Factors associated with allergic rhinitis and combined allergic rhinitis and asthma syndrome (CARAS) in children aged 5–18 years undergoing immunotherapy in a tropical low- or middle-income country

Main Article Content

Augusto Peñaranda
Manuela Gantiva https://orcid.org/0000-0002-4617-0940
Sergio Moreno-López https://orcid.org/0000-0002-3043-0963
Daniel Peñaranda https://orcid.org/0000-0002-2220-0746
Lucía C. Pérez-Herrera https://orcid.org/0000-0001-8041-6433
Elizabeth García https://orcid.org/0000-0002-7456-4007

Keywords

Allergy, Allergic Rhinitis, Asthma, Allergic Disease, Immunotherapy, Tropical Climate

Abstract

Background: Tropics have some particularities that can impact the natural history and factors associated with allergic diseases. However, few studies described the characteristics of patients with allergic rhinitis (AR) and combined AR and asthma syndrome (CARAS) in Latin American tropical countries.


Objective: This study aimed to determine the medical, social, and environmental factors associated with AR and CARAS in children aged 5–18 years treated with immunotherapy in two allergy referral centers in Bogotá (Colombia).


Material and methods: An observational, cross-sectional study was conducted between January 2018 and January 2019. International Study Asthma Allergies Childhood-III and sociodemographic questionnaires were applied to adolescents and parents of children undergoing immunotherapy at the allergy consult in the Hospital Universitario Fundación Santa Fe de Bogotá and UNIMEQ-ORL.


Results: Among 830 children aged 5–18 years, 38.1% (n = 316) were women. Up to 63.25% of the population had a positive skin prick test for house dust mites: 63.25% for Dermatophagoides pteronyssinus, 61.81% for Dermatophagoides farinae, and 31.57% for Blomia tropicalis. The factors associated with AR were male sex (PR: 1.31, 95% CI: 1.08–1.57), antibiotic consumption during the first year of life (PR: 0.80; 95% CI: 0.63–0.99), and exposure to dogs (PR: 1.32; 95% CI: 1.06–2.66). The factors associated with CARAS were older age (PR=0.95; 95% CI: 0.95–0.99), acetaminophen consumption over four times a year (PR: 1.31; 95% CI: 1.03–1.55), and antibiotic consumption during the first year of life (PR: 1.21; 95% CI: 1.06–1.34).


Conclusion: A high prevalence of B. tropicalis was found in this study. The factors associated with AR and CARAS are like those described in high-income tropical countries. Further studies are needed in low- or middle-income tropical countries to identify modifiable factors associated with allergic diseases.

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References

1. Pinto Pereira LM, Jackman J, Figaro N, Babootee N, Cudjoe G, Farrell S, et al. Health burden of co-morbid asthma and allergic rhinitis in West Indian children. Allergol Immunopathol (Madr). 2010;38(3):129–34. 10.1016/j.aller.2009.09.002

2. Dierick BJH, van der Molen T, Flokstra-de Blok BMJ, Muraro A, Postma MJ, Kocks JWH, et al. Burden and socioeconomics of asthma, allergic rhinitis, atopic dermatitis and food allergy. Expert Rev Pharmacoecon Outcomes Res. 2020;20(5):437–53. 10.1080/14737167.2020.1819793

3. Caraballo L, Zakzuk J, Lee BW, Acevedo N, Soh JY, Sánchez-Borges M, et al. Particularities of allergy in the tropics. World Allergy Organ J. 2016;9(20):20. 10.1186/s40413-016-0110-7

4. Pérez-Herrera LC, Moreno-López S, Peñaranda D, García E, Chapman E, Peñaranda A. Frequency of self-reported allergies at a high-complexity referral hospital in Colombia, a tropical Latin American country. Allergol Immunopathol (Madr). 2021;49(5):100–5. 10.15586/aei.v49i5.449

5. Sole D, Mallol J, Wandalsen GF, Aguirre V. Prevalence of symptoms of eczema in Latin America: Results of the International Study of Asthma and Allergies in Childhood (ISAAC) Phase 3. J Investig Allergol Clin Immunol. 2010;20(4):311–23.

6. Moreno-López S, Pérez-herrera LC, Peñaranda D, Hernández D, García E, Peñaranda A. Prevalence and associated factors of allergic diseases in school children and adolescents aged 6–7 and 13–14 years from two rural areas in Colombia. Allergol Immunopathol (Madr). 2021;49(116):2–9. 10.15586/aei.v49i2.183

7. Peñaranda A, Aristizabal G, García E, Vásquez C, Rodríguez-Martinez CE. Rhinoconjunctivitis prevalence and associated factors in school children aged 6–7 and 13–14 years old in Bogota, Colombia. Int J Pediatr Otorhinolaryngol. 2012;76(4):530–5. 10.1016/j.ijporl.2012.01.010

8. Roberts G, Pfaar O, Akdis CA, Ansotegui IJ, Durham SR, Gerth van Wijk R, et al. EAACI Guidelines on allergen immunotherapy: Allergic rhinoconjunctivitis. Allergy. 2018;73(4):765–98. 10.1111/all.13317

9. Frati F, Incorvaia C, Cavaliere C, Di Cara G, Marcucci F, Esposito S, et al. The skin prick test. J Biol Regul Homeost Agents. 2018;32(Suppl. 1):19–24.

