The online version of this article (doi:10.1186/2045-7022-4-20) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
DLL developed the study-design, coordinated the data recollection and analysis and was in charge of the publication writing, submission and review process. HD was involved with the design of the study, the data analysis, review and approval of publication content. KSH designed the randomization and chaired the statistical analysis. He is author of several figures and he contributed to the review and approval of statistical data. AM discussed the design of the study –statistical part- and coordinated the statistical data analysis. RM has had a definite impact on the study design, gave the global ideas for the data analysis, corrected the publication draft and approved its final content. AAC, MAM, MBB, RCJ, MLCP, MACR, RGA, CYGC, DAGI, RGM, DHC, FJLZ, JALP, JJMC, NMJ, MAMA, AMH, AMM, DNL, LJPN, ERS, NRP and PGRO have participated in the details in design per center, data collection per center, data-correction and review and approval of the Mexican data in the publication. All authors read and approved the final manuscript.
Allergen exposure leads to allergen sensitization in susceptible individuals and this might influence allergic rhinitis (AR) phenotype expression. We investigated whether sensitization patterns vary in a country with subtropical and tropical regions and if sensitization patterns relate to AR phenotypes or age.
In a national, cross-sectional study AR patients (2-70 y) seen by allergists underwent blinded skin prick testing with a panel of 18 allergens and completed a validated questionnaire on AR phenotypes.
628 patients were recruited. The major sensitizing allergen was house dust mite (HDM) (56%), followed by Bermuda grass (26%), ash (24%), oak (23%) and mesquite (21%) pollen, cat (22%) and cockroach (21%). Patients living in the tropical region were almost exclusively sensitized to HDM (87%). In the central agricultural zones sensitization is primarily to grass and tree pollen. Nationwide, most study subjects had perennial (82.2%), intermittent (56.5%) and moderate-severe (84.7%) AR. Sensitization was not related to the intermittent-persistent AR classification or to AR severity; seasonal AR was associated with tree (p < 0.05) and grass pollen sensitization (p < 0.01). HDM sensitization was more frequent in children (0-11 y) and adolescents (12-17 y) (subtropical region: p < 0.0005; tropical region p < 0.05), but pollen sensitization becomes more important in the adult patients visiting allergists (Adults vs children + adolescents for tree pollen: p < 0.0001, weeds: p < 0.0005).
In a country with (sub)tropical climate zones SPT sensitization patterns varied according to climatological zones; they were different from those found in Europe, HDM sensitization far outweighing pollen allergies and Bermuda grass and Ash pollen being the main grass and tree allergens, respectively. Pollen sensitization was related to SAR, but no relation between sensitization and intermittent-persistent AR or AR severity could be detected. Sensitization patterns vary with age (child HDM, adult pollen). Clinical implications of our findings are dual: only a few allergens –some region specific- cover the majority of sensitizations in (sub)tropical climate zones. This is of major importance for allergen manufacturers and immunotherapy planning. Secondly, patient selection in clinical trials should be based on the intermittent-persistent and severity classifications, rather than on the seasonal-perennial AR subtypes, especially when conducted in (sub)tropical countries.
Additional file 1: Figure S1: Skin prick test positivity all allergens nationwide: wheal size. (JPEG 80 KB)13601_2013_893_MOESM1_ESM.jpeg
Additional file 2: Table S1: Mean wheal size (cm2) of pollen extracts in SPT (+) subjects per subgroup. Table S2. Mean wheal size (cm2) of non-pollen extracts in SPT (+) subjects per subgroup. (XLS 48 KB)13601_2013_893_MOESM2_ESM.xls
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- Allergen sensitization linked to climate and age, not to intermittent-persistent rhinitis in a cross-sectional cohort study in the (sub)tropics
Martín Bedolla Barajas
Ruth Cerino Javier
María de la Luz Cid del Prado
Manuel Alejandro Cruz Moreno
Roberto García Almaráz
Cecilia Y García-Cobas
Daniel A Garcia Imperial
Rosa Garcia Muñoz
Francisco J Linares-Zapien
Jorge A Luna-Pech
Juan J Matta-Campos
Norma Martinez Jiménez
Miguel A Medina-Ávalos
Alejandra Medina Hernández
Alberto Monteverde Maldonado
Doris N López
Luis J Pizano Nazara
Emmanuel Ramirez Sanchez
José D Ramos-López
Pablo G Rodríguez-Ortiz
- BioMed Central
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