Asthma and Sensitization Pattern in Children

The prevalence of specific sensitization and its clinical relevance for the development of allergic diseases and asthma is one of the subjects currently being in the focus of scientific studies. In the field of asthma we find additionally several studies of occupational asthma with specific sensitization and of treatment efficacy and duration of omalizumab in asthma patients with high IgE levels, which will not be discussed in this chapter. Several other studies focus on general aspects of sensitization pattern or classification of specific sensitization corresponding to type or severity of asthma or globally the development of asthma in different populations. Based on a short literature review of such studies we will finally present own representative data of our German Health Interview and Examination Survey for Children and Adolescents (KiGGS). In this presentation we will describe specific IgE levels to several common aeroallergens in asthmatic and nonasthmatic children, search for a possible correlation between the number of sensitizations and the development of asthma and correlations between age, gender, social and migration status and rural or urban residency of the children and their sensitization status. Finally we will try to identify high risk mono- and polysensitization for asthma and will compare typical combinations of sensitizations in children with and without asthma

Factors contributing to conductance and outcome of specific immunotherapy: Data from the German National Health Interview and Examination Survey 1998

Background: Allergies are an increasingly relevant public health problem. Specific immunotherapy (sIT) is presently the only causal treatment option. This study aimed to assess the frequency and determinants of sIT use and factors associated with treatment outcome. Methods: A cross-sectional analysis based on data from the German National Health Interview and Examination Survey 1998. Results: 2727 (39.2%) of study participants reported physician-diagnosed allergic disease. Among these, 16.5% (n ¼ 296) stated to have undergone sIT. In this subset 43.4% (n ¼ 129) reported improvement of symptoms, 21.9% (n ¼ 65) had not changed, and 34.6% (n ¼ 102) had discontinued treatment. The majority of patients treated with sIT showed multiple allergic symptoms and sensitisations. Factors significantly correlated with sIT treatment in multivariable analyses included rhinitis, asthma, several sensitisations, higher social status and residence in larger cities. Rhinitis and neurodermatitis were positively, and food allergy was negatively associated with the completion of sIT. No factors predicting improvement due to sIT could retrospectively be identified. Conclusion: Treatment with sIT under ‘real life’ conditions does not exactly follow current clinical guideline recommendations. In addition, patients may be selected for IT by socio-demographic factors. Whether this contributes to considerable discontinuation rates and limited effectiveness as observed here, needs further investigation.Peer Reviewe

Correlations Between Allergic and Infectious Diseases – Results of the Latest German National Health Survey (NHS98) and the German Health Interview and Examination Survey for Children and Adolescents (KiGGS)

In the literature, according to the hygiene hypothesis, infections should be expected to correlate with fewer allergies. However, several studies clearly show that infections – especially infections of the upper respiratory tract – and surrogate parameters such as the use of antibiotics or paracetamol correlate with a higher rate of allergies. This article reviews the literature (50 articles are analyzed) on possible connections between infections and allergies and offers some possible explanations. Original data from population-based health interviews and examination surveys of adults, children and adolescents are added. These data show a clear correlation between most infections and an enhanced allergy rate. Nevertheless, although the correlastions obtained seem intriguing, it has to be kept in mind, that no clear direction of the correlations can be stated since the database does not allow for such interpretation. So, the data do not necessarily add to the picture of the hygiene hypothesis, as the infections could have followed the allergies. The probability of suffering from an allergy rises with the number of infections (or vice versa) a person has had (e.g. the risk for adults of developing asthma is enhanced to 1.3 CI-95% 1.2-1.4 with enhanced numbers of former infections with pertussis, chickenpox, scarlet fever, dysentery or typhoid/paratyphoid). This applies especially to pertussis (e.g. 15.8% CI-95% 13.6-18.3% of children with hayfever had pertussis versus 7.6% CI-95% 6.9-8.3% of the healthy children) and chickenpox infections (e.g. 84.7% CI-95% 82.7-86.6% of children with hayfever had chickenpox versus 66.8% CI-95% 65.8-67.8% of the healthy children), both of which are preventable by vaccination

Sensibilisierungsstatus bei Kindern und Jugendlichen mit Heuschnupfen und anderen atopischen Erkrankungen

