The Journal of Asthma Research. Vol. 16. No. 3, April, 1979
J Asthma Downloaded from informahealthcare.com by McMaster University on 11/17/14 For personal use only.
Allergenic Factors and Symptomatology of Respiratory Allergy Patients*
Allergy is one of the most ancient and common of human ailments. It has been estimated that approximately 10 per cent of the population has been inflicted with one or more major allergic disorders in the United States of America,’ while the number of people suffering with active allergy ailments in the United Kingdom’ is 12 per cent. The statistics of the prevalence of allergy among the inhabitants of the Indian subcontinent are not known, but the incomplete statistics3 revealed that as many as 10 per cent have been suffering with respiratory allergic disorders. Allergic disorders among human beings4* are attributed to several causative agents (pollen, fungal spores, dusts, dust-mites, danders, feathers, pollutants and climatic factors). Pollen, fungal spores and house dust-mites are the chief offending allergens among them. A thorough understanding of the symptomatology of respiratory allergy patients is essential for the diagnosis and therapeutic treatment of respiratory allergy patients. Investigations aimed at explaining the relationships between the concentration and diurnal periodicities of the major causative factors and symptomatology of respiratory allergy patients are, therefore, a prerequisite; but such studies are almost unknown except for a few isolated report^.^-'^ The results of correlative studies carried out on the prevalence of atmospheric total pollen, major individual pollen types, total fungal spores, and house dust-mites and symptomatology of respiratory allergy patients in Delhi, together with the relationships of the last with the temperature and relative humidity, are presented here. The studies show that there is no functional connection between the quantum of atmospheric allergens and the incidence of respiratory allergic cases, but the latter seems to have significant relationship to the temperature.
Materials and Methods The concentrations of atmospheric pollen, fungal spores, and house dustmites are expressed as monthly means. The means of pollen were calculated (No./cm’) from the data of eight annual surveys conducted at four different ecological sites in Delhi from 1973-1975,13 while those of fungal spores and house dust-mites were based on only one year’s data.I4*” Temperature and relative humidity (5%) were expressed as monthly mean values based on the * Presented at the VIth International Palynological Conference held at Lucknow in DecemberJanuary 1976-77. t Department of Botany, University of Delhi, Delhi 110007. Director, National Allergy Centre, A-10 Pamposh Enclave, New Delhi 110048.
*
97
98
C. BABU, A. SINGH AND D. SHIVPURI
J Asthma Downloaded from informahealthcare.com by McMaster University on 11/17/14 For personal use only.
data recorded at Safdarjang Airport, New Delhi, for the year 1973. The percentage of patients reporting symptoms in different months was calculated, based on the medical case histories of 280 Delhi patients of naso-bronchial allergy attended for treatment at the Clinical Research Centre of Vallabhbhai Pate1 Chest Institute, University of Delhi, Delhi. The percentage of patients showing reactions to individual pollen allergens was calculated only from those patients positive (2+ to 4+ skin reactions) to respective pollen allergens.
Results and Discussion The statistical test of significance (student’s ‘t’ test) of the ‘r’ values (calculated by using Pearson’s Product-Moment Correlation Coefficient) revealed lack of significant correlation in all the causative factors analysed except in the temperature, which showed a highly significant negative correlation (see Figure S
=
o=
= 1
220-
1
200 -
A=
POLLEN
R E L b T l V E HUMIDITY
E
r
360
I,
f
3
I
LL LL
0 (r
w
4140
a (
3
3
z
51L16V I
33p>0051
35
A
,120
-
1
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W 2
:loo a
-
::80-
‘ A
a
0
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I
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ul
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I r = O 46, p z 0 0 5 1
-
0
a 0 z
051
0 001. X
u
0
-1
l r = O
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O 051
GRAINS I r = - O
F U N G A L S P O R E S I ( = O 1 7 , p ’0
0
3
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01
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a
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0 I .
30
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I
50
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60
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PERCENTAGE Q F D E L H I P A T I E N T S SHOWINGSYMPTOMS
FIG. 1.-Correlation between some known allergenic factors and total symptornatology of respiratory allergy patients.
99
J Asthma Downloaded from informahealthcare.com by McMaster University on 11/17/14 For personal use only.
