Asthma and lower airway disease
Aeroallergen sensitization correlates with PC20 and exhaled nitric oxide in subjects with mild-to-moderate asthma

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Background

Aeroallergen sensitization in adult asthmatic patients from a wide geographic area has not been correlated with patients' characteristics, markers of airways inflammation, and lung function.

Objective

We assessed data obtained from the Asthma Clinical Research Network trials to determine the relationship of aeroallergen sensitization to age, sex, ethnicity, and markers of inflammation and airways function.

Methods

Skin testing (14 epicutaneous) was performed on 1338 subjects with objectively diagnosed mild-to-moderate asthma from 11 Asthma Clinical Research Network studies. Skin testing used identical techniques and a quality assurance program to ensure uniformity across centers.

Results

Ninety-five percent of the subjects had at least 1 positive skin test response. Of these, 14% had positive reactions to 1 or 2 allergens and 81% had positive reactions to 3 or more allergens, and 2% of subjects reacted only to seasonal allergens, 26% only to perennial allergens, and 67% to both. Increasing IgE and exhaled nitric oxide values, decreasing PC20 values, and minority ethnicity significantly correlated with the number of positive skin test responses. Subjects with late-onset asthma were less likely to be sensitized; nonetheless, 89% of subjects older than 60 years had positive responses.

Conclusion

Ninety-five percent of patients with mild-to-moderate asthma might have an allergic component. Age does not significantly affect aeroallergen sensitization, but the pattern of allergic sensitization varies with ethnicity and geography. Measures used to characterize asthma, such as IgE, exhaled nitric oxide, and PC20 values, are correlated with aeroallergen sensitization.

Section snippets

Methods

We assessed data from subjects who provided written informed consent and were randomized into multiple studies performed by the National Heart, Lung, and Blood Institute's Asthma Clinical Research Network (ACRN). Subjects were recruited from pulmonary and allergy clinics and through advertisements to the general public. The vast majority of subjects were recruited from non–allergy clinic populations. The studies included SOCS,10 SLIC,11 BARGE,12 BAGS,13 CIMA,14 MICE,15 DICE,16 IMPACT,17 SMOG,18

Results

One thousand three hundred thirty-eight subjects were included in this analysis, and Table I summarizes their baseline characteristics. Additional demographics are available in Table II. Patients ranged in age from 12 to 65 years, with 58% being female and 42% being male. Ethnicity distribution included 65% white, 21% African American, 8% Hispanic, and 6% “other.” Skin test results to specific antigens and to positive and negative controls are noted in Table III.

Ninety-five percent of subjects

Discussion

Our data demonstrate that as many as 95% of subjects with mild-to-moderate asthma have aeroallergen sensitization. Unfortunately, we are unable to determine by using our database whether allergy symptoms and skin test results correlated. Ideally, the term “allergic” should be reserved for patients with symptoms associated with exposure to the allergen identified by a positive skin test response. Therefore for the purpose of this article and consistent with the literature, we have used the term

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  • Cited by (0)

    Supported by grants U10-HL51831, U10-HL51845, U10-HL51823, U10-HL51843, U10-HL56443, U10-HL51834, U10-HL51810, U10-HL74227, U10-HL74231, U10-HL74204, U10-HL74212, U10-HL74073, U10-HL74206, U10-HL74208, U10-HL74225, and U10-HL74218.

    Disclosure of potential conflict of interest: T. J. Craig is on the advisory board for Aventis; has consulting arrangements with Genentech/Novarits, Glaxo, Schering-Plough, and AstraZeneca; and has received research support from Schering-Plough, Merck, Glaxo, ACAAI, Methaparm, Dyax, Lev, PDL, Centacore, Sanofi-Aventis, and Altana. R. F. Lemanske has consulting arrangements with Novartis, Merck, GlaxoSmithKline, Aventis, and AstraZeneca; has received research support from the National Heart, Lung, and Blood Institute; and is on the speakers' bureau for Merck and GlaxoSmithKline. M. E. Weshsler has consulting arrangements with Genentech, Novartis, Merck, Aerocrine, Graceway, and Schering-Plough; has received research support from GlaxoSmithKline; an is on the speakers' bureau for Genentech, Novartis, Merck, and GlaxoSmithKline. S. Wasserman has consulting arrangements with AstraZeneca, Genentech, Novartis, Tanex, Icos, Vistakon, Tanabe, and Amylin; has received research support from GlaxoSmithKline, and Schering-Plough; is on the speakers' bureau for AstraZeneca; has served as an expert witness in medical malpractice cases about anaphylaxis, asthma, and drug allergies; and has served as an expert witness on the health effects of mold exposure. The rest of the authors have declared that they have no conflict of interest.

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