Im vorliegenden Beitrag werden die Zusammenhänge zwischen bestehenden Sensibilisierungen gegen häufige Allergene (Mono- und Polysensibilisierungen, Höhe der IgE-Antikörperspiegel und IgE-Muster) und der Prävalenz von aktuell vorliegendem Heuschnupfen beziehungsweise von anderen atopischen Erkrankungen bei Kindern und Jugendlichen dargestellt. Die Analyse basiert auf Daten der KiGGS-Studie. Die Datenauswertungen erfolgten in SPSS mit Complex-samples-Methoden. Atopische Erkrankungen wurden in einem ärztlichen Interview erfragt, spezifische IgE-Antikörper ab dem Alter von drei Jahren mittels ImmunoCap®-Testsystem bestimmt. Die Prävalenz von Heuschnupfen und Polysensibilisierungen nimmt mit steigendem Lebensalter der Probanden signifikant zu, Jungen sind häufiger von Sensibilisierungen betroffen als Mädchen, Migranten seltener. Mit zunehmender Zahl an älteren Geschwistern sinkt die Prävalenz von Heuschnupfen und Sensibilisierungen signifikant, eine Atopie der Eltern erhöht sie. Es wurden unterschiedliche positive Beziehungen zwischen steigenden IgE-Antikörperspiegeln und dem Vorliegen von aktuellem Heuschnupfen identifiziert, besonders steil zeigt sich der Zusammenhang bei pflanzlichen Inhalationsallergenen und mit diesen kreuzreagierenden Nahrungsmittelallergenen. Bereits geringste spezifische IgE-Antikörperspiegel gegen nahezu alle getesteten Allergene korrelieren mit einer höheren Heuschnupfenprävalenz. Fazit: Die Studie gibt Hinweise darauf, dass die klinische Einstufung geringster IgE-Spiegel als „grenzwertig positiv“ diskutiert werden sollte, ebenso wie die Indikation zur Hyposensibilisierung.The dependencies between sensitization to common allergens (mono- and polysensitization, IgE level and patterns) and symptomatic hay fever and other atopic diseases, respectively, in children and adolescents are shown in this analysis. The evaluation was based on the KiGGS (“Kinder- und Jugendgesundheitssurvey”) study. Our analysis was performed using complex samples methods with SPSS. Participants were interviewed by a physician using a validated questionnaire asking for atopic diseases and symptoms. Specific IgE levels were measured from the age of 3 years on by using the ImmunoCap® test system. The prevalences of hay fever and polysensitizations both significantly increase with increasing age of the participants, while boys are more often affected than girls and migrants less often regarding sensitizations. Prevalence of hay fever decreases with increasing number of older siblings and increases with atopy of one or both parents. Different positive correlations between increasing IgE levels and hay fever were identified, the greatest association was observed with herbal inhalative allergens and cross-reacting food allergens. Lowest IgE levels to nearly all of the tested allergens show a positive correlation with hay fever prevalence. In conclusion, the study indicates that the clinical definition of the lowest positive IgE levels as “marginal” should be discussed as well as indications for specific immunotherapy

Major comorbid conditions in asthma and association with asthma-related hospitalizations and emergency department admissions in adults: results from the German national health telephone interview survey (GEDA) 2010

