Clinical Improvement of Asthma after Anthelminthic

Treatment in a Tropical Situation

NEIL R. LYNCH, MIGUEL PALENQUE, ISABEL HAGEL, and MARIA C. DIPRISCO
Instituto de Biomedicina, Facultad de Medicina, Universidad Central de Venezuela, Caracas; and Clinica Experimental de Asma,
FONDENE, Isla de Coche, Venezuela

Intestinal helminths are among the most common infectious organisms of humans, particularly in
tropical regions, and can induce the production of large quantities of IgE antibody. Part of this re-
sponse is directed against the helminths own antigens, but a polyclonal stimulation also occurs that
may increase the allergic reactivity toward environmental allergens. The importance of this in the
symptomatology of asthma in these regions is, however, uncertain. In the present study we evalu-
ated the effect of regular anthelminthic treatment with albendazol for 1 yr on a group of asthmatic
patients in a zone in which these parasites are endemic. The number of asthmatic crises, need for
maintenance therapy with inhaled steroids, and use of inhaled b2-agonists were compared both with
those in the year prior to the study for the treated patients, and with those in a group of asthmatic
subjects evaluated in parallel, but in whom the parasitic infections were not controlled. Significant
improvement in all of these indicators of clinical status occurred in the treated group, not only for the
period of anthelminth administration, but also for the year following. However, after 2 yr without
treatment, the severity of asthma reverted to the initial state. No significant changes were observed
in the control group over the entire period of evaluation. At the beginning of the study, the patients’
pulmonary function was below the levels predicted for normal individuals, but this was not changed
by the anthelminthic treatment. The patients’ total serum IgE levels, which were elevated at the be-
ginning of the study, were significantly diminished by the anthelminth administration, as were the
specific IgE antibody levels and positivity in skin tests for immediate hypersensitivity to the common
environmental allergen Dermatophagoides sp. However, the specific response to Ascaris lumbricoides,
a common helminth in the area, was maintained despite treatment. These results indicate that intes-
tinal helminthic infections can contribute to the clinical symptoms of asthma in an endemic situation.
This may occur via a direct response to the parasite and/or a nonspecific potentiation of allergic reac-
tivity to environmental allergens. Lynch NR, Palenque M, Hagel I, DiPrisco MC. Clinical improve-
ment of asthma after anthelminthic treatment in a tropical situation.
AM J RESPIR CRIT CARE MED 1997;156:50–54.

