BMJ Open 2013;3:e002835 doi:10.1136/bmjopen-2013-002835

• Epidemiology

Asthma and atopic dermatitis are associated with increased risk of clinical Plasmodium falciparummalaria

1. Magali Herrant1,2, 
2. Cheikh Loucoubar1,2,3,4, 
3. Hubert Bassène5, 
4. Bronner Gonçalves2,
5. Sabah Boufkhed2, 
6. Fatoumata Diene Sarr2, 
7. Arnaud Fontanet6,7, 
8. Adama Tall2,
9. Laurence Baril2, 
10. Odile Mercereau-Puijalon8, 
11. Salaheddine Mécheri9,11,
12. Anavaj Sakuntabhai1,10, 
13. Richard Paul1

+Author Affiliations

1. ¹Institut Pasteur, Unité de la Génétique Fonctionnelle des Maladies Infectieuses, CNRS URA3012,  Paris, France
2. ²Institut Pasteur de Dakar, Unité d'Epidémiologie des Maladies Infectieuses, Dakar, Senegal
3. ³INSERM, U946, Genetic Variation and Human Diseases Unit, Paris, France
4. ⁴Université Paris Diderot, Sorbonne Paris Cité, Institut Universitaire d'Hématologie, Paris, France
5. ⁵Institut de Recherche pour le Développement (IRD), Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, URMITE CNRS-IRD 198 UMR 6236, Dakar, Sénégal
6. ⁶Institut Pasteur, Unité d'Epidémiologie des Maladies Emergentes, Paris, France
7. ⁷Conservatoire National des Arts et Métiers, Paris, France
8. ⁸Institut Pasteur, Unité d'Immunologie Moléculaire des Parasites, CNRS URA2581, Paris, France
9. ⁹Institut Pasteur, Unité de Biologie des Interactions Hôte Parasite, Paris, France
10. ¹⁰Complex Systems Group, Faculty of Science, Mahidol University, Bangkok, Thailand
11. ¹¹Centre National de la Recherche Scientifique, Unité de Recherche Associée 2581, Paris, France

1. Correspondence toDr Richard Paul; richard.paul@pasteur.fr

• Received 5 March 2013
• Revised 13 June 2013
• Accepted 18 June 2013
• Published 24 July 2013

Abstract

Objectives To assess the impact of atopy and allergy on the risk of clinical malaria.

Design A clinical and immunological allergy cross-sectional survey in a birth cohort of 175 children from 1 month to 14 years of age followed for up to 15 years in a longitudinal open cohort study of malaria in Senegal. Malaria incidence data were available for 143 of these children (aged 4 months to 14 years of age) for up to 15 years. Mixed-model regression analysis was used to determine the impact of allergy status on malaria incidence, adjusting for age, gender, sickle-cell trait and force of infection.

Main outcome measures Asthma, allergic rhinoconjunctivitis and atopic dermatitis status, the number of clinical Plasmodium falciparum malaria episodes since birth and associated parasite density.

Results 12% of the children were classified as asthmatic and 10% as having atopic dermatitis. These groups had respectively a twofold (OR 2.12 95%; CI 1.46 to 3.08; p=8×10⁻⁵) and threefold (OR 3.15; 1.56 to 6.33; p=1.3×10⁻³) increase in the risk of clinical P falciparummalaria once older than the age of peak incidence of clinical malaria (3–4 years of age). They also presented with higher P falciparum parasite densities (asthma: mean 105.3 parasites/μL±SE 41.0 vs 51.3±9.7; p=6.2×10⁻³. Atopic dermatitis: 135.4±70.7 vs 52.3±11.0; p=0.014). There was no effect of allergy on the number of non-malaria clinical presentations. Individuals with allergic rhinoconjunctivitis did not have an increased risk of clinical malaria nor any difference in parasite densities.

Conclusions These results demonstrate that asthma and atopic dermatitis delay the development of clinical immunity to P falciparum. Despite the encouraging decrease in malaria incidence rates in Africa, a significant concern is the extent to which the increase in allergy will exacerbate the burden of malaria. Given the demonstrated antiparasitic effect of antihistamines, administration to atopic children will likely reduce the burden of clinical malaria in these children, increase the efficacy of first-line treatment antimalarials and alleviate the non-infectious consequences of atopy.

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