Prevalence and severity of asthma, rhinitis, and atopic eczema in 13- to 14-year-old schoolchildren from the northeast of England

Oxidative Stress and Antioxidant Pathway in Allergic Rhinitis

Oxidative stress is the cause and consequence of redox metabolism in various physiological and pathological conditions. Understanding the molecular pathways underlying oxidative stress and the role of antioxidants could serve as the key to helping treat associated diseases. Allergic rhinitis is a condition that deteriorates the daily function and quality of life of afflicted individuals and is associated with a high socioeconomic burden and prevalence. Recent studies have focused on the role of oxidative stress and antioxidants in allergic rhinitis. This review discusses animal and clinical studies on oxidative markers and the potential therapeutic dietary antioxidants for allergic rhinitis.

Use of Sublingual Immunotherapy for Aeroallergens in Children with Asthma

Asthma is a heterogeneous disease that in children is often allergen-driven with a type 2 inflammation. Sublingual immunotherapy represents an important progress in the use of personalized medicine in children with allergic asthma. It is a viable option for house dust mite-driven asthma and in subjects with the asthma associated with allergic rhinitis. The use and indications for isolated asthma caused by other allergens are still controversial owing to heterogeneity of commercially available products and methodological limitations of studies in children. Nevertheless, most studies and meta-analyses found the efficacy of sublingual immunotherapy. Sublingual immunotherapy is safe but cannot be recommended in children with uncontrolled asthma.

The current prevalence of asthma, allergic rhinitis, and eczema related symptoms in school-aged children in Costa Rica

OBJECTIVE

Asthma prevalence in Costa Rica is among the highest worldwide. We aimed to determine the prevalence of asthma among school-age children in the Central Highland Area of Costa Rica.

METHODS

Cross-sectional study using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire was performed. Parents or guardians of children aged 6-13 years completed written questionnaires.

RESULTS

Total of 2817 school-aged children returned these questionnaires (74.1% return rate). The prevalence of asthma, rhinitis, and eczema was 21.9%, 42.6%, and 19.2%, respectively. The co-existence of the 3 diseases was seen in 22.6% of children with asthma. Boys had a slightly higher prevalence of these conditions, and younger children had higher prevalence of asthma and eczema, but lower prevalence of rhinitis than older children. The use of acetaminophen and antibiotics in the first 12 months of life showed a significant association with the prevalence of asthma, rhinitis, and eczema. Wheezing with exercise, dry cough at night, and ever rhinitis was highly associated with asthma symptoms in the last 12 months. In contrast, no association was found between children exposed to smoking at home. Frequent traffic next to the house was reported more frequently by the parents of children with asthma, although no significant association was found.

CONCLUSION

The prevalence of asthma showed a significant decrease compared to previous studies. However, there was an unexpected high prevalence of rhinitis. Exposure to acetaminophen and antibiotic during the first year of life was highly associated with asthma symptoms.

Applicability of evidence from previous systematic reviews on immunotherapy in current practice of childhood asthma treatment: a GRADE (Grading of Recommendations Assessment, Development and Evaluation) systematic review

OBJECTIVE

Because most children with asthma now use inhaled corticosteroids (ICS), the added benefit of immunotherapy in asthmatic children needs to be examined. We re-assessed the effectiveness of subcutaneous (SCIT) and sublingual immunotherapy (SLIT) in childhood asthma treatment focusing on studies with patient-relevant outcome measures and children using ICS.

METHODS

We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to systematically search and appraise the evidence using predefined critical patient-relevant outcomes (asthma symptoms, asthma control and exacerbations). We searched to retrieve systematic reviews and randomised controlled trials on immunotherapy for asthma in children (1960-2017). We assessed the quality of the body of evidence with GRADE criteria.

RESULTS

The quality of the evidence for SCIT was very low due to a large risk of bias and indirectness (dated studies in children not using ICS). No effect of SCIT was found for asthma symptoms; no studies reported on asthma control. For asthma exacerbations, studies favoured SCIT. We have little confidence in this effect estimate, due to the very low quality of evidence. For SLIT, quality of the evidence was very low due to a large risk of bias, indirectness and imprecision. The outcome 'asthma symptoms' could not be calculated due to lack of standardisation and large clinical heterogeneity. Other predefined outcomes were not reported.

CONCLUSION

The beneficial effects of immunotherapy in childhood asthma found in earlier reviews are no longer considered applicable, because of indirectness (studies performed in children not being treated according to current asthma guidelines with ICS). There was absence of evidence to properly determine the effectiveness or lack thereof of immunotherapy in asthma treatment in children with ICS.

Sex-Related Allergic Rhinitis Prevalence Switch from Childhood to Adulthood: A Systematic Review and Meta-Analysis

BACKGROUND

A sex-related switch in the prevalence of asthma from childhood (male predominance) to adulthood (female predominance) has been described, but for allergic rhinitis this remains unclear. We aimed to examine sex- and age-group-specific differences in allergic rhinitis prevalence by systematically evaluating studies from across the globe.

METHODS

A systematic search of MEDLINE and Embase for population-based cross-sectional studies was performed regardless of the language of publication. The search was restricted to the present millennium (2000 to June 2014). Study quality was defined by the sampling method, response rate, sample size, and data collection method. To assess sex differences in the prevalence of self- or parent-reported symptoms of rhinitis, calculated pooled estimates of the male-female ratio (MFR) were obtained using random-effects model meta-analyses due to heterogeneity. A meta-regression analysis was also performed.

RESULTS

Out of 6,539 publications identified, 67 cross-sectional population-based studies (291,726 males and 301,781 females) were included in our meta-analysis. In children (<11 years of age) significantly more boys than girls had rhinitis symptoms (MFR 1.21, 95% CI 1.17-1.25), whereas in adolescents (11 to <18 years of age) males were significantly less often affected than females (MFR 0.90, 95% CI 0.85-0.95). No sex-specific prevalence difference was observed in adults (MFR 0.96, 95% CI 0.83-1.17). These findings were consistent in all continents except in Asia, where the male predominance remained beyond childhood.

CONCLUSIONS

The male predominance of rhinitis prevalence in childhood changed towards a female predominance in adolescence across the globe, except in Asia. Longitudinal studies are needed to confirm these cross-sectional data and examine possible determinants and underlying mechanisms.

Prevalence and allergen of allergic rhinitis in Korean children

BACKGROUND

In recent decades, the amount of data about allergic rhinitis (AR) in Korean National Health Insurance Service has increased.

