use of anti-inflammatory mediators and limited education about healu' care

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Allergen Skin Test Reactivity and Eosinophilia in Adult Bronchial Asthmatic Patients

  1. 1. Original Article Allergen Skin Test Reactivity and Eosinophilia in Adult Bronchial Asthmatic Patients Tasmina Parveenl, Eram Mustafizl, Abdul Matin Anamur Rashid Choudhury2, Matia Ahmedl and Noorzahan Begum3 Abstract Asthma affects more than 100 million people worldwide. lncreased morbidrty s mun',laet'a a.3 -a! include increased exposure to indoor allergens and environmental pollutants o!'er!se :' ae:a'Z agonist, under-use of anti-inflammatory mediators and limited education about healu' care A e'qt represents a specific alteration in biologic reactivity mediated by an immunologic mec;a^ s- 3-'- resutting in an adverse physiologic response. Some of the type of allergen's senstuvrfl c) sr' a'u' test (SPT) and blood eosinophil count were studied in adult asthmatic patients to find oa Ih€,' salJs in this group of patients and also to observe their relationships. This study was caried oui t' :^e Department of Physiology, Bangabandhu Sheik Muiib Medical [Jnivers$ Dhaka and Asthma Ce::'e Mohakhali, Dhaka from January 2OO5 to December 2005. Allergen skin prick tests were done c:, pepy's skin prick method and absolute eosinophil count in blood was also done by haemocytomeq) T 30 asthmatic patients and 30 age and sex matched control subiects. Data were analyzed stattstcal!', by unpaired student's t-test and Chi-square test. ln this study, maximum numbers of asthmatic patens had positive SPT for dust mite, which was foltowed by house dust and by cockroach. Frequency' percentage for dust mite was significantty higher (p <0.05) than that of house dust and cockroach. lt ffas atso significantly higher in house dust than that of cockroach (p <0.001). The mean eosinophil oun'! was significantty high (p <0.001) in asthmatic adufts compared to that of healthy subiects. On the other hand, the association between the positive skin prick tests of all allergens used in this study and increased eosinophit counts were not statistically significant (p >0.05 ). Therefore, it can be concluded that different allergens like, house dust, dust mite and cockroach are responsible for bronchial asthma in our country, which can be detected by SPT. Thus it can be used for identification of type of actual atteryens responsible for bronchiat asthma. This may be a useful measure for earlier detection ol allergens and for hyposensitization or desensitization of that patients accordingly with those allergens- Keywords: Allergen, Eosinophil, Bronchial asthma (J lJttara Adhunik Med ColL 2011; 1(1) : 3-7). the atopic state3. ln their study, most of them had shown that atopy is closely related to asthmaa Allergy plays a role in wide range of the diseases. ranging from itching of the skin to potentially fatal condition such as bronchial asthma5- Asthma due to allergy is often associated with a personal and famtly history of allergic diseases such as rhinitis. urticaria and eczema with positive wheal and flare skin reactsts to injection of intradermal indoor and outdoor atrbome allergens and associated with increased eosinophtl count in the blood6. Allergens trigger asthmatic attacks in 60 to 909o of children and in 50% of adults. Approximalely 75 to 90% of the patients with asthma had positive skin test results2. Majority of allergens that provoke bronchial asthma are airborne. Again, asthma due to allergy is frequently seasonal. Anon seasonal perennialform may results from allergy to house dust , house dust mite, animaldanders ,feathers , molds and other allergens present continuously in the environment6. Introduction Allergic diseases like asthma, hay fever, allergic rhinitis are important causes of morbidity. Different observers found interrelationships among serum total lgE level and allergy skin prick test in general populationl-2. Allergy represents a specific alteration in biologic reactivity mediated by an immunologic mechanism and resulting in an adverse physiologic response. Different investigators studied that immediate hypersensitivity response in atopic individuals are generally associated with increased eosinophil count by which is the essential feature ol 1. Department of Physiology, Uttara Adhunik Medical College (UAMC), Dhaka, Bangladesh. 2. Department of Urology, BSMMU, Dhaka 3. Department of Physiology, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka 1000, Bangladesh. Address of Correspondence: Dr. Tasmina Parveen, Assoc. Professor, Department of Physiology, Uttara Adhunik Medical College, Sonargaon Jonopath, Plot # 34, Road # 4, Section # 9, Uttara Model Town, Dhaka 1230, Bangladesh.
