1.
Original Article
Allergen Skin Test Reactivity and Eosinophilia in
Adult Bronchial Asthmatic Patients
Tasmina Parveenl, Eram Mustafizl, Abdul Matin Anamur Rashid Choudhury2, Matia Ahmedl and
Noorzahan Begum3
Abstract
Asthma affects more than 100 million people worldwide. lncreased morbidrty s mun',laet'a a.3 -a!
include increased exposure to indoor allergens and environmental pollutants o!'er!se :' ae:a'Z
agonist, under-use of anti-inflammatory mediators and limited education about healu' care A e'qt
represents a specific alteration in biologic reactivity mediated by an immunologic mec;a^ s- 3-'-
resutting in an adverse physiologic response. Some of the type of allergen's senstuvrfl c) sr' a'u'
test (SPT) and blood eosinophil count were studied in adult asthmatic patients to find oa Ih€,' salJs
in this group of patients and also to observe their relationships. This study was caried oui t' :^e
Department of Physiology, Bangabandhu Sheik Muiib Medical [Jnivers$ Dhaka and Asthma Ce::'e
Mohakhali, Dhaka from January 2OO5 to December 2005. Allergen skin prick tests were done c:,
pepy's skin prick method and absolute eosinophil count in blood was also done by haemocytomeq) T
30 asthmatic patients and 30 age and sex matched control subiects. Data were analyzed stattstcal!',
by unpaired student's t-test and Chi-square test. ln this study, maximum numbers of asthmatic patens
had positive SPT for dust mite, which was foltowed by house dust and by cockroach. Frequency'
percentage for dust mite was significantty higher (p <0.05) than that of house dust and cockroach. lt ffas
atso significantly higher in house dust than that of cockroach (p <0.001). The mean eosinophil oun'!
was significantty high (p <0.001) in asthmatic adufts compared to that of healthy subiects. On the other
hand, the association between the positive skin prick tests of all allergens used in this study and
increased eosinophit counts were not statistically significant (p >0.05 ). Therefore, it can be concluded
that different allergens like, house dust, dust mite and cockroach are responsible for bronchial asthma
in our country, which can be detected by SPT. Thus it can be used for identification of type of actual
atteryens responsible for bronchiat asthma. This may be a useful measure for earlier detection ol
allergens and for hyposensitization or desensitization of that patients accordingly with those allergens-
Keywords: Allergen, Eosinophil, Bronchial asthma
(J lJttara Adhunik Med ColL 2011; 1(1) : 3-7).
the atopic state3. ln their study, most of them had
shown that atopy is closely related to asthmaa
Allergy plays a role in wide range of the diseases.
ranging from itching of the skin to potentially fatal
condition such as bronchial asthma5- Asthma due to
allergy is often associated with a personal and famtly
history of allergic diseases such as rhinitis. urticaria
and eczema with positive wheal and flare skin reactsts
to injection of intradermal indoor and outdoor atrbome
allergens and associated with increased eosinophtl
count in the blood6.
Allergens trigger asthmatic attacks in 60 to 909o of
children and in 50% of adults. Approximalely 75 to
90% of the patients with asthma had positive skin test
results2. Majority of allergens that provoke bronchial
asthma are airborne. Again, asthma due to allergy is
frequently seasonal. Anon seasonal perennialform may
results from allergy to house dust , house dust mite,
animaldanders ,feathers , molds and other allergens
present continuously in the environment6.
Introduction
Allergic diseases like asthma, hay fever, allergic
rhinitis are important causes of morbidity. Different
observers found interrelationships among serum total
lgE level and allergy skin prick test in general
populationl-2. Allergy represents a specific alteration
in biologic reactivity mediated by an immunologic
mechanism and resulting in an adverse physiologic
response. Different investigators studied that
immediate hypersensitivity response in atopic
individuals are generally associated with increased
eosinophil count by which is the essential feature ol
1. Department of Physiology, Uttara Adhunik Medical College
(UAMC), Dhaka, Bangladesh.
2. Department of Urology, BSMMU, Dhaka
3. Department of Physiology, Bangabandhu Sheikh Mujib
Medical University, Shahbag, Dhaka 1000, Bangladesh.
Address of Correspondence: Dr. Tasmina Parveen, Assoc.
Professor, Department of Physiology, Uttara Adhunik Medical
College, Sonargaon Jonopath, Plot # 34, Road # 4, Section # 9,
Uttara Model Town, Dhaka 1230, Bangladesh.

2.
J Uttara Adhunik Med. College
Different investigators evaluated about the relationships
of allergy skin test reactivity and eosinophilia to the
respiratory symptomsT" They observed the prevalence
ol symptoms of allergic diseases is increased in
patients having increased eosinophil count and it may
be the strongest among asthma patients. Again , a
high prevalence of positive skin reaction was reported
in children with asthma but a very little information is
available on the prevalence of immediate skin test
reactivity in adult patients with asthma. lt was shown
that among 260 patients of adult asthma, 60% had
reacted to house dust, 51% reacted to house dust
6111s8'12.
