Sex differences in heritability of sensitization to Blomia tropicalis in asthma using regression of offspring on midparent (ROMP) methods.

A genetic basis for asthma- and atopy-related quantitative traits, such as allergen-specific immunoglobulin E (IgE) levels, has been suggested by the observed familial aggregation of these traits in temperate climates. Less information is available for tropical climates, where different allergens may predominate. Sensitivity to the mite Blomia tropicalis is related to asthma in tropical climates, but heritability of B. tropicalis sensitivity and the impact of age, sex, and other environmental covariates on heritability have not been widely explored. Total and specific IgE levels were measured by immunochemiluminescent assay in 481 members of 29 Barbadian families (comprised of 340 parent-offspring trios or pairs) ascertained through two asthmatic siblings. Trait heritability was estimated using regression of offspring on mid-parent (ROMP) and pairwise correlation analysis of unadjusted IgE levels and on residual values after adjustment for covariates. Heritability of IgE levels to the major antigen of B. tropicalis (Blo t M) estimated by ROMP in 180 complete parent-offspring trios was 0.56. Heritability was consistently greater for male offspring than for female offspring. Similar sex-specific patterns were observed for specific IgE to Dermatophagoides pteronyssinus and total IgE levels and were relatively unaffected by adjustment for covariates. Pairwise correlational analyses of specific and total IgE levels showed similar results. Moderate heritability of Blo t M IgE levels was detected in these Barbadian families and was greater for sons than daughters. Adjustment for covariates had minimal impact. This suggests that future investigations of genetic determinants of IgE levels should include approaches that allow for potential sex differences in their expression.

Correlates of sensitization to Blomia tropicalis and Dermatophagoides pteronyssinus in asthma in Barbados.

BACKGROUND: Sensitivity to the mite Blomia tropicalis is related to asthma in tropical climates, but correlates of sensitivity to B. tropicalis and its relationship to Dermatophagoides pteronyssinus sensitivity have not been widely examined in families with asthma. The main objective of this study was to determine prevalence and correlates of sensitivity to these mites in families with asthma and characteristics of persons sensitized to both. METHODS: Antibodies to major antigens (Blo t 5 and Der p 1) of these mites were measured by immunochemiluminescent assay in 481 members of 29 families from Barbados ascertained through two asthmatic siblings. RESULTS: Blo t 5 sensitivity was present in 261 subjects (46%) and was associated with younger age, higher total serum IgE level, and more than a three-fold increased prevalence of asthma (42 vs. 13%). Der p 1 sensitivity was less common (27%) and showed similar associations with age, IgE, and asthma. Of the 261 subjects sensitized to Blo t 5, 116 were also sensitized to Der p 1; they were younger, had higher total and Blo t 5 specific IgE levels, and had more than twice the asthma prevalence as those sensitized to Blo t 5 alone (59 vs. 29%). Der p 1 sensitivity without Blo t 5 sensitivity was uncommon; 90% of those sensitized to Der p 1 were also sensitized to Blo t 5. Geometric mean total IgE levels were lowest in the 207 participants without any mite sensitization (102 U/ml), intermediate in 158 sensitized to either Blo t 5 OR Der p 1 (609 U/ml), and highest in 116 sensitized to both (1,869 U/ml). CONCLUSIONS: Blo t 5 is the predominant sensitizing mite allergen in these Barbadian families with correlates similar to Der p 1. Concomitant sensitization to Der p 1 appears to identify a more reactive subgroup of individuals at a higher risk of asthma.

Management of teeth requiring root canal treatment and views on continuing professional education in endodontics by dental practitioners in Trinidad and Tobago [abstract]