Helminthic parasites provide particularly potent stimuli for
the synthesis of IgE antibody (1), and the existence of allergic-
type reactivity to these organisms is well recognized (2). In ad-
dition, immediate hypersensitivity skin-test reactions to ex-
tracts of these parasites are very common in situations in
which such infections are endemic (3). For a number of years,
however, controversy has surrounded both the possible in-
volvement of helminthic infection in the pathogenesis of respi-
ratory disease (4–6) and its influence on the prevalence of al-
lergic conditions in the tropical environment (3, 7). This may
be at least partly due to the ability of these parasites to also
cause an interleukin-4 (IL-4)-dependent polyclonal stimula-
(Received in original form June 19, 1996 and in revised form March 10, 1997)
Supported by Consejo Nacional de Investigación Cientifica y Tecnológica RPV
170041, Consejo de Desarrollo Cientifica y Humanistica/Universidad Central de
Venezuela, Congreso de la Republica/Ministerio de Educación/UCV, World Bank
grant VEN/96/002/14, and grant SD.000.0309 from Astra-Draco, Sweden.
Correspondence and requests for reprints should be addressed to Dr. Neil Lynch,
Instituto de Biomedicina, Aptdo. 4043, Carmelitas, Caracas, 1010A, Venezuela.
Am J Respir Crit Care Med Vol. 156. pp. 50–54, 1997
tion of IgE synthesis (8, 9). Helminthic infections of low inten-
sity can nonspecifically potentiate the synthesis of IgE anti-
body against environmental allergens, and thus enhance
allergic reactivity (10–13). In contrast, the excess polyclonal
IgE stimulated by more intense helminthic infection can sup-
press the allergic response by producing mast-cell saturation
(14) and inhibition of specific IgE antibody synthesis (3, 7). In
previous studies, we have demonstrated a direct relation be-
tween helminthic infection and pulmonary function. Thus,
bronchial challenge with helminth extracts can induce bron-
choconstriction in clinically asthmatic children in areas in which
helminthic infection is endemic (15). Also, nonasthmatic chil-
dren in such areas can respond significantly to bronchodilator
inhalation, and this response can be reversed by anthelminthic
treatment (16). Moreover, parasite eradication can produce a
reactivation of allergic reactivity toward common environmen-
tal allergens in children in whom this is suppressed by exces-
sively polyclonal IgE (17).
Considering the complexity of the possible influence of hel-
minthic infection on allergic reactivity, we evaluated in the
present study the effect of regular and prolonged anthelmin-
Lynch, Palenque, Hagel, et al.: Helminthic Infection and Asthma
thic treatment on a group of clinically asthmatic patients in a
tropical environment in which these parasites are endemic. As
the intensity of infection in this group was low to moderate,
we hypothesized that such treatment would improve the pa-
tients’ clinical condition either: (1) by removing the specific al-
lergic stimulus exerted by the parasites at the level of the lung;
(2) by decreasing the potentiating effect that helminthic infec-
tion might have on the synthesis of IgE antibody against com-
mon environmental allergens, such as house-dust mite; or (3)
both.
METHODS
Asthmatic Patients
The study was performed on a total of 89 asthmatic patients (age:
18.5 6 14.6 yr [mean 6 SD]; 48% male and 52% female), who for a
number of years had attended the asthma clinic established by the
Fund for the Development of the State of Nueva Esparta (FONDENE)
on Coche Island, Venezuela. The patients were all of very low socio-
economic level, being classified as in a condition of “critical poverty”
according to the scale in official use in Venezuela (18). Because the
clinic belongs to the only medical facility on the island, and provides
treatment free of charge, the patients do not seek attention elsewhere.
The only criteria applied in the selection of these patients was that
they had active asthma, were experienced in the performance of pul-
monary function tests, and agreed to participate in the full study pro-
gram. At the outset of the study, 100 patients were selected, 50 of
whom were randomly assigned to the treatment group and 50 to the
untreated control group. Of the former, 10 were excluded from the fi-
nal analysis because of noncompliance with the treatment protocol. In
one treated patient, two mild asthmatic episodes closely followed al-
bendazol administration. Although it was uncertain whether this oc-
curred by chance, or was due to the anthelminthic agent, this patient
was also withdrawn from the study.
Ethical Considerations
The study protocol was approved by the ethical committee of the In-
stitute of Biomedicine of the Central University of Venezuela and the
administrative medical staff of the Coche Island medical dispensary
Venezuelan Ministry of Health and Social Assistance, to which the
asthma clinic is attached. It was also ratified by the National Council
for Scientific and Technological Investigation (CONICIT) of Venezu-
ela. The investigative procedures applied were part of the routine
evaluation and follow-up program of the asthma clinic, which up to
the time of the study did not include rigorous control of parasitic in-
fection in its patients. In this respect, the control group was not de-
prived of the right to receive anthelminthic treatment, but rather this
was formally implemented in the treated group on a regular basis. Be-
cause of the low socioeconomic level and correspondingly limited
medical awareness of the patients, the administration of a placebo to
the control group was not considered acceptable by the members of
