Allergen Sensitization Profiles in a Population-Based Cohort of ChildrenHospitalized for Asthma

摘要

>Rationale: Allergen sensitization is associated with asthma morbidity. A better understanding of allergen sensitization patterns among children hospitalized for asthma could help clinicians tailor care more effectively. To our knowledge, however, sensitization profiles among children hospitalized for asthma are unknown.>Objectives: We sought to describe allergen sensitization profiles and the distribution of self-reported in-home exposures among children hospitalized for asthma. We also sought to assess how sensitization profiles varied by sociodemographic and clinical factors.>Methods: This population-based cohort study includes data for 478 children, aged 4–16 years, hospitalized for an asthma exacerbation. Predictors included child age, race, sex, insurance status, reported income, salivary cotinine, exposure to traffic-related air pollution, asthma and atopic history, and season of admission. Outcomes included serum IgE specific to Alternaria alternata/A. tenuis, Aspergillus fumigatus, American cockroach, mouse epithelium, dust mite (Dermatophagoides pteronyssinus and farinae), cat dander, and dog dander (deemed sensitive if IgE ≥ 0.35). Self-reported adverse exposures included mold/mildew, water leaks, cockroaches, rodents, and cracksor holes in the walls or ceiling. Presence of carpeting and furry pets was alsoassessed.>Measurements and Main Results: More than 50% of included patients weresensitized to each of Alternaria, Aspergillus, dustmite, cat dander, and dog dander; 28% were sensitized to cockroach and 18% to mouse.Roughly 68% were sensitized to three or more allergens with evidence of clustering.African American children, compared with white children, were more likely to besensitized to Alternaria, Aspergillus, cockroach,and dust mite (all P < 0.01). White children weremore likely to be sensitized to mouse, cat, and dog (allP < 0.01). Lower income was associated withcockroach sensitization whereas higher income was associated with dog and catsensitization (all P < 0.01). Atopic history wasassociated with sensitization to three or more allergens(P < 0.01). Although 42% reported exposure to atleast one adverse in-home exposure (and 72% to carpet, 51% to furry pets), only weakrelationships were seen between reported exposures and sensitizations.>Conclusions: Most children admitted to the hospital for asthmaexacerbations are sensitized to multiple indoor allergens. Atopy on the inpatientunit serves as a potential target for improvement in chronic asthma management.