eISSN: 09748369

Inhalant allergens in respiratory disorders:

­comparative study on the intradermal
skin testing, IgE levels and spirometry
in South Indian population

Biology and Medicine

Research Article

Volume 4, Issue 4, Pages 167–177, 2012

Research Article Biology and Medicine, 4 (4): 167–177, 2012

www.biolmedonline.com

Inhalant allergens in respiratory disorders: comparative study

on the intradermal skin testing, IgE levels and spirometry
in South Indian population
MSS Ansari*, MH Hussain
Department of Pulmonary and Critical Care Medicine, Mahavir Hospital and Research Centre,
Hyderabad, Andhra Pradesh, India.

*Corresponding Author: mohdsoheb@yahoo.co.in

Accepted: 25th Sep 2012, Published: 09th Oct 2012

Abstract
Allergy is considered to be the most damaging factor for the causation of bronchial asthma. An attempt was made
to identify the allergens and the risk factors, and their correlation with IgE levels and spirometry – the measuring of
breath which is the most common of the pulmonary function. The study group consisted of 139 patients suffering from
asthma from South India, visiting Mahavir Hospital. Screening and clinical investigations were performed for all cases.
Intradermal skin test was done for the identification of allergens. Patients with respiratory allergy were in the age
group of 20–39 years. About 55.4% were males and 44.6% females and 59.7% were from urban areas. The disease
conditions prevalent among these patients were asthma and rhinitis in 64%, asthma in 29.5%, asthma, urticaria and
rhinitis in 4.3%, and asthma and urticaria in 2.2%; some of the male patients were cigarette smokers. Most individuals
used LPG as fuel (96%) and few individuals used kerosene and cow dung as fuel. The percentage of patients positive
for various fungal and pollen allergens was identified. Comparative studies with spirometry showed FEV1, FVC, and
FEV1/FVC were ,80%. IgE levels were more than 100 IU in 87% of individuals. 40% of patients had family history
of allergy and 10% had history of pets at home. Higher prevalence of asthma was among men. Maximum popula-
tion was from urban areas. Allergic symptoms co-existed and skin testing reflected the behavior of disease. Patients
with allergen sensitivity showed obstructive airways. It is concluded that the identification of allergens can allow early
­intervention of ongoing disease and modification of subsequent natural history of disease.

Keywords: Respiratory allergy; IgE; spirometry; allergen; skin testing.

Introduction increased risk of developing disease. In this study,

Airborne bio-pollutants pose a great ­problem
globally due to their allergenic properties. Agents
causing respiratory allergies in human beings
of biological origin are collectively known as
­Bio-aeroallergens (Singh and Singh, 1994)..
Atopic allergy is caused due to high levels of
immunoglobins – IgE and has a multifactorial
inheritance pattern. Among the environmental
factors, aeroallergens play a major role in caus-
ing allergies; this can be determined by testing
the patient against known antigen (Anuradha
et al., 2006).
Allergic diseases are complex multifac-
torial diseases and their development and phe-
notypic expression depends on an interaction
between environmental exposure to allergens
and non-specific adjuvant factor and genetic
factors (Ober, 1998). Children born from par-
ents of asthma and allergic diseases present an
we screened patients from South India for deter-
mining their cause of asthma and rhinitis using
skin testing methods, spirometry, and IgE levels.
Patients and Methods
Study group
The study group consisted of 139 patients.
A detailed history was taken and thorough
clinical examination was done and asthma was
defined as per the questionnaire. The study was
conducted for one year and eight months (from
July 2010 to March 2012).
Study protocol
A detailed history was taken and clinical exami-
nation was performed. The questionnaire used
in this study had two components. The first
part of the questionnaire aimed at collecting

