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ORIGINAL ARTICLE
Year : 2015  |  Volume : 29  |  Issue : 2  |  Page : 79-83

Sensitization to aeroallergens in patients with allergic rhinitis, asthma, and atopic dermatitis in Shiraz, Southwestern Iran


1 Ali-Asghar Allergy Clinic; Allergy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
2 Department of Pediatrics, College of Medicine, Islamic Azad University, Kazerun, Iran
3 Ali-Asghar Allergy Clinic, Shiraz University of Medical Sciences, Shiraz, Iran

Date of Web Publication9-Mar-2016

Correspondence Address:
Niloofar Kolahi
Department of Pediatrics, College of Medicine, Islamic Azad University, Kazerun Branch, Kazerun
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-6691.178272

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  Abstract 

Background: Aeroallergens as one of the most common cause of allergic disease derived from pollens, dust mites, fungi, and animals. The prevalence of aeroallergens is different in various areas. Objectives: This study was designed to identify the frequency of sensitization to aeroallergens in patients with allergy in Shiraz, Southwestern Iran. Materials and Methods: This descriptive study included 656 patients with allergy from Southwestern Iran from July to December 2014. Sensitization to aeroallergens was assessed by skin prick test using a panel of common 15 aeroallergens in studied patients. Results: A positive skin test to at least one of the applied allergens was seen in 74.5% of our patients. The female to male ratio and mean age of the patients were 1.27 and 27.6 ± 14.7 years, respectively. Pollens were the most common type of aeroallergens (64.6%), followed by dust mites (34.6%), cockroach (30.6%), and molds and cat hair (16% for each). Among pollens, the frequency of sensitization to weeds, grasses, and trees was in turn. Conclusion: The results of the present study revealed that pollens play as a main sensitizing allergen in asthma, allergic rhinitis, and eczema. This pattern was compatible with the results from studies carried out in this area.

Keywords: Aeroallergens, allergic rhinitis, asthma, atopic eczema, pollen, skin test


How to cite this article:
Moghtaderi M, Hejrati Z, Kolahi N, Heidari B. Sensitization to aeroallergens in patients with allergic rhinitis, asthma, and atopic dermatitis in Shiraz, Southwestern Iran . Indian J Allergy Asthma Immunol 2015;29:79-83

How to cite this URL:
Moghtaderi M, Hejrati Z, Kolahi N, Heidari B. Sensitization to aeroallergens in patients with allergic rhinitis, asthma, and atopic dermatitis in Shiraz, Southwestern Iran . Indian J Allergy Asthma Immunol [serial online] 2015 [cited 2019 Sep 15];29:79-83. Available from: http://www.ijaai.in/text.asp?2015/29/2/79/178272


  Introduction Top


Allergic rhinitis (AR), asthma, and atopic dermatitis (AD) arise from the acute or chronic exposure of a sensitized individual to different aeroallergens. [1],[2],[3] Aeroallergens including pollens, fungal spores, mite fecal pellets and animal dander, the concentration of which in outdoor and indoor environment, are prominent causes of allergic disease. [4],[5],[6] There are wide variations in type and frequency of aeroallergens in different countries, depending on the geographic area; climate and vegetation. [7]

Pollen allergens released from tree, weed and grass and they are various at the different region. There are a large number of allergenic mold spores that some specious including Alternaria and Aspergillus are more prevalent. Many different types of mites have been reported in house dust, and they live on host skin scales and other debris. Among animals, the most common allergenicity is related to dog and cat. The best-recognized source of allergens in inner-city asthma is cockroach. [8],[9],[10],[11],[12]

Allergic diseases ate diagnosed by obtaining a careful history, physical examination, and appropriate laboratory test. The primary test for the diagnosis of immunoglobulin E (IgE)-mediated allergy is skin prick test (SPT); it is informative, safe, and easy to perform. In SPT, culprit antigen combines with IgE antibodies fixed to mast cells, chemical mediators are released from mast cells within 5 min resulting in the formation of a wheal. [13]

The knowledge of sensitization to these aeroallergens is a great importance guide for clinicians in better diagnosis and treatment of allergic patients. In Shiraz, an earlier survey of common aeroallergens in 212 patients with AR was conducting in 2001 by Kashef et al. [14] The present study has been conducted on a larger number of patients with AR, asthma, and AD in this area during 2014.