ALLERGENIC FACTORS A N D SYMPTOMATOLOGY OF ALLERGY PATIENTS
1).When the major individual pollen types were plotted against the monthly percentage of patients reporting symptoms, no significant correlation was obtained except in Prosopis, which showed a significant positive correlation (see Figure 2). This suggests that it is not the quantity but the quality (type) of the allergen which is the major factor in the incidence of symptomatic respiratory allergy. This is further confirmed by the fact that the pollen of Prosopis juliflora showed a significant positive correlation. However, the absence of significant Correlation in cases of well-known, notorious pollen allergens, such as grasses and cheno-amaranth on the one hand, and a highly significant negative correlation with the temperature on the other hand, does explain that it is not just the type of pollen but other causative/or promoting 75
rI
0 z GRASSES ( r z - 0 . 3 6 r p > O . O 5 ) z CHENO/AMARANTH ir zO.lQ,p>o.05 I :PROSOPISlr~0.75,p~0.Oll I X r 37.61848+0.66452~1 A zBRASSICA ( r z 0 . 4 3 , p>0.051 A zMORUS I r -0.27, p>O.OJI 0: A R T E M l S A ( r r 0 . 2 l , p > O 0 5 1
*
65 (-u E
\o
A
0
55
0
0
35
25
0
t 0
0
0
0 0
0
5
A
0
0
0 0
0
A
20
30
40
50
60
70
80
PERCENTAGE OF PATIENTS
FIG. 2.-Relationship between major offending pollen allergens and monthly percentage of patient reporting symptoms positive to respective pollen allergens (2+ to 4+ skin reactions).
J Asthma Downloaded from informahealthcare.com by McMaster University on 11/17/14 For personal use only.
100
C. BABU, A. SINGH A N D D. SHIVPURI
factors which are responsible for the symptomatology of respiratory allergy patients. A similar observation with ragweed pollen asthma has also been reported by Bruce and coworkers,IGwho found essentially no relationship between asthma scores and pollen counts of ragweed in ragweed-proven asthmatic patients. The percentage of relative humidity does not show any significant relationship with the monthly percentage of patients reporting symptoms, and this point proves that the temperature is the major and important factor in precipitating the symptoms of respiratory allergy patients. This observation confirms the view expressed by other workers."12 It is likely that the low temperature is conducive to the onset of symptoms among patients who are already allergic to one or other allergens, but the real role of temperature in symptomatology is not known. The possibility that the high incidence of symptomatic respiratory allergy in patients during the winter months may be due to increased incidence of respiratory infections, house dust, and house dust-mites from blankets and old cotton mattresses (which in India are taken out after 6-8 months storage) cannot be ruled out, because these agents may act as triggers in patients. The conclusions are that the concentration of atmospheric pollen, fungal spores and house dust-mites does not have a functional relationship with the symptomatology of respiratory allergy patients, but the type of pollen appears to have some connection with it. Temperature plays an important role in precipitating symptoms among respiratory allergy patients. Volumetric analysis of air-borne allergens is not of much significance in allergic studies, particularly with the symptomatology. Symptomatology is a complex phenomenon, and is greatly influenced by extrinsic and intrinsic factors. Summary
An attempt has been made in the present study to find out the relationship between the symptomatology of nasobronchial allergy patients of Delhi with markedly positive skin reactions and prevalence of total pollen concentration in the atmosphere, concentration of major individual pollen types, total fungal spores and house dust mites together with climatic factors such as mean monthly temperature and relative humidity. A statistically significant correlation was not found between symptomatology of the patients of Delhi and mean monthly relative humidity, atmospheric concentration of pollen, fungal spores and house dust mites. A significant negative correlation was observed between symptomatology of patients and mean monthly temperature. Except for the pollen of prospis which showed significant positive correlation with the symptomatology of Delhi patients, a significant positive correlation was absent with respect to other individual pollen types.
Acknowledgment We are thankful to Mr. Neeraj Mathur for helping in statistical analysis.
ALLERGENIC FACTORS A N D SYMPTOMATOLOGY OF ALLERGY PATIENTS
101
J Asthma Downloaded from informahealthcare.com by McMaster University on 11/17/14 For personal use only.
