SKIN-TEST REACTIVITY TO INDOOR ALLERGENS AS A MARKER OF ASTHMA SEVERITY IN CHILDREN WITH ASTHMA

Background: Specific IgE responses to common indoor aeroallergens in c hildren with asthma have been found to be associated with acute asthma . Objective: The purpose of this study was to examine the association between asthma severity and skin test reactivity to four common indoor allergens. Methods: The charts of 139 asthmatic children, aged 5 to 1 8 years, seen in a pediatric allergy clinic were reviewed to obtain th e results of skin tests to cat, dog, cockroach, and dust mite allergen s, FEV1, anti-asthma medication requirements and demographic character istics. Logistic regression for ordinal data was used to examine the a ssociation between skin test reactivity and asthma severity (mild, mod erate or severe) as determined from FEV1 and medication usage. Results : The rate of allergen sensitivities were dust mite 55%, cockroach 50% , cat 29% and dog 17%. Children with positive skin test to cat allerge n were more likely to have a higher asthma severity rating than childr en with a negative cat allergen skin test [proportional odds ratio (OR ) = 3.0, 95% confidence interval (CI) = 1.4 to 6.1, P = .003]. This as sociation remained significant after we controlled for skin test react ion to the other three allergens and various sociodemographic factors (adjusted OR = 3.0, 95% CI = 1.3 to 7.2, P = .013). The ORs for sensit ivity to dog, cockroach, and dust mite allergen did not differ signifi cantly from one, but children who were sensitized to all four allergen s had an OR of 4.8 (95% CI = 1.3 to 18, P = .019) relative to children who were not sensitized to any of the four allergens. This associatio n also remained significant after controlling for sociodemographic var iables (P = .030). Conclusion: Children with combined sensitivity to c at, dog, dust mite, and cockroach allergens were at increased risk of having more severe asthma. Our data also suggest that sensitization to cat allergen per se is a risk factor for more severe disease in these asthmatic children.