[Clinical characteristics of the fatal and near-fatal asthma in Alternaria alternata sensitized patients].
OBJECTIVE
Some studies have pointed to Alternaria alternata as a trigger of fatal and near-fatal asthma (NFA) crises. The objective of this study was to determine the clinical characteristics of fatal and NFA crisis in patients sensitized to Alternaria.


METHODS
One hundred ninety four patients with fatal or NFA attacks were enrolled in a multicenter (33 Spanish hospitals), prospective study. We gathered the characteristics and clinical course of the crises. We performed the following tests: spirometry, prick-test to common allergens, and specific IgE to Alternaria when patients were in stable condition. The sensitization test to Alternaria was performed when the prick-test and/or specific IgE levels were positive.


RESULTS
Twenty (10%) patients were sensitized to Alternaria. When compared to non-sensitized patients, Alternaria sensitized patients were significantly younger, 35 (15) vs 50 (21) years old (p<0.001); their hospital admission length was shorter, 6.5 (5.5) against 9 (7) days (p=0.039); they had a higher number of deaths or severe neurological sequelae, 15 vs 3% (p=0.026); they had a higher sensitization frequency to the remaining allergens, 68 against 22% (p=0.003); and they exhibited a fewer bronchodilation response upon inhaled salbutamol, 6 vs 10% (p=0.013).


CONCLUSIONS
The clinical characteristics of Alternaria sensitised, fatal-and NFA-patients, seem to identify a particular phenotype. Specific avoidance strategies could be useful to prevent fatal and NFA attacks.
Plaza
Vicente
V
Departament de Pneumologia, Hospital de la Santa Creu i Sant Pau, Barcelona, España.
Serrano
José
J
Picado
César
C
Cosano
Javier
J
Ancochea
Julio
J
de Diego
Alfredo
A
Martín
Juan José
JJ
Sanchís
Joaquín
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000485:Allergens / Q000276:immunology*; D000528:Alternaria / Q000276:immunology*; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D000908:Antibodies, Fungal / Q000097:blood; D001249:Asthma / Q000276:immunology / Q000401:mortality* / Q000628:therapy; D002648:Child; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012882:Skin Tests; D013147:Spirometry
D000485:Allergens; D018927:Anti-Asthmatic Agents; D000908:Antibodies, Fungal; D007073:Immunoglobulin E