References 1. WILLIAMS, D. A. In Allergy (ed. Jamer, J.M.) 76-119. Blackwell Scientific Publ., Oxford, 1959. 2. BARKIN, G. D. & MCGOVERN, J. P. Allergy statistics, Ann. Allergy 24602-609, 1966. R. Definition, incidence, aetiology and natural history of asthma, Indian J. 3. VISHWANATHAN, Chest Dis. 6109-124, 1964. 4. SHELDON, J. M., LOVEL,R. G. & MATHEWS, K. P. A Manual of Clinical Allergy, W. B. Saunders, Philadelphia, 1967. 5. NEWMARK, F. M. Pollen aerobiology-The need for research and compilation, Ann. Allergy 26358-373, 1968. 6. SALVAGGIO, J., SEABURY, J. & SCHOENHARDT, E. A. New Orleans asthma, J. Allergy Clin. Immunol. 48:96-114, 1971. J., ZASLOW, L., GREER,J. & SEABURY, J. New Orleans asthma. 111. Semiquanti7. SALVAGGIO, tative aerometric pollen sampling 1967 and 1968, Ann. Allergy 29305-317, 1971. 8. BOOTH,S., DE GROOT, I., MARKUSH, R. & HORTON, R. J. Detection of asthma epidemics in seven cities, Arch. Enuiron. Health 10:152-155, 1965. 9. COHEN, A. A., BROMBERG, S., BUECHLEY, R. W., HEIDERSCHELT, L. T . & SHY,C. M. Asthma and air pollution from a coal fueled power plant, Am. J . Pub. Health 62(9):1181-1188, 1972. 10. GREENBERG, L., FIELD,F., REED,J. I. & ERHARDT, C. L. Asthma and temperature change, Arch. Enuiron. Health 8642-647, 1964. Asthma and temperature change, Arch. Enuiron. Health 12561-563, 1966. 11. -. 12. CHARPIN, J., BOUTIN, C., ARNAUD, A,, DELGOVE, P. & OREHEK, J . Environment and respiratory allergic diseases. In Allergy 74 (ed. Ganderton, M. A. & Frankland, A. W.) 285-302, 1975. 13. SINGH, A. B. Studies on atmospheric pollen of Delhi with reference to respiratory allergy. Ph.D. Thesis submitted to Delhi University, 1977. 14. AGARWAL, M. K. & SHIVPURI, D. N. Fungal spores-The role in respiratory allergy, Advances in Pollen Spore Research 1:18-128, 1974. D. N . & MENON,M. P. S. Seasonal periodicity of house dust mite 15. DAR, N., SHIVPURI, population, Aspects Allergy Appl. Immun. Z63-70, 1974. 16. BRUCE,C. A,, NORMAN, P. S., ROSENTHAL, R. R. & LICHENSTEIN, L. M. The role of ragweed pollen in autumnal asthma, J. Allergy Clin. Immunol. 59:449-459, 1977.
J Asthma Downloaded from informahealthcare.com by McMaster University on 11/17/14 For personal use only.
Allergenic Factors and Symptomatology of Respiratory Allergy Patients*
Allergy is one of the most ancient and common of human ailments. It has been estimated that approximately 10 per cent of the population has been inflicted with one or more major allergic disorders in the United States of America,’ while the number of people suffering with active allergy ailments in the United Kingdom’ is 12 per cent. The statistics of the prevalence of allergy among the inhabitants of the Indian subcontinent are not known, but the incomplete statistics3 revealed that as many as 10 per cent have been suffering with respiratory allergic disorders. Allergic disorders among human beings4* are attributed to several causative agents (pollen, fungal spores, dusts, dust-mites, danders, feathers, pollutants and climatic factors). Pollen, fungal spores and house dust-mites are the chief offending allergens among them. A thorough understanding of the symptomatology of respiratory allergy patients is essential for the diagnosis and therapeutic treatment of respiratory allergy patients. Investigations aimed at explaining the relationships between the concentration and diurnal periodicities of the major causative factors and symptomatology of respiratory allergy patients are, therefore, a prerequisite; but such studies are almost unknown except for a few isolated report^.^-'^ The results of correlative studies carried out on the prevalence of atmospheric total pollen, major individual pollen types, total fungal spores, and house dust-mites and symptomatology of respiratory allergy patients in Delhi, together with the relationships of the last with the temperature and relative humidity, are presented here. The studies show that there is no functional connection between the quantum of atmospheric allergens and the incidence of respiratory allergic cases, but the latter seems to have significant relationship to the temperature.
Materials and Methods The concentrations of atmospheric pollen, fungal spores, and house dustmites are expressed as monthly means. The means of pollen were calculated (No./cm’) from the data of eight annual surveys conducted at four different ecological sites in Delhi from 1973-1975,13 while those of fungal spores and house dust-mites were based on only one year’s data.I4*” Temperature and relative humidity (5%) were expressed as monthly mean values based on the * Presented at the VIth International Palynological Conference held at Lucknow in DecemberJanuary 1976-77. t Department of Botany, University of Delhi, Delhi 110007. Director, National Allergy Centre, A-10 Pamposh Enclave, New Delhi 110048.