Many of the new materials and techniques used in endodontics (root canal treatment) require considerable practice to master and many require continuing education courses to allow formal instruction. Nothing is known regarding techniques employed and views on continuing professional education (CPE) in endodotics by dentists in Trinidad and Tobago. With the shift toward evidence-based dentistry and rising patient expectation of quality oral health care, a survey was conducted to describe these issues. A self-administered postal questionnaire was sent to all registered dentists in Trinidad and Tobago. Seventy dentists responded after two mailings. Most respondents worked primarily in private practice (85.5 percent). Years since qualification ranged from 2 to 45 years and 54.3 percent were qualified for more than 10 years. Most frequent treatment of an acute dental abcess involved opening, preparing the canal(s), dressing and prescribing antibiotics (40 percent). Forty-one respondents (58.6 percent) ocassionally completed root canal treatment in a single visit. Isolation of the tooth for molar root treatment always caused difficulty for thirty-five respondents (50 percent) and rubber dam isolation was used routinely by only nine respondents (12.9 percent). Most respondents either filed (20 percent) or reamed (18 .6 percent) for canal preparation usually using K files. Thirty-three respondents (47 percent) used sodium hypochlorite to irrigate the tooth and thirty-one (44.3 percent) used cold lateral condensation of gutta percha to obturate. Thirty-four respondents (48.6 percent) subscribed to professional journals and sixty-seven (95.7 percent) had attended some form of Continuing Professional Education. Sixty-seven (95.7 percent) of respondents would attend CPE in endodontics if available in Trinidad and Tobago, with most (72.9 percent) preferring a lecture/seminar format addressing problem-solving and new techniques. Respondents to this survey showed use of a wide range of techniques and materials but still expressed considerable interest in developing their skills in endodontics through formal CPE. (AU)

Smoking cessation - the role of the dental team implications for the Caribbean [abstract]

There is increasing awareness that cigarette smoking not only threatens systemic health but also compromises oral health. For example, smoking can result in staining of teeth, halitosis (bad breath), altered salivary flow, predisposition to chronic and acute periodontal disease and oral candidosis, delayed wound healing, failure of dental implants, oral mucosal lesions, oral precancer and cancer. Although data from the United Kingdom show a reduction in the prevalence of smoking since the 1960s, there is an upward trend of smoking among young adults, particularly teenage girls. There are no comparable data for the Caribbean but it is plausible to assume a similar trend may exist, suggesting the need for primary prevention strategies. The dental team often treats patients in a primary care setting and, apart from an important role in early detection of smoking-related oral conditions, may also be well placed to aid in preventive strategies through the implementation of chair-side smoking cessation programmes. These programmes are based on the 4-As strategy: Ask, Advise, Assist, Arrange, and have been recently developed specifically for the dental team. There should also be close collaboration between the dental team and other primary health care professionals to improve health promotion strategies aimed at reducing the prevalence of smoking. Dental health professionals in the Caribbean must be made aware of smoking cessation programmes for their patients and research into their effectiveness, in a Caribbean population, is required. (AU)

The cost of treating acute asthma at the Queen Elizabeth Hospital, Barbados

OBJECTIVES: To determine the cost of treating acute asthma at the Queen Elizabeth Hospital (QEH) and to identify ways of reducing these costs. DESIGN AND METHODS: Case notes of all patients presenting to the Asthma Bay of the QEH during a two-week period in March 1999, were reviewed. Data, extracted included gender, arrival time, number of nebulizations, dosage of oral prednisolone and inhalers prescribed. A questionnaire was completed by a sample of these patients regarding use of inhalers, follow-up care and time lost from work and school. RESULTS: A total of 303 cases were reviewed and 75 patients completed questionnaires. The majority of asthmatics received oral prednisolone (74 percent) and/or three nebulizations (42 percent). The cost of treating each patient was determined to be approximately US $22.00, including medical and nursing salary costs. The annual cost to the QEH was estimated to be US $214,000 including the costs of admitting patients. Indirect costs included the time lost from work or school in 86 percent of patients and in 56 percent of parents taking time off to look after their sick children. The questionnaire survey revealed that 63 percent of patients with "preventer" medications were not using them and only 38 percent received follow-up care. Seventy-four percent of these patients had repeated asthmatic attacks during the preceding 3 months with 11 percent having more than six attacks. CONCLUSIONS: A significant amount of money is spent on asthma care at the QEH. However, improper understanding and use of medication coupled with lack of continuity of care lead to poor control and frequent attacks. These findings justify the need for an asthma clinic for these patients.(Au)