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Research Article Biology and Medicine, 4 (4): 167–177, 2012

i­nformation on respiratory symptoms and estab-   3. Alternaria

lishing a diagnosis of asthma based on this data.   4. Candida albicans
The second component was aimed at collect-   5. Cladosporium
ing information on possible demographic and   6. Curvularia species
environmental exposure factors influencing the   7. Fusarium soloni
prevalence of asthma. The respiratory ques-   8. Helminthosporium
tionnaires from The International Union Against   9. Mucor mucedo
Tuberculosis and Lung Diseases (IUATLD) 1984 10. Nigrospora
and The International Study of Asthma and 11. Rhizopus
Allergies in Childhood (ISAAC) 1998 were used 12. Trichoderma
(Burney et al., 1989, ISAAC, 1998; Jindal et al.,
2000). Routine screening investigations in all Insect:
cases giving emphasis on blood eosinophilia,   1. Ant
stool examination, X-ray chest, and pulmonary   2. Housefly
function test were performed.   3. Mosquito
Informed consent from all the partici-   4. Cockroach
pants was obtained before the start of the study.   5. Cantheroid beetle
The clearance certificate was obtained from hos-   6. Moth
pital’s Review Board and Ethical Committee.
Dust:
Antigen used in present study
Various types of pollen, fungi, insect, dust, danders,   1. Cotton dust
and feathers were the antigens included in the   2. House dust mite
study and these are listed in Annexure I.   3. House dust
  4. Paper dust
  5. Rice grain dust
Annexure I   6. Wheat thrashing dust
  7. Wheat grain dust
Pollens used for skin testing:   8. Straw dust
1. Ageratum conyzoides
2. Amaranthus species Danders:
3. Argemone mexicana   1. Buffalo dander
4. Artemisia scoparia   2. Cat dander
5. Azadirachta indica   3. Cow dander
6. Brassica campestris   4. Dog dander
7. Cassia occidentalis   5. Sheep dander
8. Cenchrus ciliaris
9. Chenopodium album Feathers:
10. Cynodon dactylon
  1. Chicken feathers
11. Gynandropsis gynandra
  2. Pigeon feathers
12. Lawsonia inermis
13. Morus alba
Precaution taken to avoid false-positive reaction
14. Parthenium hysterophorus
Antigen used for intradermal testing was always
15. Pennisetum typhoides
kept in refrigeration at 48C and no extract was used
16. Prosopis juliflora
after the date of expiry. The concentrations of all
17. Ricinus communis
the injectable antigens used were 1:500 w/v, using
18. Rumex dentatus
a sterile hypodermic needle. Standard procedure
19. Sorghum vulgare
was followed to inject only 0.02 ml of the antigen
20. Xanthium strumarium
extract. The space between the sites of injection
21. Zea mays
was maintained at 5 cm to avoid overlapping. No
test was done during the asthma exacerbation.
Fungi:
Patient apprehensions toward the performance
  1. Aspergillus flavus of skin test were avoided by explaining in detail
  2. Aspergillus fumigatus about the procedure before performing the test.