the community. Instead, we received ethical permission to inform the
treated group of our objective of controlling their helminthic infec-
tions without specifically explaining to them the hypothesis of the
study that their asthma would also improve with such control.
Anthelminthic Treatment
Albendazol (400 mg) was administered monthly for a period of 1 yr to
the treated group. Since the patients were in a situation of endemic
helminthiasis, treatment was administered irrespective of the results
of the initial fecal examination, and the anthelminthic agent was ad-
ministered regularly to ensure that reinfection did not occur during
the study period. The treatment was personally administered by social
workers of the medical dispensary, and any patient who missed two
successive doses was withdrawn from the study. The year of treatment
was considered as Year 1 of the study, and the subsequent 2 yr, when
the anthelminthic agent was not administered, were designated Years
2 and 3. Because of the degree of poverty of the patients, the level of
autoadministration of anthelminthic agents is minimal, and we found
no evidence of this occurring in the control group.
51
Management of Asthma
The strategy for asthma management employed in the asthma clinic is
maintenance inhalation of beclomethasone (100 mg twice daily), com-
plemented with inhaled salbutamol (200 mg as needed) when signifi-
cant symptoms (cough, dyspnea, wheezing) occur. If this treatment
was not sufficient to control asthmatic episodes in the patients in the
study, they were treated as outpatients in the asthma clinic, receiving
intravenous methylprednisolone (1.5 mg/kg) and nebulized fenoterol
(250 mg) and ipratropium bromide (125 mg). If asthmatic crises oc-
curred more than twice monthly, the beclomethasone used for main-
tenance treatment was changed to inhaled budesonide (200 mg twice
daily). When a patient was symptom-free for a period of 3 mo, the
maintenance treatment was suspended, and was resumed if symptoms
reappeared. Because of the cost of the asthma medication, the asthma
clinic was the only source of treatment available to the patients, and
we were therefore able to accurately monitor the consumption of these
drugs over the year prior to the commencement of the treatment pe-
riod (designated Year 0), and for Years 1 to 3 of the study. We should
note here that the day-to-day clinical management of the patients was
the responsibility of short-term interns who staffed the medical dis-
pensary, and who were not aware of the objective of the study. They
were, however, informed that the patients were receiving albendazol.
Evaluation of Pulmonary Function
As part of the routine clinical management of patients by the asthma
clinic, tests of pulmonary function are regularly given by the resident
chest physician (Dr. M. Palenque) to all patients in the control pro-
gram, following the guidelines of the American Thoracic Society
(ATS) (19). For the purpose of our study, pulmonary function was
measured immediately prior to the beginning of the study (Year 0)
and again at the end of Year 1, using a Respiradyne II solid-state
spirometer (Sherwood Medical, St. Louis, MO). The values of FVC,
FEV1, peak expiratory flow rate (PEFR), and maximum midexpira-
tory flow (MMEF) rate were calculated. Because many of the patients
were children, the absolute spirometric values at the beginning and
end of the study period could not be directly compared. For this rea-
son, they were expressed as percentages of the values predicted ac-
cording to the height and sex of the patients, using normal values de-
termined for a group of Spanish subjects (20), or as the FEV1/FVC
ratio, also expressed as a percentage. Prior to the study, the bronchial
hyperreactivity (BHR) of the patients was confirmed by bronchial
provocation with histamine (21), in which 1 ml of histamine base (as
dihydrochloride; Sigma Chemical Co., St. Louis, MO) was nebulized
in stepwise concentrations from 0.0081 mg/ml to 5.0 mg/ml. Changes
in FEV1 of > 20% (PC20) at a histamine concentration < 2.5 mg/ml
were considered to indicate a state of BHR. This test was repeated at
the end of Year 1. All asthma medication was suspended on the day
before the testing of pulmonary function. We should point out here
that this aspect of the evaluation was not performed in a blind man-
ner, since the chest physician was aware of the objectives of the study.
In a group of 10 asthmatic patients of higher socioeconomic level
on a neighboring island (Margarita Island), and in whom helminthic
infection was not endemic, pulmonary function tests were performed
before and then again at 1 and 24 h after the administration of al-
bendazol, to determine whether this affected their pulmonary func-
tion. Although the data for this group are not presented here, we
found that this treatment had no bronchodilator effect.
Parasitologic Examination
Three serial fecal samples were collected into preservative solution
(40% tincture of merthiolate, 5% formaldehyde, 1% glycerol) and ex-
amined microscopically. These tests were performed at the beginning
of the study and at regular intervals during the treatment period. Fe-
cal egg counts were not performed on the study group, but in work
that is not reported here, we have found that the whole population
from which the patients were drawn has a point-prevalence of 40 to
50% for intestinal helminths, and that the intensities of infection are
from light to moderate. For example, the median egg count per gram
of feces in infected individuals was 1,540 for Ascaris lumbricoides.
52 AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE VOL. 156 1997