The economics of asthma treatment in Barbados: a review of the drug cost

OBJECTIVE: To determine the annual cost of treating asthma in Barbados over a ten-year period. METHODS: The Barbados Drug Service is the central procurement agent for drugs on the Barbados National Formulary. Information on the costs of the various asthma medications, and the number of prescriptions written for these drugs, were obtained from the Barbados Drug Service records. The prescriptions written for asthma medications between 1986 and 1997 were analysed and the annual cost of the various categories of asthma calculated. RESULTS: The annual drug cost of treating asthma in Barbados increased from $293,111 in 1987 to $1,268,348 in 1996, a four-fold increase over ten years. There was a rapid rise in the cost of anti-inflammatory drugs during the study period, from $48,628 or 16.5 percent of total drug cost in 1986 to $503,092 or 39.6 percent of total drug cost in 1997. The cost of inhaled beta-2-agonists over the same period increased from $131,154 or 44.7 percent of the total drug cost in 1997. However, the cost of oral beta-2-agonists decreased over the ten-year period, reflecting the increased use of the inhaled form of the medication. With the increasing number of acute asthmatics seen in the Accident and Emergency Department at the Queen Elizabeth Hospital, the cost of nebulization solutions increased eight-fold, from $8,361 in 1986 to $69,172 in 1997. CONCLUSIONS: Asthma has been an increasing burden on the medical resources of Barbados over the past decade. The drug costs of treating asthma have increased significantly over the 10-year period 1986 to 1997 and accounted for 5.8 percent of the annual budget of the Barbados Drug Service in 1997.(Au)

Dense mapping of chromosome 12q13.12-q23.3 and linkage to asthma and atopy

BACKGROUND: Asthma is a complex disease characterized by a high prevalence of allergic diathesis and the almost ubiquitous presence of upper airway disease (eg rhinitis). Previously, we observed linkage of asthma among Afro-Caribbean families to markers in chromosome 12q, which contains a number of genes encoding for products closely related to allergic airway inflammation and disease. OBJECTIVE: To identify susceptibility loci in chromosome 12q contributing to the genetics of upper and lower airway diseases and to expand the region to include genes encoding IFN- ã(IFNG) and one of the signal transducers and activators of transcription (STAT6), we conducted further linkage studies among 33 multiplex families. METHODS: We characterized 528 subjects from Barbados for asthma; 82 percent were characterized for allergic rhinitis. Two-point and multipoint linkage analysis of 22 microsatellite markers (spanning ~79 centimorgan) was performed. RESULTS: Affected sib-pair analysis revealed significant evidence for linkage to asthma over approximately 30 cM (P < .05 to .002), with the best evidence for linkage at a CA repeat polymorphism in the first intron of IFNG in 12q21.1 (P = .002). Evidence of linkage to allergic rhinitis was observed in the same region (D12S313, P = .006, and IFNGCA, P = .01. respectively). Multipoint linkage analysis also provided evidence for linkage to asthma, with the best nonparametric linkage analysis score at D12S326 (nonparametric linkage score = 3.8, P = .0008). Modest evidence for linkage to allergic rhinitis was observed next to D12S326 at D12S1052 (p = .036) CONCLUSIONS: Our findings suggest that (1) one or more loci in the chromosome 12q13.12-q23.3 region are contributing to the expresstion of the clinical phenotype asthma and the strongest evidence for linkage is in a region near the gene encoding IFNG and (2) a susceptibility locus for both asthma and allergic rhinitis maps to this region.

Work site heart health promotion and practice: a pilot project of the Heart Foundation of Barbados

The workplace has long been recognised as an important setting in which to promote the practice of healthy living since most individuals spend more than one-third of their day in such situations which might be considered a "captive environment". The Heart Foundation of Barbados, aware of the significantly high prevalence of lifestyles related illnesses and the opportunities and potential for effecting positive change in the workplace, embarked on a worksite heart pilot project aimed at determining the feasibility of establishing such a programme in Barbados and determining its impact and effect on health practices of workers in the workplace and elsewhere. The study was conducted among the staff of a local professional services firm. It consisted of risk factor screening of staff members, teaching of and certification in Cardiopulmonary Resuscitation (CPR), and facilitating regular related activities. Two years after the initiation of the project an anonymous knowledge, attitudes and practice questionnaire was administered to participants. 116 (88 percent) members of staff was taught and certified in CPR, and a further 3 persons were trained and certified as CPR instructors. Anthropometric and blood pressure measurements were performed on the 116 participants. Over the two years of the project the company developed a significantly enhanced health consciousness and profile, as evidenced by the formation of a health club, active participation in national healthy lifestyles activities and the conducting of a regular related seminars, lectures and associated and related activities. Finally, among those responding to the knowledge attitudes and practices survey 60 percent of 60 participants returning completed questionnaires reported a positive change in their lifestyle as a direct result of the programme. Among 63 percent there was an enhanced personal attitude to the company. 36 participants (60 percent), reported that they would provide assistance in an emergency situation, of which 64 percent expressed confidence in doing so, and 58 percent attributed their confidence to their involvement in the programme. Preliminary results suggest that the introduction and implementation of a work site heart health promotion and practice programme is acceptable to workers in Barbados, is feasible, and results in improvement of worker health attitudes and practices.(AU)

