Addo-Yobo E O, Custovic A, Taggart S C, Craven M, Bonnie B, Woodcock A
Department of Child Health, Komfo Anokye Teaching Hospital, PO Box 1934, Kumasi, Ghana.
J Allergy Clin Immunol. 2001 Sep;108(3):363-8. doi: 10.1067/mai.2001.117464.
Asthma is increasing in prevalence and severity in Africa. Previous studies have suggested that the prevalence of atopy in West Africa was low.
We sought to investigate the risk factors for asthma in Ghanaian school children.
Fifty children (age range, 9-16 years) with a physician diagnosis of asthma and asthma symptoms within the previous 12 months and 50 age- and sex-matched healthy control subjects were randomly selected and evaluated by means of questionnaire, skin testing, total and specific IgE measurements, and allergen level measurements from bed dust samples (mite, cat, dog, and cockroach).
Asthmatic children were exposed to higher levels of mite allergens than were control children (geometric mean, 19 microg/g [95% CI, 13.6-26.5] vs. 11.2 microg/g [7.4-15.7]; P <.05). Cat and dog allergen levels were low. There was a marked dissociation between skin test responses and the presence of specific IgE to cat and dog (CAP method). However, 84% of subjects with positive cat dander-specific IgE levels in cat CAP tests and negative skin test responses did not have Fel d 1-specific IgE (chimeric ELISA). In the univariate analysis significant associations with the patient group were found for sensitization to mite (odds ratio [OR], 9.3; 95% CI, 3.7-23.4) and cockroach (OR, 3.9; 95% CI, 1.3-11.6), inner-city residence (OR, 3.5; 95% CI, 1.4-8.9), asthma in family member (OR, 3.5; 95% CI, 1.4-9.0), low (<5) position in sibship (OR, 3.6; 95% CI, 1.2-11), presence of smoker in home (OR, 3.7; 95% CI, 1.2-11.9), small household size (OR, 0.57; 95% CI, 0.35-0.93), and use of electricity as domestic fuel (OR, 0.34; 95% CI, 0.12-0.97). In the multivariate analysis sensitization to mites remained the strongest risk factor associated with the asthmatic group (OR, 10.4; 95% CI, 3.5-30.9). The other significant associations were inner-city residence (OR, 4.8; 95% CI, 1.5-5.2), sensitization to cockroach (OR, 4.9; 95% CI, 1.3-18.6), and position in sibship of less than 5 (OR, 6.3; 95% CI, 1.3-29.4).
Sensitization to dust mite and cockroach allergens, inner-city residence, and low position in sibship were independent risk factors for asthma in Ghanaian children.
在非洲，哮喘的患病率和严重程度正在上升。此前的研究表明，西非特应性疾病的患病率较低。
我们试图调查加纳学龄儿童哮喘的危险因素。
随机选取50名在过去12个月内有医生诊断为哮喘且有哮喘症状的儿童（年龄范围9 - 16岁）以及50名年龄和性别匹配的健康对照者，通过问卷调查、皮肤试验、总IgE和特异性IgE测量以及来自床尘样本（螨虫、猫、狗和蟑螂）的过敏原水平测量进行评估。
哮喘儿童接触的螨虫过敏原水平高于对照儿童（几何均值，19微克/克[95%置信区间，13.6 - 26.5]对比11.2微克/克[7.4 - 15.7]；P <.05）。猫和狗过敏原水平较低。皮肤试验反应与针对猫和狗的特异性IgE的存在之间存在明显的分离（CAP方法）。然而，在猫CAP试验中猫皮屑特异性IgE水平为阳性且皮肤试验反应为阴性的受试者中，84%没有Fel d 1特异性IgE（嵌合ELISA）。在单变量分析中，发现与患者组有显著关联的因素包括对螨虫致敏（优势比[OR]，9.3；95%置信区间，3.7 - 23.4）、对蟑螂致敏（OR，3.9；95%置信区间，1.3 - 11.6）、居住在市中心（OR，3.5；95%置信区间，1.4 - 8.9）、家庭成员中有哮喘患者（OR，3.5；95%置信区间，1.4 - 9.0）、在兄弟姐妹中排行靠后（<5）（OR，3.6；95%置信区间，1.2 - 11）、家中有吸烟者（OR，3.7；95%置信区间，1.2 - 11.9）、家庭规模小（OR，0.57；95%置信区间，0.35 - 0.93）以及使用电力作为家庭燃料（OR，0.34；95%置信区间，0.12 - 0.97）。在多变量分析中，对螨虫致敏仍然是与哮喘组相关的最强危险因素（OR，10.4；95%置信区间，3.5 - 30.9）。其他显著关联因素包括居住在市中心（OR，4.8；95%置信区间，1.5 - 5.2）、对蟑螂致敏（OR，4.9；95%置信区间，1.3 - 18.6）以及在兄弟姐妹中排行小于5（OR，6.3；95%置信区间，1.3 - 29.4）。
对尘螨和蟑螂过敏原致敏、居住在市中心以及在兄弟姐妹中排行靠后是加纳儿童哮喘的独立危险因素。
