Abstract
BACKGROUND—The amount of allergen necessary to sensitise genetically "at risk" children is unclear. The relation between allergen exposure and asthma is also uncertain. METHODS—To ensure a wide range of allergen exposures the data from case-control studies of asthma in children aged 12-14 years attending three schools in Los Alamos, New Mexico and Central Virginia were combined. Skin prick tests to indoor and outdoor allergens and bronchial hyperreactivity to histamine were assessed in children with and without symptoms of asthma. The concentration of mite, cat, and cockroach allergens in dust from the children's homes was used as a marker of exposure. RESULTS—Three hundred and thirty two children (157 with asthmatic symptoms and 175 controls) were investigated. One hundred and eighty three were classified as atopic on the basis of allergen skin prick tests and 68 as asthmatic (symptoms plus bronchial responsiveness). The prevalence and degree of sensitisation to mite and cockroach, but not cat, was strongly associated in atopic children with increasing domestic concentrations of these allergens. Asthma was strongly associated with sensitisation to indoor allergens (p<10-6) and weakly to outdoor allergens (p = 0.026). There was an association between current asthma and the concentration of mite allergen amongst atopic children (p = 0.008) but not amongst those who were specifically mite sensitised (p = 0.16). CONCLUSIONS—The domestic reservoir concentration of mite and cockroach, but not cat, allergen was closely related to the prevalence of sensitisation in atopic children. However, the prevalence of current asthma had a limited relationship to these allergen measurements, suggesting that other factors play a major part in determining which allergic individuals develop asthma.
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- Arshad S. H., Matthews S., Gant C., Hide D. W. Effect of allergen avoidance on development of allergic disorders in infancy. Lancet. 1992 Jun 20;339(8808):1493–1497. doi: 10.1016/0140-6736(92)91260-f. [DOI] [PubMed] [Google Scholar]
- Burrows B., Martinez F. D., Halonen M., Barbee R. A., Cline M. G. Association of asthma with serum IgE levels and skin-test reactivity to allergens. N Engl J Med. 1989 Feb 2;320(5):271–277. doi: 10.1056/NEJM198902023200502. [DOI] [PubMed] [Google Scholar]
- Call R. S., Smith T. F., Morris E., Chapman M. D., Platts-Mills T. A. Risk factors for asthma in inner city children. J Pediatr. 1992 Dec;121(6):862–866. doi: 10.1016/s0022-3476(05)80329-4. [DOI] [PubMed] [Google Scholar]
- Cookson W. O., Sharp P. A., Faux J. A., Hopkin J. M. Linkage between immunoglobulin E responses underlying asthma and rhinitis and chromosome 11q. Lancet. 1989 Jun 10;1(8650):1292–1295. doi: 10.1016/s0140-6736(89)92687-1. [DOI] [PubMed] [Google Scholar]
- Custovic A., Taggart S. C., Woodcock A. House dust mite and cat allergen in different indoor environments. Clin Exp Allergy. 1994 Dec;24(12):1164–1168. doi: 10.1111/j.1365-2222.1994.tb03323.x. [DOI] [PubMed] [Google Scholar]
- Duff A. L., Pomeranz E. S., Gelber L. E., Price G. W., Farris H., Hayden F. G., Platts-Mills T. A., Heymann P. W. Risk factors for acute wheezing in infants and children: viruses, passive smoke, and IgE antibodies to inhalant allergens. Pediatrics. 1993 Oct;92(4):535–540. [PubMed] [Google Scholar]
- Gelber L. E., Seltzer L. H., Bouzoukis J. K., Pollart S. M., Chapman M. D., Platts-Mills T. A. Sensitization and exposure to indoor allergens as risk factors for asthma among patients presenting to hospital. Am Rev Respir Dis. 1993 Mar;147(3):573–578. doi: 10.1164/ajrccm/147.3.573. [DOI] [PubMed] [Google Scholar]
- Ingram J. M., Sporik R., Rose G., Honsinger R., Chapman M. D., Platts-Mills T. A. Quantitative assessment of exposure to dog (Can f 1) and cat (Fel d 1) allergens: relation to sensitization and asthma among children living in Los Alamos, New Mexico. J Allergy Clin Immunol. 1995 Oct;96(4):449–456. doi: 10.1016/s0091-6749(95)70286-5. [DOI] [PubMed] [Google Scholar]