Obesity in food handlers

The objective of this study was to determine whether obesity is an occupational hazard in food handlers. 309 persons who presented to two Barbadian group General Practices for food handling certification were studied. The results demonstrate that a majority (55.3 percent) of food handlers had grade 1 obesity or overweight (BMI > 25 kg/sq m). The prevalence in men 67/104 (64.4 percent) was as great as in women 104/175 (59.4 percent). Overweight was high in the relatively young age groups, 30-39 (60.9 percent), 40-49 (75 percent) and 50-59 (69.7 percent). Among the food handlers it was seen more frequently in those with sedentary lifestyles (76/116; 65.5 percent) and in those who had worked more than 10 years in the food handling industry (91/140; 65 percent). No association was found between overweight and use of alcohol or tobacco, but among the food handlers studied were many who demonstrated inaccurate perception of their body image, with 74 of the 190 (39 percent) who thought their weight to be normal, actually classified as overweight. Obesity or overweight is most likely and occupational hazard in food handlers. They work in an industry that is growing rapidly in Barbados as tourism services expand and as the local population adopts the lifestyle of eating out more often. Food handlers are required by law to be certified annually as fit to work. It is important that doctors recognize the threat of obesity and use the opportunity of this annual examination to screen and intervene for this hazard.(AU)

The microbiological analysis of Sahara dust and its association with asthma in Barbados

Sahara or African dust originates on the African continent and its transported across the North Atlantic to Barbados and other Caribbean Islands by the North East Trade Winds. The amount of dust deposited in Barbados has shown a steady increase over the years and so has the incidence of respiratory disease and asthma. This study investigated the monthly variation of the concentration of Sahara dust in the atmosphere the presence of micro-organisms in it. It also examined whether there was any association between these and asthmatic attendances at the Asthma Bay of the Accident and Emergency Department of the Queen Elizabeth Hospital (QEH). During the one year study period, dust deposition was lowest during February and March 1996 and heaviest during April to July 1996 with the peak in April. The peak in April did not coincide with any noticeable increase in asthma attendances during that month. A total of 289 dust samples were collected and cultured. The cultures grew mainly bacillus species and fungi, including several species of Aspergillus. 43 samples (14.8 percent) grew bacilli and fungi and 5 (1.7 percent) grew organisms other than bacilli and fungi, such as micrococci. More colonies of fungi were isolated during the early part of the year and more bacilli were found during the latter part of the year when there was the peak attendance at the QEH Asthma Bay. It is concluded that the content of Sahara dust may be of greater importance to the development of asthma than the concentration of the dust.(AU)

Prevalence of asthma and wheezing illnesses in Barbadian school children: the Barbados national asthma and allergy study

In Barbados, there has been a fourfold increase in the number of asthmatic visits to the Accident and Emergency department of the Queen Elizabeth Hospital between 1980 and 1994. However, there are no data on the prevalence of asthma in Barbados. This study was done to determine the prevalence of childhood asthma using the International Study of Asthma and Allergy in Childhood (ISAAC) questionnaires. Questionnaires were distributed to parents of 3,894 pupils (age group 6-7 years) in all 91 primary schools in Barbados, and 3,500 questionnaires were completed by pupils (age 13-14 years) in all 46 secondary schools. The data analysis was carried out by Systems Caribbean Limited utilising SPSS. In the 6-7 years olds, the prevalence of self-reported asthma was 16.8 percent with doctor diagnosed asthma of 16.5 percent wheeze had occurred at some time in 30.7 percent and in the previous 12 months in 18.3 percent. In the 13-14 year-olds, self reported asthma was 17 percent, doctor diagnosed asthma 15.9 percent, wheeze occurring at some time was 30.1 percent and wheeze in the previous 12 months was 17.7 percent. Of the 6-7 year-olds, of those who wheezed in the previous 12 months, 78 percent had 1-3 attacks, 18.5 percent had 4-12 attacks and 3.5 percent had more than 12 attacks. In the 13-14 year-olds, 76.5 percent had 1-3 attacks in the previous 12 months, 18.2 percent had 4-12 attacks, 5.3 percent had more than 12 attacks. There was no difference in frequency of smokers in the household between those who wheezed in the previous 12 months and those who never wheezed. Overall, wheezing was more frequent in boys than in girls. The prevalence of asthma in Barbados is high for a tropical island with relatively little atmospheric pollution. The increase has coincided with increasing affluence and trend toward urbanisation and modernisation of the domestic environment.(AU)

