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Larenas-Linnemann D, Michels A, Dinger H, Shah-Hosseini K, Mösges R, Arias-Cruz A, Ambriz-Moreno M, Barajas MB, Javier RC, de la Luz Cid Del Prado M, Moreno MAC, Almaráz RG, García-Cobas CY, Garcia Imperial DA, Muñoz RG, Hernández-Colín D, Linares-Zapien FJ, Luna-Pech JA, Matta-Campos JJ, Jiménez NM, Medina-Ávalos MA, Hernández AM, Maldonado AM, López DN, Pizano Nazara LJ, Sanchez ER, Ramos-López JD, Rodríguez-Pérez N, Rodríguez-Ortiz PG. Allergen sensitization linked to climate and age, not to intermittent-persistent rhinitis in a cross-sectional cohort study in the (sub)tropics. Clin Transl Allergy 2014; 4:20. [PMID: 24976949 PMCID: PMC4073512 DOI: 10.1186/2045-7022-4-20] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 05/05/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Allergen exposure leads to allergen sensitization in susceptible individuals and this might influence allergic rhinitis (AR) phenotype expression. We investigated whether sensitization patterns vary in a country with subtropical and tropical regions and if sensitization patterns relate to AR phenotypes or age. METHODS In a national, cross-sectional study AR patients (2-70 y) seen by allergists underwent blinded skin prick testing with a panel of 18 allergens and completed a validated questionnaire on AR phenotypes. RESULTS 628 patients were recruited. The major sensitizing allergen was house dust mite (HDM) (56%), followed by Bermuda grass (26%), ash (24%), oak (23%) and mesquite (21%) pollen, cat (22%) and cockroach (21%). Patients living in the tropical region were almost exclusively sensitized to HDM (87%). In the central agricultural zones sensitization is primarily to grass and tree pollen. Nationwide, most study subjects had perennial (82.2%), intermittent (56.5%) and moderate-severe (84.7%) AR. Sensitization was not related to the intermittent-persistent AR classification or to AR severity; seasonal AR was associated with tree (p < 0.05) and grass pollen sensitization (p < 0.01). HDM sensitization was more frequent in children (0-11 y) and adolescents (12-17 y) (subtropical region: p < 0.0005; tropical region p < 0.05), but pollen sensitization becomes more important in the adult patients visiting allergists (Adults vs children + adolescents for tree pollen: p < 0.0001, weeds: p < 0.0005). CONCLUSIONS In a country with (sub)tropical climate zones SPT sensitization patterns varied according to climatological zones; they were different from those found in Europe, HDM sensitization far outweighing pollen allergies and Bermuda grass and Ash pollen being the main grass and tree allergens, respectively. Pollen sensitization was related to SAR, but no relation between sensitization and intermittent-persistent AR or AR severity could be detected. Sensitization patterns vary with age (child HDM, adult pollen). Clinical implications of our findings are dual: only a few allergens -some region specific- cover the majority of sensitizations in (sub)tropical climate zones. This is of major importance for allergen manufacturers and immunotherapy planning. Secondly, patient selection in clinical trials should be based on the intermittent-persistent and severity classifications, rather than on the seasonal-perennial AR subtypes, especially when conducted in (sub)tropical countries.
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Affiliation(s)
- Désirée Larenas-Linnemann
- Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico
| | - Alexandra Michels
- Institute of Medical Statistics, Informatics and Epidemiology (IMSIE), University of Cologne, Cologne, Germany ; University of Cologne, Cologne, Germany
| | - Hanna Dinger
- Institute of Medical Statistics, Informatics and Epidemiology (IMSIE), University of Cologne, Cologne, Germany ; University of Cologne, Cologne, Germany
| | - Kijawasch Shah-Hosseini
- Institute of Medical Statistics, Informatics and Epidemiology (IMSIE), University of Cologne, Cologne, Germany ; University of Cologne, Cologne, Germany
| | - Ralph Mösges
- Institute of Medical Statistics, Informatics and Epidemiology (IMSIE), University of Cologne, Cologne, Germany ; University of Cologne, Cologne, Germany
| | - Alfredo Arias-Cruz
- Mexican Study Group on Allergic Rhinitis and Skin Sensitivity. Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico ; Centro Regional de Alergia e Inmunología Clínica, Hospital Universitario "Dr. José Eleuterio González" de la Universidad Autónoma de Nuevo León, Monterrey, Nuevo León
| | - Marichuy Ambriz-Moreno
- Mexican Study Group on Allergic Rhinitis and Skin Sensitivity. Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico
| | - Martín Bedolla Barajas
- Mexican Study Group on Allergic Rhinitis and Skin Sensitivity. Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico ; Servicio de Alergia e Inmunología Clínica, División de Medicina Interna, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca" Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | - Ruth Cerino Javier
