New research on pediatric and inner city asthma
unveiled at the 2004 AAAAI Annual Meeting

Risk factors for persistent wheezing in young children
(SAN FRANCISCO, March 22, 2004) - Exposure to high levels of cockroach allergen, sensitization to indoor allergens and family history of allergy were strongly associated with persistent wheezing in children, according to a study presented at the American Academy of Allergy, Asthma and Immunology's (AAAAI) 2004 Annual Meeting.

Virginia P. Ferriani, MD, University of Sao Paula, Brazil, and colleagues evaluated the risk factors associated with persistent wheezing beyond the first two years of life among children living in a subtropical area. Eighty children who had been to the Emergency Department for an episode of wheezing in the first 2 years of life underwent clinical evaluation and skin prick testing to inhalant and food allergens for two years following their initial episode of wheezing.

Of the 73 children who completed the study, 38 (52%) were categorized with persistent wheezing (3 or more episodes treated with beta-2 agonists). Researchers found that the risk factors were family history of allergy, exposure to levels of cockroach allergen in the kitchen, and allergic sensitization at age 2-4.

Variances in IgE response in children with cat contact
The effect of cat contact on children with allergies is different between social groups, according to a study presented at the 2004 AAAAI Annual Meeting in San Francisco.

Ursula Kramer, PhD, and colleagues from the Institut für Umweltmedizinische Forschung, Dusseldorf, Germany, investigated six-year-old children living in East and West Germany between 1991 and 2000. Information about the education of parents, cat contact and specific sensitization against cat allergen was available for 3,241 children.

The study found that in female children where both parents had an education with less than 10 years of schooling, 2.5 % of the children with cat contact, but 4.5% without were sensitized against cat allergen. In families where parents had more of an academic education, the findings were reversed, with 6% of the children with cat contact, but only 2.6% of the children without contact sensitized to cat allergens. Researchers believe that behavioral differences concerning contact with cats may lead to these differences.

Asthma symptom triggers in adolescents
Exercise and colds/flu are the most common reported triggers of asthma in adolescents, according to a study presented at the 2004 AAAAI Annual Meeting in San Francisco.

George Pyrgos, MD, from Johns Hopkins Bayview Medical Center, and colleagues evaluated asthma symptoms in adolescents and trigger awareness by their parent/guardians, by conducting a cross-sectional study of 162 adolescents with asthma. The study subjects underwent several evaluations including a questionnaire querying for asthma triggers and skin testing.

The most common triggers identified by the adolescents were: exercise (89%), colds/flu (83%), dust (71%), weather changes (71%), emotions (63%), grass (52%), cats (48%), cold air (47%), irritants (45%), and dogs (35%). Foods were the most unusual triggers (e.g. milk 9%, seafood 8%, peanuts 3%).

Undiagnosed asthma among inner city athletes
Many inner city youth and high school athletes have undiagnosed asthma according to a study presented at the 2004 AAAAI Annual Meeting in San Francisco.

Lawrence A. Caliguiri, MD, FAAAAI, and colleagues from the Coalition of Health for Asthmatics in Sports and Exercise (CHASE), held exercise challenges to determine the incidence of asthma among inner city youth and high school athletes.

Results demonstrate that 49 of 127 (38%) children from ages 6 to 18 showed a 15% or more drop in forced expiratory volume (FEV) after the run. Seven of 51 (14%) children were known asthmatics with prescribed medication. Positive family history of asthma or allergies was found to be the most common prescreen answer for those at risk.

Researchers reported that letters were sent to parents to request follow-up for those children with abnormal results, however, the letters were not effective. School officials such as coaches or trainers may improve the follow-up with the children.

Home treatment program improves asthma in inner city children
Reducing exposure to home allergens and pollutants is related to the improved condition in asthmatic children in these homes, according to a study presented at the 2004 AAAAI Annual Meeting in San Francisco.

Peyton A. Eggleston, MD, FAAAAI, and colleagues from Johns Hopkins University, started a one-year, comprehensive program with 100 inner city families with asthmatic children in order to attempt to improve the incidence of asthma. The families were divided into Treatment Groups (TG) or Control Groups (CG). The TG received room a HEPA air filter, mattress/pillow encasing, cockroach/mouse extermination and education while the CG was given delayed treatment.

Results showed that both the TG and CG contained smokers and high levels of dust. The study found that most TG and CG children were atopic and some took controller medications. Daily asthma symptoms decreased in the treatment group children (58% to 35%) and increased in the control group children (41% to 66%). Researchers concluded that reducing exposure to home allergens and pollutants over one year is feasible.

School-based asthma management program reduces asthma morbidity
School-based asthma management programs that use asthma education and nurse case management considerably reduce asthma morbidity among inner-city minority children, according to a study presented at the 2004 AAAAI Annual Meeting in San Francisco.

Cleveland M. Moore, MD, and colleagues from Louisiana State University Medical Center studied the effect of school-based asthma management programs on the morbidity of asthma. One hundred and six mild to moderate-persistent inner-city children received education and nurse management for their asthma.

The study found:

• The mean age in the group was 10 years old, 42% female and 48% male
• 30% of the children's mothers had some college education
• 58% had insurance
• Increases in asthma knowledge, use of asthma tools and knowledge of medications occurred
• Reduction in the number of emergency room visits, hospitalizations and missed school days were recorded after the program.

These findings show that school environments provide an appropriate setting for medical education for continual pediatric disorders.

These studies were presented at the 2004 Annual Meeting of the American Academy of Allergy, Asthma and Immunology (AAAAI), taking place March 19-23, 2004 in San Francisco.

The AAAAI represents allergists, asthma specialists, clinical immunologists, allied health professionals and others with a special interest in the research and treatment of allergic disease. Established in 1943, the AAAAI has more than 6,500 members in the United States, Canada and 60 other countries. The AAAAI serves as an advocate to the public by providing educational information and a physician referral directory through its Web site at www.aaaai.org.

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