Evidence of linkage to loci for both asthma and allergic rhinitis on chromosome 12q 14.3-q24.1

As many as 80 percent of asthmatics have atopy and between 60 and 80 percent of allergic asthmatic have coexisting rhinitis. It has been proposed that asthma and allergic rhinitis are essentially the same inflammatory disease of human airways. Previously, we provided the first evidence for linkage of asthma and "high" total serum IgE concentration to chromosome 12q markers among families from Barbados and the US. To identify loci in this chromosome 12q region contributing to the distinct clinical phenotypes of asthma and allergic rhinitis, we conducted linkage analyses among 33 multiplex Barbadian families using densely-spaced microsatellite markers in the 12q14.3-q24.1 region. Maximal evidence for linkage to asthma and allergic rhinitis occurred at markers separated by 4.5 cM. D12S326 and D12S1052 = (NPL = 3.52, p = 0.001 and 1.72, p = 0.039, respectively), these two markers lie 9.13 cM downstream from IFNG. There was no evidence of linkage to either phenotype at markers flanking STAT6. These results suggest that a common gene on the long arm of chromosome 12 is important for both asthma and allergic rhinitis.(AU)

Obesity in food handlers

The object of this study was to determine whether obesity is an occupational hazard in food handlers. 309 persons who presented to two Barbadian group General Practices for food handling certification were studied. The results demonstrate that a majority of food handlers were obese (55.3 percent), more so than in population studies despite the relatively young age of the sample. The men 67/104 (64 percent) were just as obese as the women 104/175 (59.4 percent) and obesity was seen in the relatively young age groups, 30-39 (60.9 percent), 40-49 (75 percent) and 50-59 (69.7 percent). Among food handlers obesity was seen more frequently than in those with sedentary lifestyles 76/116 (65.5 percent) and in those who worked more than 10 years in the food handling industry 91/140 (65 percent). No association was found between obesity and use of alcohol or tobacco, but among the food handlers studied were many who demonstrated inaccurate perception of their body image, with 74 of the 190 who thought their weight to be O.K. actually measuring as obese (39 percent). Obesity is most likely an occupational hazard in food handlers. They work in an industry that is growing rapidly in Barbados as tourism services expand and as the local population adopts the western lifestyle of eating out more often. Food handlers are required by law to be certified annually as fit to work. It is important that doctors recognize the threat of obesity and use the opportunity of this annual examination to screen and intervene for this hazard. (AU)

Obesity in food handlers

The object of this study was to determine whether obesity is an occupational hazard in food handlers. 309 persons who presented to two Barbadian group General Practices for food handling certification were studied. The results demonstrate that a majority of food handlers were obese (55.3 percent), more so than in population studies despite the relatively young age of the sample. The men 67/104 (64 percent) were just as obese as the women 104/175 (59.4 percent) and obesity was seen in the relatively young age groups, 30-39 (60.9 percent), 40-49 (75 percent) and 50-59 (69.7 percent). Among food handlers obesity was seen more frequently than in those with sedentary lifestyles 76/116 (65.5 percent) and in those who worked more than 10 years in the food handling industry 91/140 (65 percent). No association was found between obesity and use of alcohol or tobacco, but among the food handlers studied were many who demonstrated inaccurate perception of their body image, with 74 of the 190 who thought their weight to be O.K. actually measuring as obese (39 percent). Obesity is most likely an occupational hazard in food handlers. They work in an industry that is growing rapidly in Barbados as tourism services expand and as the local population adopts the western lifestyle of eating out more often. Food handlers are required by law to be certified annually as fit to work. It is important that doctors recognize the threat of obesity and use the opportunity of this annual examination to screen and intervene for this hazard.

