Allergy Asthma Respir Dis.  2017 Mar;5(2):83-91. 10.4168/aard.2017.5.2.83.

Relationship between atopy and bronchial hyperresponsiveness to indirect stimuli in asthmatic children

• Park TY
• Yi MJ
• Choi WH
• Kim SY
• Yu R
• Ban JE
• Yang S
• Hwang IT
• Baek HS

• KMID: 2392379
• DOI: http://doi.org/10.4168/aard.2017.5.2.83

Abstract

PURPOSE
Both atopy and bronchial hyperresponsiveness (BHR) are characteristic features of asthma. Several BHR studies comparing groups of atopic and nonatopic asthmatics have reported conflicting results. The aim of this study was to compare BHR to indirect stimuli, such as mannitol or exercise, between atopic and nonatopic asthmatics in children.
METHODS
We performed a retrospective analysis of data from 110 children with asthma, aged 6-18 years using skin prick tests, and serum total and specific IgE levels. Atopy degree was measured using the sum of graded wheal size or the sum of the allergen-specific IgE. Bronchial provocation tests (BPTs) using methacholine were performed on all subjects. BPTs using indirect simuli, including exercise and mannitol, were also performed.
RESULTS
Asthma cases were classified as atopic asthma (n=83) or nonatopic asthma (n=27) from skin prick or allergen-specific IgE test results. There was no significant difference in the prevalence of BHR to mannitol or exercise between atopic and nonatopic asthmatics. Atopic asthma had a significantly lower postexercise maximum decrease in % forced expiratory volume in 1 second (FEV1) (geometric mean [95% confidence interval]: 31.9 [22.9-40.9] vs. 14.0 [9.4-18.6], P=0.015) and a methacholine PC20 (provocative concentration of methacholine inducing a 20% fall in FEV1) than nonatopic asthmatics (geometric mean [95% confidence interval]: 1.24 [0.60-1.87] ng/mL vs. 4.97 [3.47-6.47]) ng/mL, P=0.001), whereas mannitol PD15 (cumulative provocative dose causing a 15% fall in FEV1) was not significantly different between the 2 groups.
CONCLUSION
There was no significant difference in the prevalence of BHR to mannitol or exercise between atopic and nonatopic asthmatics in children.

Keyword

Bronchial hyper-responsiveness; Atopy; Asthma; Child

MeSH Terms

Asthma
Bronchial Provocation Tests
Child*
Forced Expiratory Volume
Humans
Immunoglobulin E
Mannitol
Methacholine Chloride
Prevalence
Retrospective Studies
Skin
Immunoglobulin E
Mannitol
Methacholine Chloride

Figure

• 

  Fig. 1. Number of study subjects who underwent that bronchial provocation tests in atopic asthma group (n=83) (A) and nonaopic asthma group (n=27) (B).

• 

  Fig. 2. Correlations between mannitol PD15, postexercise maximum decrease in FEV1, and methacholine PC20. The manntiol challenge was completed when a ≥15% fall in FEV1 from baseline occurred, which was considered to be a positive response, or when the maximum cumulative dose of mannitol (635 mg) was administered. An exercise bronchoprovocation test was used for EIB diagnosis, which was considered positive with a 10% or greater decrease in FEV1 after exercise. (A) Mannitol PD15 was significantly correlated with methacholine PC20 in asthmatic subjects (n=59, r=0.538, P<0.001). (B) Postexercise maximum decrease in FEV1 in asthmatic subjects was significantly correlated with methacholine PC20 in asthmatic subjects (n=69, r=-0.294, P=0.014). (C) Postexercise maximum decrease in FEV1 was significantly correlated with mannitol PD15 in asthmatic subjects (n=14, r=-0.474, P=0.030). PD15, cumulative provocative dose causing a 15% fall in FEV1; PC20, provocative concentration of methacholine inducing a 20% fall in FEV1; FEV1, forced expiratory volume in 1 second; EIB, exercise induced bronchoconstriction. r=Spearman correlation coefficients.

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