Geographic variations in the effect of atopy on asthma in the European Community Respiratory Health Study

doi:10.1016/j.jaci.2004.05.072

Journal of Allergy and Clinical Immunology

Volume 114, Issue 5, November 2004, Pages 1033-1039

https://doi.org/10.1016/j.jaci.2004.05.072 Get rights and content

Background

Atopy has long been related to asthma. The prevalences of both atopy and asthma have shown substantial variation.

Objective

We sought to assess geographic variations in the fraction of asthma attributable to IgE sensitization to specific allergens in the European Community Respiratory Health Survey.

Methods

A cross-sectional study was undertaken during the years 1991 and 1992 on 13,558 individuals in 36 centers in 16 countries. Asthma was defined in several ways, variously incorporating reported symptoms, bronchial responsiveness to methacholine, and physician diagnosis. Specific IgE against house dust mite (Dermatophagoides pteronyssinus), cat, timothy grass, Cladosporium herbarum, and a local allergen (birch, Parietaria judaica, or ragweed) were measured.

Results

The overall attributable fraction (AF) of asthma symptoms caused by atopy was 30% but varied widely between centers, ranging from 4% to 61%. The overall AF increased to 43% when asthma was based on wheezing and bronchial responsiveness, to 45% with a physician diagnosis of asthma, and to 48% when the patient reported more than 12 attacks in the last year. Between centers, the AF for atopy was significantly correlated with the prevalence of atopy among the asthmatic patients (r = 0.91) and with the sensitization to house dust mite (r = 0.64), as well as with the prevalence of asthma among atopic individuals (r = 0.43) and the prevalence of asthma among nonatopic individuals (r = −0.51).

Conclusion

The effect of atopy on the prevalence of asthma varies widely between centers, probably because of variations in factors related to the expression of asthma and to the prevalence of sensitization, particularly to house dust mite.

Section snippets

Methods

The ECRHS study followed a cross-sectional design and was undertaken during the years 1990 through 1994. Populations and subjects participating in the study have been described in detail elsewhere.³ The data presented here pertain to 13,558 individuals randomly selected from the general population (age range, 20-44 years) in 36 centers in 16 countries.

Asthma was defined as used in the ECRHS, namely a positive answer to any of 3 questions referring to nocturnal attacks of shortness of breath,

Results

The prevalence of specific IgE sensitization varied widely between centers, even in the same country (eg, for house dust mite, from 7% to 28% in Spain or from 18% to 35% in France; Table I). Overall, the prevalence of sensitization to house dust mite (21%) is similar to that to grass (19%), and in some of the centers, sensitization to grass is more prevalent than that to house dust mite. Mite, grass, and cat all demonstrated statistically significant heterogeneity between centers. Twenty-eight

Discussion

First, we found that between one third and one half of the prevalent cases of asthma among adults between 20 and 44 years old in the general population could be attributed to sensitization to common inhaled allergens. Second, the population AF of atopy in asthma varied widely between centers, even within the same country. Third, we found that the AF for house dust mite varied between centers, which in general did not occur for cat or grass. These findings were obtained by using the same

References (27)

A.L. Ponsonby et al.
Which clinical subgroups within the spectrum of child asthma are attributable to atopy
Chest
(2002)
P. Burney et al.
The distribution of total and specific serum IgE in the European Community Respiratory Health Survey
J Allergy Clin Immunol
(1997)
P. Plaschke et al.
Association between atopic and asthma and bronchial hyperresponsivness in Swedish adults: pets and not mites, are the most important allergens
J Allergy Clin Immunol
(1999)
R. DerSimonian et al.
Meta-analysis in clinical trials
Control Clin Trials
(1986)
P. Plaschke et al.
Association between atopic sensitization and asthma and bronchial responsiveness in Swedish adults
J Allergy Clin Immunol
(1999)
S. Lau et al.
Early exposure to house-dust mite and cat allergens and development of childhood asthma: a cohort study. Multicenter Allergy Study Group
Lancet
(2000)
A.A. Litonjua et al.
A longitudinal analysis of wheezing in young children: the independent effects of early life exposure to house dust endotoxin, allergens, and pets
J Allergy Clin Immunol
(2002)
N. Pearce et al.
How much asthma is really attributable to atopy
Thorax
(1999)
P.G. Burney et al.
The European Community Respiratory Health Survey
Eur Respir J
(1994)
S. Chinn et al.
Sensitization to individual allergens and bronchial responsiveness in the ECRHS
Eur Respir J
(1999)

J. Pekkanen et al.

Defining asthma in epidemiological studies

Eur Respir J

(1999)

C. Janson et al.

The European Community Respiratory Health Survey: what are the main results so far?