Linkage analysis of asthma, allergic rhinitis and atrophy to markers on chromosome 12q in families from Barbados - abstract

Findings from numerous studies have demonstrated that there is a strong heritable component to asthma and atrophy, although the genetic pathophysiology of these traits is poorly understood. To identify loci in chromosome 12q1s-q24.1 contributing to asthma and asthma-associated traits, we conducted linkage analyses among 29 multiples Barbadian families. Sib-pair analysis of 10 polymorphic micro satellite markers in 345 full and 219 half-sib pairs from Barbados revealed evidence for linkage of certain markers with a gene(s) controlling asthma (D12S379,p=0.001; D12S311,p=0.010; D12S95,p=0.010; D12S360,p=0.018), allergic rhinitis (D12S1052,p=0.040; D12S311,p=0.005; D12S95,p0.021), total serum IgE concentration (D12S1052,p=0.016; D12S311,p=0.007; D12S360,p=0.013; D12S78,p=0.002), and specific IgE antibodies (Alec) to the storage mite Blomia tropicalis (Blot M; D12S311,p=0.006; D12S360,p=0.007; D12S78,p=0.003). Significant evidence of transmission disequilibrium was observe for certain alleles at these loci in addition to high multi allergen IgE Ab. These findings suggest that a gene(s) in the 12q 15-q24.1 region, which contains several candidate genes, including interferon-y (IFNG), is important for asthma and the associated traits of allergic rhinitis, "high" total IgE, and "high" specific IgE (AU).

Prevalence of atopic eczema in Barbadian schoolchildren: preliminary findings from the Barbados National Asthma and Allergy Study - abstract

In 1995 and 1996 the Barbados National Asthma and Allergy Study, a questionnaire survey of all schoolchildren 6 - 7 years and aged 13 - 14 year, was conducted. The aim of the survey was to describe the prevalence and severity of asthma, rhinitis and eczema in children living in Barbados, to make meaningful comparisions with other countries (e.g Jamaica) and to obtain baseline measures for asessment of future trends in the prevalence and severity of this disease. The questionnaire sought to discover the presence of an itchy rash, persisting for more than six months, and in the typical anatomical distribution of atopic eczema. In addition, doctor diagnosed eczema was sought. Three thousand, eight hundred and ninety-four (3894) questionnaires were returned in the 6 - 7 years old age group (97 percent) and 3552 in the 13 - 14 year- old age group (88 percent). The prevalence of atopic eczema in the 6 - 7 year-old age group was 10.6 percent and in the 13 - 14 year-old age group was 10.0 percent. Diagnosis by a doctor reduced the prevalence to 6.2 percent in the primary school group and 3.6 percent in the secondary school group. This study has demonstrated for the first time in a Caribbean country the prevalence of this common childhood complaint. (AU)

Linkage of asthma and total serum IgE concentration to markers on chromosome 12q: evidence from Afro-Caribbean and Caucasian population

To identify genes potentially relevant in atopic asthma, we analyzed markers in chromosome 12q15-q24.1 for linkage to asthma and total serum Ige concentration. Sib-pair analyses of 10 markers in 345 full- and 219 half-sib pairs from 29 multiplex Afro-Caribbean families provided evidence for linkage to his region for both asthma and total serum IgE. Certain alleles at these loci showed significant evidence of transmission disequilibrium with both asthma and high IgE. Using 6 of these markers and 11 additional markers, evidence for linkage of total IgE to 12q was also found in 12 Caucasian Amish kindreds (24 nuclear families) by both sib-pair and transmission disequilibrium analyses. These findings suggest that the 12q15-q24.1 region may contain a gene(s) contolling asthma and the associated high total IgE. trait.(AU)

Weather as a predictor of the frequency of asthmatic attacks in Barbados - abstract

Daily data on asthmatic patients seen in the Accident and Emergency Department of the Queen Elizabeth Hospital for the years 1983 and 1989-1991, and corresponding daily data for the meterological variables of wind speed, relative humidity (0800 hr), vapour pressure and minimum and maximum temperatures were analysed to determine the statistical relationships that might exist. The results show positive correlation between asthma attacks and relative humidity and vapour pressure, and negative correlations for the wind speed. The data also show the existence of a seasonal variation in asthmatic attacks. It is suggested that this variation is due to the transport of aero-allergens into Barbados through the trade winds (AU)