  2. 2. J Uttara Adhunik Med. College Different investigators evaluated about the relationships of allergy skin test reactivity and eosinophilia to the respiratory symptomsT" They observed the prevalence ol symptoms of allergic diseases is increased in patients having increased eosinophil count and it may be the strongest among asthma patients. Again , a high prevalence of positive skin reaction was reported in children with asthma but a very little information is available on the prevalence of immediate skin test reactivity in adult patients with asthma. lt was shown that among 260 patients of adult asthma, 60% had reacted to house dust, 51% reacted to house dust 6111s8'12. Sensitization and exposure to indoor allergens act as risk factor for asthma . Therefore, housing condition plays an imporlant role in asthma, especially among lower socioeconomic populationl3-14. ln our country, bronchial asthma is one of the common respiratory diseases. Most of the cases are commonly treated without knowing the specific allergen, which may be a causative factor for the disease. Again, both indoor and outdoor allergens may have some role in the occurrence of the disease. lf specific allergens have been identified, which trigger asthma symptoms, better management of the patients can be done, which may lead them to a symptom-free life. ln addition, identification of the specific allergens prior to the treatment may also help the physician in planning better management of the asthmatic patients especially by hyposensitization (immunotherapy). Furthermore, physician could monitor the effect o{ immunotherapy by repeating the skin test reactivity at regular interval and thereby adjust the dose ol hypo sensitization to particular allergens accordingly. Therefore, the present study has been designed to perform allergen skin test reactivitywith various indoor allergens in adult asthmatic subjects in order to find out the common variety and to observe blood eosinophil count. ln this study the association among skin test reactivity and eosinophin count in blood were also observed in the same group of patients. The study also aimed to utilize the findings of skin prick test as background information for the clinicians in desensitizing the common allergens present in the asthmatic patients in our country and better management of bronchial asthma and also to create awareness among this group of patients so that they can take early and regular treatment. Vol.01, No.01, January 2011 Materials and Methods The present observational study was done in the Deparlment of Physiology, Bangabandhu Sheik Mujib Medical University (BSMMU), Dhaka and Asthma Centre, Mohakhali, Dhaka from January 2005 to December 2005. ln this study a total number o{ 60 subjects with age range ol 20 to 40 years of both sexes were included, ol whom 30 apparently healthy and 30 asthmatic adult subjects were included in group A (Control) and in group B (Asthmatic patients). Detailed procedures and objectives of the study were explained to the subjects and their written consents were taken before performing the study' Socio- demographic data including age, sex, family history monthly income were taken. Allergic history regarding different types of allergens including food was also taken. Both physical and clinical examinations were done lor each subject and all the information were recorded in a prefixed data sheet. Detailed procedure about the skin prick tests were briefed to allthe asthmatic patients and the tests were performed with the help of different allergens (house dust, dust mite and cockroach). Assurance was given to the patients that the study would not bring any health hazards. Blood samples were collected for determination of blood eosinophil counl both in asthmatic patients and also in healthy subjects. Results Anthropometric details of all subjects and sex distribution are shown in Table 1 and Figurel ' Both groups are matched for age, sex and body mass index (BMr). Table-l Age, sex, height, weight and BMI in different study grou7s (n = 60 ) Parameter GrouPA GrouP B P value Mean + SD Mean + SD (n = 30) (n = 30) Age (Years) 27.77 t 5.75 29.10 t 6.053 0.50 ns Height (cm) 159.63 t 5.461 160.57 t 3.910 0.10 ns Weight (kg) 61 .73 t 7 .488 63.93 t 6.933 0.50 ns BMI 24.13 x. 1.71 24] t 4-02 0.10 ns Group A: Apparently healthy adults (Control) Group B: Adults suffering from mild intermittent asthma (Experimental)
