|Year : 2013 | Volume
| Issue : 4 | Page : 237-241
Aeroallergen sensitivity among patients suffering from bronchial asthma in Bangalore
Giriyanna Gowda1, Chitra Nagaraj1, BG Parasuramalu1, N Huliraj2
1 Department of Community Medicine, Kempegowda Institute of Medical Sciences (KIMS) Hospital and Research Center, Bangalore, India
2 Department of Pulmonary Medicine, Allergy Center, Kempegowda Institute of Medical Sciences (KIMS) Hospital and Research Center, Bangalore, India
|Date of Web Publication||7-Feb-2014|
Medical Officer, Allergy Center and Assistant Professor, Department of Community Medicine, Kempegowda Institute of Medical Sciences(KIMS), Banashankari 2nd Stage, Bangalore - 560 070, Karnataka
Source of Support: None, Conflict of Interest: None
Background: Asthma is a serious public health problem throughout the world and its prevalence has increased in last 2-3 decades. Allergens are one of the many factors which trigger an attack of asthma. Skin prick test is useful in identifying the offending allergen in bronchial asthma. Aim: To identify the possible offending allergens in patients of bronchial asthma. Materials and Methods: The study was a descriptive study conducted at allergy center, Kempegowda Institute of Medical Sciences Hospital and Research Center, Bangalore from January to December 2011. Skin prick test was done in 139 patients suffering from bronchial asthma using 49 allergens extracts. Statistical Analysis: Frequency, proportions, Chi-square test, odds ratio, and 95% confidence interval was used. Results: Out of 139 patients who underwent the skin prick tests, 40% (56) were males and 60% (83) were females. Majority, that is, 60% were in the age group of 21-40 years. Forty-three percent (60) had family history of asthma/atopy, 80% (111) had allergic rhinitis, 24% (34) had chronic urticaria, and 24% (33) had allergic conjunctivitis. Out of 139 patients, 100 (71.94%) were sensitive for one or more allergens. The common offending allergens found in the study were dust mites (Dermatophagoides farinae and D. pteronyssinus (DF and DP)) - 49.28%, dusts - 7.2%, pollens - 6.77%, insects - 6.62%, fungi - 4.53%, and epithelia - 1.92%. Conclusion: The most common allergens in bronchial asthma were dust mites followed by dusts and pollens. Identifying possible allergens in asthma patients help in allergen avoidance and immunotherapy in these patients.
Keywords: Aeroallergens, bronchial asthma, skin prick test
|How to cite this article:|
Gowda G, Nagaraj C, Parasuramalu B G, Huliraj N. Aeroallergen sensitivity among patients suffering from bronchial asthma in Bangalore. Int J Health Allied Sci 2013;2:237-41
|How to cite this URL:|
Gowda G, Nagaraj C, Parasuramalu B G, Huliraj N. Aeroallergen sensitivity among patients suffering from bronchial asthma in Bangalore. Int J Health Allied Sci [serial online] 2013 [cited 2021 Jan 16];2:237-41. Available from: https://www.ijhas.in/text.asp?2013/2/4/237/126710
| Introduction|| |
Asthma is a serious public health problem throughout the world affecting people of all ages. The prevalence of asthma in the developed as well as developing countries has increased over the recent decades According to World Health Organization (WHO) it is estimated that 300 million individuals are affected with bronchial asthma worldwide and the trend is rising.  In India more than 15 million people are affected with asthma. The prevalence of asthma has increased in last 2-3 decades possibly due to change in indoor and outdoor environment. 
Asthma is a syndrome characterized by airflow obstruction that varies markedly, both spontaneously and with treatment. Asthmatics harbor a special type of inflammation in the airways that makes them more responsive than nonasthmatics to a wide range of triggers.  Allergens are one of the many factors which trigger an attack of asthma. Skin prick test is useful in identifying the offending allergen. Rackemann suggested that identification of inhalant allergen in asthmatic patients by skin prick testing places them in extrinsic (allergic) category and has more favorable prognosis than intrinsic (nonallergic) category.  Hence, the present study was done to identify offending allergens by skin prick test among patients suffering from bronchial asthma.
| Materials and Methods|| |
This was a descriptive study conducted at allergy center, Kempegowda Institute of Medical Sciences Hospital and Research Center, Bangalore from January 2011 to December 2011. Skin prick test was done in 139 patients suffering from bronchial asthma diagnosed based on Global Initiative for Asthma (GINA) guidelines.  Pregnant women, lactating woman, and patients with acute attack of asthma were excluded from the study. All patients were subjected to detailed history, clinical examination, total count, differential count, chest X-ray, and detailed ear, nose, and throat (ENT) and eye examination. Spirometry (pre- and post-bronchodilator) was done in all patients except in less than 10 years of age. Informed consent was taken before performing the test.
