ASSOCIATION BETWEEN AEROALLERGEN SENSITIZATION AND THE SEVERITY OF ASTHMA IN PEDIATRIC PATIENTS

Abstract

Asthma is one of the most common chronic diseases
in childhood, with increasing prevalence in the past
3 decades (Nievas et al, 2013). The prevalence of
asthma in the world is approximately 7.2% (6%
adults and 10% children).
There are variations in the prevalence and mortality
of asthma. WHO estimates that there are currently
250,000 deaths due to asthma. It is leading cause of
childhood hospitalization and school absenteeism.
Asthma is more prevalent in boys in the first years of
life, but in adolescents it predominates among
female subjects. Asthma affects minority and lowincome
groups disproportionately (Herzog et al,
2011; Rahajoe, 2013).
In Indonesia, Asthma is the top ten causes of
morbidity and mortality. The study data of
household health survey in 1986 in various provinces
in Indonesia showed asthma ranks 5th of 10th
causes of morbidity. In 1992 Household Health
Survey, asthma, chronic bronchitis and emphysema
as 4th cause of death in Indonesia (5.6%). In 1995,
the prevalence of asthma in Indonesia approximately
13/1000, compared with chronic bronchitis is
11/1000 and pulmonary obstruction is 2/1000
(Guidelines for Diagnosis and Management of
Asthma In Indonesia, 2013)
Asthma is a heterogeneous disorder in children that
is characterized by recurrent airway obstruction,
bronchial hyper-responsiveness, and airway
inflammation. (Herzo et al, 2011).
The pathophysiologic basis of asthma is not well
understood. It appears to have a complex,
multifactorial etiology which results from an
interplay of many hereditary factors and a number
of environmental factors. Bronchial biopsies from
patients with even mild asthma have evidence of
chronic inflammation, and cytokines and other
mediators of inflammation are found in bronchial
washings from asthma patients. Some families are
more prone to development of allergies, and there is
a well-known association between allergies and
asthma. This suggests a genetic predisposition, but it
appears that a number of genes are involved.
Proceeding ICMHS 2016 ISBN 978-602-60569-3-1
127
Figure 1. Pathophysiology of astma
Source: Busse W. & Lemanske R: N. Engl. J. Med.
2001;344(5):350-362
Asthma attacks is vary from mild to severe and life
threatening. The various factors which can trigger
asthma attacks, such as exercise, allergens,
infections, sudden changes in air temperature, or
exposure to respiratory irritants such as cigarette
smoke and others. (Rahajoe, 2013)
Aeroallergen sensitization is a risk factor in the
development of childhood asthma. Aeroallergen
sensitization occurs in most patients with asthma
and is noted in a high percentage of patients with
mild and moderate asthma. The percentage of those
that are atopic with severe asthma appears less, but
still approximates the percent seen in patients with
mild and moderate asthma. The most commonly
implicated allergens are house dust mite (HDM),
cockroach, and furred animals. Aeroallergen
sensitization can be evaluated using skin testing. (Raj
et al, 2013)
House dust mites are arachnids that are microscopic
in size (~0.33mm long). They are found in dust and
products with woven material or stuffing such as
mattresses, pillows, stuffed animals, and bedding.
Their life cycle from egg to adult takes 3 to 4 weeks
and they live for 6 to 8 weeks. Females produce 40
to 80 eggs during this time.
It has been shown that dust mite exposure in early
childhood is an important determinant in asthma
development. Sporik et al. showed that 16 of 17
children with asthma were sensitized to dust mite.
urther, the higher the level of dust mite exposure at
1 year old, the earlier the first episode of wheezing
occurred. The relative risk of asthma was almost 5-
times greater in the subjects who were exposed to
high levels of dust mite allergen (>10 μg/g) (Baxi et
al, 2010)
They demonstrated that early exposure to house
dust mite was associated with an increased risk of
asthma and late onset wheezing. They followed a
group of 440 children from birth to 7 years and
found that children exposed to high levels of dust
mite allergen in their bed at 2 to 3 months old had a
3-fold increase in the odds of asthma at age 7 years
old compared with those exposed to low level dust
mite allergen (Baxi et al, 2010)
Skin prick testing (SPT) is an easy, cost-effective and
convenient approach to identify sensitization to
allergens. SPT detects the presence of allergen
specific IgE bound to mast cells by eliciting mast cell
degranulation to the specific allergen being tested
(Raj et al, 2013).
The purpose of this study was to determine the
association of aeroallergen sensitization and the
severity of asthma in pediatric patients.