OBJECTIVE

To investigate the prevalence and quality of sensitized allergens of AR in Korean children and adolescents.

METHODS

This study obtained the results of the Korean International Study of Asthma and Allergies in Childhood questionnaires and the skin-prick test (SPT) results of 14,356 students who participated in a health screening from 2010 to 2014. AR was defined as one with current symptoms of AR with at least one or more positive results of an SPT with inhalant allergens.

RESULTS

The prevalence of AR in children was 20.8%. Positive rates of the allergen group were 87.3% for house-dust mites, 37.0% for pollen, 12.4% for mold, and 8.4% for pets. The common allergens in descending order were Dermatophagoides pteronyssinus, Dermatophagoides farinae, Betula, Humulus, Alnus, and Alternaria. As the children became older, pollen-sensitization rates tended to increase (p value for trends, <0.001). In metropolitan and middle inland areas, weed pollen was the most common pollen. The rates of tree-pollen sensitization were the highest at the seaside and in the southern inland. The most common comorbid allergic diseases associated with AR were pollen allergy and allergic conjunctivitis at 37.0% and 34.5%, respectively.

CONCLUSIONS

This was the first study conducted in Korea to investigate the prevalence of AR in the general population by using both questionnaires and SPTs. The allergens used for the SPTs were chosen based on the common allergens in this study, and this current pollen data will contribute to establish the cause of increasing AR prevalence in Korea.

The Role of Human Milk Immunomodulators in Protecting Against Viral Bronchiolitis and Development of Chronic Wheezing Illness

Infants who are breastfed are at an immunological advantage when compared with formula fed infants, evidenced by decreased incidence of infections and diminished propensity for long term conditions, including chronic wheeze and/or asthma. Exclusive breastfeeding reduces the duration of hospital admission, risk of respiratory failure and requirement for supplemental oxygen in infants hospitalised with bronchiolitis suggesting a potentially protective mechanism. This review examines the evidence and potential pathways for protection by immunomodulatory factors in human milk against the most common viral cause of bronchiolitis, respiratory syncytial virus (RSV), and subsequent recurrent wheeze in infants. Further investigations into the interplay between respiratory virus infections such as RSV and how they affect, and are affected by, human milk immunomodulators is necessary if we are to gain a true understanding of how breastfeeding protects many infants but not all against infections, and how this relates to long-term protection against conditions such as chronic wheezing illness or asthma.

Evaluation of the effect of pollution and fungal disease on Pinus radiata pollen allergenicity

BACKGROUND

Pollutants and other stressing factors like mold infection might increase the production of pathogen-related proteins in plants. Since this is invoked as one of the causes for the high prevalence of allergic diseases in developed countries, we aimed to determine the potential effect of environmental pollution, with or without mold infection of the trees, on the allergenic potency of pine pollen (Pinus radiata).

METHODS

Pine pollen samples were recovered from three selected areas: low polluted (A), highly polluted (B) and highly polluted and infected with fungi (Spheropsis sapinea) (C). The allergenic potency of pollen from areas A, B or C were compared in vivo in 35 pine pollen-allergic patients by skin prick test and specific IgE (sIgE) quantification. Pollen was also analyzed in vitro by SDS-PAGE immunoblotting, RAST inhibition and cDNA-AFLP (amplified fragment length polymorphism) to compare differences in proteins and mRNA expression.

RESULTS

The allergenic potency measured by prick test, sIgE and RAST inhibition was greater in pollen A, which was exposed to smaller amounts of NO(x), PM(10) and SO(2) but greater amounts of O(3). No differences were found in IgE-binding bands in immunoblotting or densitometry of the bands. In cDNA-AFLP, three homologous transcript-derived fragments were expressed in samples B only, with an expressed sequence tag related with stress-regulated gene expression.

CONCLUSIONS

A greater allergenic potency, in terms of skin tests and sIgE, is observed in pine pollen coming from unpolluted areas. We consider that this fact might be related to a higher exposure to ozone, resulting in a greater expression of allergenic proteins.

Bayesian modeling and inference for meta-data with applications in efficacy evaluation of an allergic rhinitis drug

Allergic rhinitis is an allergic inflammation of the nasal membranes. The symptoms include disorders in nose and eyes. Studies have been carried out on safety and efficacy evaluation of triamcinolone acetonide aqueous nasal spray. To combine the results from different studies, we propose random-coefficient regression models. The properties of the proposed models are examined. The models are compared via the deviance information criterion (DIC), and Bayesian computations are carried out via MCMC sampling. A set of meta-data from nine clinical trials is analyzed in detail via the proposed methodology.

Rhinoconjunctivitis prevalence and associated factors in school children aged 6-7 and 13-14 years old in Bogota, Colombia

OBJECTIVE

Allergic rhinitis is one of the most frequent chronic diseases among children. The objective of the study was to assess the prevalence of rhinoconjunctivitis and determine clinical, social and environmental associated factors, among school children aged 6-7 years and adolescents aged 13-14 years in Bogotá, Colombia.

METHODS

We used ISAAC (International Study of Asthma and Allergies in Childhood) phase III study methodology and questionnaire for design and data collection, and we did a secondary analysis of these data. The sample consisted of 3830 registers from adolescents between 13 and 14 years old and 3256 registers from children between 6 and 7 years.

RESULTS

The prevalence of rhinoconjunctivitis symptoms in the last year was 17.2% (95% CI, 15.9-18.5) in children vs. 24.9% (95% CI, 23.6-26.3) in adolescents. In both groups there was a female predominance in children (17.8% vs. 16.5%), and in the teenagers group (28.0% vs. 21.4%), though the differences were not statistically significant. The factors associated with rhinoconjunctivitis in the group of 6-7 years where: asthma [OR 3.9; (95% CI, 2.8-5.4)], atopic dermatitis [OR 2.3; (95% CI, 1.7-3.1)], use of acetaminophen in the last year [OR 2.6; (95% CI, 1.4-4.9)], use of antibiotics in the first year of live [OR 1.7; (95% CI, 1.3-2.3)], higher maternal education [OR 1.5; (95% CI, 1.0-2.3)] and cesarean delivery [OR 1.6; (95% CI, 1.2-2.1)]. Among the 13-14 year age-group, factors associated with rhinoconjunctivitis included: asthma [OR 2.6; (95% CI, 2.0-3.4)], atopic dermatitis [OR 1.8; (95% CI, 1.4-2.3)], use of acetaminophen in the last year [OR 1.8; (95% CI, 1.4-2.4)], consumption of fast-food three times or more per week [OR 1.5; (95% CI, 1.2-2.0), ever smoked [OR 1.4; (95% CI, 1.2-1.7)] and meat consumption was protective factor [OR 0.7; (95% CI, 0.5-0.9)].

