Allergic sensitization is age-dependently associated with rhinitis, but less so with asthma

doi:10.1016/j.jaci.2015.06.015

Journal of Allergy and Clinical Immunology

Volume 136, Issue 6, December 2015, Pages 1559-1565.e2

https://doi.org/10.1016/j.jaci.2015.06.015 Get rights and content

Background

Epidemiologic data describing the association between allergic sensitization and asthma and allergic rhinitis in adults are scarce.

Objective

To determine the prevalence and impact of specific sensitization to airborne allergens on asthma and allergic rhinitis among adults in relation to age.

Methods

A random population sample (age 21-86 years) was examined with structured interview and analysis of specific IgE to 9 common airborne allergens. Of those invited, 692 (68%) subjects participated in blood sampling. IgE level of 0.35 U/mL or more to the specific allergen was defined as a positive test result.

Results

Allergic sensitization decreased with increasing age, both in the population sample and among subjects with asthma and allergic rhinitis. In a multivariate model, sensitization to animal was significantly positively associated with asthma (odds ratio [OR], 4.80; 95% CI, 2.68-8.60), whereas sensitization to both animal (OR, 3.90; 95% CI, 2.31-6.58) and pollen (OR, 4.25; 95% CI, 2.55-7.06) was significantly associated with allergic rhinitis. The association between allergic sensitization and rhinitis was consistently strongest among the youngest age group, whereas this pattern was not found for asthma. The prevalence of allergic sensitization among patients with asthma decreased by increasing age of asthma onset, 86% with asthma onset at age 6 y or less, 56% at age 7 to 19 years, and 26% with asthma onset at age 20 years or more.

Conclusions

Sensitization to animal was associated with asthma across all age groups; allergic rhinitis was associated with sensitization to both pollen and animal and consistently stronger among younger than among older adults. Early onset of asthma was associated with allergic sensitization among adults with asthma.

Section snippets

Study area

The study was performed within the Obstructive Lung Diseases in Northern Sweden Studies in Norrbotten, the northernmost county of Sweden. The county is sparsely inhabited, with approximately 250,000 inhabitants in an area of 105,000 km². The climate is subarctic, with cold and long winters and mild summers. The study was approved by the Regional Ethical Review Board at Umeå University, Sweden.

Study population

The study population is presented in Fig E1 in this article's Online Repository at www.jacionline.org.

Prevalence of allergic sensitization

The prevalence of sensitization to any allergen decreased with increasing age: 45% in the age group 21 to 40 years, 30% in the age group 41 to 60 years, and 15% in the age group 61 to 86 years (P < .001) (Table I). A similar trend of a decreasing prevalence by age was observed for the most common sensitizers: dog, cat, timothy, birch, and horse. Sensitization to mite was less common, and only 0.7% were sensitized to mold. No significant differences by sex were observed.

Prevalence of asthma and allergic rhinitis

The prevalence of

Discussion

In this study of adults, a major finding includes a marked decrease in allergic sensitization among subjects with asthma with increasing age of asthma onset. Of those with asthma onset before the age of 6 years, 86% were sensitized in adulthood, whereas only 26% of the subjects with asthma with an adult onset (age ≥20 years) of asthma were sensitized. Furthermore, the PAF of allergic sensitization for asthma was 49% for the age group 22 to 40 years but only 11% for the age group 61 to 86 years.

References (41)

K. Warm et al.
Low incidence and high remission of allergic sensitization among adults
J Allergy Clin Immunol
(2012)
E. Broadfield et al.
Increase in the prevalence of allergen skin sensitization in successive birth cohorts
J Allergy Clin Immunol
(2002)
M. Westman et al.
Natural course and comorbidities of allergic and nonallergic rhinitis in children
J Allergy Clin Immunol
(2012)
M.S. Perzanowski et al.
Relevance of allergens from cats and dogs to asthma in the northernmost province of Sweden: schools as a major site of exposure
J Allergy Clin Immunol
(1999)
H. Backman et al.
Prevalence trends in respiratory symptoms and asthma in relation to smoking—two cross-sectional studies ten years apart among adults in northern Sweden
World Allergy Organ J
(2014)
S.J. Arbes et al.
Asthma cases attributable to atopy: results from the Third National Health and Nutrition Examination Survey
J Allergy Clin Immunol
(2007)
M. Simola et al.
Changes in skin and nasal sensitivity to allergens and the course of rhinitis: a long-term follow-up study
Ann Allergy Asthma Immunol
(1999)
P. Badorrek et al.
Pollen starch granules in bronchial inflammation
Ann Allergy Asthma Immunol
(2012)
J. Sunyer et al.
Geographic variations in the effect of atopy on asthma in the European Community Respiratory Health Study
J Allergy Clin Immunol
(2004)
T.J. Craig et al.
Aeroallergen sensitization correlates with PC(20) and exhaled nitric oxide in subjects with mild-to-moderate asthma
J Allergy Clin Immunol
(2008)

C. Miranda et al.

Distinguishing severe asthma phenotypes: role of age at onset and eosinophilic inflammation

J Allergy Clin Immunol

(2004)

E.P. Ronmark et al.