Background: It remains unclear to what extent asthma in adults is linked to allergic rhinitis (AR), gastroesophageal reflux disease (GERD), and acetylsalicylic acid exacerbated respiratory disease (AERD), and how these comorbidities may affect asthma outcomes in the general population. We therefore aimed to assess the prevalence of these major comorbidities among adults with asthma and examine their impact on asthma exacerbations requiring hospital care. Methods: A total of 22,050 adults 18 years and older were surveyed in the German National Health Telephone Interview Survey (GEDA) 2010 using a highly standardized computer-assisted interview technique. The study population comprised participants with self-reported physician-diagnosed asthma, among which the current (last 12 months) prevalence of AR and GERD-like symptoms (GERS), and life-time prevalence of AERD was estimated. Weighted bivariate analyses and logistic regression models were applied to assess the association of each comorbid condition with the asthma outcome (any self-reported asthma-related hospitalization and/or emergency department (ED) admission in the past year). Results: Out of 1,136 adults with asthma, 49.6% had GERS and 42.3% had AR within the past 12 months; 14.0% met the criteria of AERD, and 75.7% had at least one out of the three conditions. Overall, the prevalence of at least one exacerbation requiring emergency room or hospital admission within the past year was 9.0%. Exacerbation prevalence was higher among participants with comorbidities than among those without (9.8% vs. 8.2% for GERS; 11.2% vs. 7.6% for AR, and 22.2% vs. 7.0% for AERD), but only differences in association with AERD were statistically significant. A strong association between asthma exacerbation and AERD persisted in multivariable logistic regression analyses adjusting for sex, age group, level of body mass index, smoking status, educational attainment, and duration of asthma: odds ratio (OR) = 4.5, 95% confidence interval (CI) = 2.5-8.2. Conclusions: Data from this large nation-wide study provide evidence that GERS, AR and AERD are all common comorbidities among adults with asthma. Our data underline the public health and clinical impact of asthma with complicating AERD, contributing considerably to disease-specific hospitalization and/or ED admission in a defined asthma population, and emphasize the importance of its recognition in asthma care

Prevalence of sensitisation to aeroallergens and food allergens

In view of the increasing prevalence of allergies, up-to-date data on the prevalence of allergic sensitisation are of major interest. In the German Health Interview and Examination Survey for Adults (DEGS1) (2008–2011), blood samples from a population-based sample of 7,025 participants aged 18 to 79 years were analysed for specific IgE antibodies against 50 common single allergens and screened for common aeroallergens (SX1) and grass pollen (GX1). In all, 48.6% of the participants were sensitised to at least one allergen. Overall, men were more frequently sensitised to at least one allergen than women were. Sensitisations to at least one allergen were more common among younger than older participants and among participants with a higher socio-economic status. In all, 33.6% of the participants were sensitised to common aeroallergens, 25.5% to food allergens and 22.6% to wasp or bee venoms. Compared with the German National Health Interview and Examination Survey 1998 (GNHIES98), the prevalence of sensitisation to common aeroallergens increased from 29.8 to 33.6%.This increase was statistically significant only in women. The results of DEGS1 still showed a high prevalence of allergic sensitisation

Häufigkeit allergischer Erkrankungen in Deutschland

In der ersten Welle der „Studie zur Gesundheit Erwachsener in Deutschland“ (DEGS1) wurden aktuelle und bundesweit repräsentative Daten zum allergischen Krankheitsgeschehen von 7988 18- bis 79-Jährigen mittels computergestützter, ärztlicher Interviews erhoben. Demnach liegt die Lebenszeitprävalenz (LZP) für Asthma bronchiale bei 8,6%, Heuschnupfen bei 14,8%, Neurodermitis und Urtikaria bei jeweils 3,5%, Kontaktekzeme bei 8,1%, Nahrungsmittelallergien bei 4,7% und Insektengiftallergien bei 2,8%. Insgesamt ist bei einem knappen Drittel der Erwachsenen mindestens eine der genannten Allergien jemals ärztlich diagnostiziert worden. Aktuell leiden fast 20% an mindestens einer Allergie. Frauen sind generell häufiger betroffen als Männer und Jüngere häufiger als Ältere. Außerdem sind Allergien in den alten Bundesländern verbreiteter als in den neuen. Ein hoher sozioökonomischer Status und das Leben in Großstädten erhöhen ebenfalls die Krankheitshäufigkeit. Im 10-Jahres-Trend stieg die Asthmaprävalenz um knapp 3%, die Prävalenzen für Urtikaria und Kontaktekzeme sanken, die LZP für Heuschnupfen, Neurodermitis und Nahrungsmittelallergie blieb unverändert. Dadurch ist die Allergieprävalenz insgesamt von 32,7% auf 28,7% rückläufig.In the first wave of the “German Health Interview and Examination Survey for Adults” (DEGS1), up-to-date and representative data regarding allergic diseases in 7,988 18- to 79-year-old subjects living in Germany were collected using computer-assisted medical interviews. The study identified a lifetime prevalence of 8.6% for asthma, 14.8% for allergic rhinoconjunctivitis, 3.5% each for atopic dermatitis and urticaria, 8.1% for contact eczema, 4.7% for food allergies and 2.8% for insect venom allergies. Overall, nearly one third of adults in Germany have been diagnosed with at least one of the above-mentioned allergies during their lifetime by a physician. Currently, nearly 20% suffer from at least one allergic disease. Generally, women reported an allergic disease more frequently than men did and younger subjects more frequently than older ones. Additionally, allergies are more common in the former federal states of West Germany than in the former East German federal states. A high socioeconomic status and living in large cities both increase allergy risk. During the last 10 years, asthma prevalence increased about 3%, whereas the prevalence of urticaria and contact eczema declined. The lifetime prevalence of allergic rhinoconjunctivitis, atopic dermatitis and food allergies appeared unchanged. In total, allergy prevalence has declined from 32.7 to 28.7% over the past decade. An English full-text version of this article is available at SpringerLink as supplemental

