Association between atopic sensitization and asthma and bronchial hyperresponsiveness in Swedish adults: Pets, and not mites, are the most important allergens,☆☆,

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Abstract

Background: Atopic sensitization is a well-known risk factor for asthma and bronchial hyperresponsiveness (BHR). Mites have been regarded as the most important allergens, but the prevalence of sensitization to mites is relatively low in Sweden. Objective: The aim of the study was to investigate possible associations between sensitization to various allergens and asthma and BHR in adults. Methods: A random sample of 1859 subjects, aged 20 to 46 years, was investigated in a cross-sectional study by using a questionnaire, skin prick tests (SPTs), specific and total IgE measurements, and methacholine bronchial challenge tests. Possible associations were analyzed univariately and by using multivariate logistic regression analysis and proportional hazard regression analysis. Results: Positive SPT and specific IgE results were more common in subjects with asthma and BHR than in subjects without these conditions for all allergens. The independent associations between positive SPT responses and asthma and BHR are given as adjusted prevalence ratios (PRRs): pets and asthma, PRR = 3.6; pets and BHR, PRR = 2.0; grass and asthma, PRR = 2.0; grass and BHR, PRR = 1.7; mites and asthma, PRR = 1.4; and mites and BHR, PRR = 1.2. The use of specific IgE measurements instead of SPTs showed essentially similar results. Conclusion: Cats and dogs were the sensitizing allergens most closely associated with asthma and BHR. The relationships with sensitization to grass and mites were less pronounced. (J Allergy Clin Immunol 1999;103:58-65.)

Section snippets

Study design and population

The study was performed in accordance with the ECRHS protocol 17 (ie, a cross-sectional investigation of a random sample of the general population). A random sample of 1800 men and 1800 women, aged 20 to 44 years, was selected from each of these centers by using the population registers. A postal questionnaire was sent to all subjects in December 1990 18 ; the response rate was 86%. With the aim of obtaining 600 subjects from each center, random subsamples of individuals (950, 800, and 672

Study participation

The questionnaire was answered by 1859 of the 2084 subjects invited to participate. SPTs were performed on 1572 individuals, IgE tests in 1470, and bronchial methacholine challenges in 1450. In all, 1412 subjects participated in SPTs and tests for BHR, and 1318 participated in IgE tests and tests for BHR. When comparing participants with nonparticipants by using the data from the stage 1 screening questionnaire, there was no difference regarding self-reported asthma attacks or current smoking,

DISCUSSION

Asthma and BHR were both associated with sensitization to pets and, to a smaller degree, with sensitization to grass. Asthma was additionally, but to a less pronounced degree, associated with sensitization to HDMs. Our finding of a strong association between sensitization to pets and asthma was underlined by the increase in asthma prevalence as the RAST class increased. More than 30% of the subjects with a RAST class of 3 or more to cats had asthma.

Several indoor allergens are recognized as

Acknowledgements

We thank N. B. Lindholm, E. Berglund, B. Lundbäck, L. Rosenhall, and G. Boman for their participation in this study. These results come from a national analysis of data collected for the European Community Respiratory Health Survey. A final international comparison might use a different form of analysis.

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    Supported by grants from the Swedish Heart and Lung Foundation, the Swedish Association Against Asthma and Allergy, the Swedish Medical Research Council, the Associations Against Asthma and Allergy in Göteborg and Uppsala, the Herman Krefting Foundation, the Bror Hjerpstedt Foundation, and the County Councils of Göteborg and Uppsala.

    ☆☆

    Reprint requests: Peter Plaschke, MD, Department of Medicine, Roskilde County Hospital, Køgevej 7-13, DK 4000 Roskilde, Denmark.

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