Exposure and sensitization to indoor allergens: Association with lung function, bronchial reactivity, and exhaled nitric oxide measures in asthma

doi:10.1067/mai.2003.1654

Journal of Allergy and Clinical Immunology

Volume 112, Issue 2, August 2003, Pages 362-368

https://doi.org/10.1067/mai.2003.1654 Get rights and content

Abstract

Background: Exposure to high levels of allergens in sensitized asthmatic patients causes worsening of pulmonary function in experimental studies. Chronic exposure to lower, naturally occurring levels of allergens might increase the severity of asthma. Objective: We sought to study the associations between sensitization and exposure to common indoor allergens (dust mite, cat, and dog) in the home on pulmonary function, exhaled nitric oxide (eNO), and airway reactivity in asthmatic patients. Methods: Dust samples were collected from the living room carpet and mattress of 311 subject's homes, and Der p 1, Fel d 1, and Can f 1 concentrations were measured by using ELISAs. Spirometry, nonspecific bronchial reactivity, and eNO were measured. Results: Subjects both sensitized and exposed to high levels of sensitizing allergen had significantly lower FEV₁ percent predicted values (mean, 83.7% vs 89.3%; mean difference, 5.6%; 95% CI, 0.6%-10.6%; P = .03), higher eNO values (geometric mean [GM], 12.8 vs 8.7 ppb; GM ratio, 0.7; 95% CI, 0.5-0.8; P = .001), and more severe airways reactivity (PD₂₀ GM, 0.25 vs 0.73 mg; GM ratio, 2.9; 95% CI, 1.6-5.0; P < .001) compared with subjects not sensitized and exposed. No significant effect of the interaction between sensitization and exposure was found for FEV₁ percent predicted and eNO values. However, there was a significant effect of the interaction between sensitization and exposure to any allergen (P = .05) and between sensitization and exposure to cat allergen (P = .04) for nonspecific bronchial reactivity. Conclusion: Asthmatic subjects who are exposed in their homes to allergens to which they are sensitized have a more severe form of the disease. (J Allergy Clin Immunol 2003;112:362-8.)

Section snippets

Methods

Subjects provided written informed consent and were recruited into the study if they had a physician diagnosis of asthma with symptoms requiring treatment with at least a short-acting bronchodilator in the previous 12 months. Study participants were selected randomly from a clinical trial database of asthmatic patients. The subjects were from the Greater Manchester area, United Kingdom, and were a mixture of hospital and primary care patients.

The study protocol was approved by the local

Results

Three hundred eleven subjects were recruited into the study. Demographics and baseline results are listed in Table I.

. Demographic details and baseline results

Measure	Value
Age	10-68 y (mean, 42 y; 95% CI, 41-44 y)
Sex
Male	128 (41.2%)
Female	183 (58.8%)
Smoking status
Smokers	42 (13.5%)
Nonsmokers	269 (86.5%)
Asthma treatment
Receiving inhaled steroids	197 (63%) (mean dose, 728 μg; median dose, 500 μg; 95% CI, 659-797 μg)
Not receiving inhaled steroids	114 (37%)
FEV₁ percent predicted	n = 311; range, 25%-131%

Discussion

This is one of the first large studies assessing the influence of both sensitization and exposure to indoor allergens on the severity of asthma, as measured on the basis of pulmonary function tests, BR, and eNO. In a cohort of more than 300 asthmatic subjects with disease of varied severity, we have demonstrated significantly lower FEV₁ values, higher levels of eNO, and increased BR in subjects who were both sensitized and exposed to sensitizing allergen compared with that seen in other

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^☆: Reprint requests: Stephen J. Langley, MD, MBA, Medicines Evaluation Unit, North West Lung Centre, Wythenshawe Hospital, Manchester, M23 9LT, United Kingdom.

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Environmental and Occupational DisordersExposure and sensitization to indoor allergens: Association with lung function, bronchial reactivity, and exhaled nitric oxide measures in asthma☆

Abstract

Section snippets

Methods

Results

Discussion

J Immunol Methods

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

Lancet

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

Exposure and sensitization in infants and children

Curr Opin Allergy Immunol

Serum house dust mite antibodies: predictor of increased bronchial responsiveness in adults of a community

Eur Respir J

Serum house-dust mite antibodies and reduced FEV1 in adults of a Norwegian community

Am J Respir Crit Care Med

Sensitization to individual allergens as risk factors for lower FEV1 in young adults

Int J Epidemiol

Mucosal inflammation in asthma

Am Rev Respir Dis

Prolonged allergen exposure induces structural airway changes in sensitized rats

Am J Respir Crit Care Med

Repeated allergen exposure of sensitized Brown-Norway rats induces airway cell DNA synthesis and remodelling

Eur Respir J

Allergen-induced increase in non-allergic bronchial reactivity

Clin Allergy

Standardization of lung function tests—1993 Update. Report of the Working Party for the European Community for Steel and Coal

Eur Respir J

Environmental and Occupational Disorders
Exposure and sensitization to indoor allergens: Association with lung function, bronchial reactivity, and exhaled nitric oxide measures in asthma☆

Serum house-dust mite antibodies and reduced FEV₁ in adults of a Norwegian community

Sensitization to individual allergens as risk factors for lower FEV₁ in young adults