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The epidemiology of allergic sensitization and the relation to asthma and rhinitis: the Obstructive Lung Disease in Northern Sweden (OLIN) studies thesis XIV
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Pulmonary Medicine. (OLIN-studierna)
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Allergic sensitization is the most important risk factor for asthma and rhinitis among children, adolescents and young adults. Less is known about the incidence and remission of allergic sensitization, particularly in older adults. Furthermore, it is not clear if the earlier documented increase in prevalence of allergic sensitization continues. This thesis is focused on prevalence, incidence and remission of allergic sensitization to airborne allergens among adolescents and adults as well as on time trends in prevalence among adults. Furthermore, associated risk factors and the relation of allergic sensitization to asthma and rhinitis were assessed.

Methods: In the study of children and adolescents, incidence, remission and prevalence of allergic sensitization were assessed in a cohort study of schoolchildren, aged 7-8 years (y) at baseline. In the studies of adults, incidence and remission of allergic sensitization were assessed in a randomly selected adult population sample in 1994 (n=664) aged 20-69 y, which was followed up in 2004 (n=555). Trends in prevalence of allergic sensitization were assessed by comparing two cross-sectional studies; the cohort from 1994 and another randomly selsected population sample examined in 2009 (n=737). The relation of allergic sensitization to asthma and rhinitis was determined in the adult cohort in 2009. Allergic sensitization was assessed by skin prick test (SPT) with ten common airborne allergens at ages 7-8, 11-12 and 19 y in the cohort of children and in the participants ≤ 60 y in the adult cohorts. Specific IgE to nine airborne allergens was analyzed in the adult cohorts in 2004 and 2009. Risk factors for allergic sensitization and variables defining respiratory disease and symptoms were assessed by questionnaires in the cohort of children and by structured interviews in the adult cohorts.

Results: The 10-year cumulative incidence of allergic sensitization among the adults from 1994 to 2004 was 5%, while remission was 32%. In both adult cohorts, the prevalence of allergic sensitization was highest among young adults, aged 20-29 y, 55% and 61% and decreased significantly with increasing age. Among children and adolescents, both incidence and persistence of allergic sensitization were high, and the prevalence of allergic sensitization increased by age from 21% at age 7-8 y to 42% at age 19 y. Multisensitization at age 19 y was strongly associated with early onset of sensitization. The prevalence of sensitization to the major specific allergens birch, timothy, cat and dog as well as multisensitization (from 40% in 1994 to 56% in 2009, p=0.002) increased significantly from 1994 to 2009 among the adults. Sensitization to any allergen increased from 35% to 39%, however not significantly (p=0.13). A family history of allergic rhinitis was strongly and consistently associated with allergic sensitization in all ages. Male sex and urban living were significantly positively and birth order and furry animals at home in childhood were negatively associated with onset of sensitization before the age of 7-8 y, but not with onset of sensitization from 11-12y to 19 y. Young adult age and urban living were significant factors associated with allergic sensitization in adult age. Sensitization to any animal was significantly positively associated with current asthma (OR4.80 (95% CI 2.68-8.60)), whereas both sensitization to any pollen (OR 4.25 (2.55-7.06)) and any animal (OR 3.90 (95% CI 2.31-6.58)) were associated with current allergic rhinitis. The association between allergic sensitization and allergic rhinitis was strongest in young adult age and decreased with increasing age, while asthma was similarly associated with sensitization to any animal across all adult ages. Among asthmatics, the prevalence of allergic sensitization decreased with increasing age of asthma onset.

Conclusion: Both incidence and persistence of allergic sensitization were high among children and adolescents explaining the increase in prevalence by increasing age. An inverse pattern with low incidence and high remission of allergic sensitization was seen among adults. The decrease in prevalence of allergic sensitization by increasing adult age might at least partly be explained by normal ageing and not only by an effect of year of birth (cohort effect). The significant increase in prevalence of sensitization to the specific allergens explained the significant increase in multisensitization over 15 years. A family history of allergy was the strongest and the only consistent risk factor for allergic sensitization in all ages. The prevalence of allergic sensitization decreased with increasing age of asthma onset among adult asthmatics.

Place, publisher, year, edition, pages
Umeå: Umeå Universitet , 2015. , 74 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1755
Keyword [en]
adolescence, adults, allergic rhinitis, allergic sensitization, asthma, childhood, epidemiology, specific IgE
National Category
Respiratory Medicine and Allergy
Research subject
Lung Medicine
Identifiers
URN: urn:nbn:se:umu:diva-109776ISBN: 978-91-7601-346-5 (print)OAI: oai:DiVA.org:umu-109776DiVA: diva2:859109
Public defence
2015-11-06, Sunderby Sjukhus, Konferenscentrum, Aulan, Sunderby Sjukhus, Luleå, 13:00 (English)
Opponent
Supervisors
Available from: 2015-10-09 Created: 2015-10-06 Last updated: 2015-10-08Bibliographically approved
List of papers
1. Low incidence and high remission of allergic sensitization among adults
Open this publication in new window or tab >>Low incidence and high remission of allergic sensitization among adults
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2012 (English)In: Journal of Allergy and Clinical Immunology, ISSN 0091-6749, E-ISSN 1097-6825, Vol. 129, no 1, 136-142 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Prospective studies on the incidence and remission of allergic sensitization among adults are rare.

OBJECTIVE: We sought to assess the incidence, remission, risk factors, and prevalence of allergic sensitization in relation to aging over a 10-year period.