CONCLUSION

In both studied groups, the estimated prevalence of rhinoconjunctivitis symptoms was relatively high. Future in-depth research is needed to assess the complex interactions between allergic rhinoconjunctivitis symptoms and social and environmental factors.

Asthma prevalence among 16- to 18-year-old adolescents in Saudi Arabia using the ISAAC questionnaire

BACKGROUND

Most of the studies investigating the prevalence of asthma in various countries have focused on children below the age of 15 years or adults above the age of 18 years. There is limited knowledge concerning the prevalence of asthma in 16- to 18-year-old adolescents. Our objective was to study the prevalence of asthma and associated symptoms in 16- to 18-year-old adolescents in Saudi Arabia.

METHODS

A cross-sectional study was conducted in secondary (high) schools in the city of Riyadh utilizing the International Study of Asthma and Allergies in Children (ISAAC) questionnaire tool.

RESULTS

Out of 3073 students (1504 boys and 1569 girls), the prevalence of lifetime wheeze, wheeze during the past 12 months and physician-diagnosed asthma was 25.3%, 18.5% and 19.6%, respectively. The prevalence of exercise-induced wheezing and night coughing in the past 12 months was 20.2% and 25.7%, respectively. The prevalence of rhinitis symptoms in students with lifetime wheeze, physician-diagnosed asthma and exercise-induced wheeze was 61.1%, 59.9% and 57.4%, respectively. Rhinitis symptoms were significantly associated with lifetime wheeze (OR = 2.5, p value < 0.001), physician-diagnosed asthma (OR = 2.2, p < 0.001), and exercise-induced wheeze (OR = 1.9, p value < 0.001).

CONCLUSIONS

The prevalence of asthma and associated symptoms in 16- to 18-year-old adolescents in Saudi Arabia is high, although it is within range of reported prevalence rates from various parts of the world.

The burden of allergic rhinitis and asthma

Asthma and allergic rhinitis are common health problems that cause major illness and disability worldwide. The prevalence of allergic rhinitis is estimated to range from 10% to 20% in the USA and Europe. Multiple factors contribute to the wide range of reported prevalence rates. These include type of prevalence rate reported (current or cumulative), study selection criteria, age of participants, differences in survey methods, varied geographic locations and socioeconomic status, any of which are significant enough to confound direct comparison between studies. There is no standard set of diagnostic criteria for allergic rhinitis. In most studies, the criteria for diagnosis are based on the subject's reporting, solely by questionnaire and rarely confirmed by skin testing. In addition, most studies focus on hay fever, leaving perennial allergic rhinitis underestimated. Sinus imaging is generally not performed and, therefore, rhinosinusitis not differentiated. Some investigators report 'current' prevalence while others report 'cumulative' or 'lifetime' prevalence. Epidemiologic studies have consistently shown that asthma and rhinitis often coexist in the same patients. The prevalence of asthma is <2% in subjects without rhinitis while it varies from 10% to 40% in patients with rhinitis. Furthermore, the majority of patients with asthma experience rhinitis, which is a factor in the risk for asthma. Despite recognition that allergic rhinitis and asthma are global health problems, there are insufficient epidemiologic data and more data are needed with regard to their etiologic risk factors and natural history. This aim of this review is to enable the reader to discuss prevalence, risk factors and prognosis of allergic rhinitis and asthma.

A national audit of pollen immunotherapy for children in the United Kingdom: patient selection and programme safety

BACKGROUND

Specific immunotherapy (SIT) is an effective treatment for grass and/or tree pollen-induced severe allergic rhinoconjunctivitis. However, there are limited detailed data on the use of immunotherapy in children in the United Kingdom.

OBJECTIVES

We audited NHS paediatric practice against current national guidelines to evaluate patient selection, SIT modalities and adverse events (AEs).

METHODS

Paediatricians offering pollen SIT were identified through the British Society of Allergy and Clinical Immunology Paediatric Allergy Group (BSACI-PAG) and the database of SIT providers compiled for the Royal College of Physicians and Royal College of Pathologists 2010 joint working group. Standardized proformas were returned by 12 of 20 centres (60%), including 12 of 14 centres offering subcutaneous immunotherapy (SCIT) (85%).

RESULTS

Three hundred and twenty-three children, with mean age 11 years at initiation (69% boys), had undergone 528 SIT cycles (SCIT 31%) over 10 years. Fifty-five percent of all patients had asthma. Among SCIT programmes 24.5% patients had perennial (± seasonal) asthma; 75.6% of asthmatics undertaking SCIT had treatments at BTS/SIGN step 2 or above. AEs occurred frequently (50.4% of all SIT cycles) but were mild. In sublingual immunotherapy (SLIT) treatment, local intraoral immediate reactions were most common (44.9% SLIT cycles), as compared with delayed reactions around the injection site in SCIT (28.3% SCIT cycles). An asthma diagnosis had no impact on the number of cycles with AEs, or the severity reported. Few cycles (2.9%) were discontinued as a result of AE(s).

CONCLUSIONS AND CLINICAL RELEVANCE

Pollen SIT is available across England, though small numbers of children are being treated. Current national guidelines to exclude asthmatic children in SIT programmes are not being adhered to by most specialist paediatric allergy centres. SCIT and SLIT has been well tolerated. Review of patient selection criteria is needed and may allow greater use of this therapeutic option in appropriate clinical settings.

Specificity in the association of anxiety, depression, and atopic disorders in a community sample of adolescents

The specificity of relationships between anxiety and depressive symptoms, with each of the major atopic disorders of asthma, allergic rhinitis (AR), and atopic dermatitis (AD) was systematically investigated within a single study sample. Participants included 367 adolescents who participated in a community, longitudinal study investigating risk factors for the development of psychiatric and physical health problems. Mental health symptoms were assessed at 7, 9, 11, and 13 years of age. Lifetime history of atopic disorders was assessed by parent report at age 13. Analysis of variance was used to investigate the specificity of the associations between anxiety and depression, and each of the atopic disorders. Results indicated that anxiety was associated with a lifetime history of atopic disorders as a group. The association was significantly strengthened when controlling for depression and externalizing psychiatric symptoms. Among atopic disorders, "pure" anxiety was associated with asthma and AR, and having both asthma and AR strengthened the association compared to having either disorder alone. The association of "pure" anxiety with asthma and AR is consistent with existing data suggesting a relationship between anxiety and respiratory disorders. Having both asthma and AR appeared to confer an additive "dose effect" on the strength of the association. The lack of an association with depression suggests that other factors may contribute to the differential expression of anxiety and depression with atopic disorders. Findings demonstrate the importance of assessing the impact of co-morbid psychiatric symptoms and atopic disorders within individual studies to determine the specificity of underlying relationships between these conditions.