*
97
98
C. BABU, A. SINGH AND D. SHIVPURI
J Asthma Downloaded from informahealthcare.com by McMaster University on 11/17/14 For personal use only.
data recorded at Safdarjang Airport, New Delhi, for the year 1973. The percentage of patients reporting symptoms in different months was calculated, based on the medical case histories of 280 Delhi patients of naso-bronchial allergy attended for treatment at the Clinical Research Centre of Vallabhbhai Pate1 Chest Institute, University of Delhi, Delhi. The percentage of patients showing reactions to individual pollen allergens was calculated only from those patients positive (2+ to 4+ skin reactions) to respective pollen allergens.
Results and Discussion The statistical test of significance (student’s ‘t’ test) of the ‘r’ values (calculated by using Pearson’s Product-Moment Correlation Coefficient) revealed lack of significant correlation in all the causative factors analysed except in the temperature, which showed a highly significant negative correlation (see Figure S
=
o=
= 1
220-
1
200 -
A=
POLLEN
R E L b T l V E HUMIDITY
E
r
360
I,
f
3
I
LL LL
0 (r
w
4140
a (
3
3
z
51L16V I
33p>0051
35
A
,120
-
1
A
W 2
:loo a
-
::80-
‘ A
a
0
W
60-
m
I
LO1-1
ul
t z
3
= 93
I r = O 46, p z 0 0 5 1
-
0
a 0 z
051
0 001. X
u
0
-1
l r = O
p
O 051
GRAINS I r = - O
F U N G A L S P O R E S I ( = O 1 7 , p ’0
0
3
z
40 20 -
01
0
a
@
0 I .
30
0
LO
a
I
50
@, @
60
@
@
3
70
1, j:
PERCENTAGE Q F D E L H I P A T I E N T S SHOWINGSYMPTOMS
FIG. 1.-Correlation between some known allergenic factors and total symptornatology of respiratory allergy patients.
99
J Asthma Downloaded from informahealthcare.com by McMaster University on 11/17/14 For personal use only.
ALLERGENIC FACTORS A N D SYMPTOMATOLOGY OF ALLERGY PATIENTS
1).When the major individual pollen types were plotted against the monthly percentage of patients reporting symptoms, no significant correlation was obtained except in Prosopis, which showed a significant positive correlation (see Figure 2). This suggests that it is not the quantity but the quality (type) of the allergen which is the major factor in the incidence of symptomatic respiratory allergy. This is further confirmed by the fact that the pollen of Prosopis juliflora showed a significant positive correlation. However, the absence of significant Correlation in cases of well-known, notorious pollen allergens, such as grasses and cheno-amaranth on the one hand, and a highly significant negative correlation with the temperature on the other hand, does explain that it is not just the type of pollen but other causative/or promoting 75
rI
0 z GRASSES ( r z - 0 . 3 6 r p > O . O 5 ) z CHENO/AMARANTH ir zO.lQ,p>o.05 I :PROSOPISlr~0.75,p~0.Oll I X r 37.61848+0.66452~1 A zBRASSICA ( r z 0 . 4 3 , p>0.051 A zMORUS I r -0.27, p>O.OJI 0: A R T E M l S A ( r r 0 . 2 l , p > O 0 5 1
*
65 (-u E
\o
A
0
55
0
0
35
25
0
t 0
0
0
0 0
0
5
A
0
0
0 0
0
A
20
30
40
50
60
70
80
PERCENTAGE OF PATIENTS
FIG. 2.-Relationship between major offending pollen allergens and monthly percentage of patient reporting symptoms positive to respective pollen allergens (2+ to 4+ skin reactions).
J Asthma Downloaded from informahealthcare.com by McMaster University on 11/17/14 For personal use only.