Large scale questionnaire survey on respiratory health in Sweden: effects of late- and non-response

Respir Med

(2009)

B.G. Toelle et al.

Childhood factors that predict asthma in young adulthood

Eur Respir J

(2004)

M.R. Sears et al.

A longitudinal, population-based, cohort study of childhood asthma followed to adulthood

N Engl J Med

(2003)

A. Bjerg-Backlund et al.

Asthma during the primary school ages–prevalence, remission and the impact of allergic sensitization

Allergy

(2006)

Y. Schoefer et al.

KORA Study Group. Predictivity of allergic sensitization (RAST) for the onset of allergic diseases in adults

Allergy

(2008)

U. Bodtger et al.

Rhinitis symptoms and IgE sensitization as risk factors for development of later allergic rhinitis in adults

Allergy

(2006)

A. Linneberg et al.

Temporal trends of aeroallergen sensitization over twenty-five years

Clin Exp Allergy

(2007)

E. Ronmark et al.

Major increase in allergic sensitization in schoolchildren from 1996 to 2006 in northern Sweden

J Allergy Clin Immunol

(2009)

K. Blomme et al.

Prevalence of allergic sensitization versus allergic rhinitis symptoms in an unselected population

Int Arch Allergy Immunol

(2013)

Cited by (63)