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Testing was not done in females at the
time of pregnancy or during menstruation.
Inclusion criteria
Age 10–50 years. H/O recurrent attack of
­paroxysmal dyspnea. A defined H/O respiratory
allergy to inhalants, with emphasis on allergy due
to dust. All patients having seasonal or perennial
attacks of asthma.
Exclusion criteria
All cases that were excluded had the presence of
other causes of dyspnea like cardiac, renal, and
infective condition of lungs. All patients suffer-
ing from tropical pulmonary eosinophilia, emphy-
sema bronchitis, tuberculosis, and all females
who were pregnant.
The present study was undertaken in
allergy clinic with the aim to identify the precipi-
tating factors in respiratory allergic disorders.
Spirometry
Spirometry is an important tool used for gen-
erating pneumotachographs, which are help-
ful in assessing conditions such as asthma,
pulmonary fibrosis, cystic fibrosis, and chronic
obstructive pulmonary disease (COPD). The
spirometry was performed by Micro medical
USB Spirometer. The forced vital capacity (FVC)
and forced expiratory volume in first second
(FEV1) was measured using standard guidelines
(American Thoracic Society, 1995). Because the
procedure is effort dependent, and performed
until a deviation of FEV1 and FVC was less than
5%, only the best curve was used for analysis.
Spirometery data were expressed as the per-
centage of predicted value at any age and height
was corrected for using standardized residual
(Global Strategy for Asthma Management and
Prevention, 2006). FEV1/FVC values less than
80% with normal FVC taken to indicate airway
obstruction (Jasmeet et al., 2007; Chowgule
et al., 1995). Patients with more severe disease
have a greater reduction in observed values of
these parameters. Additionally, quantification of
bronchodilator reversibility on spirometry was
done. First baseline spirometry maneuver was
done followed by the inhalation of 200–400 mg
of salbutamol, and repetition of spirometry
after 15–30 min. A greater than 12% relative,
plus a greater than 200 ml absolute, increment
in either FVC or FEV1 over the baseline value
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was considered as suggestive of bronchodilator
reversibility, and strongly favors the diagnosis of
bronchial asthma (American Thoracic Society,
1995).
ELISA method for total IgE
The total IgE levels were performed by using
commercially available ELISA kit from General
Biological Corp., Taiwan. Anti-IgE wells were
used to detect the levels of total IgE. Patients’
sera 20 ml and control were added into appropri-
ate wells. One hundred microliter of zero buffer
was taken in each well and mixed thoroughly
for 10 seconds and incubated at room tem-
perature for 30 min. Washings were carried out
5 times with distilled water and 150 ml of anti-IgE
enzyme conjugate was added and gently mixed
and incubated for 30 min at room temperature.
The wells were washed 5 times and 100 ml of
tetramethylbenzidine (TMB) solution was added
and incubated for 20 min. Reaction was stopped
by adding 50 ml of stop solution in each well and
the optical density was read at 490 nm with a
micro liner plate reader within 15 min. The test
considered positive for value .100 IU/L (Longhini
et al., 2004).
Specific skin testing
The skin testing to 21 pollens, 12 fungal, 6 insect,
8 dust, 8 danders, and 2 feathers was carried
out in a standard manner. The pollen antigen
selected based on the local aerobiological cal-
endar was used for skin testing by intradermal
injection (curewell India Ltd). Intradermal injec-
tion of buffer saline acted as negative control
and histamine phosphate as positive control.
Immediate and late phase cutaneous responses
were recorded at 20 min and 6 hours after aller-
gen challenge respectively. The skin reactions
were graded as per the criteria of (Shivpuri and
Singh, 1971).
Interpretation of test
The reactions were measured in millimeters
after 20 min. The intensity of positivity of reac-
tion was judged by the size of the wheel formed.
The intradermal reaction due to the antigen was
compared with the control and graded according
to the criteria given in the CSIR brochure which
supplied the antigen. The positive reaction were
graded as 11, 21, 31, 41 as given below.
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Research Article
Criteria of positivity and grading of skin tests
Grade Size of wheel
11 2.5 times or more of the
negative control
21 3 times or more of the
negative control
31
4 times or more of the
negative control
41 4–6 times of the negative
control with pseudopodia
Preparation of the patient for the test
Anti-histamic and tranquilizers were stopped for
at least 48 hours before the intradermal test. The
patients were also advised not to take ephedrine,
adrenaline, aminophylline, and other bronchodi-
lators about 24 hours prior to the test. The site
of test was anterior aspect of forearm and lat-
eral part of the upper arm. Care was taken not to
have any hair over the area where the skin test
was being performed.
Injections containing the test allergens
were given in a linear row and the site of injection
were numbered according to the antigen used.
Phosphate buffer saline and histamine diphos-
phate (100 μ/ml) were also injected as negative
and positive controls. Reactions were recorded
after a period of 4–6 hours at the maximum.
Results
In the present study of 139 patients, the maximum
number of respiratory allergy cases were in the
age group of 20–39 years (age group 10–19 5 9,
20–29 5 45, 30–39 5 52, .40 5 33 patients) and
55.4% were males and 44.6% females with male
predominance seen. Further, 40.28% of patients
were from rural areas and 59.7% were from urban
areas from South India (Tables 1–3).
The percentage of patients with asthma
and rhinitis was 64%, asthma only 29.5%,
asthma, urticaria, and rhinitis was 4.3%, and
asthma and urticaria was 2.2% (Table 4).
Cigarette was the commonest form of smoked
tobacco with 7.2% cigarette smokers and 92%
were non-smokers (Table 5). In the present study,
Liquefied ­petroleum gas was the common-
est cooking fuel used by 96% and 2.9% used
­kerosene and 0.7% used cow dung (Table 6).
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Percentage of patients with perennial
symptoms was 39.6%, perennial/winter was
14.4%, rainy/winter (25.9%), rainy (5%), winter
(10.8%), perennial/rainy (1.4%), and perennial/
rainy/winter (2.9%) as indicated in Table 7. The
percentage of patients affected with allergy in
months, July–October was 25.2%, July–February
was 24.5%, March–June was 6.5%, and percent-
age of patients without seasonal involvement
was 43.9% (Table 8).
Prevalence of family history with first
degree relative was 40.3%. Father/sister 5 0.7%,
sister/brother 5 3.6%, mother 5 8.6%, grand-
parents 5 7.2%, father 5 10.1%, sister 5 2.9%,
brother 5 0.7%, mother/father 5 4.3%, daugh-
ter 5 1.4%, and son 5 0.75% (Table 9).
In 59.7% there was no significant family
history.
In 87.7% of patients IgE levels were
more than 100 IU/L and 12% were less than
100 IU/L (Table 10).
In 58.99% of patients, FEV1 was .80%
and in 40%, FEV1 was ,80% and FVC was
,80% in 57.54% and .80% in 42.44% and
FEV1/FVC % was .80% in 81.29% and ,80%
in 18.69% (Tables 11–13).
Percentage of patients having pets was
9.4% and about 90.6% of patients were not
having pets (Table 14).
The percentage of different pollens in
the study was as follows: Artemisia (10.8%),
Pennisetum (7.2%), Parthenium (5.8%), Sorgum,
Prosopis, Cenchrus (2.9%), Azadirachta,
Gynandropsis, Rumex, Zea mays, Amaranthus
spinosus (2.2%), and Cassia, Morus alba, ­Ricinus
(0.75%) as indicated in Table 15.
The percentage of fungal aller-
gens were as follows: Curvularia (45%),
Aspergillus flavus, Rhizopus (33.9%), Aspergillus
fumigatus, Alternaria (30%), Trichoderma (30.2%),
Cladosporium (27%), Helminthosporium (23%),
Nigrospora (18%), Candida (17%), Mucor (9.4%),
Fusarium (6.5%) as indicated in Table 16.
The percentage of insect allergens
included in the study was as follows: housefly
(25.9%), cockroach (25.2%), ant (18%), mos-
quito (10.8%), and moth (8.6%). Cantheroid was
positive in 2.9% (Table 17).
Cotton dust (18%), rice grain dust (15.8%),
house dust (12%), and wheat grain dust (3.6%)
as indicated in Table 18.
Danders and feathers were not positive
in any patient (Tables 19 and 20).
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Table 1: Age distribution of patients. Table 7: Season distribution of the disease.

