Asthma diagnosis and treatment
Geographic variations in the effect of atopy on asthma in the European Community Respiratory Health Study

https://doi.org/10.1016/j.jaci.2004.05.072Get rights and content

Background

Atopy has long been related to asthma. The prevalences of both atopy and asthma have shown substantial variation.

Objective

We sought to assess geographic variations in the fraction of asthma attributable to IgE sensitization to specific allergens in the European Community Respiratory Health Survey.

Methods

A cross-sectional study was undertaken during the years 1991 and 1992 on 13,558 individuals in 36 centers in 16 countries. Asthma was defined in several ways, variously incorporating reported symptoms, bronchial responsiveness to methacholine, and physician diagnosis. Specific IgE against house dust mite (Dermatophagoides pteronyssinus), cat, timothy grass, Cladosporium herbarum, and a local allergen (birch, Parietaria judaica, or ragweed) were measured.

Results

The overall attributable fraction (AF) of asthma symptoms caused by atopy was 30% but varied widely between centers, ranging from 4% to 61%. The overall AF increased to 43% when asthma was based on wheezing and bronchial responsiveness, to 45% with a physician diagnosis of asthma, and to 48% when the patient reported more than 12 attacks in the last year. Between centers, the AF for atopy was significantly correlated with the prevalence of atopy among the asthmatic patients (r = 0.91) and with the sensitization to house dust mite (r = 0.64), as well as with the prevalence of asthma among atopic individuals (r = 0.43) and the prevalence of asthma among nonatopic individuals (r = −0.51).

Conclusion

The effect of atopy on the prevalence of asthma varies widely between centers, probably because of variations in factors related to the expression of asthma and to the prevalence of sensitization, particularly to house dust mite.

Section snippets

Methods

The ECRHS study followed a cross-sectional design and was undertaken during the years 1990 through 1994. Populations and subjects participating in the study have been described in detail elsewhere.3 The data presented here pertain to 13,558 individuals randomly selected from the general population (age range, 20-44 years) in 36 centers in 16 countries.

Asthma was defined as used in the ECRHS, namely a positive answer to any of 3 questions referring to nocturnal attacks of shortness of breath,

Results

The prevalence of specific IgE sensitization varied widely between centers, even in the same country (eg, for house dust mite, from 7% to 28% in Spain or from 18% to 35% in France; Table I). Overall, the prevalence of sensitization to house dust mite (21%) is similar to that to grass (19%), and in some of the centers, sensitization to grass is more prevalent than that to house dust mite. Mite, grass, and cat all demonstrated statistically significant heterogeneity between centers. Twenty-eight

Discussion

First, we found that between one third and one half of the prevalent cases of asthma among adults between 20 and 44 years old in the general population could be attributed to sensitization to common inhaled allergens. Second, the population AF of atopy in asthma varied widely between centers, even within the same country. Third, we found that the AF for house dust mite varied between centers, which in general did not occur for cat or grass. These findings were obtained by using the same

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