KORELASI SENSITISASI ALERGEN INDOOR DENGAN FREKUENSI EKSASERBASI ASMA PADA ANAK

Irene, dr. Putu Siadi Purniti, Sp.A

2011 | Tesis | S2 Ked.Klinik/MS-PPDS

Cepatnya peningkatan insidens asma menunjukkan pentingnya faktor lingkungan di samping faktor genetik. Sensitisasi terhadap alergen indoor yang bersifat perenial dihubungkan dengan peningkatan gejala asma. Penelitian ini bertujuan untuk mengetahui korelasi sensitisasi terhadap alergen indoor dengan frekuensi eksaserbasi asma pada anak. Penelitian potong lintang dilakukan pada penderita asma berusia 6-12 tahun di Bagian/SMF Ilmu Kesehatan Anak RSUP Sanglah, Denpasar. Pemeriksaan sensitisasi dilakukan dengan metode Skin Prick Test (SPT) terhadap tujuh alergen indoor. Derajat sensitisasi dinilai dengan mean wheal diameter (positif ≥3 mm dibandingkan kontrol negatif). Frekuensi eksaserbasi asma selama tiga bulan dinilai secara retrospektif. Hasil SPT positif terhadap satu atau lebih alergen pada 84 dari 89 anak (94%). Median usia subjek 93 bulan (rentang interkuartil: 81-117 bulan), dan jenis kelamin laki-laki sebesar 64%. Jumlah sensitisasi menunjukkan korelasi positif dengan frekuensi eksaserbasi asma dalam tiga bulan (r=0,284; P=0,007). Mean wheal diameter masing-masing alergen indoor tidak berkorelasi dengan frekuensi eksaserbasi asma. Status atopi orangtua dan saudara kandung, infeksi saluran napas yang mendahului eksaserbasi asma, penggunaan obat pengendali, dan paparan asap rokok tidak berhubungan dengan frekuensi eksaserbasi asma. Reaktivitas SPT yang diperantarai IgE terhadap alergen indoor umum terjadi pada penderita asma anak di Denpasar, Bali. Meskipun banyak faktor yang memberikan kontribusi dalam eksaserbasi asma anak, banyaknya sensitisasi terhadap alergen indoor berkorelasi langsung dengan peningkatan eksaserbasi asma. Tipe bangunan di tempat penelitian cenderung terbuka sehingga diduga mempengaruhi konsentrasi alergen dan intensitas paparan.

The rapid increase in asthma incidence implies to the importance of environmental factor over genetic factor. Sensitisation to perennial indoor allergens has been associated with the increase of asthma symptoms. This research aims to identify the correlation between sensitisation to indoor allergens and asthma severity in children. A cross-sectional study was held in the Pediatric Department of Sanglah Hospital, Denpasar, on asthmatic children aged 6 to 12 years. The degree of sensitisation was assessed by the mean wheal diameter (positive ≥ 3 mm from negative control) for seven common indoor allergens. Frequency of asthma exacerbation for three consecutive months prior to data collection was retrospectively reviewed. Skin test results from 84 of 89 (94%) asthmatic children were positive for one or more allergens. The median of patients’ ages was 93 months (interquartile range 81-117 months), and males constituted 64%. Higher frequency of asthma exacerbation was significantly correlated with the numbers of allergens with positive sensitisation (r=0,284; P=0,007). On the contrary, this correlation did not exist between mean wheal diameter of each allergen and frequency of asthma exacerbation. Frequency of asthma exacerbations was independent of parental and sibling atopic history, preceding respiratory infection, use of controller and passive environmental tobacco smoke exposure. IgE-mediated skin test reactivity was common among asthmatic children in Denpasar, Bali. Despite the contribution of other factors in asthma exacerbation, higher frequency of asthma exacerbation was directly correlated to more numbers of positive sensitisation to indoor allergens. The numerous openings in the types of housing in the sites of research suspectedly influence allergen concentrations and the intesity of exposure.

Kata Kunci : frekuensi eksaserbasi, sensitisasi, alergen indoor