Sensitization and exposure to indoor allergens act as
risk factor for asthma . Therefore, housing condition
plays an imporlant role in asthma, especially among
lower socioeconomic populationl3-14. ln our country,
bronchial asthma is one of the common respiratory
diseases. Most of the cases are commonly treated
without knowing the specific allergen, which may be
a causative factor for the disease. Again, both indoor
and outdoor allergens may have some role in the
occurrence of the disease. lf specific allergens have
been identified, which trigger asthma symptoms,
better management of the patients can be done, which
may lead them to a symptom-free life. ln addition,
identification of the specific allergens prior to the
treatment may also help the physician in planning
better management of the asthmatic patients
especially by hyposensitization (immunotherapy).
Furthermore, physician could monitor the effect o{
immunotherapy by repeating the skin test reactivity
at regular interval and thereby adjust the dose ol hypo
sensitization to particular allergens accordingly.
Therefore, the present study has been designed to
perform allergen skin test reactivitywith various indoor
allergens in adult asthmatic subjects in order to find
out the common variety and to observe blood
eosinophil count. ln this study the association among
skin test reactivity and eosinophin count in blood were
also observed in the same group of patients. The study
also aimed to utilize the findings of skin prick test as
background information for the clinicians in
desensitizing the common allergens present in the
asthmatic patients in our country and better
management of bronchial asthma and also to create
awareness among this group of patients so that they
can take early and regular treatment.
Vol.01, No.01, January 2011
Materials and Methods
The present observational study was done in the
Deparlment of Physiology, Bangabandhu Sheik Mujib
Medical University (BSMMU), Dhaka and Asthma
Centre, Mohakhali, Dhaka from January 2005 to
December 2005. ln this study a total number o{ 60
subjects with age range ol 20 to 40 years of both
sexes were included, ol whom 30 apparently healthy
and 30 asthmatic adult subjects were included in group
A (Control) and in group B (Asthmatic patients).
Detailed procedures and objectives of the study were
explained to the subjects and their written consents
were taken before performing the study' Socio-
demographic data including age, sex, family history
monthly income were taken. Allergic history regarding
different types of allergens including food was also
taken. Both physical and clinical examinations were
done lor each subject and all the information were
recorded in a prefixed data sheet.
Detailed procedure about the skin prick tests were
briefed to allthe asthmatic patients and the tests were
performed with the help of different allergens (house
dust, dust mite and cockroach). Assurance was given
to the patients that the study would not bring any
health hazards. Blood samples were collected for
determination of blood eosinophil counl both in
asthmatic patients and also in healthy subjects.
Results
Anthropometric details of all subjects and sex
distribution are shown in Table 1 and Figurel ' Both
groups are matched for age, sex and body mass index
(BMr).
Table-l
Age, sex, height, weight and BMI in different study
grou7s (n = 60 )
Parameter GrouPA GrouP B P value
Mean + SD Mean + SD
(n = 30) (n = 30)
Age (Years) 27.77 t 5.75 29.10 t 6.053 0.50 ns
Height (cm) 159.63 t 5.461 160.57 t 3.910 0.10 ns
Weight (kg) 61 .73 t 7 .488 63.93 t 6.933 0.50 ns
BMI 24.13 x. 1.71 24] t 4-02 0.10 ns
Group A: Apparently healthy adults (Control)
Group B: Adults suffering from mild intermittent asthma
(Experimental)

3.
Allergen Skin Test Reactivity and Eosinophilia in Adult Bronchial Asthmatic Patients
500
450
60
E50o
I
t40
30
20
Fig.-I: Showing distribution of the subiect by sex (n
= 60).
Results of skin prick tests (SPTs) with three different
allergens are shown in Figure 2. Maximum percentage
of asthmatic patients showed positive reaction with
dust mite which was statistically significant (p<0.001).
T Parveen et al
Fig.-3: Showing mean absolute eosinophil count in
different study groups (n = 60). Group A = Control;
Group B = Experimental.
Table-ll
Distribution of the subjects by absolute eosinophil
count in different groups (n = 60)
Absolute df GroupA Group B f value p value
eosinophil (n = 30) (n = 30)
count No. (%) No. (%)
(cells/trl)
400
3s0
o
= 3oo
oL
.o oEn
=
zrv
I 2oo
6
o iso10
0 100
50
-. 25
o
3zo
ItoL
L15
Normal
(<27511t1)
Higher
(>27Slul)
27 (e0.0) I (26.7)
1 24.754 0.001-.-
3 (10.0) 22 (73.3)
Fig.-2: Distribution of the asthmatic patients by the
findings of skin prick tests (PST) (n = 30).