Arzneimitteltherapie des Asthma bronchiale - Ergebnisse des Bundes-Gesundheitssurveys 1998

Die Lebenszeitprävalenz des Asthma bronchiale beträgt für Erwachsene ca. 5%. Die Wahl der Arzneimitteltherapie richtet sich nach dem Schweregrad der Erkrankung: Sie umfasst die alleinige (bedarfsweise) Anwendung von Bronchodilatatoren bis hin zur zusätzlichen ständigen Anwendung inhalativer und systemischer Glukokortikosteroide. In der vorliegenden Publikation werden die Prävalenz und die medikamentöse Therapie des Asthma bronchiale in einer repräsentativen Stichprobe der 18- bis 79-jährigen Wohnbevölkerung in Deutschland analysiert. Gleichzeitig wird auf die Inanspruchnahme medizinischer Leistungen wie Klinikaufenthalt, notärztliche Behandlung und ambulante ärztliche Behandlung in Abhängigkeit von der Medikation eingegangen. 17,3% der Probanden, die eine ärztliche Diagnose Asthma bejahten, gaben an, ständig kortikoidhaltige Arzneimittel anzuwenden. 19,1% nahmen diese zeitweise, und 61,8% nahmen keine kortikoidhaltigen Arzneimittel ein. Die häufigste Inanspruchnahme medizinischer Leistungen nach einem Asthmaanfall zeigte sich bei Patienten, die angaben, ständig Glukokortikoide anzuwenden. Ältere Asthmatiker nahmen sehr viel häufiger ständig Glukokortikoide ein, nur bei sehr jungen spielte die gelegentliche Einnahme eine überproportionale Rolle. Bei der Erfassung der aktuellen Arzneimittelanwendung (letzte 7 Tage vor der Befragung) mit Hilfe des Arzneimittelsurveys zeigte sich für die Antiasthmatika das folgende Bild: 47,8% der Personen mit Selbstangabe eines Asthma bronchiale in den letzten 4 Wochen gaben die Anwendung inhalativer Adrenergika, 34,8% die Anwendung inhalativer Glukokortikoide, 2,1% die Anwendung systemischer Adrenergika und 19,3% die Anwendung von Theophyllinpräparaten an. Die gemessenen Theophyllinspiegel lagen bei 34,4% unter 5 mg/l, bei 28,1% zwischen 5 und 8 mg/l, bei 35,9% zwischen 8 und 20 mg/l und bei 1,6% der Probanden knapp über 20 mg/l. Die Ergebnisse könnten darauf hinweisen, dass insbesondere junge Asthmatiker unzureichend antiinflammatorisch behandelt werden. Diesen Hinweisen muss weiter nachgegangen, um – bei einer Bestätigung eines Defizits – Maßnahmen zur noch besseren Anlehnung an die existierenden Therapierichtlinien treffen zu können. Insbesondere die gemessenen Theophyllinspiegel der Probanden haben bestätigt, dass ein Drugmonitoring nicht nur ein wichtiger Bestandteil von Gesundheitssurveys ist, sondern auch dazu beitragen könnte, die Sicherheit und Effizienz der Asthmatherapie zu verbessern.The lifetime prevalence of bronchial asthma in adults is approximately 5%. Recommended drug therapy of this condition depends largely on its severity and varies from the on demand use of bronchodilators as a single measure up to the additional and sometimes permanent use of inhaled and/or systemic glucocorticoids. In this study, the prevalence and drug therapy of bronchial asthma were analysed in a representative sample of the resident population in Germany aged 18–79 years. We also report about health care utilization, like hospital stay, emergency treatments and use of ambulant medical care, and its associations with asthma medication. Of those study participants who affirmed a medical diagnosis of asthma, 17.3% used corticoid drugs continuously, 19.1% occasionally and 61.8% never. Use of medical services after an asthma attack was reported most often by those who took corticoid drugs regularly. Older people with asthma mostly used glucocorticoids regularly, while in very young patients the occasional use of corticoids was reported more often. When looking at the actual drug use (7 days before the examination) according to the drug usage questionnaire, anti-asthma drugs were mentioned as follows: 47.8% of persons with asthma, diagnosed during the last 4 weeks, used inhaled adrenergic drugs, 34.8% inhaled glucocorticoids, 2.1% systemic adrenergic drugs and 19.3% systemic theophyllines. The measured serum concentrations of theophylline were below 5 mg/l in 34.4%, between 5 and 8 mg/l in 28.1%, between 8 and 20 mg/l in 35.9% and somewhat over 20 mg/l in 1.6%. Our data suggest that especially young asthmatics may not be sufficiently treated with anti-inflammatory therapy, but further studies are needed. If such a deficit can be confirmed, measures for better adherence of therapy to existing guidelines should be considered. Our results, especially on serum concentrations of theophylline, suggest that therapeutic drug monitoring (TDM) of serum samples is not only an important tool in health surveys, but also suitable for increasing the safety and quality of drug treatment in asthmatics

