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Influence of atopy and asthma on exhaled nitric oxide in an unselected birth cohort study
  1. Martha Scott1,2,
  2. Abid Raza1,2,
  3. Wilfried Karmaus3,
  4. Frances Mitchell1,
  5. Jane Grundy1,
  6. Ramesh J Kurukulaaratchy1,2,
  7. S Hasan Arshad1,2,
  8. Graham Roberts1,2
  1. 1The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport, Isle of Wight, UK
  2. 2School of Medicine, University of Southampton, Southampton, UK
  3. 3Epidemiology and Biostatistics Department, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
  1. Correspondence to Dr Graham Roberts, The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport, Isle of Wight PO30 5TG, UK; g.c.roberts{at}


Background Asthma is considered to be associated with elevated levels of exhaled nitric oxide (FeNO). The nature of this relationship and how it is influenced by atopy are still not resolved.

Methods The Isle of Wight birth cohort (N=1456) was reassessed at 18 years of age. Participants able to attend the research centre were assessed by questionnaires, skin prick testing and FeNO in order to explore the interrelationship between asthma, atopy and FeNO.

Results Atopy was significantly associated with higher levels of FeNO. However, the level of FeNO for non-atopic asthmatic participants was no different to the non-atopic no-asthma group. The highest levels of FeNO were seen in subjects with both atopy and asthma. In addition, FeNO was positively associated with increasing atopic burden as evidenced by increasing FeNO with increasing skin prick testing positivity, and with increasing severity of atopic asthma as evidenced by the number of attacks of wheezing. FeNO and current inhaled corticosteroid use were not significantly associated.

Conclusions FeNO behaves as a biomarker of atopy and the “allergic asthma” phenotype rather than asthma itself. This may explain why FeNO-guided asthma treatment outcomes have proved to be of limited success where atopic status has not been considered and accounted for.

  • Adolescence
  • asthma
  • atopy
  • birth cohort
  • exhaled nitric oxide

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  • Funding The 18-year assessment of the 1989 Isle of Wight birth cohort was funded by the National Institute of Health, USA (Grant5 R01 HL082925-02) and the British Medical Association.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Isle of Wight, Portsmouth and South East Hampshire research ethics committee (06/Q1701/34).

  • Provenance and peer review Not commissioned; externally peer reviewed.