  Materials and methods Top


This descriptive study involved patients with AR, asthma, and AD referred to a referral allergy clinic at Ali-Asghar Hospital affiliated to Shiraz University of Medical Sciences, Shiraz, Iran from July 2014 to December 2014. The diagnosis of AR was based on allergic rhinitis and its impact on asthma, [15] asthma according to Global Initiative for Asthma, [16] and AD based on the criteria of Hanifin and Rajka [17] in order with the supervision of allergy subspecialist. Patients who were being treated with systemic corticosteroids, angiotensin-converting-enzyme inhibitors, or beta blockers and pregnant women as well as those with positive dermatographism were excluded from the study. The study protocol was approved by the Institutional Ethics Committee and informed consents were obtained from the patients.

Demographic data including age, sex, and region of growing were recorded for each patient by interview.

SPTs were performed on the forearms with standard commercial extracts of (1) tree mix (beech, birch, cottonwood, elm, maple, oak, red river, shagbark hickory, sweat gum, sycamore, and white ash), (2) common weed mix (cocklebur, plantain, lamb's quarter, redroot, pigweed, and Russian thistle), (3) grass mix (Bermuda, Kentucky, meadow, orchard, redtop, ryegrass, sweet vernal, and timothy), (4) mugwort, (5) Russian thistle, (6) Bermuda grass, (7) timothy grass (8) wheat, (9) Dermatophagoides pteronyssinus, (10) Dermatophagoides farinae, (11) Alternaria, (12) Aspergillus, (13) mold mix (Alternaria, Aspergillus niger, Cladosporium, Penicillium, Bipolaris sorokiniana), (14) cockroach mix (American, German), and (15) cat hair. Allergens were selected for the study, based on the type of plants grown and other allergens which were identified and introduced by the same studies in this area. These 15 commercial extracts (Greer, USA) were pricked with a sterile lancet on patients, forearm. To avoid false-positive results, the drops were placed at least 2 cm apart from each other. Histamine (10 mg/mL) and saline were used as positive and negative controls, respectively. The results of the skin tests were examined after 15 min and considered positive when the wheal was 3 mm greater in diameter than the negative control. Topical corticosteroids were stopped 1 day before the skin test. Individuals were requested not to take any type of antihistamine medication for 5 days before the SPT.

Statistical analysis

Continuous variable was presented as the mean and standard deviation. The association between two category variables was made using Chi-square test and t-test. Fisher's exact test with Monte Carlo method was used, P < 0.05 was considered as significant. Data analyses were performed with SPSS 18.0 (SPSS Inc., Chicago, IL, USA).


  Results Top


All patients were from Shiraz, Southwestern Iran where all grew up. Six hundred and fifty-six patients (female 368, male 288) in the age range of 2-74 years old (mean age 27.6 ± 14.7 years) with AR, asthma symptoms, and AD were included in this study. Among them, 74.5% patients showed a positive skin test to at least one of the applied allergens. Pollens were the most common type of aeroallergens (64.6%), followed by dust mites (34.6%), cockroach (30.6%), molds and cat hair (each 16%). Among 423 patients with sensitization to pollens, the frequency of sensitization to weeds was (84.1%) followed by grasses (63.8%), and trees (49.4%).

The age distribution of allergic patients to pollens, house dust mites, cockroach, molds, and cat hair is given in [Table 1]. Prevalence of sensitization to aeroallergens lower in patients younger than 5 compare with older age, but the differences among three age groups was not statistically significant.
Table 1: The age distribution of allergic patients to different aeroallergens


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Patients with allergic rhinitis

The total patients who suffered from AR were 475 (72.4%). Among these patients, 266 were female (56%) and 209 (44%) were male. The mean age of patients was 27.2 ± 13.4 years, ranging from 2 to 49 years. A positive SPT to at least one of the allergens was seen in 350 (73.6%) of AR patients: 65.8% to pollen allergens, 32.8% to dust mites, 30.5% to cockroach, 15.5% to cat hair, and 14.7% to molds. [Figure 1] has shown the frequency of positive skin test to 15 applied allergens in patients with AR.
Figure 1: Aeroallergen sensitization to 15 applied allergens in patients with allergic rhinitis in percent by skin prick test

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Patients with asthma

Fifty-three patients (8%) with asthma (23 women, 30 men), aged 3-53 years (mean age 24.7 ± 16.8) were included. Of 53 patients with asthma, a positive SPT to at least one of the allergens was seen in 37 (66%) of them. The common aeroallergens were pollen (47.1%), cockroach (35.8%), dust mites (30.1%), molds (24.5%), and cat allergens (16.9%). [Figure 2] shows the rate of positive reactions to 15 aeroallergens in 53 patients with asthma, as proven by the SPT.
Figure 2: The prevalence of positive skin test to 15 applied allergens in patients with asthma in percent (%)

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Patients with allergic rhinitis and asthma

