Risk factors for acute asthma in tropical America: a case–control study in the City of Esmeraldas, Ecuador. Issue 5 (August 2015)

• Record Type: Journal Article
• Authors: Ardura‐Garcia, Cristina; Vaca, Maritza; Oviedo, Gisela; Sandoval, Carlos; Workman, Lisa; Schuyler, Alexander J.; Perzanowski, Matthew S.; Platts‐Mills, Thomas A.E.; Cooper, Philip J.
• Is Part Of: Pediatric allergy and immunology. Volume 26:Issue 5(2015)
• Page Start: 423
• Page End: 430
• Publication Date: 2015-08
• Subjects: Allergy in children -- Periodicals; Immunologic diseases in children -- Periodicals; 617
• DOI: 10.1111/pai.12401
• Languages: English
• ISSNs: 0905-6157

Abstract

<abstract abstract-type="main" id="pai12401-abs-0001"> <title>Abstract</title> <sec id="pai12401-sec-0001" sec-type="section"> <title>Background</title> <p>Despite the high asthma rates described in Latin America, asthma risk factors in poor urban settings are not well established. We investigated risk factors for acute asthma among Ecuadorian children.</p> </sec> <sec id="pai12401-sec-0002" sec-type="section"> <title>Methods</title> <p>A matched case–control study was carried out in a public hospital serving a coastal city. Children with acute asthma were age‐ and sex‐matched to non‐asthmatics. A questionnaire was administered, and blood, as well as stool, and nasopharyngeal swabs were collected.</p> </sec> <sec id="pai12401-sec-0003" sec-type="section"> <title>Results</title> <p>Sixty cases and 119 controls aged 5–15 were evaluated. High proportions of cases were atopic with population‐attributable fractions for atopy of 68.5% for sIgE and 57.2% for SPT. Acute asthma risk increased with greater titers of mite IgE (3.51–50 kU/l vs. <0.70kU/l – OR 4.56, 95% CI 1.48–14.06, p = 0.008; >50kU/l vs. <0.70kU/l – OR 41.98, 95% CI: 8.97–196.39, p < 0.001). Asthma risk was significantly independently associated with bronchiolitis (adj. OR: 38.9, 95% CI 3.26–465), parental educational level (adj. OR 1.26, 95% CI: 1.08–1.46), and presence of sIgE (adj. OR: 36.7, 95% CI: 4.00–337), while a reduced risk was associated with current contact with pets (adj. OR: 0.07, 95% CI: 0.01–0.56). Rhinovirus infection was more frequent in cases (cases 35.6% vs. controls 7.8%, p = 0.002). None of the cases were on maintenance therapy with inhaled corticosteroids and most relied on emergency department for control.</p> </sec> <sec id="pai12401-sec-0004" sec-type="section"> <title>Conclusions</title> <p>A high proportion of children presenting to a public hospital with acute asthma were allergic to mite, particularly at high IgE titer. Poor asthma control resulted in overuse of emergency care.</p> </sec> </abstract>