ASIAN PACIFIC JOURNAL OF ALLERGY AND IMMUNOLOGY (1997) 15: 183-185

Aeroallergen Sensitivity of Thai Patients with Allergic Rhinitis

Phanuvich Pumhirun, Pongstorn Towiwat and Prasit Mahakit

Allergic rhinitis is one of SUMMARY The aim of this study was to determine the aeroallergen sensi­ the most common diseases. How­ tivity of allergic rhinitis patients. A total of 100 cases (female: 59, male: ever, its true prevalence in many 41, aged between 10-59 years, mean age 27.9 years) who were diagnosed with allergic rhinitis by history and clinical presentation, underwent a prick places is unknown. Studies have skin test with 30 aeroallergens, and the important sensitizing allergens shown that up to 10% of children were assessed. Skin test reactivity showing;?: 3 mm wheal with erythema and 20%-30% of adolescents have as the positive skin test, was recorded. The results of patients with posi­ I this problem. ,2,3,4 According to a tive skin tests follow. TREES: acacia 19%, mango 16%, coconut 12%. World Health Organization (WHO) GRASSES: bermuda 17%, johnson 21%, timothy 16%, bahia 16% orchard 18%. WEEDS: pigweed 16%, kochia 14%. MOLDS: alternaria 11%, clado­ allergy survey in Thailand, the pre­ sporium 11%, aspergillus 12%, penicillium 16%, helminthosporium 16%, valence of allergic rhinitis is 20%.5 botrytis 15%, rhodotorula 20%, fusarium 26%, curvularia 26%, smut mix More than 72 % of cases comprise 11%, rust 9%. EPIDERMALS: cat 29%, dog 28%, feathers 37%. INDOOR perennial allergic rhinitis, while ALLERGENS: house dust 72%, D. pteronyssinus 76%, D. farinae 79%, only 28% comprise seasonal aller­ American cockroach 60%, German cockroach 41%, kapok 30%. Eighty-five gic rhinitis.6 percent of patients sensitive to house dust mites were positive to both D. pteronyssinus and D. farinae, indicating substantial cross-reactivity. The study shows that the house dust mite and the cockroach are important Generally, the definition of aeroallergen sensitizers among the Thai population, since more than half allergic rhinitis must consist of the patients were skin-test positive to the house dust mite and the cock­ three components: First, inflamma­ roach. tion of the mucous membranes, which are characterized by a period of nasal discharge, sneezing, and rooment during symptomatic sent study was to determine the congestion, that persists for an periods. Moreover, for a better aeroallergen sensitivity of allergic average of at least 0.5-2 hours per understanding of the pathogenesis rhinitis patients who attended the day. Second, the individual's nasal of allergic rhinitis, the following Allergy Clinic of the Otolarygology reactions to certain stimuli differ four major factors should be Department of the Pramongkutklao fundamentally from that of others, known: 1) aeroallergens or anti­ Hospital in Bangkok, Thailand. with a tendency to be genetically gens; 2) immunoglobulin E and its predisposed. The third is associated regulation; 3) mediator cells and From the Department of Otolaryngology, Pra­ mongkutklao College of Medicine, Bangkok with positive skin tests to specific mediator release; 4) mediators and 10400, Thailand. aeroallergens present in the envi­ their effects. The aim of the pre­ Correspondence: Phanuvich Pumhirun · " ... , . 184' . PUMHIRUN. ET AL.

j" . , M.<\.),ERIALS KND METHODS Statistical methods polyp 7%, asthma 2%. The aller­ gen tested is followed by the per­ Subjects Statistical analysis was by centage of patients with positive descriptive analysis and all values skin tests. TREES: acacia 19%, This study was conducted are expressed as percentages. mango 16%, coconut 12 %; in the Allergy Clinic of the Oto­ GRASSES: bermuda 17%, johnson laryngology Department, Prarnong­ RESULTS 21%, timothy 16%, bahia 16%, kutklao Hospital, Bangkok Inclu­ orchard 18%; WEEDS: pigweed sion criteria: 1) patient with a his­ One hundred allergic rhini­ 16%, kochia 14%; MOLDS: alter­ tory of, and clinical presentation of, tis patients comprised 59 females naria 11 %, cladosporium 11 %, allergic rhinitis, diagnosed by an and 41 males. Ages ranged bet­ aspergillus 12%, penicillium 16%, otolaryngologist; 2) positive prick ween 10-59 years, with the mean helminthosporium 16%, botrytis skin test to common inhalant aller­ age being 27.9 years. Associated 15%, rhodotorula 20%, fusarium gens (;;:: 3 mm wheal with erythe­ diseases were sinusitis 21 %, nasal 26%, curvularia 26%, smut mix ma), Exclusion criteria: 1) patient with a severe underlying disease; 2) an irnrnuno-compromised patient; 3) prick skin test less than 3 mm Table 1. Frequency of positive reactions to allergens wheal. (N=100 patients)

