Jothimurugan, N (2008) To Study the Immune and Allergenic Profiles of Atopic Asthma Patients: A Prospective study. Masters thesis, Stanley Medical College, Chennai.
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Abstract
INTRODUCTION: Nearly 300 million people in the world suffer from asthma .Asthma is a common chronic inflammatory disease of the airways, with considerable heterogeneity both in its phenotype and in the underlying pathophysiology. Both intrinsic or non-atopic and extrinsic or atopic cases of asthma are known. Extrinsic asthma is mainly a childhood disorder though the age of onset can vary; whereas intrinsic asthma is observed where the age of onset is above 45 yrs and is mainly due to the age induced changes in the lung function. The majority of asthmatics (around 80%) are atopic, with manifestations of allergic diathesis including clinical allergy to aeroallergens and foods, or subclinical allergy apparent by skin test reactivity to allergen or elevated serum IgE. Approximately 7-10% of the Indian population, particularly children, is affected by atopic asthma. It has been estimated that 34% of the man days in India are lost due to airway related disorders, of which asthma is a major cause. Asthma and atopy are considered complex traits, with evidence of both heritable and environmental factors contributing to their pathogenesis. Atopy is known to be a strong predisposing factor in the development of asthma. Atopic asthma is a hereditary disease and is mediated both by genetic and environmental components. As its pathogenesis is complex, management of the disease is also difficult. But prevention of the disease is possible if the allergic status of patients is known. However, due to the risk of anaphylaxis the allergy test is not being performed routinely in asthma clinics managing a lot of new as well as old patients. Due to this, poor asthma patients are not aware of these allergies and do not know the status of allergen positivity they have. In contrast, skin prick test is a test which carries less risk rate of anaphylaxis due to minimum possibility of allergen entry into systemic circulation. With this background, this study emphasizes the importance of the skin prick test in asthmatics and tries to correlate with the immune response in these patients. In addition, it tries to understand the prevalence of the allergen positivity in these patients and it also explores a few interesting Findings by pedigree analysis. AIM AND OBJECTIVES AIM: To study the immune and allergenic profiles of atopic asthma. OBJECTIVES: 1. To study the allergen positivity predisposition in our environment. 2. To assess the impact of allergen positivity on IgE levels. PATIENTS AND METHODS: Recruitment of the Study Population: This study was a hospital based study, wherein, subjects were enrolled from the Allergy Clinic, Stanley Medical College, Chennai. Allergy clinic is the centre where most of the patients who complained of allergy related symptoms were referred from various other departments. Period of Study: January 2006 to January 2007 (Thirteen months). Design of Study: Prospective study. Selection of Sample: Cases - ninety (90). Controls - thirty six (35). The Steps Involved in Carrying Out the study were: 1. Phenotyping and recruitment of patients. 2. Skin prick test for allergy. 3. Allergy test grading. 4. Serum isolation and IgE estimation. 5. Statistical analysis. The probands were patients with asthma who visited the Allergy Clinic and fulfilled the following inclusion criteria: 1.Asthma diagnosed as per the definition of the American thoracic society, 1991 ie) Significant reversibility is indicated by an increase of ≥12 percent or 200 mL in FEV1 after inhaling a short-acting bronchodilator (American Thoracic Society 1991. 2. A family history of asthma. (With either parent affected preferably first generation). 3. Age group were between 11-65 years. 4. Patients were recruited only after getting consent. These probands were recruited based on the evaluation of clinical, family and environmental details using a standardized questionnaire. The questionnaire was designed to collect all the relevant information regarding the disease of the patient, and also the affection status of the family members. Patients were clinically assessed and examined for a reported history of breathlessness, wheezing and allergic symptoms including conjunctivitis, rhinitis and dermatitis. Exclusion criteria included: 1. Known chronic disease such as tuberculosis patients and symptoms suggestive of tuberculosis. 2. Age group of below 11 and above 65. 3. Patients who were not giving consent 4. Patients having negative family history. 5. Patients with history of smoking. 6. Known tropical pulmonary eosinophilic patients/other parasitic infections and symptoms suggestive of tropical pulmonary eosinophilia/other parasitic infections in the past three years. RESULTS: IgE VALUES IN PATIENTS AND CONTROLS: As mentioned in methods IgE was measured in sera and it was compared between patients and controls. p VALUE=0.0642. Patients show higher IgE than controls though it is not statistically significant. GENDER DIFFERENCE IN IGE LEVELS: Here it is seen that males have higher IgE values than females however p value is 0.1713 is nil significant. ECONOMIC STATUS AND IgE LEVELS; It shows that poor socioeconomic status people have higher IgE values as the p value is 0.0699. MODE OF LIVING AND IgE LEVELS: p value shows 0.7247. No correlation between IgE and mode of living was found. CONCLUSION: 1. The allergic status of the individual can be assessed with the help of skin prick test. This information can be used for avoidance of allergens. 2. Female patients have lesser IgE compared to male patients. 3. There is an inverse correlation between IgE levels and socio economic status. 4. Cockroach, Moth, and Grain dust rice are shown the high allergy positivity while azadirachta indica, prosopis juliflora, ricinus communis and mosquitoes are shown the lower allergy positivity. 5. Females have more tendency for allergen positivity. This predominance was very common with respect to various pollens and house dust mite. 6. There was a significant association between allergy positivity and IgE levels in case of moth allergy and eucalyptus allergy. 7. There was an inverse correlation between allergy severity grading and IgE levels in case of insect allergy and direct correlation with pollen allergy.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Immune and Allergenic Profiles ; Atopic Asthma Patients ; Prospective study |
| Subjects: | MEDICAL > General Medicine |
| Depositing User: | Subramani R |
| Date Deposited: | 23 Mar 2018 16:00 |
| Last Modified: | 23 Mar 2018 16:00 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/6474 |
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