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Risk factors for acute asthma in tropical America: a case-control study in the City of Esmeraldas, Ecuador.

Ardura-Garcia, C; Vaca, M; Oviedo, G; Sandoval, C; Workman, L; Schuyler, AJ; Perzanowski, MS; Platts-Mills, TA; Cooper, PJ (2015) Risk factors for acute asthma in tropical America: a case-control study in the City of Esmeraldas, Ecuador. Pediatric Allergy And Immunology, 26 (5). pp. 423-430. ISSN 1399-3038 https://doi.org/10.1111/pai.12401
SGUL Authors: Cooper, Philip John

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Abstract

BACKGROUND: Despite the high asthma rates described in Latin America, asthma risk factors in poor urban settings are not well established. We investigated risk factors for acute asthma among Ecuadorian children. METHODS: A matched case-control study was carried out in a public hospital serving a coastal city. Children with acute asthma were age- and sex-matched to non-asthmatics. A questionnaire was administered, and blood, as well as stool, and nasopharyngeal swabs were collected. RESULTS: Sixty cases and 119 controls aged 5-15 were evaluated. High proportions of cases were atopic with population-attributable fractions for atopy of 68.5% for sIgE and 57.2% for SPT. Acute asthma risk increased with greater titers of mite IgE (3.51-50 kU/l vs. <0.70kU/l - OR 4.56, 95% CI 1.48-14.06, p = 0.008; >50kU/l vs. <0.70kU/l - OR 41.98, 95% CI: 8.97-196.39, p < 0.001). Asthma risk was significantly independently associated with bronchiolitis (adj. OR: 38.9, 95% CI 3.26-465), parental educational level (adj. OR 1.26, 95% CI: 1.08-1.46), and presence of sIgE (adj. OR: 36.7, 95% CI: 4.00-337), while a reduced risk was associated with current contact with pets (adj. OR: 0.07, 95% CI: 0.01-0.56). Rhinovirus infection was more frequent in cases (cases 35.6% vs. controls 7.8%, p = 0.002). None of the cases were on maintenance therapy with inhaled corticosteroids and most relied on emergency department for control. CONCLUSIONS: A high proportion of children presenting to a public hospital with acute asthma were allergic to mite, particularly at high IgE titer. Poor asthma control resulted in overuse of emergency care.

Item Type: Article
Additional Information: © 2015 The Authors. Pediatric Allergy and Immunology Published by John Wiley & Sons Ltd. 423 This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Keywords: Ecuador, acute asthma, atopy, tropics, urban, acute asthma, atopy, Ecuador, tropics, urban, Allergy, 1107 Immunology, 1114 Paediatrics And Reproductive Medicine
SGUL Research Institute / Research Centre: Academic Structure > Infection and Immunity Research Institute (INII)
Journal or Publication Title: Pediatric Allergy And Immunology
ISSN: 1399-3038
Language: eng
Dates:
DateEvent
1 August 2015Published
Publisher License: Creative Commons: Attribution 4.0
Projects:
Project IDFunderFunder ID
088862Wellcome Trusthttp://dx.doi.org/10.13039/100004440
R01 AI020565National Institute of Allergy and Infectious Diseaseshttp://dx.doi.org/10.13039/100000060
PubMed ID: 25955441
Web of Science ID: WOS:000358698100005
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/107866
Publisher's version: https://doi.org/10.1111/pai.12401

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