Učestalost senzibilizacije na pelude u odrasle populacije s atopijom u Zagrebu i okolici

Mehulić, Muharem (2008) Učestalost senzibilizacije na pelude u odrasle populacije s atopijom u Zagrebu i okolici. PhD thesis, Sveučilište u Zagrebu.

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Abstract

Allergic disorders have during the last 40 years noticeably gained importance as disorders associated to modern lifestyle with increasing prevalence. For their dramatic increase in prevalence during the second half of twentieth century we still have no distinctive explanation. The questions regarding the cause of that increasement in prevalence are raised. Is that a consequence of global changes in civilized living, economic, political, cultural, meteorological, and ecological or other unknown factors? The aim of this research is based on the hypothesis that during last 15 years there had been a change in the structure of prevalence of sensitization to different aeroallergens in adult population of Zagreb and its surroundings with atopy. Specific goals were to determine the structure of prevalence of sensitization to different pollens in adult population with respiratory symptoms, as well as to determine whether there are changes in sensitization in adult population with respiratory symptoms to different aeroallergens, and to determine the changes in prevalence of sensitization to ragweed during the investigated time period. Retrospective analysis of medical records from Allergy Clinic in the period between 1991 and 2004 have identified 5591 patients. We included 794 patients during years 1991-1994, 814 patients during 1995-1999, and 969 patients during 2000-2004 as 3 time dependent subgroups. These patients were included based on having all relevant data in their medical charts: age, gender, education level, residence, referral diagnosis, dominant symptoms, result of skin-prick test (SPT), total and specific IgE. Statistical analysis was done using Statistica, Kernel release 5.5 A (StatSoft, Inc. Tulsa, OK). As statistically significant P<0.05 was considered. As risk factors for sensitization to pollens of trees, grasses and weeds we determined the decade of birth (OR, 1.21; 1.62; 1.38; P<0.0001 for all), female gender (OR, 0.66; 0.64; 0.76; P<0.008 for all), level of education (OR, 1.19; 1.18; 1.17; P<0.0001 for all), and place of residence (OR, 1.23; 1.26; 1.16; P<0.05 for all). We determined that the proportion of sensitized individuals to pollen was significantly increased from the period 1991-1994 towards 2000-2004 (64.8% to 77.6%; P<0.001 for the trend) with a significant increase in the proportion of sensitized individuals to weed pollen (43.7% to 55.7%; P=0.002 for the trend) while the proportion of sensitized to other two groups of pollen (grasses and trees) was not significantly different (grasses, 46.3% to 45.4%; P=0.972 for the trend; trees, 33.9% to 38%; P=0.131 for the trend). We also determined a significant decrease in the proportion of sensitized individuals to mites (63.2% to 45.9%; P<0.001 for the trend). A significant increase in the proportion of sensitized individuals was determined for sensitization to ragweed pollen (21.82%, 39.56%, 34.23%, P=0.004 for the trend), and to mugwort (21.82%, 40.22%, 34.23%, P=0.005 for the trend). Pronounced and significant cross-reactivity was determined for the sensitization between ragweed and mugwort (OR, >106; sensitivity, 99.25%; specificity, 100%; P<0.001). Despite all its limitations primarily based on the election bias the results of this study are conclusive about the significant change in the proportion of sensitization to different aeroallergens and different pollen groups and individual pollen species during the investigated 15-year time interval. These results have to be verified by the well planned epidemiological survey.

Abstract in Croatian

Alergije se nameću posljednjih 40 godina kao bolesti modernog načina življenja od kojih pobolijeva sve više ljudi. Za dramatičan rast prevalencije ovih bolesti koji se bilježi od druge polovice XX. stoljeća nema jedinstvenog objašnjenja. Postavlja se pitanje je li to posljedica sveukupnih promjena u civilizaciji čovjeka, ekonomskih, kulturoloških, meteoroloških, ekoloških ili drugih nepoznatih čimbenika. Cilj rada temeljio se na hipotezi da je u posljednjih godina došlo do promjene u strukturi učestalosti senzibilizacije na pojedine aeroalergene u odrasle populacije s atopijom u Zagrebu i široj okolici, te se željelo utvrditi strukturu učestalosti senzibilizacije na pojedine pelude u odrasle populacije s dišnim smetnjama, utvrditi postoje li promjene u senzibilizaciji odrasle populacije s dišnim smetnjama na pojedine aeroalergene te utvrditi postojanje eventualne promjene učestalosti senzibilizacije na pelud ambrozije u ispitivanom razdoblju. Provedenom retrogradnom analizom zdravstvenih kartona alergološke ambulante u vremenu od 1991. do 2004. godine izlučen je 5591 ispitanik koji je alergološki testiran u tom razdoblju. U analizu je po skupinama uključeno 794 ispitanika u skupini 1991.-1994. god., 814 u skupini 1995.-1999. god., te 969 u skupini 2000.-2004. god. čiji su kartoni sadržavali sve potrebne podatke o dobi, spolu, stručnoj spremi, mjestu stanovanja, uputnoj dijagnozi, dominantnim simptomima, nalazu SPT-a, ukupnom i specifičnom IgE. Statistička raščlamba provedena je u statističkom programskom paketu Statistica, Kernel release 5.5 A (StatSoft, Inc. Tulsa, OK). Kao statistički značajna korištena je razina značajnosti P<0,05. Kao rizični čimbenici za senzibilizaciju na pelud stabala, trava i korova utvrđeni su desetljeće rođenja (OR, 1,21; 1,62; 1,38; P<0,0001 za sve), spol (OR, 0,66; 0,64; 0,76; P<0,008 za sve), razina edukacije (OR, 1,19; 1,18; 1,17; P<0,0001 za sve) te mjesto stanovanja (OR, 1,23; 1,26; 1,16; P<0,05 za sve). Utvrđeno je da udio senzibiliziranih osoba na pelud statistički značajno raste od razdoblja 1991.-1994. prema razdoblju 2000.-2004. godine (sa 64,8% na 77,6%; P<0,001 za trend) uz značajan porast udjela senzibiliziranih na pelud korova (s 43,7% na 55,7%; P=0,002 za trend) dok se udio senzibiliziranih na druge dvije grupe peluda (trava i stabala) nije statistički značajno povećavao (trave, s 46,3% na 45,4%; P=0,972 za trend; stabla, s 33,9% na 38%; P=0,131 za trend). Utvrđen je statistički značajan pad udjela senzibiliziranih osoba na grinje (sa 63,2% na 45,9%; P<0,001 za trend). Statistički značajan porast udjela zabilježen za senzibilizaciju na pelud limundžika (21,82%, 39,56%, 34,23%, P=0,004 za trend), i divljeg pelina (21,82%, 40,22%, 34,23%, P=0,005 za trend). Utvrđena je izrazita unakrsna reaktivnost za senzibilizaciju na limundžik i divlji pelin (OR, >106, osjetljivost, 99,25%; specifičnost, 100%, P<0,001). Usprkos svim ograničenjima ove studije koja prvenstveno proizlaze iz selekcijske pristranosti temeljem rezultata ove studije moguće je zaključiti da je vidljiva značajna promjena u udjelu senzibilizacije na različite alergene te na različite skupine peludnih alergena uz značajnu promjenu spektra senzibilizacije u ispitivanom petnaestogodišnjem razdoblju. Navedene rezultate je potrebno provjeriti provođenjem odgovarajuće epidemiološke studije.

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