100
C. BABU, A. SINGH A N D D. SHIVPURI
factors which are responsible for the symptomatology of respiratory allergy patients. A similar observation with ragweed pollen asthma has also been reported by Bruce and coworkers,IGwho found essentially no relationship between asthma scores and pollen counts of ragweed in ragweed-proven asthmatic patients. The percentage of relative humidity does not show any significant relationship with the monthly percentage of patients reporting symptoms, and this point proves that the temperature is the major and important factor in precipitating the symptoms of respiratory allergy patients. This observation confirms the view expressed by other workers."12 It is likely that the low temperature is conducive to the onset of symptoms among patients who are already allergic to one or other allergens, but the real role of temperature in symptomatology is not known. The possibility that the high incidence of symptomatic respiratory allergy in patients during the winter months may be due to increased incidence of respiratory infections, house dust, and house dust-mites from blankets and old cotton mattresses (which in India are taken out after 6-8 months storage) cannot be ruled out, because these agents may act as triggers in patients. The conclusions are that the concentration of atmospheric pollen, fungal spores and house dust-mites does not have a functional relationship with the symptomatology of respiratory allergy patients, but the type of pollen appears to have some connection with it. Temperature plays an important role in precipitating symptoms among respiratory allergy patients. Volumetric analysis of air-borne allergens is not of much significance in allergic studies, particularly with the symptomatology. Symptomatology is a complex phenomenon, and is greatly influenced by extrinsic and intrinsic factors. Summary
An attempt has been made in the present study to find out the relationship between the symptomatology of nasobronchial allergy patients of Delhi with markedly positive skin reactions and prevalence of total pollen concentration in the atmosphere, concentration of major individual pollen types, total fungal spores and house dust mites together with climatic factors such as mean monthly temperature and relative humidity. A statistically significant correlation was not found between symptomatology of the patients of Delhi and mean monthly relative humidity, atmospheric concentration of pollen, fungal spores and house dust mites. A significant negative correlation was observed between symptomatology of patients and mean monthly temperature. Except for the pollen of prospis which showed significant positive correlation with the symptomatology of Delhi patients, a significant positive correlation was absent with respect to other individual pollen types.
Acknowledgment We are thankful to Mr. Neeraj Mathur for helping in statistical analysis.
ALLERGENIC FACTORS A N D SYMPTOMATOLOGY OF ALLERGY PATIENTS
101
J Asthma Downloaded from informahealthcare.com by McMaster University on 11/17/14 For personal use only.
References 1. WILLIAMS, D. A. In Allergy (ed. Jamer, J.M.) 76-119. Blackwell Scientific Publ., Oxford, 1959. 2. BARKIN, G. D. & MCGOVERN, J. P. Allergy statistics, Ann. Allergy 24602-609, 1966. R. Definition, incidence, aetiology and natural history of asthma, Indian J. 3. VISHWANATHAN, Chest Dis. 6109-124, 1964. 4. SHELDON, J. M., LOVEL,R. G. & MATHEWS, K. P. A Manual of Clinical Allergy, W. B. Saunders, Philadelphia, 1967. 5. NEWMARK, F. M. Pollen aerobiology-The need for research and compilation, Ann. Allergy 26358-373, 1968. 6. SALVAGGIO, J., SEABURY, J. & SCHOENHARDT, E. A. New Orleans asthma, J. Allergy Clin. Immunol. 48:96-114, 1971. J., ZASLOW, L., GREER,J. & SEABURY, J. New Orleans asthma. 111. Semiquanti7. SALVAGGIO, tative aerometric pollen sampling 1967 and 1968, Ann. Allergy 29305-317, 1971. 8. BOOTH,S., DE GROOT, I., MARKUSH, R. & HORTON, R. J. Detection of asthma epidemics in seven cities, Arch. Enuiron. Health 10:152-155, 1965. 9. COHEN, A. A., BROMBERG, S., BUECHLEY, R. W., HEIDERSCHELT, L. T . & SHY,C. M. Asthma and air pollution from a coal fueled power plant, Am. J . Pub. Health 62(9):1181-1188, 1972. 10. GREENBERG, L., FIELD,F., REED,J. I. & ERHARDT, C. L. Asthma and temperature change, Arch. Enuiron. Health 8642-647, 1964. Asthma and temperature change, Arch. Enuiron. Health 12561-563, 1966. 11. -. 12. CHARPIN, J., BOUTIN, C., ARNAUD, A,, DELGOVE, P. & OREHEK, J . Environment and respiratory allergic diseases. In Allergy 74 (ed. Ganderton, M. A. & Frankland, A. W.) 285-302, 1975. 13. SINGH, A. B. Studies on atmospheric pollen of Delhi with reference to respiratory allergy. Ph.D. Thesis submitted to Delhi University, 1977. 14. AGARWAL, M. K. & SHIVPURI, D. N. Fungal spores-The role in respiratory allergy, Advances in Pollen Spore Research 1:18-128, 1974. D. N . & MENON,M. P. S. Seasonal periodicity of house dust mite 15. DAR, N., SHIVPURI, population, Aspects Allergy Appl. Immun. Z63-70, 1974. 16. BRUCE,C. A,, NORMAN, P. S., ROSENTHAL, R. R. & LICHENSTEIN, L. M. The role of ragweed pollen in autumnal asthma, J. Allergy Clin. Immunol. 59:449-459, 1977.
