|Year : 2016 | Volume
| Issue : 2 | Page : 76-79
Identification of common allergens for united airway disease by skin prick test
Vikas Deep Mishra1, Tariq Mahmood2, Jai Krisna Mishra3
1 Department of TB and Chest Diseases, Heritage Institute of Medical Sciences, Varanasi, Uttar Pradesh, India
2 Department of TB and Chest Diseases, MLN Medical College, Allahabad, Uttar Pradesh, India
3 Department of TB and Respiratory Diseases, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
|Date of Web Publication||5-Dec-2016|
Vikas Deep Mishra
Department of TB and Chest Diseases, Heritage Institute of Medical Science, Bhadwar, Varanasi - 211 311, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
Objective: Identification of common allergens by skin prick test in patients of united airway disease. Materials and Methods: Skin prick test was performed in 60 patients of United Airway Disease to identify the common allergens. A total of 62 allergens consisting of 36 types of pollen, 5 fungi, 4 insects, 8 type of dusts, 4 dander, 3 fabrics, Dust mite and Parthenium leaves were tested. Result: Most common allergens were Dust mite (60%) followed by Parthenium leaves (45%), insects (18.75%), pollen (14.81%), dust allergens (8.51%), fabrics (8.33%), fungi (5.66%), dander (5%). Most common insect allergens were cockroach (female) (30%), cockroach (male) (23.33%). Common pollens were Ricinus communis (28.33%), Amaranthus spinosus (28.33%), Parthenium hysterophorus (26.66%), Eucalyptus tereticornis (26.66%) and Cynodon dactylon (25%). Common dust allergens were house dust (21.66%), paper dust (11.66%) and cotton mill dust (10%). Among fabrics kapok cotton (13.33%) showed maximum positivity. Among fungi Aspergillus fumigatus (10%) followed by A. niger (6.66%) were most common. In animal dander group common ones were cat dander followed by dog dander. Conclusion: In conclusion it can be said that the knowledge drawn by above study will help to treat patients by immunotherapy or avoidance strategy.
Keywords: Allergens, nasobronchial allergy, skin prick test
|How to cite this article:|
Mishra VD, Mahmood T, Mishra JK. Identification of common allergens for united airway disease by skin prick test. Indian J Allergy Asthma Immunol 2016;30:76-9
|How to cite this URL:|
Mishra VD, Mahmood T, Mishra JK. Identification of common allergens for united airway disease by skin prick test. Indian J Allergy Asthma Immunol [serial online] 2016 [cited 2017 May 30];30:76-9. Available from: http://www.ijaai.in/text.asp?2016/30/2/76/195237
| Introduction|| |
Worldwide, allergic rhinitis affects between 10% and 30% of the population,  and sensitization (IgE antibodies) to foreign protein in the environment is present in up to 40% of the population.  The rise in prevalence of allergic disease has continued in the industrialized world for more than 50 years.  In India, the prevalence of asthma in children below 9 years of age was found to be 0.8% in 1966, whereas now it has been found to be in the range of 5.6% to 23.4% in different parts of the country,  thus showing a rising trend. In recent years, there have been more and more studies indicating a strong relationship between allergic rhinitis and bronchial asthma. , In one study, up to 80% of asthmatics were found to have allergic rhinitis and likewise up to 40% of allergic rhinitis patients were found to have bronchial asthma, thus leading to the concept of united airway disease. 
There appears to be a strong association between bioparticulate matters in the atmosphere and their effect on human health. The study of airborne microorganisms, pollen, spores, and seeds, especially as agents of infection, is known as aerobiology. The bioparticulates mostly responsible for allergic symptoms are pollens, fungal spores, pest debris, household dust mite, animals dander, chemical compounds, and foodstuffs. ,, Airborne biopollutants pose an important problem worldwide due to their allergic properties.
Aeroallergens play an important role in the pathogenesis of respiratory disorder, viz., allergic rhinitis and asthma. Pollens and other aeroallergens are variable in different ecozones, and it is important to identify them for diagnosis and immunotherapy. Few previously done studies have identified aeroallergens and other bioparticles responsible for respiratory allergies in different parts of Uttar Pradesh. , The present study was undertaken to find out the aeroallergens in and around Allahabad city.
| Materials and Methods|| |
A total of sixty patients attending the outpatient department of TB and Chest Department, SRN Hospital, Allahabad, during August 2010 to July 2011 were included in the study. Of the sixty patients, 35 had as bronchial asthma and 25 were diagnosed as allergic rhinitis. The patients were diagnosed as either allergic rhinitis according to the ARIA guidelines  or bronchial asthma according to the GINA guidelines. 
