Peran Sensitisasi Protein Susu Sapi Melalui Aktifitas Limfosit Th-1 dan Th-2 serta Faktor Risiko Alergi dan Lingkungan dalam Terjadinya Mengi pada Bayi sampai dengan Usia 1 Tahun

Abstract

Background: Allergic disease is an important issue because it occurs at all levels of society and increasing the number of events in the last three decades. Allergy risk factors and cow's milk allergen sensitization together with environmental factors play an important role in the mechanism of allergy. Development of allergic diseases is determined by at least three things: the -genetic background, exposure to allergens and amplified by environmental factors. Wheezing is an early symptom of respiratory disorders that often occur as a result of allergic reactions in cliildren. Children· from families witli a history of allergic diseases will be at risk of allergic disease compared with those without a history of allergic disease in the family. Objective: Looking at the role of cow's milk allergen sensitization on the lymphocytes Th-1 and Th-2 activity and allergy risk in parent with environmental factors in association with wheezing in infants up to age 1 year were treated in the General Hospital dr. Zainoel Abidin Banda Aceh. Methods: This exploratory analytic observational study with cohort design was conducted at General Hospital dr. Abidin Abidin Banda Aceh from May to December 2013. Samples were taken with consecutive technique based on a single sample formula to estimate the proportion of the population using absolute precision in order to obtain 71 samples that fit the inclusion criteria. Examination of skin prick test as a diagnostic procedure doing by a pediatrician division of allergy and immunology, and then taken in the peripheral blood of infants median cubital vein by 5 ml by the inspection team Prodia for IL-5 and IFN-y levels by ELISA in laboratory techniques Prodia Jakarta. Samples were monitored regularly by telephone to determine allergic complaints from prospective subjects performed every week until the age of 1 year. Univariate analysis covers to see the distribution of each variable, to test the hypothesis at the bivariate level 2 variant and look for the point of intersection with the means of descriptive statistics (mean and median), and multivariate multiple logistic regression to determine risk factors. To determine the relationship between the various variables to wheeze using Chi Square test and Fisher's exact test. To assess the differences in activity of Th-1, Th-2 and the results of skin prick test - in wheezing and non-wheezing group used independent t test. Results: A cohort study in 71 subjects were followed for up to 12 months old obtained the incidence of wheezing was 64.8%. Subjects who have a low risk of allergic-being as much as 67.6% and a high allergy risk as much as 32.4%. The bivariate analysis there is significant relationship between IL-5 level with the result of skin prick test. There is a relationship of allergy risk factors (p = 0.007), cow's milk skin prick test (p = 0.000), IFN-y levels (p = 0.033), IL-5 levels (p = 0.000) and the father smoked (indoor) (p = 0.003) on the complaint of wheezing. While history of labor (p = 0.337), history of feeding (p = 0.232) and sex (p = 0.872) was not related to the complaints of wheezing. There are differences in the value of the skin prick test in children with high risk factors and mild-moderate risk factors (p = 0.010). There are differences in the levels of IL-5 in children with symptoms of wheezing and non-wheezing (p = 0.000). There are differences in the value of the skin prick test in children with symptoms of wheezing and non-wheezing (p = 0.000). But there are differences in levels of IFN-y in children with symptoms of wheezing and non-wheezing (p = 0.192). In multivariate analysis contained significantly influence levels of IFN-y against wheezing (p = 0.010) with RR 10.28 (95% Cl 1.73 to 31.61), the levels of IL-5 against wheezing (p = 0.000) with RR 20 , 69 (95% Cl 4.51 to 94.83) and patem~I smoking on wheezing (p =_ 0,020) with RR 6.49 (95% _Cl 1.33 to 31.61). Conclusion: There Js a significant relationship between IL-5 level with ·the result of skin prick test. Risk factors has significant relation on the incidence of wheezing. There are difference of average value on skin prick test results in a group of high risk and mild-moderate risk factors. Mean value of IFN-y did not differ in wheezing· and non-wheezing group. Mean value of IL-5 differ in wheezing and non-wheezing group. There are difference of average value on skin prick test results in wheezing and non-wheezing group. Parents smoking ~ndoor), particularly the father seemed related to the occurrence of wheezing. There is no relations of labor history and feeding history and sex on the occurrence of wheezing. The results of this study showed a shift picture of allergic march in Aceh with early wheezing symptoms in 4-6 month as an early sign of asthma and dermatitis. The result of study is also showed IL-5 level increased above 0,6 pg/ml with· AUC is 86% reflected the Th-2 profile examination is so realibel in allergies determination