No remission in 60% of those with childhood-onset asthma - A population-based cohort followed from 8 to 28 years of age
2024, Respiratory Medicine
Although remission occur, childhood-onset asthma may persist until adulthood. Since few longitudinal population-based studies have followed a cohort from childhood until adulthood, the knowledge on predictors of persistence of asthma is sparse.
To estimate persistence of asthma from 8 to 28 years and its associated factors.
Within the OLIN (Obstructive Lung Disease in Northern Sweden) studies, a cohort was recruited in 1996 (age 8y, n = 3430) and followed annually with questionnaires about asthma and risk factors until 19y. Clinical examinations included skin prick tests (at 8, 12 and 19y) and lung function tests (17 and 19y) whereof a subsample performed bronchial hyperreactivity test. We identified n = 248 with asthma at 8y whereof 170 (69%) participated in a follow-up at 28y (73% of possible to invite).
Of the 170 participants at 28y, 105 (61.8%) had persistent asthma (women: 49/76, 64.5%; men: 56/94, 59.6%, p = 0.513). Factors collected at recruitment: allergic sensitization (OR7.8, 95%CI 3.0–20.2), severe respiratory infection (OR2.6, 95%CI 1.1–6.3) and higher asthma severity score (OR1.6, 95%CI 1.1–2.4) were associated with asthma at 28y after adjustment for sex, family history of asthma, breastfeeding <3 months and eczema. Replacing allergic sensitization with rhinoconjunctivitis in the model yielded OR3.4 (95%CI 1.5–8.0). Bronchial hyperreactivity at age 17y associated with asthma at 28y (OR9.0, 95%CI 1.7–47.0).
Among children with asthma onset by 8y, 62% still had asthma at age 28 years. Persistent asthma was associated with allergic sensitization, rhinoconjunctivitis, severe respiratory infection, a more severe asthma and bronchial hyperreactivity.
Does allergy decrease with age?
2024, Revue Francaise d'Allergologie
LINC00299 polymorphisms rs891058, rs13395467, and rs13398375 reduce the risk of allergic rhinitis among the Chinese Han population
2023, Gene
A few studies have reported that allergic rhinitis (AR) pathogenesis is related to genetic factors. And the most important genetic factor is single nucleotide polymorphism (SNP). The study aimed to investigate the effects of LINC00299 SNPs (rs891058, rs13395467 and rs13398375) on AR risk in the Chinese Han population.
Independent sample t-test was carried out for statistical analyses of the distribution of age and BMI in AR cases and healthy controls, and χ² test was used for statistical analyses of gender and different regions. The Agena MassARRAY platform was applied for LINC00299 SNP genotyping. Further, the association between SNPs and AR risk was evaluated by odds ratios (ORs) as well as 95% confidence intervals (CIs).
Our study found that LINC00299 rs891058, rs13395467, and rs13398375 were associated with a decreased risk of AR in the Chinese Han population. More precisely, rs891058 and rs13398375 were associated with a reduced risk of AR in subjects aged ≤ 43 years. In males, subjects with BMI ≤ 24 kg/m², and from loess hills region, rs891058, rs13395467, and rs13398375 played a protective role against AR. The study on SNP-SNP interactions suggested that rs891058, rs13395467 and rs13398375 were related.
LINC00299 polymorphisms rs891058, rs13395467, and rs13398375 are associated with a reduced risk of AR in the Chinese Han population, and these SNPs can be used as potential targets to assess AR risk.
Prevalence and risk factors for allergic sensitization: 3 cross-sectional studies among schoolchildren from 1996 to 2017
2023, Journal of Allergy and Clinical Immunology: Global
The prevalence of allergic sensitization and allergic diseases has increased for decades in Northern Europe, but recent studies are lacking.
We sought to study the prevalence trends of allergic sensitization, associated risk factors, and the association with asthma and allergic rhinitis (AR) among children in Northern Sweden.
Three cohorts of children aged 7 to 8 years participated in a skin prick test (SPT) with 10 airborne allergens in 1996, 2006, and 2017, with 2148, 1693, and 1762 participants tested, respectively, representing 87% to 90% of schoolchildren in the catchment communities. Adjusted Poisson regression was used to identify risk factors for allergic sensitization and the association with asthma and AR.
The prevalence of any positive SPT response increased from 21% in 1996 to 30% in 2006 and remained at 30% in 2017 (P < .001). Sensitization to cat was the most common for all the years. The risk factor pattern for a positive SPT response was similar in all examinations, with positive and significant associations with a family history of allergy (risk ratio, 1.4-1.5) and negative and significant associations with having a cat at home (risk ratio, 0.7-0.8). The prevalence of physician-diagnosed asthma increased, but the association with allergic sensitization weakened. The opposite trends were found for AR—decreasing prevalence and strengthened association with allergic sensitization.
The prevalence of allergic sensitization increased from 1996 to 2006 but plateaued in the next decade, whereas the risk factor pattern remained stable. The diverging trends of associations between allergic sensitization and asthma and AR suggest secular trends in the clinical management of allergic diseases.
Impact of airborne pollen concentration and meteorological factors on the number of outpatients with allergic rhinitis
2023, World Allergy Organization Journal
The prevalence of allergic rhinitis (AR) caused by pollen allergen is high in northern China. This study analyzed the allergen detection results of patients with AR in Beijing Tongren Hospital from 2016 to 2019, and evaluated the association between AR and seasonal airborne pollen concentration and meteorological factors in Beijing, China. We found that AR patients caused by pollen accounted for 61.18% (16 793/27 449) in AR patients. Among them, Artemisia pollen sensitive patients accounted for 48.54% (13 325/27 449) of AR. We also found that the number of outpatients diagnosed with AR is strongly correlated with seasonal airborne pollen concentration and is influenced by meteorological factors, such as temperature and humidity. These results may help clinicians and healthcare workers to be prepared for this influx of outpatients in the relevant seasons.
Allergic rhinitis in Chinese young adults from the Singapore/Malaysia cross-sectional genetics epidemiology study (SMCGES) cohort: Prevalence, patterns, and epidemiology of allergic rhinitis
2022, World Allergy Organization Journal
Citation Excerpt :
Differences in previous prevalence estimates of AR compared to ours (39.4%) could be attributed to varying sample age groups. Indeed, age influences allergic sensitization, with the highest prevalence in 21–40-year-olds in a population of age range 21–86 years, while rhinitis prevalence increases steadily in children aged 4–18, to a peak at 35.8% in 18-year-olds.30,31 Moreover, Wang et al (2004) estimated the prevalence of rhinitis, which potentially included non-allergic rhinitis cases, resulting in a higher prevalence estimate of AR in 2004.18
Allergic rhinitis (AR) is characterized by the occurrence of at least 2 symptoms of nasal itching, nasal blockage, rhinorrhea, and sneezing, when not afflicted with a cold or flu, with defined atopic sensitization demonstrated by skin prick test or specific IgE responses. Besides the detriment to standard of living and economic burden of AR, both multicentre and single-cohort studies have observed an increase in AR prevalence in Asia over time.
In total, 12 872 individuals, with mean age 22.1 years (SD = 4.8), were recruited from universities in Singapore and Malaysia. Each participant provided epidemiological data based on an investigator-administered questionnaire adapted from the validated International Study of Allergies and Asthma in Childhood (ISAAC) protocol, and atopy status was determined using a skin prick test (SPT) performed by qualified staff. AR was diagnosed according to Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines and a positive SPT result.
Sensitization (determined by SPT) to either Blomia tropicalis or Dermatophagoides pteronyssinus was prevalent in 66.5% of the cohort. Current rhinitis (manifesting ≥2 rhinitis symptoms, within the past 12 months) was observed in 48.9% of our population, while AR, which included atopy status, was estimated at 39.4%. Sneezing and rhinorrhea were the most common symptoms among AR cases. AR prevalence decreased with increasing age (OR: 0.979; 95% CI: 0.969–0.989), while male gender (OR: 2.053; 95% CI: 1.839–2.294), and a parental history of allergic diseases (OR: 2.750; 95% CI: 2.284–3.316) were significant risk factors for AR. Upon adjustment for age, gender, and parental history, housing type (OR: 0.632; 95% CI: 0.543–0.736) and income level (>$6000 vs <$2000; OR: 2.461; 95% CI: 2.058–2.947) remained as significant risk factors for AR, while ever having kept a pet (OR: 1.167; 95% CI: 1.025–1.328) emerged as a risk factor. Conflicting results were obtained for indicators of sedentary lifestyle: frequent physical activity (OR: 1.394; 95% CI: 1.150–1.694) and increased duration spent using the TV/computer (OR: 1.224; 95% CI: 1.006–1.489) both increased the risk of AR. Lastly, we used the Quality of Diet based on Glycaemic Index Score (QDGIS) to assess the Glycaemic Index (GI) level of overall diet. We identified lower GI level of overall diet as a protective factor against AR manifestation (OR: 0.682; 95% CI: 0.577–0.807).
While the previously established non-modifiable risk factors for AR were present in our study population, the identification of modifiable risk factors, such as TV/computer usage, and dietary habits, opens a new area for research, both in the areas of gene-environment interaction, and management of AR.