Skin prick test (SPT)
The antigens were obtained from Creative Diagnostic Medicare Private Ltd, Navi Mumbai. The test was performed with 49 allergen extracts. Allergen extracts included 19 pollens, 10 fungi, five dusts, two dust mites (Dermatophagoides farinae and D. pteronyssinus
(DF and DP)), 10 insects, and three epithelia. Long-acting antihistamines were stopped 2 weeks before the test and short-acting antihistamines were stopped 5 days before the test. Sympathomimetic were stopped 12 h before the test. SPT was performed on flexor aspect of the arm and forearm (back in children) after cleaning with the isopropyl alcohol. A single drop of allergen extract of 1:10 concentration was placed along with positive control (histamine) and negative control (saline). Sterile lancet was used to prick by making a shallow lift (at an acute angle) for a second to allow adequate entry of antigen beneath the stratum corneum epidermis. This was repeated for each allergen after wiping the lancet with dry cotton. Allergen was left in place for 20 min and then reading of wheal area diameter was taken with help of measuring scale [Figure 1]. Interpretation of results was done according to Indian College of Allergy, Asthma, and Immunology guidelines.  Grade 2+ and above were considered as positives. The positive skin reactions which correlated well with the history were considered as clinically significant. 
Data was entered in Microsoft Excel 2010 and analysis was performed using Statistical Package for Social Sciences (SPSS) 19.0 version. Descriptive statistics like frequency proportions and inferential statistics like Chi-square test, odds ratio, and 95% confidence interval was used.
| Results|| |
Out of 139 patients with bronchial asthma, 56 (40.29%) were males and 83 (59.71%) were females. Majority, that is, 84 (60.43%) were in the age group of 21-40 years [Table 1]. Around 60 (43.16%) had family history of asthma/atopy. Out of 139 asthmatics, 111 (79.90%) had allergic rhinitis, 34 (24.50%) had chronic urticaria, and 33 (23.70%) had allergic conjunctivitis.
Out of 139 patients, 100 (71.94%) were sensitive for one or more allergens. The common offending allergens identified in bronchial asthma patients were dust mites (DF and DP) (49.28%), dusts (7.20%), pollens (6.77%), fungi (4.53%), insects (6.62%), and epithelia (1.92%). Among dust mites DP was found in 52.52% followed by DF (46.04%). The most common dust allergens were paper dust (12.23%), house dust (10.07%), cotton dust (8.63%), and wheat dust (5.76%).
The most common pollens were Parthenium hysterophorus (20.86%), Peltophorum pterocarpum (15.11%), Chenopodium album (12.95%), Xanthium strumarium (10.79%). Prosopis juliflora (9.35%), Ageratum conyzoides (7.91%), Casuarinas equisetifolia (6.47%), Acacia arabica (5.76%), Amaranthus spinosus (5.76%), Cocos nucifera (5.76%), and Cassia siamea (5.04%).
The most common fungi were Aspergillus flavus (6.47%), Candida albicans (6.47%), Alternaria alternate (5.76%), Curvularia lunta (5.76%), Aspergillus niger (5.04%), and Clodosporium herbarum (5.04%).
The most common insects were cricket (22.30%), mosquito (10.07%), wasp (7.19%), grasshopper (5.76%), moth (5.76%), and house fly (5.04%). In epithelia, dog (2.88%), buffalo (1.44%), and sheep (1.44%) were the common allergens. The results of the skin reactivity are shown in the [Table 2].
Comparison of asthmatics between those with positive skin prick test and negative skin prick test was done. Age of onset <20 years and family history of asthma was more in positive skin prick test compared to negative skin prick test patients and the difference was statistically different (P < 0.05). It indicates that the patient with family history of asthma and early age of onset more likely to have positive skin test. Association with other allergic diseases like allergic rhinitis, chronic urticaria, and allergic conjunctivitis was more common with positive skin prick test when compared to negative skin prick test. Allergic rhinitis and allergic conjunctivitis showed statistical significance (P < 0.05), but not chronic urticaria. Among the aggravating factors, history of symptoms on exposure to dust was more common with positive skin prick test and was statistically significant (Chi-square 17.26, P = 0.000032) [Table 3].
|Table 3: Comparison between skin prick test positive and skin prick test negative bronchial asthmatics|
Click here to view
| Discussion|| |
In the present study, dust mites (49.28%) were the commonest allergens followed by dusts (7.2%), pollens (6.77%), insects (6.62%), fungi (4.53%), and epithelia (1.92%). In a study conducted by Agrawal et al.,  found that
78% were positive to dust mites followed by 66% to insects, 44% to insects, 42% to fungi, and 20% to animal dander. Hendrick et al.,  analyzed skin prick test in 656 asthmatics where positive skin prick reactions were reported to DF (82%), pollens (66%), animal dander (38%), Aspergillus fumigatus (16%), and other moulds (21%). In a study conducted by Bandele et al.,  found that house dust mite (61%), dusts (55%), feathers (30%), grass pollen (21%), and tree pollen (16%). In both the above studies, dust mites were commonest allergens which were similar to our study findings. In a study conducted by Prasad et al.,  found the common offending allergen were insects (21.2%), followed by dusts (12%), pollens (7.8%), animal dander (3.1%), and fungi (1.3%). In this study, skin prick test for dust mites was not done.