Peak expiratory flow rate and spirometry of all the patients were done. Skin prick test with 62 allergens extract was done of all the sixty patients. The allergen extract included 36 types of pollen, five fungi, four insects, eight types of dust, four animal dander, three fabrics, and two miscellaneous groups.
Sixty-two allergens, together with a positive control (glycerol: histamine acid phosphate [1:100]) and a negative control (glycerol buffer), made up of a total of 64 pricks to be given to the patients. Keeping a distance of approximately 2 cm between two allergens, 32 allergens (in three rows) were given in the left forearm, and likewise, 32 pricks were given in the right forearm, in a single setting. A drop of allergen (concentration 1:10) was put on the ventral aspect of the forearm, and then a 26-gauge hypodermic needle was passed through it to 0.5 mm beneath the skin and slightly lifted to allow some allergen extract to enter the stratum corneum of the skin. The skin reaction manifested as a wheal was measured after 15 min and labeled according to the criteria of Agarwal et al. 2003. Skin reaction 2+ and above was considered as strongly positive and the allergens for the above study were bought from Alcit India Pvt Ltd., New Delhi, India.
| Discussion|| |
Aeroallergens are an important cause of allergic respiratory disease worldwide. In the present study, dust mite (60%) followed by Parthenium leaves (45%) were found to be the most common allergens. After these, the various groups of allergens responsible for respiratory allergy were as follows insects (18.75%), pollens (14.81%), dust allergens (8.51%), fabrics (8.33%), fungi (5.66%), and finally, animal dander (5%). Agrawal et al.  in their study conducted at the same center a few years ago also reported a maximum number of positivity by dust mite followed by Parthenium leaves; however, unlike the present study, after these, the maximum positivity was shown by pollen group of allergens.
In the present study, the major pollen allergens [Table 1] were Ricinus communis (28.33%), and Amaranthus spinosus (28.33%), followed by Parthenium hysterophorus (26.66%), Eucalyptus tereticornis (26.66%), Cynodon dactylon (25%), Argemone mexicana (23.33%), Ailanthus excelsa (21.66%), Brassica campestris (20%), Adhatoda vasica (20%), Putranjiva roxburghii (20%), and Holoptelea integrifolia (18%). In comparison to the study done by Agrawal et al.,  R. communis, A. spinosus, and A. mexicana were found to be the dominant allergens. In comparison to the study conducted by Prasad et al.  in Lucknow, certain new allergens such as Ranunculus sceleratus, Artemisia scoparia, Cannabis sativa, Lawsonia inermis, Ipomoea fistulosa, Maerua arenaria, Suaeda fruticosa, Albizia lebbeck, Broussonetia papyrifera, Cocos nucifera, and Kigelia pinnata were found in the present study. In the study conducted by Shivpuri,  the major pollens were Holoptelea, Sorghum vulgare, Pennisetum, Artemisia, R. communis, Morus alba, Cassia, A. mexicana, C. dactylon, Carica, Cannabis, Xanthium strumarium, Amaranthus, Imperata, and Putranjiva.
Among the fungi group [Table 2], the most common allergens were Aspergillus fumigatus (10%) followed by Aspergillus niger (6.66%) and Candida albicans (5%). Agrawal et al.  reported Candida albicans to be more allergenic than A. niger. Prasad et al.  did not found Candida to be allergenic. Shivpuri  found Curvularia, Alternaria, A. fumigates, Phoma, Neurospora, Aspergillus tamarii, Helminthosporium, A. niger, Rhizopus nigricans, Trichoderma, and Cladosporium to be the most common allergens in patients of nasobronchial allergy. Insects were also found to be the major sensitizers in a good number of patients. Cockroach (female) (30%) followed by cockroach (male) (23.33%) and moth (15%) [Table 3]. The findings of the present study are similar to that of Agrawal et al.,  Gaur et al.  found allergy to moth, mosquito, locust (male), locust (female), dragonfly, grasshopper, jassids, housefly, cockroach, and honeybee to be common in patients of nasobronchial allergy. Among the various dust allergens, house dust (21.66%) was the major sensitizer, to be followed by paper dust (11.66%), cotton mill dust (10%), hay dust (8.33%), and grain dust wheat (8.33%) [Table 4]. Earlier, Holopainen et al.  reported the sensitivity of house dust to be 44% in their study. Acharya  found house dust followed by wheat dust, cotton dust, and paper dust to be common among patients of nasobronchial allergy. Only 5% of patients showed allergy to various animal dander extracts [Table 5]. The most common was cat dander (8.33%). In the fabric allergens section, Kapok cotton (13.33%) was found to show a maximum number of positive reaction, followed by silk raw (8.33%) and sheep wool (3.33%) [Table 6]. Similar results were seen by Agrawal et al.  and Prasad et al.  Dust mite (60%) followed by Parthenium leaves (45%) were found to be the most common allergens [Table 7].