Gender differences in indoor allergen exposure and association with current rhinitis

BACKGROUND

Differences between boys and girls in allergic manifestations are well known, and this difference is possibly not attributed to physiological differences alone.

OBJECTIVE

We, therefore, investigated whether boys and girls could be exposed to different allergen levels at home and whether indoor allergen levels could be differently associated with rhinitis in boys and girls at 10 years of age.

METHODS

Cat, dog and house dust mite (HDM) allergen levels in mattress dust and interview data regarding current allergic disease were available for 797 10-year-old children (360 girls) in The Environment and Childhood Asthma Study in Oslo.

RESULTS

Girls had higher concentrations of cat and dog allergens in their mattresses compared with boys, also in homes without cats [geometric mean 95% confidence intervals (95% CI): 0.37 (0.31, 0.44) for girls and 0.26 (0.23, 0.30) microg cat allergen/g dust for boys, P=0.002], and without dogs [girls: 0.74 (0.63, 0.86) and boys: 0.55 (0.48, 0.62) microg dog allergen/g dust, P=0.003]. No difference was observed for HDM allergen (Der p 1) levels. Of the 190 (23.8%) children reporting current rhinitis, 144 (75.8%) were sensitized to at least one allergen. The adjusted odds ratio for current rhinitis increased with 1.20 (95% CI: 1.01, 1.42) per 1 microg/g dust increase in Der p 1 for girls (P=0.037), but not for boys (P=0.91).

CONCLUSION

Girls had higher levels of cat and dog allergens in mattress dust compared with boys, whereas no difference was observed for Der p 1 allergen. Nevertheless, only increasing levels of Der p 1 and not cat and dog allergens significantly increased the risk of current rhinitis in girls, whereas no significant association was observed for boys.

Risk factors for allergic rhinitis in Costa Rican children with asthma

BACKGROUND

Risk factors for allergic rhinitis (AR) in asthmatics are likely distinct from those for AR or asthma alone. We sought to identify clinical and environmental risk factors for AR in children with asthma.

METHODS

We performed a cross-sectional study of 616 Costa Rican children aged 6-14 years with asthma. Candidate risk factors were drawn from questionnaire data, spirometry, methacholine challenge testing, skin testing, and serology. Two outcome measures, skin test reaction (STR)-positive AR and physician-diagnosed AR, were examined by logistic regression.

RESULTS

STR-positive AR had high prevalence (80%) in Costa Rican children with asthma, and its independent risk factors were nasal symptoms after exposure to dust or mold, parental history of AR, older age at asthma onset, oral steroid use in the past year, eosinophilia, and positive IgEs to dust mite and cockroach. Physician-diagnosed AR had lower prevalence (27%), and its independent risk factors were nasal symptoms after pollen exposure, STR to tree pollens, a parental history of AR, inhaled steroid and short-acting beta2 agonist use in the past year, household mold/mildew, and fewer older siblings. A physician's diagnosis was only 29.5% sensitive for STR-positive AR.

CONCLUSIONS

Risk factors for AR in children with asthma depend on the definition of AR. Indoor allergens drive risk for STR-positive AR. Outdoor allergens and home environmental conditions are risk factors for physician-diagnosed AR. We propose that children with asthma in Costa Rica and other Latin American nations undergo limited skin testing or specific IgE measurements to reduce the current under-diagnosis of AR.

Allergic rhinitis in children: incidence and treatment in Dutch general practice in 1987 and 2001

Allergic rhinitis is a common chronic disorder in children, mostly diagnosed in primary health care. This study investigated the national incidence and treatment of allergic rhinitis among children aged 0-17 yr in Dutch general practice in 1987 and 2001 to establish whether changes have occurred. A comparison was made with data from the first (1987) and second (2001) Dutch national surveys of general practice on children aged 0-17 yr. Incidence rates were compared by age, sex, level of urbanization and season. The management of the general practitioner was assessed regarding drug prescriptions and referrals to medical specialists, and compared with the clinical guideline issued in 1996. The incidence rate of allergic rhinitis increased from 6.6 (1987) to 9.2 (2001) per 1000 person-years. We found a male predominance with a switch in adolescence to a female predominance at both time points. The increase in incidence was the highest in rural (<30,000 inhabitants) and suburban areas (30,000-50,000 inhabitants). Compared to 1987, there was a significant increase in incidence in the central part of the Netherlands in 2001. In both years, the incidence was higher in spring compared with the other seasons. In 2001, children of natives and western immigrants visited the general practitioner more often with complaints of allergic rhinitis compared to 1987. In 1987, prescribed medication consisted mainly of nasal corticosteroids (36%) and in 2001 of oral antihistamines (45%). Although a clinical guideline was not issued until 1996, overall, the treatment of allergic rhinitis by general practitioners was in both years in accordance with the current clinical guideline, but with a stronger adherence in 2001. The results show an increased incidence in the past decades of allergic rhinitis in children in Dutch general practice. The shift to a smaller spectrum of prescriptions in 2001 may be a result of the 1996 clinical guideline.

Prevalence of asthma, allergic rhinitis and eczema among Lebanese adolescents

OBJECTIVE

Studies on allergic diseases remain scarce in Lebanon. The aim of the present study was to determine prevalence and characteristics of asthma, allergic rhinitis and eczema among Lebanese school children.

METHODS

The study was cross-sectional in design performed on a convenient sample of 3,115 students (13-14 yr) selected from 13 schools in 5 Lebanese provinces. Students were asked to complete the Arabic version of the International Study of Asthma and Allergies in Childhood questionnaire. Logistic regression was performed to assess the characteristics of having asthma, allergic rhinitis and eczema in the past year.