METHODS: In 1994, a sample of 664 adults (68% of invited) participated in clinical examinations, including a structured interview and skin prick tests (SPTs). The sample was randomly selected from a large questionnaire survey in Northern Sweden. In 2004, 555 subjects (93% of invited) were re-examined by using the same methods as in 1994. IgE levels were also measured in 2004.

RESULTS: In 1994, the prevalence of any positive SPT response was significantly related to age, with the highest prevalence (55%) in subjects aged 20 to 29 years and the lowest prevalence (26%) in subjects aged 50 to 60 years. A similar age-related prevalence was found in 2004, and sensitization to pollen and pets was most common in both years. The results of the SPTs were verified by means of specific IgE measurement. The incidence of any positive SPT response was low. Only 9 subjects had any positive SPT response (ie, a cumulative incidence of 5% over 10 years). Remission was greater (ie, 32% over 10 years). The main risk factors for allergic sensitization were young age and a family history of allergy. Having had furred animals at home during childhood was negatively related to specific IgE levels.

CONCLUSION: The low incidence and high remission in adulthood explain the decreasing prevalence of allergic sensitization by age. Thus the low prevalence of allergic sensitization among the elderly found in cross-sectional studies is an effect of normal aging and not primarily a birth cohort effect.

Keyword
Allergic sensitization, skin prick test, specific IgE, epidemiology, adults, incidence, remission, risk factors
National Category
Respiratory Medicine and Allergy
Research subject
Lung Medicine
Identifiers
urn:nbn:se:umu:diva-51108 (URN)10.1016/j.jaci.2011.08.033 (DOI)000298634000017 ()21975174 (PubMedID)
Available from: 2012-01-10 Created: 2012-01-10 Last updated: 2017-12-08Bibliographically approved
2. High incidence and persistence of allergic sensitization to airborne allergens in a population-based cohort followed from age 7 to 19 years – Report from the Obstructive Lung Disease in Northern Sweden (OLIN)
Open this publication in new window or tab >>High incidence and persistence of allergic sensitization to airborne allergens in a population-based cohort followed from age 7 to 19 years – Report from the Obstructive Lung Disease in Northern Sweden (OLIN)
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(English)Manuscript (preprint) (Other academic)
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:umu:diva-109857 (URN)
Available from: 2015-10-07 Created: 2015-10-07 Last updated: 2015-10-07
3. Increase in sensitization to common airborne allergens among adults: two population-based studies 15 years apart
Open this publication in new window or tab >>Increase in sensitization to common airborne allergens among adults: two population-based studies 15 years apart
2013 (English)In: Allergy, Asthma & Clinical Immunology, ISSN 1710-1484, E-ISSN 1710-1492, Vol. 9, no 1, 20- p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Studies on time trends of allergic sensitization among adults are rare. The aim of the study was to compare the prevalence of allergic sensitization to common airborne allergens among adults 15 years apart and to identify risk factors for allergic sensitization.

METHODS: Clinical examinations including skin prick test (SPT) and structured interviews were performed in two random population samples in 1994 and 2009. Furthermore, specific IgE was analyzed in 2009. SPT data were available for 483 subjects in 1994 and for 463 subjects in 2009 in ages 20--60 years. Specific IgE was analyzed in 692 subjects in ages 20--79 years.

RESULTS: Sensitization to cat (16% to 26%, p < 0.001), dog (13% to 25%, p < 0.001), birch (13% to 18%, p = 0.031) and timothy (12% to 21%, p < 0.001), based on SPT, increased significantly from 1994 to 2009. Sensitization to any positive SPT increased from 35% to 39%, p = 0.13.The proportion of having >=3 positive SPT reactions increased from 40% to 56%, p = 0.002. The sensitization pattern yielded similar results based on specific IgE. Risk factors for allergic sensitization were having a family history of allergy (OR 3.1, 95% CI 2.0-4.8 for any positive SPT; OR 2.7, 95% CI 1.8-4.0 for any elevated IgE) and urban living (OR 1.7, 95% CI 1.0-2.7; OR 1.5, 95% CI 1.0-2.4).

CONCLUSIONS: The prevalence of allergic sensitization to major airborne allergens as well as multi-sensitization increased significantly between the study years. Young age, a family history of allergy and urban living were significant risk factors for allergic sensitization.

Place, publisher, year, edition, pages
BioMed Central, 2013
Keyword
Allergic sensitization, Epidemiology, IgE, Population study, Prevalence, Skin prick test
National Category
Public Health, Global Health, Social Medicine and Epidemiology Respiratory Medicine and Allergy Immunology in the medical area
Identifiers
urn:nbn:se:umu:diva-85534 (URN)10.1186/1710-1492-9-20 (DOI)000332407900001 ()23758681 (PubMedID)
Available from: 2014-02-06 Created: 2014-02-06 Last updated: 2017-12-06Bibliographically approved
4. Allergic sensitization is age-dependently associated with rhinitis, but less so with asthma
Open this publication in new window or tab >>Allergic sensitization is age-dependently associated with rhinitis, but less so with asthma
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2015 (English)In: Journal of Allergy and Clinical Immunology, ISSN 0091-6749, E-ISSN 1097-6825, Vol. 136, no 6, 1559-U201 p.Article in journal (Refereed) Published
Abstract [en]

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.

Keyword
Adults, allergic rhinitis, allergic sensitization, asthma, epidemiology, specific IgE
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:umu:diva-107036 (URN)10.1016/j.jaci.2015.06.015 (DOI)000366044300017 ()26220530 (PubMedID)2-s2.0-84952639759 (Scopus ID)
Available from: 2015-08-17 Created: 2015-08-17 Last updated: 2017-05-09Bibliographically approved

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