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Allergen wheal area during early childhood predicts allergic rhinitis phenotypes at age four

Codispoti, Christopher D.

Abstract Details

2012, PhD, University of Cincinnati, Medicine: Epidemiology (Environmental Health).

Allergic rhinitis (AR) is an IgE-mediated disease of the upper respiratory tract characterized by symptoms of rhinorrhea, nasal obstruction, itching, and sneezing in response to allergen exposure. Allergic rhinitis is common in childhood, affecting 42% of six year old children, and is associated with an increased risk of asthma. Thus, determining early childhood risk factors may be important for not only AR, but also asthma. The study hypothesis is that size of the specific aeroallergen wheal area in ages one through three is significantly associated with AR at age four.

Two specific aims were completed to test this hypothesis. The first specific aim of this study was to determine the size of the skin prick test (SPT) wheal area from 15 individual aeroallergens during early childhood (age one through three) and its association with AR at age four. The second aim was to determine if any individual age-specific aeroallergen wheal area association persisted in a multivariate logistic regression model after controlling for covariates and multiple testing. The analysis was extended further to address a more specific phenotype, allergic eosinophilic rhinitis (AER), defined as AR with nasal eosinophilia. We examined if the individual aeroallergen wheal areas were associated with AER in univariate and multivariate analysis.

This study was part of the Cincinnati Childhood Asthma and Air Pollution Study where allergen skin prick tests (SPT) were performed at ages one through four at annual clinical visits. SPT wheal circumferences were traced, recorded on transpore tape, and digitized which allowed accurate estimates of wheal areas by planimetry. Timothy and Alternaria wheal areas at age two were significantly associated to AR at age four (aOR 1.06; 95% CI, 1.02 - 1.11; p = 0.01) and (aOR 1.07; 95% CI 1.0-1.15; p = 0.04), respectively. Fescue, dog, and Penicillium wheal areas at age three were significantly associated with AR at age four (aOR 1.08; 95% CI, 1.02 - 1.15; p = 0.02), (aOR 1.06; 95% CI, 1.01 - 1.12; p = 0.03) and (aOR 1.14; 95% CI, 1.06 - 1.23; p = 0.001), respectively. At age three, maple and Penicillium wheal areas were significantly associated with AER at age four, (aOR 1.07; 95% CI, 1.01 - 1.13; p = 0.02) and (aOR 1.18; 95% CI, 1.06 - 1.32; p = 0.002), respectively. The conclusion of this study is that the size of aeroallergen wheal area during the first three years of life predicts AR phenotypes at age four. The significance of this finding is that the risk of AR at age four can be attributed to the wheal area of a few aeroallergens. This finding can be used to refine high-risk populations in AR intervention trials. Future studies should investigate if this AR finding extend to earlier into preschool years, to school age children, why these allergens are immunogenic and if wheal area predicts lower respiratory (ex. asthma) phenotypes.

Grace Lemasters, PhD (Committee Chair)
David Bernstein, MD (Committee Member)
Linda Levin, PhD (Committee Member)
Michell Lierl, MD (Committee Member)
129 p.

Recommended Citations

Citations

  • Codispoti, C. D. (2012). Allergen wheal area during early childhood predicts allergic rhinitis phenotypes at age four [Doctoral dissertation, University of Cincinnati]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1338581769

    APA Style (7th edition)

  • Codispoti, Christopher. Allergen wheal area during early childhood predicts allergic rhinitis phenotypes at age four. 2012. University of Cincinnati, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=ucin1338581769.

    MLA Style (8th edition)

  • Codispoti, Christopher. "Allergen wheal area during early childhood predicts allergic rhinitis phenotypes at age four." Doctoral dissertation, University of Cincinnati, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1338581769

    Chicago Manual of Style (17th edition)