Asthma, allergic sensitization and lung function in sickle cell disease
Main Article Content
Keywords
Sickle cell disease, Asthma, Allergic sensitization, Lung function
Abstract
Background: Pulmonary disease is a frequent acute and chronic manifestation in sickle cell disease (SCD), presenting high morbidity and mortality.
Objectives: To identify the prevalence and association of asthma, allergic sensitization and altered pulmonary function in patients with SCD (SS and Sβo).
Methods: A single-center, cross-sectional study was conducted, in which 70 patients with SCD and 44 controls, aged six to 18 years, responded to the questionnaire of the International Study of Asthma and Allergies in Childhood (ISAAC), complemented with an anamnesis regarding the associated clinical outcomes. All patients underwent immediate hypersensitivity skin tests with aeroallergens and a pulmonary function evaluation (spirometry). Regarding the statistical analysis, parametric and non parametric methods were used, depending on the variables studied. Tests were considered significant when p < 0.05.
Results: There was no significant difference between the patients and controls regarding the prevalence of asthma and allergic sensitization (p > 0.05). The number of occurrences of acute chest syndrome per patient per year was significantly higher for asthmatic patients than for nonasthmatic patients (p = 0.04). Obstructive pulmonary function occurred in 30.9% of the patients and in 5.4% of the controls, and restrictive pulmonary function occurred in 5.5% of the patients and 5.4% of the controls. Asthma and wheezing in the last 12 months had significant associations with obstructive pulmonary function (p = 0.014 and p = 0.027, respectively).
Conclusions: The occurrence of asthma, allergic sensitization and alteration in lung function in patients with SCD reinforces the importance of routine monitoring of these diagnoses, which allows for early treatment and prevention of the evolution of pulmonary disease in adulthood.
References
[2]. Vij R, Machado RF. Pulmonary complications of hemoglobinopathies. Chest. 2010;138:973-83.
[3]. GINA. Global initiative for asthma; 2016. Available in: http://www.ginasthma.org/ Accessed August 24, 2019.
[4]. Morris CR. Mechanisms of vascular dysfunction in sickle cell disease and thalassemia. Hematology Am Soc Hematol Educ Program. 2008:177-85.
[5]. Field JJ, DeBaun MR. Asthma and sickle cell disease: two distinct diseases or part of the same process? Hematology Am Soc Hematol Educ Program. 2009:45-53.
[6]. Anim SO, Strunk RC, DeBaun MR. Asthma morbidity in children with sickle cell disease. Expert Respir Med. 2011;5(5):635-45.
[7]. Solé D, Camelo-Nunes IC, Wandalsen GF, Mallozi MC. Asthma in children and adolescents in Brazil: contribution of the International Study of Asthma and Allergies in Childhood (ISAAC). Rev Paul Pediatr. 2014;32:114-25.
[8]. Rodrigues JC, Cardieri JMA, Bussamra MHCF, Nakaie CMA, Almeida MB, Silva Filho LVF, Adde FV. Provas de func¸ão pulmonary em crianc¸as e adolescentes. J Pneumol. 2002;28(3):207-21.
[9]. Knight-Madden JM, Forrester TS, Lewis NA, Greenough A. Asthma in children with sickle cell disease and its association with acute chest syndrome. Thorax. 2005;60:206---10.
[10]. DeBaun MR, Rodeghier M, Cohen RT, Kirkham FJ, Rosen CL, Roberts I, et al. Factors predicting future ACS episodes in children with sickle cell anemia. Am J Hematol. 2014;89:212-7.
[11]. Strunk RC, Cohen RT, Cooper B, Rodeghier M, Kirkham FJ, Warner JO, et al. Wheezing symptoms and parental asthma are associated with a doctor diagnosis of asthma in children with sickle cell anemia. J Pediatr. 2014;164:821-6.
[12]. Koumbourlis AC. Lung function in sickle cell disease. Paediatr Respir Rev. 2014;15:33---7.
[13].Solé D, Naspitz CK. Epidemiology of Asthma: ‘‘International Study of Asthma and Allergies in Childhood’’ ISAAC. Rev Bras Alergia Imunopatol. 1998;21:38-45.
[14]. Oppenheimer J, Nelson HS. Skin testing. Ann Allergy Asthma Immunol. 2006;96 1 Suppl: S6-12.
[15]. Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, et al. ATS/ERS Task Force: Standardisation of Lung Function Testing. Eur Respir J. 2005;26:319-38.
[16]. Sylvester K, Patey R, Milligan P, Dick M, Rafferty G, Rees D, et al. Pulmonary function abnormalities in children with sickle cell disease. Thorax. 2004;59:67---70.
