Sensitization to mite allergens is a risk factor for early and late onset of asthma and for persistence of asthmatic signs in children

doi:10.1016/S0091-6749(95)70168-0

Journal of Allergy and Clinical Immunology

Volume 95, Issue 3, March 1995, Pages 655-662

https://doi.org/10.1016/S0091-6749(95)70168-0 Get rights and content

Abstract

Background: To describe the natural history of asthma between the ages of 7 and 10 years and to analyze risk factors for prevalences, as well as new onset of asthma-like symptoms, a longitudinal study of 1812 children was conducted. Methods: In four surveys, each 1 year apart, four asthma-like symptoms and several hypothetical risk factors were ascertained through standardized questionnaires. Sensitization to seven common inhalant allergens was measured by skin prick testing. Exposure to mite allergens (Der p I, Der f I) was assessed by measuring the antigen concentrations in the dust of each child's mattress. Occurrence of more than one asthma-like symptom closely related to the practitioner's diagnoses of bronchial asthma and recurrent wheezy bronchitis was used as the outcome variable. Results: After an initial prevalence of 14.5%, new onset of symptoms in children unaffected at the beginning was reported in 7.2% during the 3 years. Of the factors explaining prevalence and persistence of asthma-like symptoms (sensitization to mite allergens and animal danders, history of hay fever and eczema, low gestational age, male gender, parental atopy), only sensitization to mite allergens (odds ratio = 2.3, 95% confidence interval = 1.1-4.7) and parental atopy (odds ratio = 2.1, 95% confidence interval = 1.2-3.7) were also significantly associated with new onset. In a relatively small number of sensitized subjects with new onset of symptoms (n = 31), mite antigen concentration did not appear to be associated with incidence of symptoms. Conclusion: Sensitization to mite allergens antedated the onset of asthma-like symptoms, and no strong effect of allergen exposure on clinical development could be found. Thus the primary focus should be on preventing sensitization to mite allergens by implementing avoidance measures in infancy or at early school age in order to reduce the onset of asthma at a later stage. (J ALLERGY CLIN IMMUNOL 1995;95:655-62.)

Section snippets

Study population

Data were collected in a longitudinal study designed to assess risk factors for allergy and asthma in a community-based cohort of children.⁷ All parents in three mainly urban areas of Southwestern Germany (Freiburg, Lörrach/Weil, and Kehl) whose children started school in 1989 (N = 2604) were invited to participate, and of these, 1812 (70%) took part. Three questionnaires (surveys 1 to 3: 1990, n = 1812; 1991, n = 1626; and 1992, n = 1477) were distributed and completed by the parents. If

RESULTS

Of the 1812 children who participated in the first survey, 199 (11%) had been diagnosed with asthma. Among these children, one of the four asthma-like symptoms was reported in 34 (17.1%), and in 119 (59.8%) more than one symptom had occurred. In contrast, only 8.9% of the nonasthmatic children (n = 143) had more than one symptom, and one symptom was observed in 302 of them (18.8%). The yearly prevalences of more than one asthma-like symptom in the following three surveys were lowest in the

DISCUSSION

In a community-based cohort of children, prevalences and incidences of asthma-like symptoms were ascertained in order to describe the natural history of asthma between the ages of 7 and 10 years and to analyze risk factors for prevalences and new onset of symptoms. The number of symptoms was counted, and because presence of more than one symptom is closely related to doctors' diagnoses of asthma, this variable was focused for risk assessment. The study shows an initial prevalence (more than one

Acknowledgements

We thank Mrs. Susanne Huber, Mrs. Monika Mortensen, and Mrs. Sabine Linser-Haar for their excellent collaboration in the field study. They conducted the SPTs, the household visits, and the analyses in the laboratory, respectively.

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Approximately 44% and 40% of children were exposed to Bla g 1 levels greater than 2 U/g and HDM levels greater than 2 μg/g, respectively, and 24% reported at least 1 hospitalization in the previous 4 months. The median Bla g 1 level was significantly higher in the homes of children hospitalized compared with those with no hospital admissions (7.2 vs 0.8 U/g). In multivariable models, the odds of hospitalization were significantly higher in children exposed to Bla g 1 levels greater than 2 U/g (adjusted odds ratio, 4.2; 95% confidence interval, 1.24–14.17), independent of sensitization status. Exposure to HDMs was not associated with any measure of morbidity.
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^☆: From ^aUniversity Children's Hospital, Freiburg; ^b University Children's Hospital, Vienna; and ^cNORDIG Institute for Health Research and Prevention, Hamburg.

^☆☆: Supported by the German Federal Ministry for Research and Technology (grant no. 0701565).

^★: Reprint requests: Joachim Kuehr, University Children's Hospital, D-79106 Freiburg, Mathildenstr. 1, Germany.

^★★: 1/1/60298

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Sensitization to mite allergens is a risk factor for early and late onset of asthma and for persistence of asthmatic signs in children☆,☆☆,★,★★

Abstract

Section snippets

Study population

RESULTS

DISCUSSION

Acknowledgements

The relative risks of sensitivity to grass pollen, house dust mite and cat dander in the development of childhood asthma

Clin Exp Allergy

Sensitivity to common allergens: relation to respiratory symptoms and bronchial hyper-responsiveness in children from three different climatic areas of Australia

Clin Exp Allergy

Natural history of childhood asthma. 20-year follow-up

Arch Dis Child

Clinical atopy and associated factors in primary-school pupils

Allergy

Prognosis of positive allergy skin tests in an asymptomatic population

J A LLERGY CLIN I MMUNOL

New onset wheezing in an older male population: evidence of allergen sensitization in a longitudinal study

J ALLERGY CLIN IMMUNOL

Early childhood risk factors for sensitization at school age

J ALLERGY CLIN IMMUNOL

High mite-allergen exposure increases the risk of sensitization in atopic children and young adults

J ALLERGY C LIN IMMUNOL

Mite allergen exposure is a risk for the incidence of specific sensitization

J ALLERGY CLIN IMMUNOL

Regression analysis for correlated data

Annu Rev Public Health

Comparison of baseline and repeated measure covariate techniques in the Framingham Heart Study

Stat Med