TABLE 1
EFFECT OF ANTHELMINTHIC TREATMENT ON THE CONTROL OF ASTHMA

Control of Asthma*

Maintenance Treatment MDI Crises

Year† (mo) (n/yr) (n/yr)

Treated group, n 5 39 0 5.5 6 0.8 4.5 6 0.7 4.3 6 1.0

1 3.9 6 0.8 2.3 6 0.4 2.9 6 0.8
2 2.4 6 0.7 2.1 6 0.6 1.9 6 0.8
3 5.6 6 0.8 5.3 6 0.9 4.3 6 1.0
Untreated group, n 5 50 0 6.7 6 0.8 4.0 6 0.7 3.8 6 0.9
1 6.6 6 0.8 4.3 6 0.7 3.8 6 0.9
2 7.1 6 0.8 4.8 6 0.7 3.6 6 0.6
3 7.0 6 0.8 5.0 6 0.6 3.6 6 0.5

Definition of abbreviation: MDI 5 metered dose inhaler.

* Mean 6 SEM of number of months per year that maintenance therapy was administered, number of metered dose inhalers consumed
per year, and number of asthmatic episodes per year that required outpatient attention.
†
Year 0 5 year prior to study. Year 1 5 year of anthelminth administration in the treated group. Years 2 and 3 5 first and second post-
treatment years.

Immunologic Evaluation
Skin-prick tests for immediate hypersensitivity were performed with
extracts of Dermatophagoides pteronyssinus and A. lumbricoides, and
as a positive control, with 1% (wt/vol) histamine. Wheal diameters of
> 3 mm were considered positive. Total IgE levels were measured
with the Phadebas radioimmunosorbent test (PRIST) (Pharmacia,
Uppsala, Sweden), and expressed as IU/ml. Levels of IgE for the fore-
going allergens were measured with the Phadebas radioallergosorbent
(RAST) test, and expressed as Phadebas RAST units/ml (PRU/ml).
As suggested by the manufacturers of the test, values > 0.7 PRU/ml
(RAST Level 2) were considered positive.
Statistical Analysis
Owing to a high degree of dispersion of the values of most of the contin-
uous variables measured, nonparametric statistical tests (one-way anal-
ysis of variance [ANOVA], Wilcoxon’s test) were applied, using the In-
Stat program of Graphpad Software (San Diego, CA). For convenience
of presentation, the means 6 SEM are shown in the tables. Frequency
analyses of discrete variables were performed with the chi-square test.
RESULTS
Parasitologic Evaluation
At the beginning of the study, 41% of the entire group of pa-
tients were found to be infected with helminths. The predomi-
nant parasites were Trichuris trichiura (26%) and Ascaris lum-
bricoides (23%). Infections were detected at some time in six
of the anthelminth-treated patients during Year 1 of the study.
Clinical Status
Owing to the low level of literacy and medical awareness of
the study group, we chose three criteria, that depended di-
rectly or indirectly on the asthma clinic, to estimate the clinical
status of the patients. These were: (1) the number of months
per year that maintenance therapy with beclomethasone was
administered; (2) the number of metered-dose inhalers (MDI)
of salbutamol that were used electively by the patients to con-
trol symptoms; and (3) the number of times the patients re-
quired attention in the asthma clinic for episodes that did not
respond adequately to the b2-agonist. The results of this analy-
sis are presented in Table 1, where it can be seen that during
the year of anthelminth treatment (Year 1), there were statis-
tically significant decreases in the number of months of main-
tenance treatment (p , 0.01), the number of asthmatic crises
(p , 0.001), and the number of MDIs used (p , 0.001) as com-
pared with the year prior to the study (Year 0). In contrast, no
significant changes were found in these parameters in the un-
treated control group. Of the 39 anthelminth-treated patients,
35 were followed for a further 2 yr (Years 2 and 3), during
which time the anthelminth was not administered. Table 1
shows that the severity of the asthma continued to decline
during Year 2, but that it reverted to the initial levels in Year
3. We should note here that the four patients who were lost to
long-term follow-up were not remarkable in the severity of
their asthma during Year 1. In Table 2 we present the fre-
quency distribution of asthmatic crises in the 35 anthelminth-
treated patients who were evaluated over the entire 4-yr pe-
riod. It can be seen that before the anthelminth treatment
(Year 0), the therapeutic regimen used by the asthma clinic re-
sulted in the symptoms being well controlled in 60% of the pa-
tients, moderately controlled in 28%, and poorly controlled in
12%. For the year following the period of anthelminth admin-
istration (Year 2), these percentages were 80%, 17%, and 3%,
respectively (p , 0.01).
Pulmonary Function
The pulmonary function of the anthelminth-treated and con-
trol groups was measured immediately prior to the beginning
of the study (Year 0) and at the end of Year 1. The spiromet-
ric results were expressed as percentages of the predicted val-
ues, and in Table 3 it can be seen that no significant changes
were detected in either group. The FEV1/FVC ratios were also
unchanged (mean 6 SD of the treated group: 76 6 8% in
Year 0 and 80 6 10% in Year 1). We should note here that pa-
TABLE 2
FREQUENCY OF ASTHMATIC CRISES IN 35
ANTHELMINTH-TREATED PATIENTS
Year*
†
No. of crises/yr 0 1 2 3
,3 21‡ 25 28 24
3–12 10 8 6 6
. 12 4 2 1 5
* Year 0 5 year prior to study. Year 1 5 year of anthelminth administration. Year 2
and 3 5 the first and second posttreatment years.
†
Number of asthmatic episodes per year that required outpatient attention.
‡
Number of patients. Only the 35 patients who were followed for 3 yr are consid-
ered.
Lynch, Palenque, Hagel, et al.: Helminthic Infection and Asthma 53

