Allergic Sensitization and Respiratory Health in Children With Asthma in the Eastern Mediterranean

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Abstract RATIONALE: The spring and fall seasons in Eastern Mediterranean are characterized by moderate temperatures, low precipitation and atmospheric instability that increase potential exposure to aeroallergens through frequent desert dust storms and high pollen counts. Although aeroallergen exposure may worsen asthma in atopic children, the association of atopy with respiratory health in a region characterized by overlapping seasonal dust and pollen periods, such as Cyprus and Crete, Greece, has not been examined. METHODS: We conducted a secondary analysis of respiratory health data collected during a randomized clinical trial in primary school children with asthma in Cyprus and Crete, which included the use of air purifiers and recommendations to limit outdoor activities (NCT03503812). The study took place in spring 2019 and 2021 in Cyprus and spring 2019 and fall 2021 in Crete. Children were assessed 3 to 4 times over 4 months, including allergen sensitization evaluated at the end of the follow-up using skin prick tests with a panel of 14 aeroallergens common in Cyprus and Crete. Mixed effect models were used to assess associations between atopy and respiratory health measures, adjusting for study arm, country, year, weeks on study, age, and gender. RESULTS: The analytical sample included 133 children (79 atopic and 54 non-atopic; mean (SD) age=9.5 (1.6) years; 64% boys). Over the study period, atopic children exhibited 113.2% (95% CI=66.7%, 172.5%) higher fractional exhaled nitric oxide (FeNO) levels and were more likely to use asthma medication in the preceding month (OR=2.30, 95% CI=1.06, 4.98), compared to non-atopic children with asthma. There was no significant difference in childhood Asthma Control Test (c-ACT) scores (median=23 to 25 at each study visit) or healthcare visits. Among atopic participants, there was a significant weekly decline in %-predicted FEV1 (-0.28, 95% CI=-0.43, -0.13) and FEV1/FVC% (-0.15, 95% CI=-0.24, -0.07). Sensitivity analyses that only included children assessed during spring (pollen season) yielded similar findings. The most common sensitizing antigens among atopic children were seasonal, including Olive (55.4%) and tree mix (45.2%). Children with only seasonal sensitization had the highest odds ratio (OR=4.62, 95% CI=1.53, 13.97) for asthma medication use during the study compared to non-atopic children. CONCLUSIONS: Lower pulmonary function, increased medication use and higher FeNO among atopic children with asthma suggest that atopic children may be prone to worse asthma morbidity compared to non-atopic children during the overlapping seasonal dust and pollen periods in Cyprus and Crete, despite no meaningful change in monthly c-ACT score.

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