Age group Total Frequency Percent
10–19 9 Perennial 55 39.6
20–29 45 Perennial/winter 20 14.4
30–39 52 Rainy/winter 36 25.9
40 and above 33 Rainy 7 5
Total 139 Winter 15 10.8
Perennial/rainy 2 1.4
Perennial/rainy/ 4 2.9
Table 2: Sex distribution of patients. winter
Frequency Percent Total 139 100
Male 77 55.4
Female 62 44.6
Total 139 100
Table 8: Distribution of symptoms during
various months.
Table 3: Population distribution of patients. Frequency Percent
Frequency Percent July–October 35 25.2
Rural 56 40.28 July–February 34 24.5
Urban 83 59.7 March–June 9 6.5
No season 61 43.9
Total 139 100
Total 139 100

Table 4: Bronchial asthma and its association

with rhinitis and urticaria.
Table 9: Family history of allergy.
Frequency Percent
Frequency Percent
Asthma/urticaria/ 6 4.3
rhinitis Father/sister 1 0.7
Asthma/rhinitis 89 64 Sister/brother 5 3.6
Asthma 41 29.5 Mother 12 8.6
Asthma/urticaria 3 2.2 Grandparents 10 7.2
Total 139 100 Father 14 10.1
Sister 4 2.9
Brother 1 0.7
Table 5: Smoking history. Mother/father 6 4.3
Frequency Percent Daughter 2 1.4
Cigarette smoking 10 7.2 Son 1 0.7
No smoking 129 92.8 No family history 83 59.7
Total 139 100 Total 139 100

Table 6: History of exposure of patients to

various cooking gases. Table 10: IgE levels in patients.
Frequency Percent Frequency Percent
Kerosene 4 2.9 ,100 17 12.2
Cow dung 1 0.7 .100 74 53.2
LPG 134 96.4 .400 48 34.5
Total 139 100 Total 139 100

