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  1. 1. The Clinical Course of Allergic Rhinitis & Asthma Poster# 254 In the Aftermath of Hurricane Katrina Annette Fiorillo, DO; Prem Kumar MD; Douglas Bartslow, MD Louisiana State University Health Science Center, New Orleans Introduction Results Mechanism of Mold and Disease •Hurricane force winds of Katrina lead to Levee breaches resulting in massive flooding of homes and business •Allergic & Immunologic 3 • Stagnant water in the buildings coupled with loss of power, high temperatures -Atopic Asthma and Allergic Rhinitis and humidity lead to heavy mold growth -Hypersensitivity pneumonitis • Many of our patients in the aftermath of Katrina reported increased symptoms -Allergic bronchopulmonary aspergillosis (ABPA) of Allergic Rhinitis and Asthma. -Immune dysfunction resulting from mold exposure •We investigated patients who reported increased allergic symptoms post- -Allergic fungal sinusitis (AFS) Katrina and compared their clinical status before pre-Katrina •Toxic effects of Mold exposure 4 -Mycotoxins •All patients with increased symptoms developed neosensitization to environmental allergens including molds •Irritant effects of Mold exposure -Volatile compounds (MVOC’s) •Worsening asthma symptoms/development of asthma was also noted Abstract Literature Review Background: In the aftermath of hurricane Katrina several of our patients reported exacerbations Reference History attributed to mold exposure Affected building and specific mold of allergic rhinitis (AR) , allergic conjunctivitis (AC) and either exacerbations or Patient Peak Flow Pre- Peak-Flow Neosensitization Need for Oral Hospitalization implicated development of asthma. As a result of Katrina, many homes were flooded, causing Katrina Post Katrina Molds, Grass, Steroids Brunkreef 1989 6273 children respiratory questionnaires Homes total mold spores count Weeds 5 no controls significantly increased levels of airborne molds. We sought to investigate if these changes in reported symptoms correlated with changes in Skin Prick Test (SPT) Strachan 1990 6 Children with asthma wheezing more in Homes total mold spores count reactivity, changes in peak flow measurements and/or changes in treatment. home units higher mold counts. Spirometry Methods: performed Pt #1 600-640 500-510 + + - At the start of this pilot clinical study we investigated patients who reported Johanning 1996 43 workers questionnaires no control Office building stachyboytrus species Pt #2 400-420 295-300 + + + subjects increased allergic symptoms and in whom we had previously performed SPT (pre- 7 Katrina). We then repeated SPT (post-Katrina) and compared the results to earlier Hodgosn 1998 8 197 workers questionnaires case control Office building aspergillus penicillium findings. In addition, patients who had a history of asthma or those complaining of Pt#3 600-650 500-510 + + - study control building was not tested for stachyboytrus respiratory symptoms had peak flow measurements done and their results were mold quantitation compared with those done before Katrina. We also noted any changes in Pt#4 500-550 375-400 + + - *Santilli 2003 9 Rhinitis questionnaire 85 students and Two schools total mold spores medications including the need for additional medications, the need to increase teachers Pt#5 500-550 390-410 + + +/New onset medication dose, use of systemic steroids, and number of emergency room visits or hospitalizations. asthma Results: SPT in four of five patients were reactive to many molds to which they were previously anergic. The most common molds were, Alternaria, Aspergillus fumigatus and Cladosporium. All the patients with increased respiratory symptoms had decreased peak flow measurements from their baseline and required changes Discussion in their medications including the addition of systemic steroids. One patient with increased respiratory symptoms was diagnosed with asthma which was confirmed •Dampness & mold associated illnesses have great impact on health & economy by spirometry and methalcholine challenge. In addition this patient had several emergency department visits and hospitalizations for asthma exacerbations. • Fungal elements have been suggested to contribute to asthma and allergic disease Conclusions: in sensitized individuals Many patients have demonstrated increased symptoms relating to allergic rhinitis and asthma after Katrina. These cases demonstrate that atopic patients in the Penicillum Alternaria •Studies of mold and its relationship to allergic disease remains controversial greater New Orleans have been sensitized to new allergens. Patients that are experiencing increased symptoms of rhinitis, conjunctivitis or asthma should be re- •Areas of New Orleans was devastated by hurricane Katrina and may provide a rich evaluated with SPT, spirometry and a thorough history to environmental exposure. environment for the study of mold-induced disease With the large number of people affected by Katrina, further studies should be performed as more patients return to the New Orleans area. •We reports five patients with increased symptoms of allergic disease, asthma and neosensitization to environmental allergens including mold Methods•We investigated five patients who reported worsening respiratory Aspergillus Cladosporium Referencesand/or allergic rhinitis post-Katrina Background Mechanism of Molds & Disease 1. Hossain, Mohammad, et al. Attributes of Stachybotrys and its association with human disease. JACI. Feb 2004:Vol113 2. Bush, Robert, J. Portnoy. “The role and abatement of fungal allergens in allergic diseases. JACI. March 2001. 107:S420-40•SPT were performed to the most common molds & outdoor allergens: •Fungi are ubiquitous in nature 3. Bush, R, et al. The medical effects of mold. JACI. Feb 2006:vol 117:2. •Alternaria, Aspergillus fumigatus and Cladosporium 4. Pulimood, T, Corden, Bryden, et al. Epidemic asthma and the role of the •Approximately 100,000 species of fungi recognized fungal mold alternaria alternata. Sept 2007:Vol 120:No 3. •Short and Giant Ragweed 5. Brunekreef, B, etal. Home dampness and respiratory morbidity in children. •Major molds found in air and dust include1: Am Rev Respir Dis. 1989 Nov;140(5):1363-7. •English Plantain, Bahia & Bermuda, grass, Italian Rye & Kentucky 6. Strachan DP, et al. Quantification of airborne moulds in the homes of children with and without wheeze. Thorax. 1990 May;45(5):382-7. Blue Grass -Penicillum, Cladosporium, Alternaria & Aspergillus 7. Johanning E, et al. Health and immunology study following exposure to toxigenic fungi (Stachybotrys chartarum) in a water-damaged office environment.•Results of SPT were compared to those done pre-Katrina •Studies & case reports suggest increased moisture and exposure to mold Int Arch Occup Environ Health. 1996;68(4):207-11 damaged buildings correlates with increased disease 2 8. Hodqosn MJ, et al. Building-associated pulmonary disease from exposure to Stachybotrys chartarum and Aspergillus versicolor. J Occup Environ Med. 1998 Mar;40(3):241-9.•Changes in treatment & peak flow were obtained through chart review 9. Stantilli, J. Rockwell W. Fungal contamination of elementary schools: a new environmental hazard. Ann Allergy Asthma Immunol. 2003 •Molds and its relationship to disease remains controversial Feb;90(2):203-