Skin prick reactivity among asthmatics in East Africa

Richard Kwizera, Vincent Wadda, Levicatus Mugenyi, Hellen Aanyu-Tukamuhebwa, George Nyale, Getnet Yimer, Jeremiah Chakaya, Corina De Jong, Thys Van der Molen, David W Denning, Robin Gore, Bruce J Kirenga, Richard Kwizera, Vincent Wadda, Levicatus Mugenyi, Hellen Aanyu-Tukamuhebwa, George Nyale, Getnet Yimer, Jeremiah Chakaya, Corina De Jong, Thys Van der Molen, David W Denning, Robin Gore, Bruce J Kirenga

Abstract

Background: The burden of asthma in Africa is high, and yet the disease is not universally prioritised. Data on allergic asthma and its impact on asthma morbidity are limited in Africa. Our aim was to describe the distribution of skin prick positivity among asthmatics in Eastern Africa.

Methods: From August 2016 to May 2018, 1671 asthmatic patients were enrolled from Uganda, Kenya, and Ethiopia as part of the African Severe Asthma Program clinical study. Skin prick testing was performed at baseline using a panel of 12 allergens, and factors associated with skin prick reactivity determined.

Results: Of the 1, 671 patients recruited, 71% were female with a median age of 40 years, 93.6% were aged >15 years and the patterns of asthma symptom frequency was intermittent in 2.9%, mild persistent in 19.9%, moderate persistent in 42.6% and severe persistent in 34.6% at baseline. Self-reported triggers, were dust (92%), cold weather (89%), upper respiratory infections (84%), strong smells (79%) and exposure to tobacco (78%). The majority (90%) of the participants had at least 1 positive allergen reaction, with 0.9% participants reacting to all the 12 allergens. Participants commonly reacted to house dust mites (66%), Blomia tropicalis (62%), and the German cockroach (52%). Patients sensitized to more allergens (>2) had significantly reduced lung function (FEV ≤ 80%; p = 0.001) and were more likely to visit the emergency department due to asthma (p = 0.012). There was no significant relationship between number of allergens and measures of asthma control, quality of life, and other clinical outcomes. Only the country of origin was independently associated with atopy among African asthmatics.

Conclusion: There is a high prevalence of skin prick positivity among East African patients with asthma, with the commonest allergen being house dust mite. Skin reactivity did not correlate well with asthma severity and poor asthma control. The relation between atopy, measured through skin prick testing, and measures of asthma control among asthma patients in Eastern Africa is unclear and needs further study.

Trial registration: The ASAP study was registered prospectively. ClinicalTrials.gov Identifier: NCT03065920; Registration date: February 28, 2017; Last verified: February 28, 2017.

Keywords: A. fumigatus, Aspergillus fumigatus; ACT, Asthma control test; AQLQ, Asthma Quality of Life Questionnaire; ASAP, African Severe Asthma Project; Africa; Allergy; Asthma; Atopy; COPD, Chronic obstructive pulmonary disease; East Africa; FEV, Forced Expiratory Volume; HIV, Human immunodeficiency virus; IQR, Interquartile range; Ig, Immunoglobulin; SPT; SPT, Skin prick testing; TB, Tuberculosis.

© 2020 Published by Elsevier Inc. on behalf of World Allergy Organization.

Figures

Fig. 1
Fig. 1
Distribution of allergens in adults. Figure shows the percentage positivity for each allergen per country among adults (16+ years). Participants mostly reacted to house dust mites, Blomia tropicalis and the German cockroach
Fig. 2
Fig. 2
Distribution of allergens in children. Figure shows the percentage positivity for each allergen per country among adults (12–15 years). Participants mostly reacted to house dust mites, Blomia tropicalis and the German cockroach
Fig. 3
Fig. 3
Percentage positivity of allergens per patient. The number of positive allergens per patient varied widely across the 3 countries. Ten percent of the participants did not react to any of the allergens, while 1% reacted to all the 12 allergens. Ugandans had a noticeably higher degree of atopy

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