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Table 11: Spirometry – FEV1 values in patients. Table 13: FEV1/FVC % values in patients.
Frequency Percent Frequency Percent
.80% 82 58.99 .80% 113 81.29
80–60% 38 27.3 80–60% 23 16.54
,60% 19 13.66 ,60% 3 2.15
Total 139 100 Total 139 100

Table 12: FVC % values in patients. Table 14: Exposure to pets at home.
Frequency Percent Frequency Percent
.80% 59 42.44 Dog 5 3.6
80–60% 59 42.44 Buffalo 3 2.2
,60% 21 15.10 Cat 1 0.7
Total 139 100 Dog/buffalo 1 0.7
Cat/dog 3 2.2
No exposure to pets 126 90.6
Total 139 100

Table 15: Pollen antigen tested in patients by skin test.

Frequency Percent
  1. Ageratum conyzoides – –
  2. Amaranthus spinosus 3 2.2
  3. Argemone mexicana – –
  4. Artemisia scoparia 15 10.8
  5. Azadirachta indica 3 2.2
  6. Brassica campestris – –
  7. Cassia occidentalis 1 0.7
  8. Cenchrus ciliaris 4 2.9
  9. Chenopodium album – –
10. Cynadon dactylon – –
11. Gynandropsis gynandra 3 2.2
12. Lawsonia inermis 3 2.2
13. Morus alba 1 0.7
14. Parthenium hysterophorus 8 5.8
15. Pennisetum typhoides 10 7.2
16. Prosopis juliflora 4 2.9
17. Ricinus communis 1 `0.7
18. Rumex dentatus 3 2.2
19. Sorghum vulgare 4 2.9
20. Xanthium strumarium 2 1.4
21. Zea mays 3 2.2

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Table 16: Fungal antigen tested in patients by skin test.

Frequency Percent
  1. Aspergillus flavus 46 33.9
  2. Aspergillus fumigatus 43 30.9
  3. Alternaria 43 30.9
  4. Candida albicans 24 17.3
  5. Cladosporium 38 27.3
  6. Curvularia species 63 45.3
  7. Fusarium soloni 9 6.5
  8. Helminthosporium 32 23
  9. Mucor mucedo 13 9.4
10. Nigrospora 26 18.7
11. Rhizopus 46 33.9
12. Trichoderma 42 30.2

Table 17: Insect antigen tested by skin test in Table 18: Dust antigen tested by skin test.
patients.
Frequency Percent
Frequency Percent 1. Cotton dust 25 18
1. Ant 26 18.7 2. House dust mite – –
2. Housefly 36 25.9 3. House dust 17 12.2
3. Mosquito 15 10.8 4. Paper dust – –
4. Cockroach 35 25.2 5. Rice grain dust 22 15.8
5. Cantheroid beetle  4 2.9 6. Wheat thrashing
– –
6. Moth 12 8.6   dust
7. Wheat grain dust 5 3.6
8. Straw dust – –

Table 19: Dander antigen tested by skin test.

Frequency Percent
1. Buffalo dander – –
2. Cat dander – –
3. Cow dander – –
4. Dog dander – –
5. Sheep dander – –
‘–’: None were positive.

Table 20: Feather antigen tested by skin testing.

Frequency Percent
1. Chicken feathers – –
2. Pigeon feathers – –
‘–’: None were positive.

