ASTHMA SEVERITY AND MORBIDITY IN A POPULATION-SAMPLE OF SYDNEY SCHOOLCHILDREN .2. IMPORTANCE OF HOUSE-DUST MITE ALLERGENS

Background: Despite an increasing prevalence of childhood asthma, few studies have quantified the strength of associations between asthma and its aetiological factors. Aims: To quantify the risk factors associated with childhood asthma and to investigate the characteristics of children most at risk. Methods: We studied a population sample of 1339 schoolchildren aged eight-11 years living in Sydney, NSW. Questionnaires were used to measure respiratory illness, histamine inhalation test to measure airway hyperresponsiveness (AHR), skin prick tests to measure atopy and ELISA assay to measure house dust mite allergen (Der p I) levels. 'Current asthma' was defined as the presence of wheeze in the previous year and AHR. Results: The mean Der p I level in 72 homes was 22.5 mu g/gm dust which is high compared to suggested thresholds of 2 mu g/gm for sensitisation and 10 mu g/gm for exacerbation of symptoms. Sensitisation to house dust mites was the most important risk factor for current asthma (odds ratio 7.0, 95% CI 9.4, 22.2). Sensitisation to ryegrass was of minor importance (odds ratio 2.0, 95% CI 1.4, 3.1). The presence of AHR was strongly related to the degree of sensitisation to house dust mite allergen and children with skin wheals greater than 4 mm had frequent morbidity caused by asthma. Conclusions: To reduce the high prevalence of childhood asthma in NSW, it is imperative that we design interventions which recognise that house dust mite allergens are a dominant risk factor and that children with large skin wheal reactions to this allergen are most at risk for severe illness including disturbed sleep, days missed from school and urgent medical attention.