GSTM1, GSTP1, and NQO1 Polymorphisms and Susceptibility to Atopy and Airway Hyperresponsiveness among South African Schoolchildren
Poovendhree ReddyRajen N. NaidooThomas G. RobinsGraciela MentzStephanie J. LondonHuiling LiRichard Naidoo
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Atopy
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The prevalence of asthma in children is increasing worldwide. Although the features of asthma are well documented, defining asthma remains a problem. The clinical definition of asthma does not take into account the concept of airway inflammation. A broader definition that incorporates the inflammatory process, reversibility of airway obstruction, and airway responsiveness needs to be more widely adopted. Bronchial hyperresponsiveness is one of the key features in asthma and it can be documented by using pharmacological or non-pharmacological means. The latter appears to be a more physiological test and more acceptable to children. This article gives an overview of the features of asthma and bronchial hyperresponsiveness and shows how various non-pharmacological bronchial challenge tests can help identify bronchial hyperresponsiveness and thus help diagnose asthma in children.
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To examine the prevalence of asthma symptoms, bronchial hyperresponsiveness (BHR) and atopy in a random population sample of New Zealand adults.A random sample of 2004 adults, aged 20-44 years, in Hawkes Bay, Wellington and Christchurch, were selected from respondents to a one-page respiratory screening questionnaire and invited to take part in further testing. Subjects attending the testing centres' laboratories underwent a detailed respiratory symptom questionnaire, Phazet testing to eleven common allergens, blood samples for total and specific IgE, and measurement of bronchial hyperresponsiveness. Subjects who did not wish to participate were encouraged to complete the questionnaire by telephone.A participation rate of 67% (1257 of 1877 eligibles) was achieved. We found a high prevalence for all measures of asthma in the previous 12 months: wheezing was reported by 28.5%, waking with shortness of breath by 7.7%, a physician diagnosis of asthma by 15.9% and asthma medications were used by 8.5%. Bronchial hyperresponsiveness was found in 24.9%, atopy in 34.8% and elevated serum IgE levels in 30.5%. Asthma symptoms (in the past 12 months) and atopy decreased with increasing age, whereas bronchial hyperresponsiveness increased with age. Females reported higher prevalences of waking with coughing (45.9%), nasal allergies (43.5%) and skin allergies (48.8%) compared to males (30.5%, 31.9% and 37.0%, respectively). There were no significant regional differences.Asthma symptoms, bronchial hyperresponsiveness and atopy are all common in adult New Zealanders. Their prevalence is associated with age, gender and current smoking but there are no significant regional differences between Hawkes Bay, Wellington and Christchurch.
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In 1989 a survey of 543 New Zealand rural adolescents of largely Maori descent was undertaken to determine the prevalence of asthma symptoms, bronchial hyperresponsiveness (BHR) and atopy. The overall prevalence of asthma was estimated at 13.7%, BHR at 13.4% and atopy at 31.1%. These rates were similar across the age range 13 to 18 years. The prevalence of BHR among those without asthma symptoms was 3%. Both current asthma symptoms and BHR were more common among females, but there was no difference between the sexes in the proportion with atopy. The prevalence of asthma symptoms was higher among Maoris than nonMaoris, but this difference disappeared when allowance was made for current smoking. There was a similar prevalence of BHR and atopy between these two ethnic groups. There was a similar prevalence of asthma but lower prevalence of BHR than was reported among 7-10 year olds in an urban Auckland survey. The low prevalence of BHR among those without asthma symptoms, and the uniform frequency of asthma symptoms, BHR and atopy over the age range suggest that adolescents would be a particularly useful population for national or international comparisons of the prevalence of asthma, BHR and atopy.
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Both atopy and bronchial hyperresponsiveness (BHR) are characteristic features of asthma.They are also found among non-asthmatic subjects, including allergic rhinitis patients and the general population.Atopy and BHR in asthma are closely related.Atopy induces airway inflammation as an IgE response to a specific allergen, which causes or amplifies BHR.Moreover, significant evidence of the close relationship between atopy and BHR has been found in non-asthmatic subjects.In this article, we discuss the relationship between atopy and BHR in the general population, asthmatic subjects, and those with allergic rhinitis.This should widen our understanding of the pathophysiology of atopy and BHR.
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The relationship between asthma severity and atopy is complex. Many studies have failed to show significant relationships between clinical severity or lung function and markers of atopic sensitisation.
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