RESULTS

The prevalence of ever having asthma, rhinitis and eczema was 8.3%, 45.2% and 12.8% respectively, while the prevalence of the symptoms of these diseases in the past year was 24.1%, 38.6% and 20.9%, respectively. Residing in the South and the North provinces of Lebanon and living in a busy area increased the likelihood of developing asthma and rhinitis. Higher rates of asthma and eczema, however, was noted among students going to private schools (Odds Ratio (OR) = 1.6, 95% confidence interval (CI): 1.3-2.1 and OR = 1.3, 95% CI: 1.0-1.7, respectively). Passive smoking was significantly associated with asthma only (OR = 1.3, 95% CI: 1.1-1.7). In addition to the above, the odds of having any of the three outcomes increases to at least 2.4-fold when accompanied by another allergic disease.

CONCLUSIONS

Allergic diseases are highly prevalent in Lebanon and are catching up with the rates of developed countries. Moreover, the role of each of the three diseases in the existence of the other two had the greatest impact on their prevalence.

Allergy immunotherapy among Medicaid-enrolled children with allergic rhinitis: patterns of care, resource use, and costs

BACKGROUND

Although research demonstrates that allergy immunotherapy (IT) improves allergic rhinitis (AR) outcomes, little is known about IT patterns of care and associated resource use and costs among US children with diagnoses of AR.

OBJECTIVE

We sought to examine characteristics associated with receiving IT, patterns of IT care, and health care use and costs incurred in the 6 months before versus after IT.

METHODS

We performed retrospective Florida Medicaid claims data (1997-2004) analysis of children (<18 years of age) given new diagnoses of AR.

RESULTS

Of 102,390 patients with new diagnoses of AR, 3048 (3.0%) received IT. Male patients, Hispanic patients, and those with concomitant asthma were significantly more likely to receive IT. Approximately 53% completed less than 1 year and 84% completed less than 3 years of IT. Patients who received IT used significantly less pharmacy (12.1 vs 8.9 claims, P < .0001), outpatient (30.7 vs 22.9 visits, P < .0001), and inpatient (1.2 vs 0.4 admissions, P = .02) resources in the 6 months after versus before IT. Pharmacy ($330 vs $60, P < .0001), outpatient ($735 vs $270, P < .0001), and inpatient ($2441 vs $1, P < .0001) costs (including costs for IT care) were significantly reduced after IT.

CONCLUSION

Despite suboptimal treatment persistence (only 16% of patients completed 3 years of IT), resource use and costs after treatment were significantly reduced from pre-IT levels.

Allergic rhinitis in children with asthma: a questionnaire-based study

BACKGROUND

Allergic rhinitis (AR) and asthma frequently coexist but has rarely been evaluated in children.

OBJECTIVE

This prospective study aimed to estimate the prevalence of AR in asthmatic children, and ascertain whether AR is a risk factor for the severity of asthma.

METHODS

The questionnaire, modified from the adult form of the score for allergic rhinitis (SFAR), was completed by 404 asthmatic children aged 3-18 years seen in the outpatient clinic between June 2005 and July 2007. Each item was assigned a number of points with a final score ranging from 0 to 17. AR and asthma were classified according to ARIA and GINA 2004 recommendations, respectively.

RESULTS

AR was diagnosed in 237 patients (58.7%). It was intermittent in 57.8% of the patients and persistent in 42.2%. A total score >or=9 was discriminant for AR (sensitivity=91.1%, specificity=95.2%, positive predictive value=96.4%, negative predictive value=88.3%, Youden's Index=0.86). The proportion of children having mild or moderate-to-severe asthma was independent of the presence of AR, 61.6% of moderate-to-severe asthmatic children and 55.4% of intermittent and mild asthmatic children having AR.

CONCLUSION

AR and asthma are frequently associated (58.7%). The SFAR adapted for children seems to be a simple and a reliable tool to detect AR in asthmatic children.

Common characteristics of upper and lower airways in rhinitis and asthma: ARIA update, in collaboration with GA(2)LEN

This update aimed to review the new evidence available to support or refute prior Allergic Rhinitis and its Impact on Asthma (ARIA) statements. A Medline search of publications between 2000 and 2005 was conducted, with articles selected by experts. New evidence supports previous ARIA statements, such as: (i) allergic rhinitis (AR) is a risk factor for asthma; (ii) patients with persistent rhinitis should be evaluated for asthma; (iii) most patients with asthma have rhinitis; (iv) a combined strategy should be used to treat the airways and (v) in low- to middle-income countries, a different strategy may be needed. The increased risk of asthma has also been found among sufferers from non-AR. Recent reports show AR is a global problem. Many studies demonstrated parallel increasing prevalence of asthma and rhinitis, but in regions of highest prevalence, it may be reaching a plateau. Factors associated with a reduced risk of asthma and AR have been identified, confirming previous findings of protection related to exposure to infections. Treatment of rhinitis with intranasal glucocorticosteroids, antihistamines, leukotriene antagonists or immunotherapy may reduce morbidity because of asthma. To take advantage of the paradigm of unified airways, there is a need to rationalize diagnosis and treatment to optimize management.

Trends in the prevalence and severity of asthma, rhinitis and atopic eczema in 6- to 7- and 13- to 14-yr-old children from the north-east of England

The aims of the present study were to assess time trends in symptoms of asthma, rhinitis and atopic eczema among children in the north-east of England. Two cross- sectional surveys 6 yr apart, 6- to 7- and 13- to 14 yr of age, using the International Study of Asthma and Allergies in Childhood, core questionnaire were performed. There was a general increase in symptoms for all the three conditions in both the age groups. In the age group 6- to 7 yr, the increase was generally the same in boys and girls, while in the age group 13- to 14 yr, the increase was generally more marked among boys. In the younger age group, indices related to lifetime diagnosed ever had asthma and having hay fever increased in girls but not in boys, while indices related to lifetime diagnosis of ever having eczema increased in boys and girls. In the older age group, indices related to lifetime diagnosis of ever had asthma slightly increased in boys but did not change in girls, while lifetime diagnosis of ever having hay fever slightly decreased in girls but did not change in boys. The prevalence of lifetime diagnosis of ever having eczema increased in boys and girls. Changes observed in the present study could be related to the changes in lifestyle or environmental factors, awareness or management of symptoms.