10. Paiva Ferreira LKD, Paiva Ferreira LAM, Monteiro TM, Bezerra GC, Bernardo LR, Piuvezam MR. Combined allergic rhinitis and asthma syndrome (CARAS). Int Immunopharmacol. 2019;74:105718. 10.1016/j.intimp.2019.105718

11. Mata Fernández C, Fernández-Benítez M, Pérez Miranda M, Guillén Grima F. Validation of the Spanish version of the Phase III ISAAC questionnaire on asthma. J Investig Allergol Clin Immunol. 2005;15(3):201–10.

12. Tamhane AR, Westfall AO, Burkholder GA, Cutter GR. Prevalence odds ratio versus prevalence ratio: Choice comes with consequences. Stat Med. 2016;35(30):5730–5. 10.1002/sim.7059

13. Long JS, Freese J. Regression models for categorical-dependent variables using Stata. 2nd ed. College Station, TX: Stata Corporation; 2001. 311 p. 10.1177/1536867X0200200107

14. Asher MI, Montefort S, Björkstén B, Lai CK, Strachan DP, Weiland SK, et al. Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC Phases One and Three repeat multicountry cross-sectional surveys. Lancet. 2006;368(9537):733–43. 10.1016/S0140-6736(06)69283-0

15. Martínez JNE, Aguilar ÁD RR. Sensitization to Blomia tropicalis and Dermatophagoides pteronyssinus, farinae and siboney prevalence in patients with rhinitis, allergic asthma, or both, in a population of a metropolitan area of Mexico City. Rev Alerg México. 2010;57(1):3–10.

16. Juliá-Serdá G, Cabrera-Navarro P, Acosta-Fernández O, Martín-Pérez P, García-Bello MA, Antó-Boqué J. Prevalence of sensitization to Blomia tropicalis among young adults in a temperate climate. J Asthma. 2012;49(4):349–54. 10.3109/02770903.2012.672611

17. Testa D, DI Bari M, Nunziata M, Cristofaro G DE, Massaro G, Marcuccio G, et al. Allergic rhinitis and asthma assessment of risk factors in pediatric patients: A systematic review. Int J Pediatr Otorhinolaryngol. 2020; 10.1016/j.ijporl.2019.109759

18. Mallol J, Crane J, von Mutius E, Odhiambo J, Keil U, Stewart A, et al. The International Study of Asthma and Allergies in Childhood (ISAAC) Phase Three: A global synthesis. Allergol Immunopathol (Madr). 2013;41(2):73–85. 10.1016/j.aller.2012.03.001

19. Govaere E, Gysel D Van, Massa G, Verhamme KMC, Doli E, Baets F De. The influence of age and gender on sensitization to aero-allergens. Pediatr Allergy Immunol. 2007; 10.1111/j.1399-3038.2007.00570.x

20. Penaranda A, Garcia E, Barragan AM, Rondon MA, Perez A, Rojas MX, et al. Factors associated with allergic rhinitis in Colombian subpopulations aged 1 to 17 and 18 to 59. Rhinol J. 2016;54(1):56–67. 10.4193/rhin14.234

21. Cooper PJ, Vaca M, Rodriguez A, Chico ME, Santos DN, Rodrigues LC, et al. Hygiene, atopy and wheeze–eczema–rhinitis symptoms in schoolchildren from urban and rural Ecuador. Thorax. 2014;69(3):232–9. 10.1136/thoraxjnl-2013-203818

22. Wise SK, Lin SY, Toskala E, Orlandi RR, Akdis CA, Alt JA, et al. International Consensus Statement on allergy and rhinology: Allergic rhinitis. Int Forum Allergy Rhinol. 2018;8(2):108–352. 10.1002/alr.22073

23. Bousquet J, Schünemann HJ, Samolinski B, Demoly P, Baena-Cagnani CE, Bachert C, et al. Allergic rhinitis and its impact on asthma (ARIA): Achievements in 10 years and future needs. J Allergy Clin Immunol. 2012;130(5):1049–62. 10.1016/j.jaci.2012.07.053

24. Cazzoletti L, Ferrari M, Olivieri M, Verlato G, Antonicelli L, Bono R, et al. The gender, age and risk factor distribution differs in self-reported allergic and non-allergic rhinitis: A cross--sectional population-based study. Allergy, Asthma Clin Immunol. 2015;11:36. 10.1186/s13223-015-0101-1

25. Marín-Cassinello A, Vega-Hernández MC, Lumbreras-Lacarra B, De Arriba-Méndez S, Pellegrini-Belinchón J. Prevalence of symptoms, severity and diagnosis of asthma in adolescents in the Province of Salamanca, Spain: Global Asthma Network (GAN) Phase I. Allergol Immunopathol (Madr). 2021;49(5):106–12. 10.15586/aei.v49i5.438

26. Allmers H. Frequent acetaminophen use and allergic diseases: Is the association clear? J Allergy Clin Immunol. 2005;116(4):859–62. 10.1016/j.jaci.2005.07.019

27. Ni J, Friedman H, Boyd BC, McGurn A, Babinski P, Markossian T, et al. Early antibiotic exposure and development of asthma and allergic rhinitis in childhood. BMC Pediatr. 2019;19(1):1–8. 10.1186/s12887-019-1594-4

28. Althubaiti A. Information bias in health research: Definition, pitfalls, and adjustment methods. J Multidiscip Healthc. 2016;9:211–7. 10.2147/JMDH.S104807