International Journal of Epidemiology, Vol 28, 728-734, Copyright © 1999 by International Epidemiological Association
JB Soriano, JM Anto, J Sunyer, A Tobias, M Kogevinas, E Almar, N Muniozguren, JL Sanchez, L Palenciano and P Burney
BACKGROUND: Individuals with asthma are more atopic than the general
population, but few reports have quantified this association, i.e. the
proportion of asthma in the community due to specific immunoresponse. We
aimed to determine the population attributable risk of asthma in the
community due to atopy, and the quantity and quality of specific
immunoresponses to common aeroallergens involved. METHODS: We used data
from a cross-sectional study in a random sample of the general Spanish
population, 20-44 years old, from five areas. In all, 1816 participants
were given a symptoms questionnaire, a methacholine challenge and were
assessed for atopy. Bronchial responsiveness (BR) was defined as a > or
=20% fall in forced expiratory volume in one second (FEV1) after
methacholine. Asthma was defined as symptomatic bronchial responsiveness.
Atopy was assessed by measuring serum specific IgE or skin tests for
sensitivity to Alternaria, birch, cat, Cladosporium, Dermatophagoides
pteronyssinus, olive, Parietaria, ragweed or timothy grass. RESULTS:
Sensitivity to any of the individual allergens tested significantly
increased the risk of being asthmatic, at least twofold compared to
non-atopic individuals. The population attributable risk of atopy in
explaining asthma is 41.97% (95% CI: 29.2-60.3) when adjusting for area of
residence, age, sex, and smoking. In symptomatic individuals, atopy was an
independent factor in producing an early measurable PD20 (methacholine dose
producing 20% fall in FEV1), especially in those atopic to two or more
aeroallergens, and irrespective of the particular aeroallergen.
CONCLUSIONS: Specific immunoresponse is strongly associated with asthma,
but positivity to single allergens (quality) and the number of positive
immunoresponses (quantity) do not change the per se risk of asthma in
atopic individuals.
ARTICLES
Risk of asthma in the general Spanish population attributable to specific immunoresponse. Spanish Group of the European Community Respiratory Health Survey
Respiratory and Environmental Health Research Unit, Institut Municipal d'Investigacio Medica, Barcelona, Spain.
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