TABLE 3 had positive results for both Dermatophagoides and Ascaris

EFFECT OF ANTHELMINTHIC TREATMENT ON (15%).
PULMONARY FUNCTION

% Predicted Values* DISCUSSION

Year FVC FEV1 PEFR MMEF There exists considerable evidence that helminthic infection
Treated group 0 85 6 4 73 6 3 77 6 4 60 6 4
can either increase or decrease the allergic reactivity of in-
1 82 6 3 76 6 4 80 6 4 65 6 4 fected populations (3, 6, 7). First, helminthic parasites can
Untreated group 0 84 6 3 77 6 3 77 6 4 57 6 3 stimulate the production of large amounts of specific IgE anti-
1 85 6 4 74 6 4 75 6 4 63 6 4 body against their own antigens, which sensitizes the mast
* Mean 6 SEM of spirometric values, expressed as percentages of the predicted nor-
cells of the host (1). This, coupled with the fact that many of
mal values. these parasites have lung-migratory phases, and that soluble
†
Measured immediately prior to the study (Year 0) and at the end of Year 1. parasite antigens circulate in the blood (22), suggests that such
infections could affect pulmonary physiology (6, 7). Helminths
also cause a polyclonal stimulation of IgE synthesis, which at
low intensities of infection results in enhanced allergic reactiv-
tients who at the beginning of the study were positive for hel- ity toward environmental allergens (10–13). In contrast, heavy
minths in the fecal examination showed no significant differ- parasite loads provide such a strong polyclonal stimulus that
ences in spirometric values from those who were negative the excess IgE blocks the allergic response (3, 7, 14). In view
(results not presented). Comparing the BHR to histamine be- of these considerations, the effect of anthelminthic treatment
fore and after anthelminth treatment, the PC20 values were in- on the allergic reactivity of endemic populations will depend,
creased in 38% of the patients, remained unchanged in 44%, at least in part, on the initial intensity of the infection and the
and decreased in 18%. Of particular interest is the observation allergic condition of the subjects. In accord with the complex-
that after treatment five of the patients did not react to hista- ity of this situation is our demonstration in previous studies
mine concentrations as high as 2.5 mg/ml. In fact, these pa- that the anthelminthic treatment of nonallergic children with a
tients became crisis-free, and were able to stop taking mainte- high degree of exposure to these parasites increased their al-
nance beclomethasone for essentially the whole of Years 1 lergic reactivity in immunologic terms (17), but decreased the
and 2. degree of bronchoconstriction associated with the infection
(16). For these reasons we evaluated the effect of sustained
Immunologic Evaluation anthelminthic treatment on the clinical condition of asthmatic
As no clinical changes were found in the control group, total patients in an area in which intestinal helminths are endemic.
and specific IgE levels were measured only in the treated pa- The group that we chose to study belongs to the population of
tients, before (Year 0) and after (Year 1) the period of anthel- an island close to the coast of Venezuela, which has a high
minth administration (Table 4). The total serum levels of IgE, prevalence of asthma (23), and is served by a single medical
which were initially elevated, decreased significantly (p , facility that provides attention and treatment free of charge to
0.001), and significant decreases also occurred in positivity to a community that does not have the financial resources to ob-
Dermatophagoides as reflected both by specific IgE antibody tain these services elsewhere. The prevalence of intestinal hel-
measured by RAST (p , 0.05) and skin-test results (p , minthiasis on the island is about 50%, and is of mild to moder-
0.025). Such decreases did not, however, occur in specific IgE ate intensity. We should note here that although only 41% of
antibody levels or skin-test positivity to Ascaris. In fact, there our patients were found to be infected at the beginning of the
was a tendency toward an increase in these measures. It is rel- study, this does not mean that the rest are not exposed to hel-
evant to point out here that at the beginning of the study pa- minthic parasites, as the human and worm populations in the
tients who were found to be positive for helminths in fecal study area are in dynamic equilibrium situation. In fact, the
testing showed no significant differences in these immune pa- present study found no significant differences in the immuno-
rameters from those who were negative (results not pre- logic parameters investigated in those patients who were posi-
sented). In addition, in the initial evaluations, the spirometric tive and those who were negative for helminths in the initial
results were comparable for patients who had negative skin- fecal examination.
test results for both Dermatophagoides and Ascaris (26% of During the year of regular albendazol administration, the
the group), those who had positive results for Dermatopha- control of asthma in the treated patients was significantly bet-