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Discussion
Allergy is considered as to be the important factor
causation of bronchial asthma. Allergic rhinitis,
asthma, and urticaria are atopic disease caused
in human due to environmental allergens. Allergy
has become a major health problem at any age
and major burden in affluent westernized socie-
ties where one third of general population suffers
from various forms of allergic disease during a
life span. These conditions may have profound
impact on subject’s physical, emotional, and
social well being and also substantially affect the
quality of life of the whole family. Asthma and
rhinitis account for a large number of lost school
and work days. Therefore, the present study
was to determine the sensitivity of aeroallergen
in patients visiting our hospital. Prevalence of
asthma varied from region to region (Burney et al.,
1997; Leuenberger et al., 1998). Current asthma
prevalence reported is 1.2–6.3% in most coun-
tries (Veale et al., 1996). 2.7–4% was reported in
most European countries, 12% in England, 7.1%
in US, and 9.5–17% in Australia. In India prev-
alence was 29% in Bangalore, 11.9% in Delhi,
2.2% in Chandigarh, and 2.05% in Kanpur.
Factors which cause asthma can be
age and gender-related, genetic factors, low
birth weight, indoor dampness, house dust,
mites, moulds, environmental tobacco smoke
and cooking gas, outdoor environment, and
occupation.
The geographical difference in preva-
lence of allergic disease and the short period
over which change in prevalence have occurred
indicates an environmental influence. In urban
areas, the westernized life style increased the risk
of sensitization and allergic symptoms. Low risk
of allergy had been observed in the rural dwellers
with traditional life style as seen in this study. In
urban life style, people spend more time indoor
resulted increase indoor humidity and exposure
to allergens. In the present study results are
close to earlier studies, 50% were from cities in
Hyderabad and 29.7% in semi urban area and
rural areas. This study displays broad range of
asthma prevalence in rural/urban which is due to
changes in environment and life style.
Atopy comprises all IgE-mediated dis-
ease and individual with atopy have a genetic
predisposition to produce IgE against environ-
mental allergens (Kay, 2001). In normal subject,
IgE level increases from birth to adolescence and
then decreases slowly and reaches a plateau
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Biology and Medicine, 4 (4): 167–177, 2012
after the age of 20–30 years. In adults, levels
100 IU/L are considered to be normal. Atopy is
often accompanied by elevated IgE and positive
skin test to allergens. In the present study, IgE
levels were in agreement with the levels found
in the earlier studies (Allen-Ramey et al., 2005;
Chowdary et al., 2003). In addition, patients posi-
tive to higher number of allergens had normal IgE
level (Madhuri et al., 1992).
Air-born allergens promote IgE sensitiza-
tion and development of airway disease. Traffic
related pollution had been confirmed to be asso-
ciated with asthma, and among particulate pol-
lution, ultrafine particles suggest important role
in asthma (Wong and Lai, 2004). Environmental
tobacco smoke showed increased risk of
asthma. Active smoking has been an independ-
ent factor for development of asthma. In the
present study, 7.2% were smokers and study
done recently showed a positive association
between smoking and asthma (Gwynn, 2004).
In the present study, cooking gas was LPG in
98% of patients which correlated with stud-
ies done earlier. But data from Natural Health
and Nutrient Examination Survey, United States
found no correlation between gas stove users
and change in respiratory symptoms.
Agents causing respiratory allergy in
human being are mostly of biological origin and
are collectively known as bio-allergens (Singh
and Singh, 1994). Pollen grains and fungal spores
are predominant allergens in air. Although pollen
grains have been widely studied as aeroallergens
throughout the world, far less is known about the
fungal aerosols which are present in much higher
concentration than pollens in air. Insect debris
also contributes towards the total allergen load.
In India, large number of persons have hypersen-
sitivity to grass pollens, though it is thought to be
too large to gain access into the lower airways to
trigger an asthmatic response.
The predominant pollens in the earlier
studies were Pennisetum followed by Artemisia
and Sorghum vulgare (Anuradha et al., 2006)
and in the present study the common pollens
were Artemisia 10.8%, Pennisetum 7.2%, and
Sorghum vulgare 2.9%. Also in semi urban areas
of Secunderabad, Parthenium was prevalent and
in our study Parthenium was positive in 5.8% of
patients. The most common pollen reported to
cause allergy in India is Parthenium which was
positive in only 5.8% of individuals in our study.
Brassica was most common allergen reported
from Bhopal and Kanpur, was positive in only