  3. 3. Allergen Skin Test Reactivity and Eosinophilia in Adult Bronchial Asthmatic Patients 500 450 60 E50o I t40 30 20 Fig.-I: Showing distribution of the subiect by sex (n = 60). Results of skin prick tests (SPTs) with three different allergens are shown in Figure 2. Maximum percentage of asthmatic patients showed positive reaction with dust mite which was statistically significant (p<0.001). T Parveen et al Fig.-3: Showing mean absolute eosinophil count in different study groups (n = 60). Group A = Control; Group B = Experimental. Table-ll Distribution of the subjects by absolute eosinophil count in different groups (n = 60) Absolute df GroupA Group B f value p value eosinophil (n = 30) (n = 30) count No. (%) No. (%) (cells/trl) 400 3s0 o = 3oo oL .o oEn = zrv I 2oo 6 o iso10 0 100 50 -. 25 o 3zo ItoL L15 Normal (<27511t1) Higher (>27Slul) 27 (e0.0) I (26.7) 1 24.754 0.001-.- 3 (10.0) 22 (73.3) Fig.-2: Distribution of the asthmatic patients by the findings of skin prick tests (PST) (n = 30). Results of blood eosinophil count of all subjects are shown in Figure 3. The mean (+ SD) serum total lgE level was significantly (p <0.001) higher in asthmatic patients than that of control subjects. Again distribution of all the subjects by serum total lgE level is presented in Thble 2. Serum total lgE level (>100 lUiml) was obsenred in B0% of asthmatic patients and in6.7"/" of healthy subjects. The difference was statistically significant (p <0 .001). Group A: Apparently healthy adults (Control) Group B: Adults suffering from mild intermittent asthma( experimental) n = number of subjects Value in parenthesis indicates percentage df = degree of freedom ..- = Significant at <0.001 Results of the frequency distribution of the subjects by SPT with elevated serum total lgE level are shown in Figure 4. Percentages of positive SPT patients were significantly (<0.001) higher than those of negative SPT patients with elevated serum total lgE level. Again, association of the findings of positive skin prick test (SPT) of different allergens with elevated serum total lgE level in asthmatic patients were studied. A non significant association were observed among them. No data are presented in this aspect. 16.7 ffi liru li,'l) 40*- ffi [1I ti'1I ffi
  4. 4. J Uttara Adhunik Med. College Negative 21Yo ts Positive % Negative Positive 79Yo Fig.-4: Distribution of skin prick tests (SPTs) with increased eosin oph i I cou nt. Discussion ln this study, skin prick tests were performed by using common indoor allergens like, house dust, dust mite a.nd cockroach among asthmatic patients in order to detect type of allergens present in our population with bronchial asthma. Because of non availability, SPT for other allergens were not done. Although laboratory tests for blood eosinophil count were done both in asthmatic and healthy subjects. ln this study, maximum numbers of asthmatic patients had positive SPT for dust mite which is significantly higherthan that of house dust and cockroach. Similar type of observations were made by many investigators of different countries including Bangladesh2'13'15. Significantly higher mean eosinophil count in asthmatic adults were compared to the healthy subjects. Similar observations was reported by some other investigatorsl6-17. ln this study, there was association between the positive skin prick tests of all allergens and increased eosinophil count though it was not statistically significant. Similar study was also observe612,18. Maximum numbers of asthmatic patients had increased eosinophil count and a significant association was found between asthma and eosinophilia. Several mechanisms have been proposed about the allergens induced broncho-constriction in bronchial Vol. 01, No. 01, January 2011 asthma. Eosinophilia is one of the common features in bronchial asthma especially due to allergy. Eosinophils play an imporlant role in the inflammatory process of the airways of asthmatics. These group of investigators suggested that activated eosinophils in the bronchialwall of the asthmatics release arginine- rich proCucts such as major basic protein (MBP), eosinophil cationic protein (ECP), and eosinophil peroxidase (EPO) which thereby cause bronchiale hyperresponsiveness 1 0' 1 6-17'19-21 . Moreover, there are some postulated mechanisms for eosinophilia in bronchial asthma. lncreased the numbers of eosinophils in peripheral blood may stimulate bone marrow to release interleukin-3 (lL-3) and interleukin-S (lL-5) by T-lymphocyte and mast cells, which are chemotactic for eosinophils20'22. Therefore, this study revealed that different allergens like, house dust, dust mite and cockroach are responsible for bronchial asthma in our country which can be detected by SPT. Though only three indoor allergens were studied but other indoor allergens like, pet-derived allergens, molds including outdoor allergens like, industrialfumes, ozone, pollens, grass etc may have some important role in causing bronchial asthma. Because of unavailability of all the above mentioned allergens, it was not possible to include in this study. ln addition presence of increased eosinophil count in SPT positive asthmatic patients