|Table 7: Results of skin prick test with miscellaneous allergens extract|
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| Conclusion|| |
The present study was undertaken to find out the important allergens responsible for respiratory allergy and in turn for united airway disease. The difference in markedly positive skin prick test result among various other studies may be attributed to difference in flora of the various geographical regions and to the change in flora over time and climatic conditions. It is to be remembered that such studies carried out over time to time will help in determining the major prevalent allergens of any area and thus could be helpful in treatment and immunotherapy of concerned patients.
We would like to acknowledge Late Professor (Dr.) RL Agrawal, Head of Department, Department of TB and Chest Diseases, MLN Medical College, Allahabad, for his invaluable support and guidance throughout the study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Pawankar R, Canonica GW, Holgate ST, Lockey RF. White Book on Allergy 2011-2012. Executive Summary. Wisconsin: World Allergy Organisation; 2011.
Singh AB. All India Coordinated Project on Aeroallergens and Human Health Report, Ministry of Environment and Forest; 2000.
Pariente PD, LePen C, Los F, Bousquet J. Quality-of-life outcomes and the use of antihistamines in a French national population-based sample of patients with perennial rhinitis. Pharmacoeconomics 1997;12:585-95.
Wright AL, Holberg CJ, Martinez FD, Halonen M, Morgan W, Taussig LM. Epidemiology of physician-diagnosed allergic rhinitis in childhood. Pediatrics 1994;94 (6 Pt 1):895-901.
Passalacqua G, Ciprandi G, Canonica GW. United airways disease: Therapeutic aspects. Thorax 2000;55 Suppl 2:S26-7.
Kang B, Jones J, Johnson J, Kang IJ. Analysis of indoor environment and atopic allergy in urban populations with bronchial asthma. Ann Allergy 1989;62:30-4.
Shivpuri DN. Clinically important pollens, fungal and insect allergens for nasobronchial allergy patients in India. Aspects Allergy Appl Immunol 1980;13:19-23.
Lacey J, Crook B. Fungal and actinomycete spores as pollutants of the workplace and occupational allergens. Ann Occup Hyg 1988;32:515-33.
Sahney M. Studies in the aeropalynoflora of Allahabad. In: Recent Trends in Botanical Researches. D.D. Nautiyal Commemoration Volume. Allahabad: University of Allahabad Press; 2000. p. 325-40.
Roy DC, Agarwal SK, Gupta DK. Air borne allergens around Varanasi. India J Appl Immunol 1991;5:27.
Bousquet J, Van Cauwenberge P, Khaltaev N; Aria Workshop Group; World Health Organization. Allergic rhinitis and its impact on asthma. J Allergy Clin Immunol 2001;10 5 Suppl: S147-334.
Lung function testing: Selection of reference values and interpretative strategies. American Thoracic Society. Am Rev Respir Dis 1991;144:1202-18.
Agrawal RL, Chandra A, Jain S, Agrawal G, Borkar S. Identification of common allergens by skin prick test associated with united airway disease in Allahabad, Uttar Pradesh, India. Indian J Allergy Asthma Immunol 2008;22:7-13.
Prasad R, Verma SK, Dua R, Kant S, Kushwaha RA, Agarwal SP. A study of skin sensitivity to various allergens by skin prick test in patients of nasobronchial allergy. Lung India 2009;26:70-3.
Gaur SN, Kapoor MK, Garg DC, Agarwal MK. Etiologic significance of insects in nasobronchial allergy. Aspects Allergy Appl Immunol 1985;18:19-27.
Holopainen E, Salo OP, Tarkiainan E, Malmberg H. The most important allergen in allergic rhinitis. Acta Otolaryngol 1979;360:16-8.
Acharya PJ. Skin test response to some inhalant allergens in patients of nasobronchial allergy from Andra Pradesh. Aspects Allergy Appl Immunol 1980;8:34-6.
Prasad R, Kumar R, Verma SK, Pandey US. A study of skin sensitivity to various allergens by intra dermal test in patients of bronchial asthma. Indian J Allergy Asthma Immunol 2001;15:17-21.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]