- Kuehr J., Frischer T., Meinert R., Barth R., Schraub S., Urbanek R., Karmaus W., Forster J. Sensitization to mite allergens is a risk factor for early and late onset of asthma and for persistence of asthmatic signs in children. J Allergy Clin Immunol. 1995 Mar;95(3):655–662. doi: 10.1016/s0091-6749(95)70168-0. [DOI] [PubMed] [Google Scholar]
- Luczynska C. M., Arruda L. K., Platts-Mills T. A., Miller J. D., Lopez M., Chapman M. D. A two-site monoclonal antibody ELISA for the quantification of the major Dermatophagoides spp. allergens, Der p I and Der f I. J Immunol Methods. 1989 Mar 31;118(2):227–235. doi: 10.1016/0022-1759(89)90010-0. [DOI] [PubMed] [Google Scholar]
- Mahmic A., Tovey E. R., Molloy C. A., Young L. House dust mite allergen exposure in infancy. Clin Exp Allergy. 1998 Dec;28(12):1487–1492. doi: 10.1046/j.1365-2222.1998.00423.x. [DOI] [PubMed] [Google Scholar]
- Marks G. B., Tovey E. R., Toelle B. G., Wachinger S., Peat J. K., Woolcock A. J. Mite allergen (Der p 1) concentration in houses and its relation to the presence and severity of asthma in a population of Sydney schoolchildren. J Allergy Clin Immunol. 1995 Oct;96(4):441–448. doi: 10.1016/s0091-6749(95)70285-7. [DOI] [PubMed] [Google Scholar]
- Munir A. K., Einarsson R., Dreborg S. K. Mite (Der p I, Der f I), cat (Fel d I) and dog (Can f I) allergens in dust from Swedish day-care centres. Clin Exp Allergy. 1995 Feb;25(2):119–126. doi: 10.1111/j.1365-2222.1995.tb01016.x. [DOI] [PubMed] [Google Scholar]
- Munir A. K., Kjellman N. I., Björkstén B. Exposure to indoor allergens in early infancy and sensitization. J Allergy Clin Immunol. 1997 Aug;100(2):177–181. doi: 10.1016/s0091-6749(97)70221-5. [DOI] [PubMed] [Google Scholar]
- O'Connor G., Sparrow D., Taylor D., Segal M., Weiss S. Analysis of dose-response curves to methacholine. An approach suitable for population studies. Am Rev Respir Dis. 1987 Dec;136(6):1412–1417. doi: 10.1164/ajrccm/136.6.1412. [DOI] [PubMed] [Google Scholar]
- O'Meara T. J., De Lucca S., Sporik R., Graham A., Tovey E. Detection of inhaled cat allergen. Lancet. 1998 May 16;351(9114):1488–1489. doi: 10.1016/s0140-6736(05)78870-x. [DOI] [PubMed] [Google Scholar]
- Peat J. K., Salome C. M., Berry G., Woolcock A. J. Relation of dose-response slope to respiratory symptoms in a population of Australian schoolchildren. Am Rev Respir Dis. 1991 Sep;144(3 Pt 1):663–667. doi: 10.1164/ajrccm/144.3_Pt_1.663. [DOI] [PubMed] [Google Scholar]
- Peat J. K., Tovey E., Toelle B. G., Haby M. M., Gray E. J., Mahmic A., Woolcock A. J. House dust mite allergens. A major risk factor for childhood asthma in Australia. Am J Respir Crit Care Med. 1996 Jan;153(1):141–146. doi: 10.1164/ajrccm.153.1.8542107. [DOI] [PubMed] [Google Scholar]
- Perzanowski M. S., Rönmark E., Nold B., Lundbäck B., Platts-Mills T. A. Relevance of allergens from cats and dogs to asthma in the northernmost province of Sweden: schools as a major site of exposure. J Allergy Clin Immunol. 1999 Jun;103(6):1018–1024. doi: 10.1016/s0091-6749(99)70173-9. [DOI] [PubMed] [Google Scholar]
- Platts-Mills T. A., Sporik R. B., Wheatley L. M., Heymann P. W. Is there a dose-response relationship between exposure to indoor allergens and symptoms of asthma? J Allergy Clin Immunol. 1995 Oct;96(4):435–440. doi: 10.1016/s0091-6749(95)70284-9. [DOI] [PubMed] [Google Scholar]
- Platts-Mills T. A., Vervloet D., Thomas W. R., Aalberse R. C., Chapman M. D. Indoor allergens and asthma: report of the Third International Workshop. J Allergy Clin Immunol. 1997 Dec;100(6 Pt 1):S2–24. doi: 10.1016/s0091-6749(97)70292-6. [DOI] [PubMed] [Google Scholar]
- Pollart S. M., Chapman M. D., Fiocco G. P., Rose G., Platts-Mills T. A. Epidemiology of acute asthma: IgE antibodies to common inhalant allergens as a risk factor for emergency room visits. J Allergy Clin Immunol. 1989 May;83(5):875–882. doi: 10.1016/0091-6749(89)90100-0. [DOI] [PubMed] [Google Scholar]
- Pollart S. M., Smith T. F., Morris E. C., Gelber L. E., Platts-Mills T. A., Chapman M. D. Environmental exposure to cockroach allergens: analysis with monoclonal antibody-based enzyme immunoassays. J Allergy Clin Immunol. 1991 Feb;87(2):505–510. doi: 10.1016/0091-6749(91)90009-d. [DOI] [PubMed] [Google Scholar]
