The Journal of Allergy and Clinical Immunology
Volume 120, Issue 5 , Pages 1139-1145, November 2007

Asthma cases attributable to atopy: Results from the Third National Health and Nutrition Examination Survey

  • Samuel J. Arbes Jr., DDS, MPH, PhD

      Affiliations

    • Laboratory of Respiratory Biology, Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC
    • ,
  • Peter J. Gergen, MD, MPH

      Affiliations

    • Division of Allergy, Immunology, and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
    • ,
  • Ben Vaughn, MS

      Affiliations

    • Rho, Inc, Chapel Hill, NC
    • ,
  • Darryl C. Zeldin, MD

      Affiliations

    • Laboratory of Respiratory Biology, Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC
    • Corresponding Author InformationReprint requests: Darryl C. Zeldin, MD, NIEHS/NIH, PO Box 12233, MD D2-01, Research Triangle Park, NC 27709.

Received 4 May 2007; received in revised form 18 July 2007; accepted 20 July 2007. published online 24 September 2007.

Background

The percentage of asthma cases attributable to atopy is the subject of debate.

Objectives

The objectives were to estimate the percentage of asthma cases in the US population attributable to atopy and to examine associations between allergen-specific skin tests and asthma.

Methods

Data were obtained from the Third National Health and Nutrition Examination Survey, in which subjects age 6 to 59 years were skin tested with 10 allergens. Atopy was defined as at least 1 positive allergen-specific test. Doctor-diagnosed current asthma was assessed by questionnaire.

Results

In the United States, 56.3% of the asthma cases were attributable to atopy, and that percentage was greater among males than females, among persons in the highest education category than in lower education categories, and among persons living in highly populated metropolitan areas than in all other areas. Each allergen-specific test was strongly associated with asthma before adjustment (odds ratios varied from 2.1 to 4.5); however, after adjustment by all the allergens, only tests to cat, Alternaria, white oak, and perennial rye were independently associated with asthma. Perennial rye was inversely associated with asthma. Of the 10 allergens, a positive response to cat accounted for the highest percentage of asthma cases (29.3%).

Conclusion

About half of the current asthma cases in the US population represented by the Third National Health and Nutrition Examination Survey were attributable to atopy. Some allergen-specific skin tests were not independently associated with asthma.

Clinical implications

If atopy could be prevented or reversed, or its effect on asthma blocked, then a large percentage of asthma cases in the US population could be prevented.

Key words: Allergens, allergic sensitization, allergy skin test, asthma, atopy, epidemiology, NHANES III, skin prick test, survey

Abbreviations used: BMI, Body mass index, NHANES III, Third National Health and Nutrition Examination Survey, OR, Odds ratio, PAR, Population attributable risk, RR, Relative risk, SPT, Skin prick test

 

 Supported by the Intramural Research Programs of the National Institute of Environmental Health Sciences and the National Institute of Allergy and Infectious Diseases, the National Institutes of Health.

 Disclosure of potential conflict of interest: B. Vaughn is employed by Rho, Inc. The rest of the authors have declared that they have no conflict of interest.

PII: S0091-6749(07)01460-1

doi:10.1016/j.jaci.2007.07.056

The Journal of Allergy and Clinical Immunology
Volume 120, Issue 5 , Pages 1139-1145, November 2007

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