Enhancement of mite allergen-induced eosinophil infiltration in the murine airway and local cytokine/chemokine expression by Asian sand dust

Data on the effects of sand dust toward allergic asthma produced by indoor allergens, such as house dust mites, are not currently available. This study was undertaken to clarify the role of Asian sand dust on mite allergen, Dermatophagoides farinae (D. farinae)-induced eosinophilic inflammation in the murine lung, using sand dusts from the Maowusu Desert (Inner Mongolia) (SD-1) and the Tengger Desert (China) (SD-2). ICR mice were intratracheally administered saline; SD-1 alone; SD-2 alone; D. farinae alone; D. farinae + SD-1; and D. farinae + SD-2, 4 times at 2-wk intervals. The two sand dusts enhanced infiltration of eosinophil in the airway, along with goblet-cell proliferation related to D. farinae. The degree of eosinophil infiltration induced with SD-2 was greater than with SD-1. The SD-1, which contained higher amounts of beta-glucan, increased the expression of interferon (IFN)-gamma in bronchoalveolar lavage fluids (BALF) with or without D. farinae, but SD-2 did not. Synergistically or cumulatively elevated levels of interleukin (IL)-5, eotaxin, and monocyte chemotactic protein in BALF related to D. farinae were higher with D. farinae + SD-2 than with D. farinae + SD-1. These results suggest that increased cytokine and chemokines in BALF play an important role in the enhancement of eosinophil infiltration in the airway induced by D. farinae + sand dusts. The reduced eosinophil infiltration in the SD-1-treated mice could be due to suppression of Th-2 cytokine and eotaxin via interferon-gamma induced by microbial materials, such as beta-glucan.

Prevalence and severity of asthma, rhinitis, and atopic eczema in 13- to 14-year-old schoolchildren from southern Brazil

The objective of this study was to investigate the prevalence and severity of asthma, rhinitis, and atopic eczema in schoolchildren from southern Brazil. A cross-sectional study was carried out with the International Study of Asthma and Allergies in Childhood phase III written questionnaire. The questionnaire was self-applied by 2,948 randomly selected schoolchildren aged 13 to 14 years. The lifetime prevalence rates of symptoms were as follows: wheezing, 40.8%; rhinitis, 40.7%; eczema, 13.6%; self-reported asthma, 14.6%; rhinitis, 31.4%; eczema, 13.4%. Rhinitis was reported by 55% of adolescents with current asthma (60% females vs 46.9% males). Girls 13 to 14 years of age had higher prevalence rates of asthma, rhinitis, and eczema than boys had. Atopic eczema was reported by 42.7% of girls and 31.4% of boys with asthma. The prevalence rates were statistically significant for symptoms of asthma, rhinitis, and atopic eczema in females. However, there were no statistically significant differences between the sexes in regard to reported asthma and bronchospasm induced by exercise.

Asthma, genes, and air pollution

OBJECTIVE

The objective of this article is to evaluate genetic risks associated with the pulmonary response to air pollutants, including particulates and ozone.

METHODS

A comprehensive review of articles related to the genetics of asthma with particular attention to air pollution was conducted through a search of the National Library of Medicine's PubMed database.

RESULTS

Asthma, which affects over 15 million people in the United States, is characterized by inflammation leading to reversible airflow obstruction. Triggered by exposure to numerous occupational and environmental agents, asthma has long been considered to occur more frequently in families, with upwards of a 50% higher rate in the offspring of parents with asthma. Asthma genetic studies have used two major methods: mapping techniques that pinpoint gene loci and studies that identify genes and polymorphisms associated with various asthma mechanisms such as inflammatory mediators. The most consistently replicated chromosomal regions associated with asthma have been chromosomes 2q, 5q, 6p, 12 q, and 13q. Because the formation of reactive oxygen species is a major aspect of the inflammatory process of asthma, genetic aberrations associated with antioxidants such as glutathione S-transferase (GST) may shed light on reasons why some people with asthma seem more at risk of exacerbations as a result of air pollution. People with a polymorphism at the GSTP 1 locus, which codes for GST, one of a family of pulmonary antioxidants, have higher rates of asthma. Children in Mexico City with the GSTM1 null genotype demonstrated significant ozone-related decrements in lung function. Animal studies support the key role of antioxidants in reducing the inflammatory response associated with exposure to diesel exhaust particles.

CONCLUSIONS

Oxidative stress is a key mechanism underlying the toxic effects of exposure to some types of air pollution. Asthmatics with the null genotype for the antioxidant, GST, seem more at risk of the pulmonary effects of air pollution.

Predicting premature mortality from new power plant development in Virginia

The authors estimated the number of premature deaths from particulate matter less than 2.5 microm (PM2.5) that would result from making 29 proposed fossil fuel power plants in Virginia operational. We used a U.S. Environmental Protection Agency air quality model (Climatological Regional Dispersion model) to calculate changes in ambient concentrations of PM2.5 and Cox proportional hazard modeling to calculate the resulting premature mortality. The model predicted that if all 29 plants were operational, PM2.5 concentrations would rise in 271 counties across 19 states 5 and increased average annual PM2.5 concentrations would result in a rate of 17 deaths per 37,900,026 people aged 30 yr and older (0.45 deaths per million, 95% confidence interval = 0.31, 0.59) per year by the end of 2004, increasing thereafter. Over a 6 yr period, 104 cumulative excess deaths would occur due to operations of these proposed plants. The authors recommend that precautionary principles be considered when policy decisions related to energy production from fossil fuels are made.

Prevalência de asma brônquica e de sintomas a ela relacionados em escolares do Distrito Federal e sua relação com o nível socioeconômico

OBJETIVO: Avaliar a prevalência de asma e sintomas a ela relacionados no Distrito Federal e sua relação com o nível socioeconômico, utilizando o questionário escrito do International Study of Asthma and Allergies in Childhood. MÉTODOS: Foram avaliadas 6.437 crianças, em escolas públicas e particulares, divididas em: 3.183 crianças de seis a sete anos e 3.254 de treze a catorze anos. Os dados foram analisados por sexo e grupo socioeconômico (teste do qui-quadrado). RESULTADOS: A prevalência encontrada de asma brônquica no Distrito Federal foi de 12,1% e 13,8% nas faixas etárias de seis a sete anos e treze a catorze anos, respectivamente (p < 0,04). Na faixa etária de seis a sete anos, o sexo masculino apresentou prevalências significativamente maiores de asma diagnosticada e de sintomas (p < 0,001), enquanto que na de treze a catorze anos, a maior prevalência de sintomas ocorreu no sexo feminino (p < 0,05). O grupo de piores condições socioeconômicas apresentou maiores taxas de sintomas relacionados à asma nas duas faixas etárias (p < 0,05). O diagnóstico de asma foi mais freqüente na classe social menos favorecida (p < 0,001) para o questionário respondido pelos pais. Entre os adolescentes, houve maior número de diagnósticos de asma no grupo de nível socioeconômico mais elevado (p = 0,001). CONCLUSÃO: O grupo economicamente desfavorecido apresentou prevalências maiores de sintomas de asma, assim como crises de maior gravidade. Também a prevalência de asma provável foi maior neste grupo que a de asma diagnosticada, o que sugere seu subdiagnóstico.