[17]. Kirkwood R, Sterne JAC. Essential medical statistics. 2nd ed. Massachusetts: Blackwell Science; 2006. p. 502.
[18]. Boyd JH, Macklin EA, Strunk RC, DeBaun MR. Asthma is associated with acute chest syndrome and pain in children with sickle cell anemia. Blood. 2006;108:2923-7.
[19]. Cook J, Jefferis O, Matchere P, Mbale E, Rylance J. Sickle cell disease in Malawian children is associated with restrictive spirometry: a cross-sectional survey. Int J Tuberc Lung Dis. 2013;17:1-10.
[20]. Jacob E, Sockrider MM, Dinu M, Acosta M, Mueller BU. Respiratory Symptoms and Acute Painful Episodes in Sickle Cell Disease. J Pediatr Oncol Nurs. 2010;27:33-9.
[21]. Galadanci NA, Liang WH, Galadanci AA, Aliyu MH, Jibir BW, Karaye IM, et al. Wheezing is common in children with sickle cell disease when compared to controls. J Pediatr Hematol Oncol. 2015;37:16-9.
[22]. Glassberg JA, Chow A, Wisnivesky J, Hoffman R, DeBaun MR, Richardson LD. Wheezing and asthma are independent risk factors for increased sickle cell disease morbity. Br J Haematol. 2012;159:472-9.
[23]. Pahl K, Mullen CA. Acute chest syndrome in sickle cell disease: Effect of genotype and asthma. Exp Biol Med. 2016;241:745-8.
[24]. DeBaun MR, Strunk RC. The intersection between asthma and acute chest syndrome in children with sickle cell anaemia. Lancet. 2016;387:2545-53.
[25]. Pastorino AC, Kuschnir FC, Arruda LK, Casagrande RR, Souza RG, Dias GA, et al. Sensitisation to aeroallergens in Brazilian adolescents living at the periphery of large subtropical urban centres. Allergol Immunopathol (Madr). 2008;36:9-16.
[26]. Field JJ, Stocks J, Kirkham FJ, Rosen CL, Dietzen DJ, Semon T, et al. Airway hyperresponsiveness in children with sickle cell anemia. Chest. 2011;139:563---8.
[27]. Willen SM, Rodeghier M, Strunk RC, Bacharier LB, Rosen CL, Kirkham FJ, et al. Aeroallergen sensitization predicts acute chest syndrome in children with sickle cell anaemia. Br J Haematol. 2018;180:571-7.
[28]. Gomez E, Morris CR. Asthma Management in Sickle Cell Disease. BioMed Res Int. 2013;2013:604140.
[29]. Lunt A, McGhee E, Sylvester K, Rafferty G, Dick M, Rees D, et al. Longitudinal Assessment of Lung Function in Children with Sickle Cell Disease. Pediatr Pulmonol. 2016;51:717---23.
[30]. Cohen RT, Strunk RC, Rodeghier M, Rosen CL, Kirkham FJ, Kirkby J, et al. Pattern of lung function is not associated with prior of future morbity in children with sickle cell anemia. Ann Am Thorac Soc. 2016;13:1314-23.
[31]. Arleta M, Campbell A, Nouraie M, Rana S, Onyekwere O, Ensing G, et al. Abnormal pulmonar function and associated risk factors in children and adolescentes with sickle cell anemia. J Pediatr Hematol Oncol. 2014;36:185-9.
[32]. Willen SM, Rodeghier M, DeBaun MR. Asthma in children with sickle cell disease. Curr Opin Pediatr. 2019;31(3):349-56.
[33]. Koumbourlis AC. Acute Chest Syndrome, Asthma, and Lung Function in Sickle Cell Disease- Which is the Chicken, and Which is the Egg? Ann Am Thorac Soc. 2016;13:1212-4.
[34]. An P, Barron-Casella EA, Strunk RC, Hamilton RG, Casella JF, DeBaun MR. Elevation of IgE in children with sickle cell disease in associated with doctor diagnosis of asthma and increased morbidity. J Allergy Clin Immunol. 2011;127:1140-446.
[35]. Agrawal S, Burton WB, Manwani D. A physicians survey assessing management of pulmonary involvement in sickle cell disease. Pediatric Pulmonology. 2019;54:993-1001.
[36]. Ruhl AP, Sadreameli C, Allen JL, Bennett DP, Campbell AD, Coates TD, et al. Identifying clinical and research priorities in sickle cell lung disease. Annals ATS. 2019;16:e17-32.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.