Eur Respir J

(2001)

J. Soriano et al.

Risk of asthma in the general Spanish population attributable to specific immunoresponse

Int J Epidemiol

(1999)

Cited by (126)

Allergenic and chemical pollutants of indoor environments and asthma: Characterization, assessment and eviction
2023, Revue des Maladies Respiratoires
L’environnement d’un patient asthmatique peut contenir de nombreuses sources de polluants qui dégradent la qualité de l’air intérieur et présentent des conséquences importantes sur l’apparition ou le contrôle de l’asthme. L’évaluation et l’amélioration de la qualité de l’air intérieur doivent prendre une place importante dans la consultation en pneumologie et en allergologie. Caractériser l’environnement d’un asthmatique implique de rechercher des polluants biologiques avec les allergènes d’acariens, les moisissures et les allergènes relatifs à la présence d’animaux de compagnie. Il est important d’évaluer la pollution chimique représentée par une exposition aux composés organiques volatiles qui sont de plus en plus présente dans nos logements. Le tabagisme actif ou passif doit toujours être recherché et quantifié. L’évaluation de l’environnement est médiée par plusieurs méthodes qui dépendent du polluant recherché mais la place de la méthode immuno-enzymatique par ELISA reste centrale pour les polluants biologiques. Une éviction globale de tous les polluants de l’environnement intérieur est médiée par les conseillères en environnement intérieur et permet d’obtenir une évaluation et un bon contrôle de l’air intérieur. Cette méthode utilisée dans une logique de prévention tertiaire permet d’améliorer le contrôle de l’asthme chez les enfants mais aussi chez les adultes.
The environment of an asthmatic patient can contain numerous sources of pollutants that degrade the quality of indoor air and have major repercussions on the occurrence and control of asthma. Assessment and improvement of the quality of indoor air should be assigned a major role in pneumology and allergology consultations. Characterization of an asthmatic's environment entails a search for biological pollutants with mite allergens, mildew, and allergens resulting from the proximity of pets. It is important to evaluate the chemical pollution represented by exposure to volatile organic compounds, which are increasingly present in our lodgings. Active or second-hand smoking must in all circumstances be sought out and quantified. Assessment of the environment is mediated by several methods, of which the application depends not only on the pollutant sought out, but also on enzyme-linked immunosorbent assay (ELISA), which has an essential role in quantification of biological pollutants. Attempts at expulsion of the different indoor environment pollutants is mediated by indoor environment advisors, whose efforts are aimed at obtaining reliable evaluation and control of indoor air. Implemented as a form of tertiary prevention, their methods are conducive to improved asthma control, in adults as well as children.
L'asthme et l'allergie, rencontres de type 2
2023, Revue des Maladies Respiratoires Actualites
Correlation between sensitization to house dust mite major allergens, age, and symptoms in Japanese house dust mite allergic subjects
2022, International Immunopharmacology
Citation Excerpt :
The house dust mites (HDM), Dermatophagoides pteronyssinus (D. pteronyssinus) and Dermatophagoides farinae (D. farinae) are the most common indoor allergens worldwide and a significant factor in the development of respiratory allergic diseases including allergic rhinitis (AR) and allergic asthma (AA) [1–5].
Der p 23 has recently been recognized as a new house dust mite (HDM) major allergen that may be linked to the development of asthma in HDM allergic patients. This study aimed to investigate the frequency of sensitization to HDM major allergen components including Der p 23 and to examine the correlation between HDM-sensitization and AR symptom score in Japanese HDM allergic rhinitis (AR) patients without allergic asthma.
Serum samples (n = 120) collected from Japanese HDM AR patients (12 to 64 years) without asthma were assessed for allergen-specific IgE (s-IgE) by ImmunoCAP (Dermatophagoides pteronyssinus (D. pteronyssinus; Der p) extract, Der p 23) or immunosolid-phase allergen chip (Der p 1, Der p 2).
Japanese HDM AR patients without asthma showed a high prevalence of allergic sensitization to the HDM major allergens Der p 1 (94.2%), Der p 2 (97.5%) and Der p 23 (71.7%). No difference in the prevalence was detected for Der p 1 and Der p 2 s-IgE among three age groups. However, the prevalence of Der p 23 s-IgE was significantly higher in the younger group compared to the elderly group. No significant correlation was found between AR symptom scores and concentration of s-IgE towards Der p extract and any of the three HDM major allergens.
