Influence of Helminthiasis on Allergic Asthma

Shivakumar, G (2007) Influence of Helminthiasis on Allergic Asthma. Masters thesis, Kilpauk Medical College, Chennai.


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INTRODUCTION: What represents a disease or infection in one scenario may well have a beneficial effect in quite another. There is growing interest at the international level on the possible interrelationship between helminthic infection and allergic asthma, although the exact nature of the relationship remains uncertain. Allergic asthma is one of the most common respiratory ailments in children as well as the adult population. Whereas most cases of asthma originate in childhood, the natural history of the disease is poorly understood. In the developing tropical countries helminthiasis is a major public health problem. The epidemiologic observation that atopic asthma is very common and helminthiasis uncommon in developed countries and that the converse is true in developing countries has lead to the speculation that the two phenomena may be inversely related. However, the relationship between helminthiasis and allergic asthma remains largely uncertain. It has been proven in various studies that despite equal living conditions, the intensity of parasite infection was greater among non-allergic individuals than allergic patients. Chronic and persistent helminthic load can suppress the allergic responses by causing an IL-4 dependant activation of 3 non-specific polyclonal IgE production and thereby saturation of mast cells29,2. The allergen specific IgE gets diluted in this polyclonal IgE rise. This causes a fall in the atopic responses to specific allergens. It is also worthwhile to mention that as the socio economic status decreases the helminthiasis rate increases and serum IgE level rises. In accordance with the above, parasite eradication can produce resurgence of allergic reactivity towards common environmental allergens in populations in whom this was suppressed by excessive polyclonal IgE2. AIM OF THE STUDY: 1. To study the influence of Helminthic Infection on the disease process of Allergic Asthma. 2. To find out the prevalence of Helminthiasis in Atopic Asthma patients. MATERIALS AND METHODS: A prospective study and analysis of patients aged 5 – 40 attending the allergy and asthma clinic at Govt. General Hospital, Govt. Royapettah Hospital & Institute of Child Health, Chennai. Study Population: The study was conducted over a six months period from June 2005 to Nov 2005. The study population largely belonged to the lower socioeconomic strata living in suburban Chennai. The patients, because of financial constraints had limited access to paid health services and were basically dependant on Govt. Health care setup. Fifty atopic asthma patients were chosen for the study and were followed up by outpatient department reviews. Study Design: Cohort study of 50 allergic asthma patients divided into 2 groups based on the presence or absence of the risk factor – helminthiasis. Inclusion Criteria: 1. Typical patients of atopic asthma as evidenced by Clinical history – age of onset, seasonal variation, known allergen, family history. Physical examination – wheeze, associated allergic rhinitis, Eczema. Investigation – skin test reactivity, spirometry. 2. Worm infestation as proven by: Investigation – Stool tests for eggs and one or both of the following criteria. Clinical history – Pruritis, Pica, Passing worms in stools. Supportive evidence – eosinophilia, serum IgE. Exclusion Criteria: 1. Comorbid conditions like pulmonary tuberculosis, cardiovascular illness and pregnant women were excluded. 2. Patients who were smokers were excluded as it might confound the results. 3. Occupations predisposing to lung diseases like cotton workers, cane factory & leather factory workers were excluded. OBSERVATION: In this prospective cohort study, the study population comprising of 50 patients of allergic asthma were distributed into two age-matched groups of 25 each, based on the presence or absence of worm infestation. The results of the observations were compared between the two groups at the end of the six month study period. Group I - Worm Infested Asthma patients - 25, Group II - [Control] Non-Worm infested Asthma patients - 25. CONCLUSION: Fifty patients of allergic asthma were divided into two study groups based on the presence or absence of worm infestation. They were followed up for a period of six months, clinical course and investigations compared. The prevalence of ascariasis in allergic asthma patients was 23.15%. There was no statistical significant difference in the age wise worm infestation rates. The prevalence ratio of helminthiasis among male and female asthmatic population was 2.6 : 1. The study also points out the significant difference in worm infestation rates between lower and higher income group (1.7:1). Helminthiasis was associated significantly with milder disease course than the control group (p=0.041399). The presence of worm infestation was significantly associated with improved performance of spirometry (p=0.04322). The skin test reactivity was significantly reduced in the worm group as compared to the non- worm group (p=0.0254). There was no significant difference in the IgE levels between the two groups.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Influence ; Helminthiasis ; Allergic Asthma.
Subjects: MEDICAL > General Medicine
Depositing User: Subramani R
Date Deposited: 10 Mar 2018 03:46
Last Modified: 10 Mar 2018 03:46

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