In the present study, 6.77% were positive to pollens. The most common among pollen were Parthenium hysterophorus (20.86%) followed by Peltophorum pterocarpum (15.11%), Chenopodium album (12.95%), and Xanthium strumarium (10.79%). From southern India, studies carried out revealed that Casuarina, Parthenium, Spathodia, Cheno/Amaranth, Cocos, Eucalyptus, Poaceae, Peltophorum, and Cyperaceae are dominant pollens. , Subbarao et al.,  recorded allergenicity to Parthenium hysterophorus pollen extracts in 12% bronchial asthma patients from Bangalore. In a study conducted by Prasad et al.,  in Lucknow observed that the most common pollen was Amaranthus spinosus (35.4%) followed by Argemone mexicana (22.9%), Adhatoda vasica (18.5%), Ailanthus (12.5%), and Cannabis (8.3%). In a study conducted by Agrawal et al.,  in Allahabad, Uttar Pradesh revealed the most common pollen were Cynodon dactylon (56%) followed by Gynandropis gynandra (54%), Brassica campestris (52%), Putranjiva roxburghii (52%), Sorghum vulgare (46%), Chenopodium album (32%), Xanthium strumarium (28%), and Parthenium hysterophorous (26%). This variation in the pollen sensitivity may be due to geographical variation. The pollen allergens vary from place to place and also from time to time. There is need of conducting studies across different parts and from time to time to identify the common aeroallergens in a particular area. 
In the present study, 4.53% were positive to fungi. The most common fungi were Aspergillus flavus (6.47%), Candida albicans (6.47%), Alternaria alternate (5.76%), and Curvularia lunta (5.76%). In a study conducted by Agrawal et al.,  reported Aspergillus fumigatus (16%) showed marked skin positivity followed by Candida albicans (10%) and Aspergillus niger (10%). In a study conducted by Prasad et al.,  reported common fungal antigens were Aspergillus fumigatus followed by Aspergillus flavus, Alternaria teneis followed by Fusarium sodani. Aspergillus group shows marked skin sensitivity in both studies which was similar to our study findings.
In the present study, 6.62% were positive to insects. In a study conducted by Prasad et al.,  showed female locust (33.3%), male locust (25%), grasshopper (20.8%), cricket (16.7%) female cockroach (16.7%), and male cockroach (14.6%). Gaur et al.,  found allergy to moth, mosquito, locust cockroach, and grasshopper were the commonest allergen in nasobronchial allergy (NBA). Achary et al.,  also found moth, mosquito, and ant to be the commonest allergen in NBA.
Comparison of the skin prick test positive and skin prick test negative revealed a number of significant differences. In the present study, age of onset <20 years and family history of asthma significantly more among those with skin prick test positive which is similar to study conducted by Bandele et al.  However, in the study conducted by Hendrick et al.,  there was no significant difference between skin prick test positives for the family history of asthma.
In the present study, allergic diseases like allergic rhinitis and allergic conjunctivitis were significantly more in the skin prick test positives, but there was no significant difference with respect to chronic urticaria. These findings are similar to study conducted by Hendrick et al.  But in a study conducted by Bandele et al.,  there was no significant difference with skin prick test positives.
The differences in the incidence of positive reactions in different studies may be due to different flora in different geographical areas and change of flora over a successive time period due to change in climatic factors. This may be also due to different studies have used different types of allergens and number of allergens used also varies. The strengths of allergen extracts used and criteria for grading of skin reactivity also vary from one study to other.
Skin prick testing along with carefully taken clinical history helps in identifying the offending allergen in bronchial asthma and other allergic disorders. Identification of the offending allergen provides an opportunity to influence the overall management of asthma by allergen avoidance wherever possible and allergen specific immunotherapy.
It is recommended to conduct this type of studies in bronchial asthma and other allergic disorders from time to time in different parts of the country to know the newer offending allergens causing allergic disorders, which in turn helps proper selection of allergens by clinician for better management.
| Acknowledgments|| |
We would like to thank all the faculty of Department of Community Medicine and Pulmonary Medicine for providing support in conducting this study. We would like to thank Dr. (Prof.) M K Sudarshan, Dean and Principal, Kempegowda Institute of Medical Sciences for moral support and encouragement in conducting the study. We would also like to thank all the patients who participated in the study.
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[Table 1], [Table 2], [Table 3]