also support these tests. The above f indings indicate that this test can be done along with SPT may be a usef ul measure for earlier detection of allergens. Accordin gly hyposensitization or desensitization of those patients with those allergens may be the preventive and therapeutic measures. All these measures can be adopted to minimize the risk of complications especially in young adults and thereby can improve their quality of life. Conclusion From the above findings it can be concluded that different allergens like, house dust, dust mite and cockroach are responsible for bronchialasthma in our country and dust mite is the commonest. Presence of all these allergens can be detected by Skin prick tests (SPTs). References 1. Sattar HA, Mobayed H, Al-Mohammed AA. The pattern of indoor and outdoor respiratory allergens in asthmatic adult patients in a humid and desert newly
  5. 5. 2. Allergen Skin Test Reactivity and Eosinophilia in Adult Bronchiat Asthmatic patients developed country. Allergo lmmunol (Paris). 2003; 35(8):300-s05. Kelley W, Argyros G and Katial RK. Allergic and environmental asthma. Available al: http//www.e m ed ic i n e. co m /m ed/to p i c3390. htm. 2004. Bardana EJ Jr. What Characterize allergic asthma? Ann Allergy. 1992; 68(5): 371-373. Burrows B, Lebowitz MD and Barbee RA. Respiratory disorders and allergy skin test reactions. -Ann lntern Med. 1976;84 134. Cotran RS, Kumar V and Robbins SL. Disease of immunity. ln Robbins Pathologic Basis of Disease, 6'h edn., WB Saunders Company, Philadelphia. 1994, p. 195. McFadden ER Jr. Asthma. ln Harrison's Principles of lnternal Medicine (lssel bacher KJ, Brannwald E, Wilsonnnn JD, Martin JB, Fanci AS and Karper DL eds.), 13th edn., 2005. pp, 1508-1515. Mc Graw-Hill lnc., New York. Tollerud DJ, O'Connor GT, Sparrow D and Weiss ST. Asthma, hay fever and phlegm production associated with distinct patterns ot allergy skin test reactivity, eosinophilia and serum lgE levels. Am Hev Respir Dis. 1991; 144: 776-781. Halonen M, Barbee RA, Lebowitz MD and Burrows B. An epidemiologic study of the interrelationships of total serum lgE, allergy skin test reactivity and eosinophilia. J Allergy CIin lmmunol. 1982; 69: 221-228. Devenney I and Falth-Magnusson K. Skin prick test may give generalized allergic reactions in infants. Ann Allergy Asthma lmmunol. 2000; 85(6): 457-460. Ulrik CS. Eosinophils and pulmonary function: An epidemiologic study of adolescents and young adults. Ann Allergy Asthma lmmunol. 1998; 80: 487-893. Arshad SH, Tariq SM, Mahews S and Hakim E. Sensitization to common allergens and its association with allergic disorders at age 4 years. Pediatrics. 2001 ; 108(2): 1-8. Burrows B, Mafiinez F, Halonen M, Barbee RAand Clin MG. Association of asthma with serum lgE levels and skin test reactivity of allergens. N Engl J Med. 1989;32Q:271-276. 17 T Parveen et al Geber LE. SeEer LH, Bouzoukis JK, Pollart SM, Chapman MD. Phts Milb TAE Sensitization and exposure to indoor allergens as rsk hciors for asthma among patients presenting to ho6Frtai. fun R* Rapr Ds. 19S: 147: 573578. Mondol EA and Rahnan ASMM. Prevalence of Mite allergens amongst gatren:s of bronchial asthma. Bangladesh Amd Fo{ces l',e J z}n 26:41-45. Celedon JC, Palmer LJ. Wetss STfJang Brnvan. Fang Z and Xu X. Asthma. rhrnrlrs a.c sk. t€s' reactivrty to aeroallergens in famrhes of asth"na:r sj.€cts in Anourng. China. Am J Respir Cnt Care l{eo 23€' '53,i '1C8- 1112. Laprise C, Boulet LP. Aiftvay respo.lsle.ess a.c a:cp.v in families of patients with asthma Ct,. t-,6: ryeo '99€: 19(60):461-469. Erikson NE, Moller C, Wih, JA and Zo,ucas r.r qr - ^.cr allergens, inhalant insect allergens arc s-'-c relationships to indoor environmenl Cc.::- :a'i sensitization to different allergens. Varku P-'-.cr.:.:!.,a ' Alargologija. 2000. Jansen DF, Rijcken B, Schouten. The relahonsr cs :'s..' test positivity, high serum lgE level and Penpre'a :,.:r: eosinophilia to symptomatic and asymptoma:.: a -.ra, hyperresponsiveness. Am J Respir Crit Care r.kc '?- 159(3): 924-9s1. Burrows B, Hasan FM, Barbee RA. Halone- r.' a': Lebowitz MD. Epidemiologic observations on ecsrr€c. a and its relation to respiratory disorder. Am Re' ?es:' Dis. 1980; 122: 709-717. Horn BR, Robin ED, Theodore J and Kessei Ar Tc:a eosinophil counts in the management of bronchra as}-a N Engl J Med. 1975',292: 1152-1155. Lewis SA, Pavord lD, Stringer JR. The relatim b€f^ee. peripheral blood leukocyte counts and resp'atc'' symptoms, atopy, lung function ano d'n2.t responsiveness in adults. Chest. 2001: 119. 1!1": Platts-Mills TAE and DeWeck Al. Dust mite allerge.s a-3 asthma - A world wide problem (lntemational !rybftsroc J Allergy Clin lmmunol. 1989; 83: 416. 13 14 15. 16. 18 19. B. 20. 21 o '10 11. 1a12

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