Procedures Allergens Patient (%) All subjects were in­ Trees acacia 19 structed to cease intake of antihis­ mango 16 tamine for 48 hours prior to prick coconut 12 skin test. Allergenic extracts were Grasses bermuda 17 selected according to aeroallergens johnson 21 7 8 in Thailand. • ,9,10 The allergenic ex­ timothy 16 bahia 16 tracts were 1:20 weight/volume for orchard 18 trees (coconut), grasses (bermuda, johnson, timothy, bahia, orchard), Weeds pigweed kochia 16 weeds (kochia), molds (alternaria, 14 cladosporium, aspergillus, penicil­ Molds aiternaria 11 lium, helminthosporium, fusarium, cladosporium 11 smut mix), epidermals (dog, aspergillus 12 feathers), indoor allergens (house penicillium 16 helminthosporium 16 dust, American cockroach, German botrytis 15 cockroach, kapOk), 1:40 weight/ rhodotorula 20 fusarium 26 volume for trees (acacia, mango), curvularia 26 weeds (pigweed), molds (botrytis, smut mix 11 rhodotorula, curvularia); 1 :50 rust 9 weight/volume for rust; 10,000 Epidermals cat 29 AU/rnl for epidermais (cat), indoor dog 28 feathers 37 allergens (D. jarinae, D. ptero­ nyssinus), by Greer Laboratories, Indoor allergens house dust 72 D. pteronyssinus 76 Inc., USA. Histamine phosphate 1 D. farinae 79 mglrnl was used as positive control, Cockroach. American 60 and glycerine saline as negative Cockroach. German 41 kapok 30 control. The tests should be read in 20 minutes,ll AEROALLERGEN SENSITIVITY IN ALLERGIC RHINITIS PATIENTS 185

11 %, rust 9%; EPIDERMALS: cat tive patients were skin test positive Chng HH. Allergen skin test and total 29%, dog 28%, feathers 37%; to both species of Dermatophag­ IgE in adults with rhinitis in Singa­ INDOOR ALLERGENS: house oides, indicating substantial cross­ pore. Asian Pac J Allergy Immunol 1996; 14: 9-12. dust 72%, D. pteronyssinus 76%, reactivity. Associated diseases that 5. Pumhirun P, Evans R ill, Mahakit P, D. farinae 79%, American cock­ were found m this group were et al. WHO allergy survey in Thai­ roach 60%, German cockroach sinusitis 21 %, nasal polyps 7%, land. Second Asian Pacific Congress 41 %, kapok 30%, as presented in and asthma 2%. The most common of Allergology and Clinieal Immuno­ Table 1. associated disease m this group logy 1995; Taipei, Taiwan: 193. 6. Pumhirun P, Mahakit P, Nondavamch was sinusitis, followed by nasal A. Allergic rhinitis. Otolaryngol Head DISCUSSION polyp and asthma. This study Neck Surg 1992; 7: 81-5. shows that the house dust mite and 7. Kongpamchkul A, Vichyanond P, Tu­ The skin prick test is rec­ the cockroach are the most impor­ chinda M. Allergen skin test reactivi­ ties aIllong asthmatic Thai children. J ommended as the method of choice tant aeroallergen sensitizers in Thai by the European Academy of Aller­ MedAssoc Thailand 1997; 80: 69-75. allergic rhinitis patients, since more 8. Malainual N, Vichyanond P, Phan­ gology and Clinical Immunology, than half the patients were skin test Urai P. House dust mite fauna in because of its safety and reliabi­ positive to the house dust mite and Thailand Clin Exp Allergy 1995; 25: lity,I2,13 and it is also recommended the cockroach. 554-60. in the United States as the most 9. Pumhirun P, Nondavanich A, Limpra­ sertsiri S, Poommark C. Aeroaller­ convenient and inexpensive ACKNOWLEDGEMENTS genic molds in Bangkok. Royal Thai screening method for the diagnosis Army Med J 1993; 46: 147-51. of IgE mediated allergic reaction, 14 This study was supported 10. Tuchinda M, Theptaraonon Y, Lim­ sathaoyourat N. A ten-year surveil­ and therefore we applied this test in by a grant from the Prarnongkut­ screening our P!ltients for this lance of atmospheric pollens and klao Hospital Foundation. I would moulds in the Bangkok area. Asian study. The most important aeroal­ like to thank Maj. Amornratana Pac J Allergy Immuno11983; I: 7-9. lergens in this study group are the Kumsiri and Capt. Savenee Chan­ II. Booth BH. Diagnosis of immediate I house dust mite, house dust, and tasatkosol, for their excellent tech­ hypersensitivity. In: Patterson R, ed. ! the cockroach, as shown by the Allergic diseases: diagnosis and man­ nical assistance. agement. 4th ed. Philadelphia: Lip­ I incidence of D. farinae 79%, D. pincott 1993; p.195-223. I pteronyssinus 76%, house dust REFERENCES 12. Bousguet J, Michel FE. In vivo meth­ 1 .j 72%, American cockroach 60%, ods for study ofallergy. In: Middleton and German cockroach 41 %. I. Hagy GW, Settipane GA. Bronchial E, ed. Allergy: principle and practice. 1 These were the indoor aeroaller­ asthma, allergic rhinitis and allergy 4th ed. St Louis: Mosby 1990; p 573- I skin tests anlong college students. J 4. gens. Other groups of aeroallergens Allergy 1969; 44: 323-32. 13. Dreborg S, Backman A, Basomba A, were: epidermals 28-37%, molds 9­ MaJmpberg H. Symptoms of chronic et al. Skin test used in type I allergy 26%, grasses 16-21%, trees 12­ 2. and allergic rhinitis and occurrence of testing: position paper of the European 19%, and weeds 14-16%. nasal secretion granulocytes in univer­ Aeademy of Allergy and Clinieal Im­ sity students, school children and munology. Allergy 1989; 44: I-59. Thirteen patients out of 84 infants. Allergy 1979; 36: 389-94. 14. Berstein IL. Proceedings of the Task 3. Haahtela T, Heiska.la M, Suaniemi 1. mite-allergic patients were senSI­ Force on Guidelines for Standardizing Allergic disorders and immediate skin Old and New Technologies Used for tized to either D. farinae or D. test reactivity in Finnish adolescents. the Diagnosis and Treatment of Aller­ pteronyssinus, but not to both. Allergy 1980; 35: 433-41. gic Diseases. J Allergy Clin Immunol Eighty-five percent of mite-sensi­ 4. Allumoortil BJ, Lee HS, Lee FYW, 1988; 82: 487-526.