- Mexican Study Group on Allergic Rhinitis and Skin Sensitivity. Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico ; CEINTAP (centro de investigación y tratamiento del asma pediátrico), Hospital Regional de Alta Especialidad del Niño. Dr. Rodolfo Nieto Padrón, Villahermosa, Tabasco, Mexico
| | - María de la Luz Cid Del Prado
- Mexican Study Group on Allergic Rhinitis and Skin Sensitivity. Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico
| | - Manuel Alejandro Cruz Moreno
- Mexican Study Group on Allergic Rhinitis and Skin Sensitivity. Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico ; Clinica Santa Cruz, Villahermosa, Tabasco
| | - Roberto García Almaráz
- Mexican Study Group on Allergic Rhinitis and Skin Sensitivity. Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico ; Allergy Department, Hospital Infantil de Tamaulipas, Cd.Victoria, Tamaulipas, Mexico
| | - Cecilia Y García-Cobas
- Mexican Study Group on Allergic Rhinitis and Skin Sensitivity. Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico ; Inmunología y Alergia, UMAE Hospital de Especialidades, CMNO, IMSS, Guadalajara, Jalisco, Mexico
| | - Daniel A Garcia Imperial
- Mexican Study Group on Allergic Rhinitis and Skin Sensitivity. Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico ; Allergy Department, Hospital Médica Tec 100, Querétaro, Querétaro, Mexico
| | - Rosa Garcia Muñoz
- Mexican Study Group on Allergic Rhinitis and Skin Sensitivity. Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico
| | - Dante Hernández-Colín
- Mexican Study Group on Allergic Rhinitis and Skin Sensitivity. Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico ; Servicio de Alergia e Inmunología Clínica, División de Medicina Interna, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca" Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | - Francisco J Linares-Zapien
- Mexican Study Group on Allergic Rhinitis and Skin Sensitivity. Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico ; Centro de Diagnostico y Tratamiento de Enfermedades Alérgicas y Asma de Toluca, Toluca, Estado de México
| | - Jorge A Luna-Pech
- Mexican Study Group on Allergic Rhinitis and Skin Sensitivity. Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico ; Inmunología y Alergia, UMAE Hospital de Especialidades, CMNO, IMSS, Guadalajara, Jalisco, Mexico
| | - Juan J Matta-Campos
- Mexican Study Group on Allergic Rhinitis and Skin Sensitivity. Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico ; Allergy and Clinical Immunology Department, Hospital of specializations CMN 'Siglo XXI', Mexico, DF, Mexico
| | - Norma Martinez Jiménez
- Mexican Study Group on Allergic Rhinitis and Skin Sensitivity. Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico
| | - Miguel A Medina-Ávalos
- Mexican Study Group on Allergic Rhinitis and Skin Sensitivity. Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico
| | - Alejandra Medina Hernández
- Mexican Study Group on Allergic Rhinitis and Skin Sensitivity. Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico ; Coordination of evidence based medicine (EBM), Facultad de medicina. Universidad Autonoma de Queretaro, Querétaro, Querétaro, Mexico
| | - Alberto Monteverde Maldonado
- Mexican Study Group on Allergic Rhinitis and Skin Sensitivity. Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico
| | - Doris N López
- Mexican Study Group on Allergic Rhinitis and Skin Sensitivity. Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico
| | - Luis J Pizano Nazara
- Mexican Study Group on Allergic Rhinitis and Skin Sensitivity. Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico ; Clinical immunology & allergy department, Clínica Hospital San Jose, Cd.Obregón, Sonora, Mexico
| | - Emmanuel Ramirez Sanchez
- Mexican Study Group on Allergic Rhinitis and Skin Sensitivity. Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico ; Allergy and immunology department, General Hospital of Cancun "Dr. Jesus Kumate Rodriguez', Cancun, Quintana Roo, Mexico
| | - José D Ramos-López
- Mexican Study Group on Allergic Rhinitis and Skin Sensitivity. Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico ; Servicio de Alergia e Inmunología Clínic, Seguro Social, Hospital General de Zona No2, Potosí, Potosí, Mexico
| | - Noel Rodríguez-Pérez
- Mexican Study Group on Allergic Rhinitis and Skin Sensitivity. Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico ; Pediatrics and Immunology, Autonomous university of Tamaulipas, H.Matamoros, Tamaulipas, Mexico
| | - Pablo G Rodríguez-Ortiz
- Mexican Study Group on Allergic Rhinitis and Skin Sensitivity. Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico ; Hospital Star Médica Mérida, Mérida, Yucatan, Mexico
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