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2.9% patients in our study. Amaranthus was the increment in either FEV1 or FVC after bronchodi-
common pollen reported from Delhi and was lator was suggestive of reversibility and favor
positive in 2.2% individuals in our study. diagnosis of asthma. In the present study, FEV1,
In Vishakapatnam 26% were positive FVC, and FEV1/FVC were less than 80% and
to Artemisia which was positive in 10.8% in our close to studies done earlier.
study (Raju et al., 1990). Also observation was
made with predominant pollen Gynandropsis
gynandra (Latha, 2002) which was positive in
Conclusion
2.2% in our study. Other positive pollens in the
present study were Prosopis juliflora, Cassia
The individuals with asthma were frequently sen-
occidentalis, and Cenchrus ciliaris.
sitive to more than one allergen. For example,
Fungi are ubiquitous in nature and like
heredity, cooking gas, and smoking were the risk
pollens the concentration and the nature of fun-
factors plus sensitivity to inhalant allergens such
gal spores varies with the temperature, humidity,
as pollens, fungal, danders, and insect debris
rainfall, wind-velocity, and vegetation of a region
as major source. The presence of one symptom
(Raja Rajeswari et al., 1985). Predominant fungi
is a risk factor for the development of sever-
observed in the present study were Aspergillus
ity of other symptoms, and allergic symptoms
flavus, Aspergillus fumigatus, Alternia, Candida
co-exist or appear in sequence. In the present
albicans, Cladosporium, Curvularia, Fusarium
study, higher prevalence of asthma was among
soloni, Heliminthosporium, Mucor mucedo,
men as compared with women and maximum
Nigrospora, Rhizopus, and Trichoderma.
patients were in the age group 20–39 years. Max
Predominant fungal allergens reported from
population distribution was from urban area sup-
other parts of India are Curvularia, Fusarium,
porting the importance of environmental influ-
Aspergillus versicolor, Alternaria, Aspergillus
ence and life style changes in development of
niger, Candida, Neurospora, and Mucor (Shah
disease. Air born allergens promoted IgE sen-
and Merchant, 1983).
sitization and development of airway disease.
Besides pollen and fungal allergens
In this study, most of the cases using skin tests
insects are also very important allergens elicit-
showed that the disease was either perennial or
ing type 1 hypersensitivity response. The first
seasonal. Patient with allergen sensitivity showed
case was reported by Parlato in a patient aller-
obstructive airways with reduced FEV1, FVC, and
gic to caddiesfly (Parlato, 1929). In the present
FEV1/FVC. Therefore, it is concluded that iden-
study, insects positive were ant, housefly, mos-
tification of allergens allows early intervention of
quito, cockroach, cantheroid beetle, and moth.
ongoing disease and modification of subsequent
The perennial allergy is mostly caused by in door
natural history of disease. A positive skin test
allergens and seasonal allergy related to out door
does not always imply clinical disease, correla-
allergens. The pollens showed their incidence in
tion of positive skin test with clinical symptoms
air throughout the year and they recorded high
and seasonal variation helps in diagnosis, and
concentration in Aug–Nov and less in Dec–March
could be attempted to facilitate preparation of
(King et al., 2004) and the fungal allergens
antigen for hyposensitization of patient.
recorded high concentration during Sep–Dec
lower in rainy (Wickman et al., 2002). In the
present study, results are close to the results of
the study done earlier in which there were signifi- Abbreviations
cant positive reactions to pollens in winter and
rainy seasons (Raja Rajeswari et al., 1985). In the RHINE   – Respiratory Health in Northern
present study, positive reactions to fungi were   Europe.
more in the rainy and perennial groups. ISAAC   – International Study on Asthma and
In our study, the spirometry provided   Allergy in Children.
the measurement of the presence and severity BHR   – Bronchial Hyper Responsiveness.
of air flow limitation. Additionally, demonstration HRT   – Hormone Replacement Therapy.
of bronchodilator reversibility on spirometry was BMI   – Body Mass Index.
helpful in making a more confident diagnosis ETS   – Environmental Tobacco Smoke.
of asthma. An obstructive defect on spirometry IUATLD   – The International Union Against
is interpreted by FEV1/FVC ratio was reduced   Tuberculosis and Lung Disease.
,80% and greater than 12% or .200 ml LPG   – Liquefied Petroleum Gas.

BMID: BM-5 175

Research Article
Ethical Approval
The study was approved by the ethics commit-
tee of the Mahavir Hospital and Research Centre.
Conflict of Interests
None declared.
Acknowledgement
We are grateful to all the participants of the study
group, who volunteered to be part of this study.
We are also thankful to Dr. Kaiser Jamil, Head,
Genetics Department, Mahavir Hospital and the
Management of Mahavir Hospital and Research
Centre for their encouragement and facilities.
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