Einflussfaktoren für Asthma bronchiale bei Kindern und Jugendlichen in Deutschland

Im vorliegenden Beitrag wurden Zusammenhänge zwischen einer bestehenden Asthmaerkrankung und möglichen diesbezüglichen Einflussfaktoren auf der Datenbasis der „Studie zur Gesundheit von Kindern und Jugendlichen in Deutschland“ (KiGGS) untersucht. In dieser bundesweiten Querschnittstudie wurden zwischen 2003 und 2006 17.641 null- bis 17-jährige Kinder und Jugendliche untersucht. Die Datenerfassung umfasste eine ärztliche Untersuchung des Kindes, ein Interview der Eltern und schriftliche Fragebögen. Neben Prävalenzschätzungen wurden multivariate logistische Regressionsanalysen durchgeführt. Zunehmendes Alter und männliches Geschlecht, eine atopische Vorerkrankung des Kindes, eine positive Familienanamnese für allergische Erkrankungen sowie ein niedriges Geburtsgewicht erhöhten das Risiko für Asthma bronchiale signifikant, ebenso Übergewicht und schimmlige Wände in der Wohnung. Das Stillen hatte keine schützende Wirkung. Ein niedriges Alter der Mutter bei der Geburt und Leben in ländlichen oder kleinstädtischen Regionen erwiesen sich als protektiv. Insgesamt zeigte sich, dass die genetische Prädisposition und eine atopische Vorerkrankung des Kindes die stärksten Risikofaktoren für Asthma bronchiale sind. Aber auch Umweltfaktoren (schimmlige Wände, Leben in ländlichen und kleinstädtischen Gemeinden) und einzelne Lebensstilfaktoren spielten eine modifizierende Rolle.In this study, associations between current asthma and possible determinants were studied using data of the German Health Interview and Examination Survey for Children and Adolescents (“Studie zur Gesundheit von Kindern und Jugendlichen in Deutschland,” KiGGS). In this nationwide cross-sectional survey, 17,461 subjects aged 0–17 years were examined between 2003 and 2006. Data collection included a medical examination of the child, an interview of the parents, and written questionnaires. Apart from prevalence estimates, multivariate logistic regression analyses were performed. Increasing age and male sex, previous atopic diseases of the child, a positive family history of allergic diseases and low birth weight were significant risk factors of asthma, as were overweight and moldy walls in the residence. Breast feeding was not associated with a reduced risk of asthma. Low age at delivery of the mother and living in rural or provincial regions were shown to be protected. Overall, this study suggests that allergies of the parents and previous atopic disease of the child are the strongest determinants of asthma. However, environmental factors (mold on walls, living in rural and provincial towns) and lifestyle factors could also modify asthma risk