Seventy-three patients (11.1%) with AR and asthma (36 women, 37 men) in the age range of 4-70 years (mean age 26.9 ± 14.8) were included. Of 73 patients with AR and asthma, a positive SPT to at least one of the allergens was seen in 63 (86.3%) of them. The frequency of positive SPT to pollen allergens was 71.2%, dust mites 42.4%, cockroach 30.1%, molds 21.9%, and to cat hair 20.5%. [Figure 3] has shown the prevalence of positive skin test to 15 applied allergens in patients with AR and asthma.
Figure 3: The percent rate of sensitization to 15 studied allergens in patients with asthma and allergic rhinitis

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Patients with atopic dermatitis

Fifty-five patients (8.4%) with AD (43 female, 12 male), aged 2-74 years (mean age 33 ± 16.7) were evaluated for their SPT to 15 common regional aeroallergens. A positive SPT to at least one of the allergens was seen in 41 (74.5%) of them: 58.1% to pollen allergens, 43.6% to dust mites, 27.2% to cockroach, 12.7% to cat hair, and 10.9% to molds [Figure 4].
Figure 4: The prevalence of positive skin test to 15 applied allergens in patients with atopic dermatitis in percent

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Polysensitization to more than one group of allergens was seen in 46.1% of allergic patients.


  Discussion Top


The role of aeroallergens in allergic diseases is indisputable. In this study, we found the most common sensitization were to pollens from weeds, grasses, and trees in each group of patients with allergy. The same results were reported in allergic patients from other parts of Iran and neighboring Arab countries. [18],[19],[20],[21] On the contrary our result, the hypersensitivity to house dust mites was very common in Bushehr, Southwestern Iran and North of Iran, which may be attributed to the warm and humid weather of these areas. [22],[23]

The frequency of sensitization to pollens was 65.8% among our patients with AR, whereas this frequency was higher (92.4%) by Kashef et al. study in Shiraz during 2001. [14] It is explained by cutting down of trees recently for making space to build new houses, made a tree into paper and furniture, clear land to grow grass for cows and sheep. Among pollens, prevalence pattern of different pollens including weeds, grasses, and trees was the same as in both studies.

In 2001, [14] sensitization to mites was 22.7% in patients with AR, but this rate increased to 32.8% in our patients with AR. Nowadays, People spend the majority of their time in indoor environments such as home, and it causes increased exposure to dust mites. For mold sensitization, the rate of sensitization increased from 8.3% to 14.7% during one decade in our AR patients. Molds thrive in conditions associated with increased moisture; therefore, excessive use of swamp cooler and new air conditioner in this region can explain it.

Among our patients with asthma, about 50% showed sensitization to pollens; however, the second frequent allergen was cockroach (36%). The rate of positivity to cockroach is approximately in agreement with that (27%) of the Safari et al. study in asthmatic patients in this same area. [21] Many studies have identified the importance of exposure to this insect as a major risk factor for the development of asthma in urban and inner-city people. [22],[23],[24] Detectable levels of cockroach are found in the dust of all homes belong to asthmatic patients in this area by Moghtaderi et al. study (unpublished data). The frequency of sensitization to dust mites was 30%, which is in accordance with a similar study on 1106 asthmatic patients in Doha, State of Qatar. [24]

Cat allergen has been the most extensively studied animal allergen in term of allergen exposure and development of allergic disease and asthma. [8],[25] The most sensitization to cat allergens (20.5%) was found in our patients with asthma and AR. One study in Saudi Arabia have reported the much higher frequency of sensitization to cat, [26] but other studies in Iran have reported the prevalence rate of 13% in asthmatic patients. [27] Keeping cats as pets in some families, feral cats are common in our study area, and contact with them is frequent.

Different studies show that sensitization to aeroallergens may be involved in pathogenesis and severity of AD. In patients with AD, direct or inhalational contact with house dust mite extract may be involved in pathogenesis and exacerbate the severity of disease. [28],[29] Previous reports have demonstrated that house dust mites are the most common aeroallergen in childhood eczema, [30],[31] however, 44% of our patients with AD were also showed sensitization to house dust mites.

As was reported in our study, polysensitization to more than one group of allergens was seen in 46.1% of allergic patients. Kashef et al. revealed a significant prevalence of polysensitization (76%), but this study considers sensitization to each allergen not a group of allergens. [14]

In this study, we showed the importance of pollen, dust mites and cockroach as sensitizing aeroallergens in patients with allergy in Southwestern Iran. Avoidance for dust mite and cockroach may result in improvement of symptoms in allergic patients. This study will help for selecting the panel of most common aeroallergens for SPT and will also help in finding the best specious of allergens for immunotherapy in this area.

Acknowledgments

The authors would like to thank the participants for their kind cooperation.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

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