goides alone (28%) or Ascaris alone (31%), and those who ter than that in both groups the previous year and that in the
control group of untreated patients. This improvement was
even more marked in the year following treatment, but by the
second posttreatment year the clinical condition of the pa-
TABLE 4 tients had deteriorated to its initial level. This accords with re-
EFFECT OF ANTHELMINTHIC TREATMENT ON
sults that we obtained in another study on the island (unpub-
IMMUNOLOGIC PARAMETERS lished data), which showed a relatively low level of reinfection
during the first year after prolonged treatment, but significant
Anti-Dermatophagoides Anti-Ascaris reinfection toward the second year. These results indicate that
(% positive) (% positive)
the beneficial effect of albendazol is related to its anthelmin-
Total IgE* thic activity, and not to a direct effect of the drug on the respi-
Year (IU/ml) RAST† Skin Test‡ RAST Skin Test ratory system. Although we were not permitted to use a pla-
0 2,656 6 256 41 44 44 46 cebo-control in our study, neither the patients nor the medical
1 1,364 6 124 18 18 51 54 staff directly involved in their routine clinical management
were aware of the hypothesis of the study that anthelminth
* Mean 6 SEM IgE concentrations in serum.
†
Percent of group with specific IgE antibody levels > 0.7 PRU/ml (RAST Level 2). treatment would improve the patients’ asthmatic condition.
‡
Percent of group with immediate wheal diameters > 3 mm. Moreover the criteria used for characterizing the clinical state
54 AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
of the patients were selected for the maximum possible objec-
tivity in a study of this nature. Possibly because at the begin-
ning of the study the pulmonary function of the patients, as
determined by spirometry, was not profoundly abnormal, the
clinical improvement of the treated group was not accompa-
nied by evident changes in measurements of pulmonary func-
tion. In this respect, other studies have also shown that asth-
matic patients in remission do not necessarily have normal
spirometric values (24). Of possible relevance here is a ten-
dency that we observed in the treated group toward a lower
pulmonary sensitivity to histamine challenge, which is an indi-
cator of BHR. As can occur in viral infection (25), the pres-
ence of helminth-derived products, either in the blood or oc-
curring during larval migration, may produce inflammation
and thus increase airway irritability (26, 27). Another factor to
be considered is that the tables of predicted values for spiro-
metric parameters commonly used in Venezuela, which are
based on a Spanish sample group (20), may not have been the
most suitable for our study population. Because “normal” val-
ues have not been determined for persons of low socioeco-
nomic level in developing countries, where concurrent infec-
tions and nutritional problems could be important variables,
we are unable to make firm statements on this point.
From the immunologic viewpoint, because the intensity of
helminthic infection in our study population is relatively low,
we can predict that these parasites would cause both signifi-
cant increases in total IgE levels and a potentiation of the al-
lergic response to environmental allergens. The effects of the
anthelminthic treatment in our study indicated that this is in-
deed the case, as the total serum IgE levels, which at the be-
ginning of the study were moderately elevated, decreased sig-
nificantly, as did the allergic reactivity to Dermatophagoides,
one of the predominant allergens in the tropical environment.
Further studies will, however, be required to determine the
degree to which this change contributed to the clinical im-
provement of the treated patients. Of interest is our observa-
tion that the specific response to Ascaris, one of the most com-
mon intestinal helminths on the island on which our study was
conducted, was maintained during the year of anthelminth ad-
ministration. This probably occurred because: (1) the patients
received continual immunologic stimuli in the intestine through
the ingestion of infective eggs; and (2) because the specific re-
sponse to parasite antigens is relatively independent of the
polyclonal stimulus, particularly in persons with an atopic dis-
position (unpublished observations). In fact, as the IgE response
can participate in protective mechanisms against helminthic
infection (6, 28, 29), it can be proposed that the allergic geno-
type has been conserved in evolution because of the more ef-
fective antiparasitic IgE response that it confers.
In conclusion, the results of this study are consistent with
the possibility that helminthic infection can contribute to the
symptomatology of asthma in an endemic situation, and that
this could occur both through a direct effect of the parasite
and through the nonspecific potentiation of allergic reactivity
toward environmental allergens.
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