Sensitization pattern of inhalant allergens in children with asthma who are living different altitudes in Turkey.

Variability in children's allergic sensitization has been detected not only among different countries but also among cities within the same nation but yet different climatic areas. The aim of this study was to investigate the sensitization pattern of asthmatic children who lived in different altitude areas: the two largest Turkish cities, Istanbul (sea level) and Erzurum (high altitude). Five hundred and twelve asthmatic children (6-15 years old) from Istanbul (western Turkey, at sea level) and 609 from Erzurum (eastern Turkey, at an altitude of 1800 m) were included in the study. All participants underwent skin testing with common inhalant allergens, spirometry, total IgE level, and clinical examination. The positive sensitization ratio to aeroallergens in children with asthma living at sea level was statistically higher than that in children living in the high altitude group [p = 0.001, OR (odds ratio) 4.9 (confidence interval (CI) 3.67-6.459)]. However, pollen sensitization in asthmatic children living in high altitudes was significantly higher than that in children living at sea level [p = 0.00, OR 2.6 (CI 1.79-3.87)]. Children with asthma who live at high altitudes are characterized by higher pollen but lower mite sensitization rates than those living at sea level in Turkey. Different climatic conditions and altitudes may affect aeroallergen sensitization in children with asthma.

Correlation of quality of life with clinical parameters and eosinophilic cation protein levels in children with allergic rhinoconjunctivitis.

BACKGROUND: Systemic and mucosal roles of eosinophils in the pathogenesis of allergic rhinoconjunctivitis (AR) are known. The aim of this study was to investigate the relationship of clinical parameters and quality of life with eosinophilic cationic protein (ECP) in grass pollen-sensitive children with seasonal AR. METHODS: This study included 31 children with AR and 18 healthy controls aged between 5 and 15 years. ECP levels in nasal lavage fluid and serum were measured. AR symptom scores were calculated and the pediatric rhinoconjunctivitis quality of life questionnaire (PRQLQ) was filled in for all patients. RESULTS: Mean serum and nasal ECP levels (ng/ml) were significantly higher in the patient group (p < 0.05 for both). In the AR group, the mean clinical symptom score was 7.3 +/- 2.2, while the total PRQLQ score, activity limitation, symptoms and emotional function domains were 2.5 +/- 0.9, 3.0 +/- 1.1, 2.5 +/- 1.2 and 2.6 +/- 1.1, respectively. The total clinical symptom score and disease duration showed a significant correlation with the total PRQLQ score (p = 0.00 and 0.003, respectively). However, neither nasal lavage nor serum ECP levels were significantly correlated with symptom score, duration of disease, PRQLQ total score or domains (p > 0.05 for all). CONCLUSION: These results may indicate the absence of a correlation between clinical status and quality of life and levels of ECP in tissues with allergic inflammation.

Lower respiratory tract complications during nasal provocation: nonspecific stimulant or specific allergen?

BACKGROUND: Allergic rhinitis (AR) is an allergic inflammatory disease in which allergen exposure leads to the appearance of symptoms in sensitized individuals because of histamine liberation from nasal mucosal mast cells. Comorbidity of this disease with allergic asthma is common. Therefore, the one airway one disease theory has been put forward. Lower respiratory tract provocation tests with both nonspecific (methacholine) and specific stimulants (allergen) have yielded positive results in nonasthmatic patients with AR. However, not enough research is available to demonstrate whether there is a response in the lower respiratory tract during nasal provocation tests (NPTs) performed to evaluate only nasal airway in these patients. OBJECTIVES: To determine if the lower respiratory tract was affected as a result of NPTs with nonspecific and specific stimulants in nonasthmatic patients with AR and to determine the frequency of lower respiratory tract obstruction due to NPT with nonspecific and specific stimulants. METHODS: Thirty-six participants were enrolled in the study between November 2005 and January 2006 (18 AR patients and 18 healthy control subjects). Patients underwent 2 sessions of NPT. The first session was performed with nasal methacholine as a nonspecific stimulant, and the second session was performed with nasal Olea europaea extract as a specific stimulant. The control group underwent only nonspecific nasal provocation with methacholine. Basal nasal opening and nasal pressures were evaluated spirometrically by rhinomanometric measurements and basal respiratory function tests in both groups before methacholine nasal provocation. Whether or not nasal provocation was achieved, spirometric measurements were performed in all patients and controls after NPTs. RESULTS: NPTs with methacholine resulted in a similar frequency of nasal provocation in the patient and control groups (P = .63). However, the mean methacholine dose was lower in patients with AR (P = .049). There was a decrease in parameters of asthma, including the ratio of forced expiratory volume in 1 second to forced vital capacity (P = .04), peak expiratory flow (P = .01), and forced expiratory flow between 25% and 75% (P = .004), as a result of NPTs with methacholine in the patient group. However, NPTs with allergen did not cause a change in lower respiratory tract obstruction criteria. CONCLUSIONS: Lower respiratory tract obstruction can occur after NPTs with nonspecific stimulants; therefore, tests performed with specific allergens can be regarded as safer.