Abstract 13: Elevated Atmospheric Levels of Environmental Allergens Might be Associated with Decreased Risk of an Immunologic Reaction to an Etiologic Trigger in Kawasaki Disease
Introduction: There is considerable interest in identifying potential etiologic and/or triggering agents for the severe immune response associated with Kawasaki disease (KD). The presence of environmental allergens might modulate the odds of triggering such a response despite those allergens not being direct etiologic agents.
Methods: We queried the Canadian hospital discharge database (Canadian Institute for Health Information) for hospital admissions associated with a discharge diagnosis of KD in 2011 in the Greater Toronto Area. Atmospheric levels of pollens (35 species), spores (24 species) and fungi (27 species) were measured by Aerobiology Research Laboratories (Nepean, Ontario). A number of separate models were tested using theoretical incubation periods of 0, 7, 14 or 21 days. Correlation between KD cases and atmospheric levels of environmental allergens were assessed in linear regression models.
Results: n=145 patients with KD were included. The highest levels of environmental allergens were in summer months. Overall atmospheric pollens levels were not associated with the KD cases (total pollen count r=0.04, p=0.54); there was no consistent pattern of association with specific pollens. . However, higher levels of spores were associated with a decreased prevalence of KD for all spore species (r=-0.23, p<0.001). Associations were observed for 6 of 19 specific species detected (p<0.001), including leptosphaeria, ascospores, oospore, coprinus/coprinellus, basidiospores, and uredinales. The same pattern was observed for all fungi species (r=-0.17, p=0.009). Associations were observed for 5 of 26 specific fungal species (p=0.002), including alternaria, cladosporium, epicoccum, fusarium,and fungi imperfecti. There were no discernable patterns regarding a potential incubation period.
Conclusions: High levels of environmental allergens, particularly fungus and spores, were associated with lower incidence of KD. These results suggest that environmental allergens, even if they are not etiologic agents for KD, might modulate the threshold necessary for the actual etiologic/triggering agent. Atmospheric levels of environmental allergens might be partly responsible for the KD seasonality patterns observed in Canada.
Author Disclosures: C. Manlhiot: None. S. O’Shea: None. B. Bernknopf: None. N. Chahal: None. B.W. McCrindle: None.
- © 2015 by American Heart Association, Inc.