Results of blood eosinophil count of all subjects are
shown in Figure 3. The mean (+ SD) serum total lgE
level was significantly (p <0.001) higher in asthmatic
patients than that of control subjects.
Again distribution of all the subjects by serum total
lgE level is presented in Thble 2. Serum total lgE level
(>100 lUiml) was obsenred in B0% of asthmatic
patients and in6.7"/" of healthy subjects. The difference
was statistically significant (p <0 .001).
Group A: Apparently healthy adults (Control)
Group B: Adults suffering from mild intermittent asthma(
experimental)
n = number of subjects
Value in parenthesis indicates percentage
df = degree of freedom
..-
= Significant at <0.001
Results of the frequency distribution of the subjects
by SPT with elevated serum total lgE level are
shown in Figure 4. Percentages of positive SPT
patients were significantly (<0.001) higher than those
of negative SPT patients with elevated serum total
lgE level.
Again, association of the findings of positive skin prick
test (SPT) of different allergens with elevated serum
total lgE level in asthmatic patients were studied. A
non significant association were observed among
them. No data are presented in this aspect.
16.7
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li,'l)
40*-
ffi
[1I
ti'1I
ffi

4.
J Uttara Adhunik Med. College
Negative
21Yo
ts Positive
% Negative
Positive
79Yo
Fig.-4: Distribution of skin prick tests (SPTs) with
increased eosin oph i I cou nt.
Discussion
ln this study, skin prick tests were performed by using
common indoor allergens like, house dust, dust mite
a.nd cockroach among asthmatic patients in order to
detect type of allergens present in our population with
bronchial asthma. Because of non availability, SPT
for other allergens were not done. Although laboratory
tests for blood eosinophil count were done both in
asthmatic and healthy subjects.
ln this study, maximum numbers of asthmatic patients
had positive SPT for dust mite which is significantly
higherthan that of house dust and cockroach. Similar
type of observations were made by many investigators
of different countries including Bangladesh2'13'15.
Significantly higher mean eosinophil count in
asthmatic adults were compared to the healthy
subjects. Similar observations was reported by some
other investigatorsl6-17. ln this study, there was
association between the positive skin prick tests of
all allergens and increased eosinophil count though it
was not statistically significant. Similar study was
also observe612,18. Maximum numbers of asthmatic
patients had increased eosinophil count and a
significant association was found between asthma and
eosinophilia.
Several mechanisms have been proposed about the
allergens induced broncho-constriction in bronchial
Vol. 01, No. 01, January 2011
asthma. Eosinophilia is one of the common features
in bronchial asthma especially due to allergy.
Eosinophils play an imporlant role in the inflammatory
process of the airways of asthmatics. These group of
investigators suggested that activated eosinophils in
the bronchialwall of the asthmatics release arginine-
rich proCucts such as major basic protein (MBP),
eosinophil cationic protein (ECP), and eosinophil
peroxidase (EPO) which thereby cause bronchiale
hyperresponsiveness 1 0' 1 6-17'19-21 .
Moreover, there are some postulated mechanisms for
eosinophilia in bronchial asthma. lncreased the
numbers of eosinophils in peripheral blood may
stimulate bone marrow to release interleukin-3 (lL-3)
and interleukin-S (lL-5) by T-lymphocyte and mast
cells, which are chemotactic for eosinophils20'22.
Therefore, this study revealed that different allergens
like, house dust, dust mite and cockroach are
responsible for bronchial asthma in our country which
can be detected by SPT. Though only three indoor
allergens were studied but other indoor allergens like,
pet-derived allergens, molds including outdoor
allergens like, industrialfumes, ozone, pollens, grass
etc may have some important role in causing bronchial
asthma. Because of unavailability of all the above
mentioned allergens, it was not possible to include in
this study. ln addition presence of increased eosinophil
count in SPT positive asthmatic patients also support
these tests.
The above f indings indicate that this test can be done
along with SPT may be a usef ul measure for earlier
detection of allergens. Accordin gly hyposensitization
or desensitization of those patients with those
allergens may be the preventive and therapeutic
measures. All these measures can be adopted to
minimize the risk of complications especially in young
adults and thereby can improve their quality of life.
Conclusion
From the above findings it can be concluded that
different allergens like, house dust, dust mite and
cockroach are responsible for bronchialasthma in our
country and dust mite is the commonest. Presence
of all these allergens can be detected by Skin prick
tests (SPTs).
References
1. Sattar HA, Mobayed H, Al-Mohammed AA. The pattern
of indoor and outdoor respiratory allergens in
asthmatic adult patients in a humid and desert newly

5.
2.
Allergen Skin Test Reactivity and Eosinophilia in Adult Bronchiat Asthmatic patients
developed country. Allergo lmmunol (Paris). 2003;
35(8):300-s05.
