Relationship of skin test reactivity to decrements in pulmonary function in children with asthma or frequent wheezing.

Abstract

We examined the relationship between skin test reactivity and level of FEV1 in a stratified random sample of U.S. children 6 to 12 yr of age with asthma or frequent wheezing, studied as part of the Second National Health and Nutrition Survey (NHANES II). Subjects were considered symptomatic if they reported asthma or wheezing. Spirometry was performed according to ATS standards. Skin test reactivity to Alternaria, Bermuda grass, cat, dog, house dust, mixed long and short ragweed, oak, and rye grass allergens was determined. House dust mite (-17% FEV1; 95% CI, -9 to -25), dog (-28% FEV1; 95% CI, -11 to -42), and oak (-26% FEV1, 95% CI, -16 to -35) were associated with the greatest decrements in FEV1. In general, indoor allergens (-13% FEV1; 95% CI, -6 to -20) were associated with greater effects than outdoor allergens (-5% FEV1; 95% CI, -2 to -13). The association of indoor allergens with reduced FEV1 was greater in girls (-16% FEV1; 95% CI, -5 to -25) than in boys (-8% FEV1; 95% CI, -3 to -13). Sensitization to indoor allergens among symptomatic children 6 to 12 yr of age was associated with decrements in level of FEV1.

Função pulmonar persistentemente reduzida em crianças e adolescentes com asma

“…These results support the hypothesis that indoor home allergens are involved in or are markers of greater asthma severity, playing an important role in the pathogenesis of the disease, probably early in life. (30) The analysis including atopic index data demonstrated the relationship between atopy intensity and asthma severity. However, when we consider that the proportion of patients with persistent loss of pulmonary function (i.e., 8.3%) was relatively small in comparison with the total number of asthma patients in our sample, the small number of patients with persistent loss (n = 8) makes it difficult to analyze the factors associated with this outcome.…”

“…(23) Therefore, there is evidence that structural changes are responsible for a varying degree of airway irreversibility, thereby contributing to the phenomenon of loss of pulmonary function, and that frequent exacerbations lead to a decline in pulmonary function, given that they perpetuate (19) demonstrated a significant correlation between the atopic index for indoor home allergens in childhood and the persistence of asthma into puberty. (19) Another study (30) reported associations between those allergens and reduced FEV 1 values in children aged 6-12 years. These results support the hypothesis that indoor home allergens are involved in or are markers of greater asthma severity, playing an important role in the pathogenesis of the disease, probably early in life.…”

Asthma: epidemiology, etiology and risk factors

“…Until age 13-14 years, the incidence and prevalence of asthma are greater among boys than among girls. [133][134][135][136][137][138][139][140][141][142] Studies through puberty 139,[143][144][145][146][147][148][149][150][151][152][153][154][155] have shown a greater incidence of asthma among adolescent and young adult females [133][134][135]156,157 and a greater proportion of males with remission of asthma. [136][137][138][139][140] Before age 12, boys have more severe asthma than girls, 142 with higher rates of admission to hospital.…”

Early life origins of asthma

“…Nearly 90% of children with asthma have respiratory allergies, with indoor allergens, house dust mite, Alternaria, cockroach, or cat most closely associated with childhood asthma (28). In addition, a strong correlation exists between the number of positive skin tests in children and the severity of asthma (29). Finally, the intensity of exposure to house dust mite protein during infancy has been shown to lead to an earlier onset of asthmatic symptoms in children (30).…”