Although the prevalence of sensitization towards D. pteronyssinus major allergens is high in Japanese AR patients without asthma, there was no correlation between allergen specific IgE including IgE towards Der p 23 and AR symptom in this population.
Occupation, socioeconomic status and chronic obstructive respiratory diseases – The EpiLung study in Finland, Estonia and Sweden
2022, Respiratory Medicine
To study occupational groups and occupational exposure in association with chronic obstructive respiratory diseases.
In early 2000s, structured interviews on chronic respiratory diseases and measurements of lung function as well as fractional expiratory nitric oxide (F_ENO) were performed in adult random population samples of Finland, Sweden and Estonia. Occupations were categorized according to three classification systems. Occupational exposure to vapours, gases, dusts and fumes (VGDF) was assessed by a Job-Exposure Matrix (JEM). The data from the countries were combined.
COPD, smoking and occupational exposure were most common in Estonia, while asthma and occupations requiring higher educational levels in Sweden and Finland. In an adjusted regression model, non-manual workers had a three-fold risk for physician-diagnosed asthma (OR 3.18, 95%CI 1.07–9.47) compared to professionals and executives, and the risk was two-fold for healthcare & social workers (OR 2.28, 95%CI 1.14–4.59) compared to administration and sales. An increased risk for physician-diagnosed COPD was seen in manual workers, regardless of classification system, but in contrast to asthma, the risk was mostly explained by smoking and less by occupational exposure to VGDF. For F_ENO, no associations with occupation were observed.
In this multicenter study from Finland, Sweden and Estonia, COPD was consistently associated with manual occupations with high smoking prevalence, highlighting the need to control for tobacco smoking in studies on occupational associations. In contrast, asthma tended to associate with non-manual occupations requiring higher educational levels. The occupational associations with asthma were not driven by eosinophilic inflammation presented by increased F_ENO.
Climate change and house-dust mite allergy
2021, Journal of Climate Change and Health
Diagnosis of allergy in asthma
2020, Revue des Maladies Respiratoires
L’allergie est une réaction d’hypersensibilité provoquée par des mécanismes immunologiques. Dans l’asthme, l’allergie joue un rôle complexe et il s’agit le plus souvent d’un mécanisme médié par les IgE. Elle doit être recherchée au cours de l’évaluation d’un asthme mais la mise en évidence d’une sensibilisation IgE médiée ne signifie pas de factoque l’allergène joue un rôle dans la pathologie asthmatique. Afin de faire la part des choses, il faut évaluer la pertinence clinique de la sensibilisation. Dans cet article, nous décrivons les moyens actuellement disponibles pour rechercher une sensibilisation IgE médiée chez l’asthmatique mais également les moyens d’évaluer l’exposition allergénique environnementale et son rôle dans l’asthme.
Allergy is a hypersensitivity reaction induced by immunological mechanisms. In asthma, allergy has a complex role and is usually IgE mediated. Allergy must be evaluated during the work up but evidence of IgE sensitivity does not mean that allergens play a role in the pathophysiology of the disease. The clinical relevance of the sensitivity has to be considered. This paper describes current available tools to screen for IgE sensitivity, allergen exposure and their role in asthma.

View all citing articles on Scopus

View full text

Asthma diagnosis and treatmentGeographic variations in the effect of atopy on asthma in the European Community Respiratory Health Study

Background

Objective

Methods

Results

Conclusion

Section snippets

Methods

Results

Discussion

Chest

J Allergy Clin Immunol

J Allergy Clin Immunol

Control Clin Trials

J Allergy Clin Immunol

Lancet

J Allergy Clin Immunol

How much asthma is really attributable to atopy

Thorax

The European Community Respiratory Health Survey

Eur Respir J

Sensitization to individual allergens and bronchial responsiveness in the ECRHS

Eur Respir J

Defining asthma in epidemiological studies

Eur Respir J

The European Community Respiratory Health Survey: what are the main results so far?

Eur Respir J

Risk of asthma in the general Spanish population attributable to specific immunoresponse

Int J Epidemiol

Asthma diagnosis and treatment
Geographic variations in the effect of atopy on asthma in the European Community Respiratory Health Study