Kelley W, Argyros G and Katial RK. Allergic and
environmental asthma. Available al: http//www.e
m ed ic i n e. co m /m ed/to p i c3390. htm. 2004.
Bardana EJ Jr. What Characterize allergic asthma? Ann
Allergy. 1992; 68(5): 371-373.
Burrows B, Lebowitz MD and Barbee RA. Respiratory
disorders and allergy skin test reactions. -Ann lntern Med.
1976;84 134.
Cotran RS, Kumar V and Robbins SL. Disease of immunity.
ln Robbins Pathologic Basis of Disease, 6'h edn., WB
Saunders Company, Philadelphia. 1994, p. 195.
McFadden ER Jr. Asthma. ln Harrison's Principles of
lnternal Medicine (lssel bacher KJ, Brannwald E,
Wilsonnnn JD, Martin JB, Fanci AS and Karper DL eds.),
13th edn., 2005. pp, 1508-1515. Mc Graw-Hill lnc., New
York.
Tollerud DJ, O'Connor GT, Sparrow D and Weiss ST.
Asthma, hay fever and phlegm production associated with
distinct patterns ot allergy skin test reactivity, eosinophilia
and serum lgE levels. Am Hev Respir Dis. 1991; 144:
776-781.
Halonen M, Barbee RA, Lebowitz MD and Burrows B. An
epidemiologic study of the interrelationships of total serum
lgE, allergy skin test reactivity and eosinophilia. J Allergy
CIin lmmunol. 1982; 69: 221-228.
Devenney I and Falth-Magnusson K. Skin prick test may
give generalized allergic reactions in infants. Ann Allergy
Asthma lmmunol. 2000; 85(6): 457-460.
Ulrik CS. Eosinophils and pulmonary function: An
epidemiologic study of adolescents and young adults. Ann
Allergy Asthma lmmunol. 1998; 80: 487-893.
Arshad SH, Tariq SM, Mahews S and Hakim E. Sensitization
to common allergens and its association with allergic
disorders at age 4 years. Pediatrics. 2001 ; 108(2): 1-8.
Burrows B, Mafiinez F, Halonen M, Barbee RAand Clin MG.
Association of asthma with serum lgE levels and skin test
reactivity of allergens. N Engl J Med. 1989;32Q:271-276.
17
T Parveen et al
Geber LE. SeEer LH, Bouzoukis JK, Pollart SM, Chapman
MD. Phts Milb TAE Sensitization and exposure to indoor
allergens as rsk hciors for asthma among patients presenting
to ho6Frtai. fun R* Rapr Ds. 19S: 147: 573578.
Mondol EA and Rahnan ASMM. Prevalence of Mite
allergens amongst gatren:s of bronchial asthma.
Bangladesh Amd Fo{ces l',e J z}n 26:41-45.
Celedon JC, Palmer LJ. Wetss STfJang Brnvan. Fang Z
and Xu X. Asthma. rhrnrlrs a.c sk. t€s' reactivrty to
aeroallergens in famrhes of asth"na:r sj.€cts in Anourng.
China. Am J Respir Cnt Care l{eo 23€' '53,i '1C8-
1112.
Laprise C, Boulet LP. Aiftvay respo.lsle.ess a.c a:cp.v
in families of patients with asthma Ct,. t-,6: ryeo '99€:
19(60):461-469.
Erikson NE, Moller C, Wih, JA and Zo,ucas r.r qr - ^.cr
allergens, inhalant insect allergens arc s-'-c
relationships to indoor environmenl Cc.::- :a'i
sensitization to different allergens. Varku P-'-.cr.:.:!.,a '
Alargologija. 2000.
Jansen DF, Rijcken B, Schouten. The relahonsr cs :'s..'
test positivity, high serum lgE level and Penpre'a :,.:r:
eosinophilia to symptomatic and asymptoma:.: a -.ra,
hyperresponsiveness. Am J Respir Crit Care r.kc '?-
159(3): 924-9s1.
Burrows B, Hasan FM, Barbee RA. Halone- r.' a':
Lebowitz MD. Epidemiologic observations on ecsrr€c. a
and its relation to respiratory disorder. Am Re' ?es:'
Dis. 1980; 122: 709-717.
Horn BR, Robin ED, Theodore J and Kessei Ar Tc:a
eosinophil counts in the management of bronchra as}-a
N Engl J Med. 1975',292: 1152-1155.
Lewis SA, Pavord lD, Stringer JR. The relatim b€f^ee.
peripheral blood leukocyte counts and resp'atc''
symptoms, atopy, lung function ano d'n2.t
responsiveness in adults. Chest. 2001: 119. 1!1":
Platts-Mills TAE and DeWeck Al. Dust mite allerge.s a-3
asthma - A world wide problem (lntemational !rybftsroc
J Allergy Clin lmmunol. 1989; 83: 416.
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20.
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