Clinically diagnosed childhood asthma and follow-up of symptoms in a Swedish case control study

Background

Childhood asthma has risen dramatically not only in the western societies and now forms a major and still increasing public health problem. The aims of this study were to follow up at the age of ten the patterns of asthma symptoms and associations among children with a clinically diagnosed asthma in a sizeable urban-rural community and to in compare them with demographic controls using a standardised questionnaire.

Methods

In a defined region in Sweden with a population of about 150 000 inhabitants, all children (n = 2 104) born in 1990 were recorded. At the age of seven all primary care and hospital records of the 1 752 children still living in the community were examined, and a group of children (n = 191) was defined with a well-documented and medically confirmed asthma diagnosis. At the age of ten, 86 % of these cases (n = 158) and controls (n = 171) completed an ISAAC questionnaire concerning asthma history, symptoms and related conditions.

Results

Different types of asthma symptoms were highly and significantly over-represented in the cases. Reported asthma heredity was significantly higher among the cases. No significant difference in reported allergic rhinitis or eczema as a child was found between cases and controls. No significant difference concerning social factors or environmental exposure was found between case and controls. Among the control group 4.7 % of the parents reported that their child actually had asthma. These are likely to be new asthma cases between the age of seven and ten and give an estimated asthma prevalence rate at the age of ten of 15.1 % in the studied cohort.

Conclusion

A combination of medical verified asthma diagnosis through medical records and the use of self-reported symptom through the ISAAC questionnaire seem to be valid and reliable measures to follow-up childhood asthma in the local community. The asthma prevalence at the age of ten in the studied birth cohort is considerably higher than previous reports for Sweden. Both the high prevalence figure and allowing the three-year lag phase for further settling of events in the community point at the complementary roles of both hospital and primary care in the comprehensive coverage and control of childhood asthma in the community.

Prevalência e gravidade de sintomas relacionados à asma em escolares e adolescentes no município de Duque de Caxias, Rio de Janeiro

INTRODUÇÃO: A asma é considerada a doença crônica mais comum na infância. Entretanto, há poucos estudos sobre sua prevalência em nosso meio. OBJETIVO: Avaliar prevalência e gravidade de sintomas de asma em escolares e adolescentes de Duque de Caxias (RJ). MÉTODO: Estudo transversal utilizando o questionário do International Study of Asthma and Allergies in Childhood. A amostra foi composta por alunos de 6, 7, 13 e 14 anos. RESULTADOS: Foram avaliados 4.040 alunos de 13 e 14 anos e 2.334 de 6 e 7 anos. A freqüência de sibilos nos últimos doze meses foi de 27,7% entre os mais jovens e de 19% entre os adolescentes (p < 0,0001). No primeiro grupo houve predomínio do sexo masculino (29,9% vs 25,6%, p = 0,01) e no segundo do feminino (21,9% vs 15,8%, p < 0,0001). Não existiram diferenças entre as faixas etárias relacionadas ao diagnóstico prévio de asma (cerca de 10%). Sibilância aos exercícios físicos foi mais prevalente entre os adolescentes (21,4% vs 7,8%, p < 0,0001). A gravidade dos sintomas foi maior entre as adolescentes (asma grave: 6,6% vs 4,4%, p = 0,001), não havendo diferenças entre gêneros aos 6 e 7 anos. CONCLUSÃO: A prevalência de asma em Duque de Caxias é alta, comparável à de outros municípios brasileiros e latino-americanos. Os valores são superiores aos 6 e 7 anos, quando os sintomas predominam no sexo masculino. Entre os adolescentes, a prevalência e a gravidade dos sintomas são maiores no gênero feminino, fato de observação recente e que parece representar novo comportamento epidemiológico da asma.

A survey of the quality of information leaflets on hayfever available from general practices and community pharmacies

BACKGROUND

Hayfever affects at least one in 10 people. The majority of hayfever is managed in the community setting where the management options are pharmaceutical and behavioural. Hayfever medications are available over the counter and on prescription from the general practitioner. Patient information leaflets are published to augment the advice given and to promote self-management, but these leaflets have rarely been subjected to critical review.

OBJECTIVE

To assess the quality of patient information leaflets written for people with hayfever and available from general practices and from community pharmacists.

METHOD

A structured review of patient information leaflets about hayfever. During the peak grass pollen season copies of all leaflets available were collected from a random sample of community pharmacists and general practices in Wessex. The characteristics of the leaflet were recorded and the contents and presentation of each one was reviewed using the British Medical Association patient information appraisal system. Readability was assessed using the Simple Measure of Gobbledegook (SMOG). Two allergy-accredited specialists assessed each leaflet for accuracy.

RESULTS

During the peak pollen season no leaflets were available in 30% of the Community Pharmacists and 23% general practices. In total, 38 different leaflets were identified. All the leaflets reviewed were written for adults. Forty-seven percent of the leaflets had no publication date and one-third of those dated were at least 5 years old. In general the leaflets scored highly on issues of presentation, but less than half contained information on the full range of management and treatment options, many being biased towards a single or limited range of interventions. Seventy-nine percent leaflets were produced or sponsored by pharmaceutical companies and gave prominence to their own products. All the leaflets had readability scores requiring at least secondary education (SMOG score equal or greater than 9). At least one factual inaccuracy was identified in four-fifths of leaflets.

CONCLUSION

A large number of leaflets are published for people with hayfever, but they are of variable quality and not accessible to all patients because of limited distribution or high readability scores. If all patients are to benefit from written information the authors and publishers of leaflets need to follow published recommendations, especially with respect to content and readability. In the absence of a national public health information strategy or a body that systematically vets patient information materials, clinicians must pay attention to the quality of information provided for or obtained elsewhere by their patients.