View all citing articles on Scopus

: The studies were funded by the Swedish Heart-Lung Foundation, the Swedish Asthma-Allergy Foundation, the Swedish Research Council, Umeå University, Visare Norr, and Norrbotten County Council. Additional funding was provided by ThermoFisher Scientific, Uppsala, Sweden.

: Disclosure of potential conflict of interest: K. Warm has received research support from the Swedish Heart-Lung Foundation. J. Lötvall has consultant arrangements with Novartis, AstraZeneca, GlaxoSmithKline, Sanofi, and FlagShip ventures; is employed by the University of Gothenburg; has provided expert testimony for Bahr; has received research support from AstraZeneca; has received payment for lectures from AstraZeneca, Novartis, GlaxoSmithKline, and Abdilbrahim; has patents through FlagShip ventures; and has stock/stock options through FlagShip ventures. B. Lundbäck has received research support from AstraZeneca and GlaxoSmithKline; has received payment for lectures from AstraZeneca, GlaxoSmithKline, Novartis, and Takeda; and has participated in advisory board meetings for AstraZeneca, GlaxoSmithKline, and Novartis. E. Rönmark has received research support from the Swedish Heart-Lung Foundation, the Swedish Asthma-Allergy Foundation, the Swedish Research Council, Umeå University, Visare Norr, Norrbotten County Council, and ThermoFisher Scientific. The rest of the authors declare that they have no relevant conflicts of interest.

View full text

Rhinitis, sinusitis, and upper airway diseaseAllergic sensitization is age-dependently associated with rhinitis, but less so with asthma

Background

Objective

Methods

Results

Conclusions

Section snippets

Study area

Study population

Prevalence of allergic sensitization

Prevalence of asthma and allergic rhinitis

Discussion

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

World Allergy Organ J

J Allergy Clin Immunol

Ann Allergy Asthma Immunol

Ann Allergy Asthma Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

Respir Med

Childhood factors that predict asthma in young adulthood

Eur Respir J

A longitudinal, population-based, cohort study of childhood asthma followed to adulthood

N Engl J Med

Asthma during the primary school ages–prevalence, remission and the impact of allergic sensitization

Allergy

KORA Study Group. Predictivity of allergic sensitization (RAST) for the onset of allergic diseases in adults

Allergy

Rhinitis symptoms and IgE sensitization as risk factors for development of later allergic rhinitis in adults

Allergy

Temporal trends of aeroallergen sensitization over twenty-five years

Clin Exp Allergy

Major increase in allergic sensitization in schoolchildren from 1996 to 2006 in northern Sweden

J Allergy Clin Immunol

Prevalence of allergic sensitization versus allergic rhinitis symptoms in an unselected population

Int Arch Allergy Immunol

Rhinitis, sinusitis, and upper airway disease
Allergic sensitization is age-dependently associated with rhinitis, but less so with asthma