- Postma D. S., Bleecker E. R., Amelung P. J., Holroyd K. J., Xu J., Panhuysen C. I., Meyers D. A., Levitt R. C. Genetic susceptibility to asthma--bronchial hyperresponsiveness coinherited with a major gene for atopy. N Engl J Med. 1995 Oct 5;333(14):894–900. doi: 10.1056/NEJM199510053331402. [DOI] [PubMed] [Google Scholar]
- Rosenstreich D. L., Eggleston P., Kattan M., Baker D., Slavin R. G., Gergen P., Mitchell H., McNiff-Mortimer K., Lynn H., Ownby D. The role of cockroach allergy and exposure to cockroach allergen in causing morbidity among inner-city children with asthma. N Engl J Med. 1997 May 8;336(19):1356–1363. doi: 10.1056/NEJM199705083361904. [DOI] [PubMed] [Google Scholar]
- Salome C. M., Peat J. K., Britton W. J., Woolcock A. J. Bronchial hyperresponsiveness in two populations of Australian schoolchildren. I. Relation to respiratory symptoms and diagnosed asthma. Clin Allergy. 1987 Jul;17(4):271–281. doi: 10.1111/j.1365-2222.1987.tb02015.x. [DOI] [PubMed] [Google Scholar]
- Sears M. R., Burrows B., Flannery E. M., Herbison G. P., Hewitt C. J., Holdaway M. D. Relation between airway responsiveness and serum IgE in children with asthma and in apparently normal children. N Engl J Med. 1991 Oct 10;325(15):1067–1071. doi: 10.1056/NEJM199110103251504. [DOI] [PubMed] [Google Scholar]
- Sears M. R., Herbison G. P., Holdaway M. D., Hewitt C. J., Flannery E. M., Silva P. A. The relative risks of sensitivity to grass pollen, house dust mite and cat dander in the development of childhood asthma. Clin Exp Allergy. 1989 Jul;19(4):419–424. doi: 10.1111/j.1365-2222.1989.tb02408.x. [DOI] [PubMed] [Google Scholar]
- Sporik R., Chapman M. D., Platts-Mills T. A. House dust mite exposure as a cause of asthma. Clin Exp Allergy. 1992 Oct;22(10):897–906. doi: 10.1111/j.1365-2222.1992.tb02062.x. [DOI] [PubMed] [Google Scholar]
- Sporik R., Holgate S. T., Platts-Mills T. A., Cogswell J. J. Exposure to house-dust mite allergen (Der p I) and the development of asthma in childhood. A prospective study. N Engl J Med. 1990 Aug 23;323(8):502–507. doi: 10.1056/NEJM199008233230802. [DOI] [PubMed] [Google Scholar]
- Sporik R., Ingram J. M., Price W., Sussman J. H., Honsinger R. W., Platts-Mills T. A. Association of asthma with serum IgE and skin test reactivity to allergens among children living at high altitude. Tickling the dragon's breath. Am J Respir Crit Care Med. 1995 May;151(5):1388–1392. doi: 10.1164/ajrccm.151.5.7735590. [DOI] [PubMed] [Google Scholar]
- Sporik R., Platts-Mills T. A., Cogswell J. J. Exposure to house dust mite allergen of children admitted to hospital with asthma. Clin Exp Allergy. 1993 Sep;23(9):740–746. doi: 10.1111/j.1365-2222.1993.tb00361.x. [DOI] [PubMed] [Google Scholar]
- Squillace S. P., Sporik R. B., Rakes G., Couture N., Lawrence A., Merriam S., Zhang J., Platts-Mills A. E. Sensitization to dust mites as a dominant risk factor for asthma among adolescents living in central Virginia. Multiple regression analysis of a population-based study. Am J Respir Crit Care Med. 1997 Dec;156(6):1760–1764. doi: 10.1164/ajrccm.156.6.9704026. [DOI] [PubMed] [Google Scholar]
- Tovey E. R., Chapman M. D., Wells C. W., Platts-Mills T. A. The distribution of dust mite allergen in the houses of patients with asthma. Am Rev Respir Dis. 1981 Nov;124(5):630–635. doi: 10.1164/arrd.1981.124.5.630. [DOI] [PubMed] [Google Scholar]
- Wahn U., Lau S., Bergmann R., Kulig M., Forster J., Bergmann K., Bauer C. P., Guggenmoos-Holzmann I. Indoor allergen exposure is a risk factor for sensitization during the first three years of life. J Allergy Clin Immunol. 1997 Jun;99(6 Pt 1):763–769. doi: 10.1016/s0091-6749(97)80009-7. [DOI] [PubMed] [Google Scholar]
- Yan K., Salome C., Woolcock A. J. Rapid method for measurement of bronchial responsiveness. Thorax. 1983 Oct;38(10):760–765. doi: 10.1136/thx.38.10.760. [DOI] [PMC free article] [PubMed] [Google Scholar]
- van Herwerden L., Harrap S. B., Wong Z. Y., Abramson M. J., Kutin J. J., Forbes A. B., Raven J., Lanigan A., Walters E. H. Linkage of high-affinity IgE receptor gene with bronchial hyperreactivity, even in absence of atopy. Lancet. 1995 Nov 11;346(8985):1262–1265. doi: 10.1016/s0140-6736(95)91863-9. [DOI] [PubMed] [Google Scholar]