Identification of beta-tubulin isoform V as an autoantigen in allergic rhinitis by a proteomic approach

Autoantibodies to IgE and beta2-adrenergic receptor have been reported in patients with allergic rhinitis. To investigate whether autoimmunity in allergic rhinitis is directed to such limited molecules or directed to a wide range of self proteins, we here attempted to survey autoantigens/autoantibodies comprehensively, using proteomics. Specifically, we separated proteins extracted from peripheral blood mononuclear cells by 2-dimensional electrophoresis and then detected autoantigens by subsequent western blotting with sera from patients with allergic rhinitis. As a result, we detected multiple autoantigens, some of which were further identified by mass fingerprinting. Next, we confirmed antigenicity of one of the identified autoantigens, beta-tubulin isoform V (beta-tubV), using a recombinant protein and then measured prevalence of the anti-beta-tubV autoantibodies. As a result, 52% of the tested patients with allergic rhinitis were found to possess anti-beta-tubV autoantibodies. Our study indicates that autoimmunity is a common phenomena and beta-tubV is one of the major autoantigens in allergic rhinitis.

Chlamydia pneumoniae infections in asthma: clinical implications

Chlamydia pneumoniae is an intracellular pathogen that has been suggested to play a role in the pathology of asthma. However, so far none of the studies have provided clear evidence for a causative role of C. pneumoniae infections in asthma, although there is little doubt that chronic C. pneumoniae infection does aggravate asthma and should be treated. The diagnosis of C. pneumoniae infection is still a matter of concern for it is dependent on trained skilled personnel and can vary significantly between different diagnostic laboratories. This fact is also one of the major problems encountered when comparing epidemiological studies investigating the possible role of C. pneumoniae infections and their impact on the pathogenesis of other diseases. With regard to therapy, long-term treatment with macrolides is the best available method to eradicate C. pneumoniae. Successful therapy for C. pneumoniae, however, can also be complicated by the high possibility of de novo infection as epidemiological studies have shown that the prevalence of antibodies to C. pneumoniae increases with age in all populations studied. In the northern hemisphere the prevalence of C. pneumoniae is also affected by seasonal conditions. It is too early to draw any conclusions from the equatorial belt countries. The available data on C. pneumoniae in tropical countries indicate a much faster infection rate during early adulthood with 100% serological prevalence at an age greater than 25 years. This data, if confirmed, would argue against C. pneumoniae causing asthma since the asthma prevalence in those countries does not increase in a parallel pattern. An alternative interpretation of most studies could be that the increased rate of C. pneumoniae infections in patients with asthma results from a modified susceptibility towards the microorganism, due to yet unknown changes of the host cell's physiology. It should be kept in mind that increased prevalence of C. pneumoniae infection is not restricted to asthma. Further studies are needed to understand the role of C. pneumoniae, especially of chronic infection, in the pathogenesis of inflammatory diseases with a specific focus on the effect that the microorganism triggers in the infected host cell. Only when we understand what C. pneumoniae does to its host cell will we be able to judge its impact on the overall status of an affected patient, and this knowledge will help us to develop a successful therapy.

Neonatal head circumference, neonatal weight, and risk of hayfever, asthma and eczema in a large cohort of adolescents from Sheffield, England

BACKGROUND

Neonatal physical characteristics, including head circumference and birth weight, have been hypothesized to be markers of in utero thymic development. Greater head circumference and lower birth weight have been linked in previous studies to subsequent development of asthma, and greater birth weight has been associated with subsequent development of eczema.

OBJECTIVE

To investigate potential associations between neonatal head circumference and weight and hayfever, asthma and eczema in a cohort of adolescents from Sheffield, England.

METHODS

Responses to a questionnaire inquiring about physician-diagnosed hayfever, asthma and eczema among adolescents in Sheffield, England, were linked to previously recorded measurements of weight at birth and at 1 month and head circumference at 1 month. Logistic regression methods were used to relate diagnoses to neonatal measurements and potential confounders.

RESULTS

The cohort consisted of 10,809 adolescents, of whom 16.5% reported hayfever, 18.0% asthma, and 16.2% eczema. After adjusting for sex, age at the time of the questionnaire, maternal age and gestational age at birth, number of older and younger siblings, time since birth of next older sibling, neonatal sickness, type of neonatal feeding, and maternal and paternal educational backgrounds, hayfever was the only disease associated with neonatal measurements. Comparing the highest with the lowest fifths of distributions, lifetime prevalence of hayfever was positively associated with neonatal head circumference (adjusted odds ratio 1.23, 95% CI 1.03 to 1.47) and with birth weight (1.17, 0.99 to 1.39). Hayfever was inversely related to the ratio of head circumference to birth weight (0.89, 0.75 to 1.05) and to gestational age. The associations with head circumference and birth weight were not substantially altered by further adjustment for gestational age.

CONCLUSION

Greater neonatal head circumference may be associated with an increased risk of hayfever, but the inverse relationship between hayfever prevalence and the ratio of head circumference to birth weight challenges the prior hypothesis that greater head circumference relative to body mass reflects abnormal thymic development in utero, increasing the likelihood of allergic sensitization.

Differences in airway-inflammation development by house dust mite and diesel exhaust inhalation among mouse strains

Three mouse strains (BALB/c, ICR, and C3H/He) were injected intratracheally with house dust mites (Der f) four times at 2-week intervals during exposure to diesel exhaust (DE) or clean air for 8 weeks. Der f treatment caused eosinophilic inflammation and proliferation of goblet cells in the airways of the three strains. DE + Der f caused a further increase of eosinophils in BALB/c and ICR mice, but not in C3H/He mice. DE + Der f significantly increased interleukin (IL)-5; regulated on activation, normal T cell expressed, and presumably secreted (RANTES); eotaxin, monocyte chemotactic protein-1 (MCP-1); and macrophage-inflammatory protein-1 alpha (MIP-1 alpha) in all three strains. However, the protein of IL-5 decreased more in C3H/He mice treated with DE + Der f than in mice treated with Air + Der f. The levels of IL-5 in lung tissues corresponded to the pathological changes by Der f and/or DE treatment. The levels of MCP-1 and MIP-1 alpha in the three strains corresponded to the accumulation of lymphocytes in the airway. The adjuvant effect of DE on IgG1 production was observed in the ICR and C3H/He mice. These results suggest that the murine strain differences in the production of eosinophilic airway inflammation by DE + Der f is related to differences in local expression of IL-5, eotaxin, and IgG1 production. The enhancing effects of DE exposure may be mediated mainly by local IL-5.