Asthma, Rhinitis, Other Respiratory Diseases
Hay fever and asthma in relation to markers of infection in the United States

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Abstract

Background: The hygiene hypothesis proposes that declining exposure to infections is implicated in the rising trend of allergy and asthma. Objective: We sought to test this hypothesis by examining the relationship of hay fever, asthma, and atopic sensitization with markers of infection in a large general population sample of the United States. Methods: We analyzed the data of 33,994 US residents recorded in a public database of a nationally representative cross-sectional survey (Third National Health and Nutrition Examination Survey, 1988-1994). The variables examined were sociodemographic information, lifetime diagnosis and age at first diagnosis of hay fever or asthma, current skin sensitization to 9 airborne allergens and peanut, and current serology for Toxoplasma gondii , herpes simplex viruses type 1 and 2, and hepatitis A, B, and C viruses. Results: Hay fever (adjusted odds ratio, 0.27; 95% CI, 0.18-0.41; P < .001) and asthma (adjusted odds ratio, 0.45; 95% CI, 0.31-0.66; P < .001) were less frequent in subjects seropositive for hepatitis A virus (HAV), T gondii , and herpes simplex virus 1 versus seronegative subjects after adjusting for age, sex, race, urban residence, census region, family size, income, and education. Skin sensitization to peanut and to all the airborne allergens examined, except for cockroach, was less frequent among HAV-seropositive versus HAV-seronegative subjects younger than 40 years of age. The prevalence of hay fever and asthma diagnosed at or before 18 years of age in HAV-seronegative subjects increased progressively from 2.7% (95% CI, 0.7%-4.7%) and 0.4% (95% CI, 0.1%-1.6%), respectively, in cohorts born before 1920 to 8.5% (95% CI, 7.3%-9.7%) and 5.8% (95% CI, 4.8%-6.8%), respectively, in cohorts born in the 1960s, whereas they remained constant at around 2% in all cohorts of HAV-seropositive subjects. Conclusion: In the United States serologic evidence of acquisition of certain infections, mainly food-borne and orofecal infection, is associated with a lower probability of having hay fever and asthma. Third National Health and Nutrition Examination Survey data support the hypothesis that hygiene is a major factor contributing to the increase in hay fever, asthma, and atopic sensitization in westernized countries. (J Allergy Clin Immunol 2002;110:381-7.)

Section snippets

Study design

We examined a public registry of 33,994 US residents aged 1 to 90 years or older that includes clinical and laboratory data from NHANES III and analyzed the following variables: age, sex, race, urban-rural residence, census, family size, family income, education, diagnosis ever, age at first diagnosis, current status of hay fever or asthma, skin tests for 9 airborne allergens and peanut, and serology for T gondii , herpes simplex viruses type 1 (HSV-1) and 2 (HSV-2), and hepatitis A, B, and C

NHANES III

NHANES III was conducted from 1988 through 1994 by the National Center for Health Statistics of the Centers for Disease Control and Prevention, Atlanta, Ga,20 and approved by the National Center for Health Statistics' Institutional Review Board. The survey was based on a stratified multistage clustered probability design to select a representative sample of the civilian, noninstitutionalized US population. Eighty-one geographic sites were included in the final sample. All survey participants

Results

The frequency of hay fever ever diagnosed increased progressively with age up to 60 years and declined thereafter. Asthma ever diagnosed peaked in the second and sixth decades of life. The prevalence of a positive skin prick test response to at least one allergen increased with age up to values close to 60% in the 20- to 29-year age range and declined slightly across older groups (Fig 1, A ).

. Prevalence of atopic sensitization (left axis) , lifetime diagnosis of hay fever and asthma (right axis

Discussion

This study shows that hay fever, asthma, and skin sensitization to several inhalant allergens and peanut are inversely related to serologic markers of infections (ie, HAV, T gondii , and HSV-1 antibodies) in a representative population sample of the United States. In fact, the adjusted odds of a lifetime diagnosis of hay fever or asthma in subjects seronegative for all 3 infections (HAV, T gondii , and HSV-1) were, respectively, about 4 and 2 times higher than in seropositive individuals.

In

Acknowledgements

We acknowledge the US Department of Health and Human Services, National Center for Health Statistics, as the original source of data, and we thank Jean Ann Gilder (Scientific Communication) for her help in editing the text.

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    Reprint requests (present address): Paolo M. Matricardi, MD, WHO, World Health Organization, Chronic Respiratory Diseases and Arthritis Unit, 20 Avenue Appia, CH-1211 Geneve 27, Switzerland.

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