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Department of Public
Health Medicine, UMDS Guy's Campus, London SE1 3QD, UK
Correspondence to: Miss S Chinn.
Received 22 December 1997; Returned to authors 2 March 1998; Revised version received 17 April 1998; Accepted for publication 22 April 1998
BACKGROUND
Bronchial
responsiveness is known to be related to atopy, but the relative
contribution of sensitisation to individual allergens in the UK, or
whether serum total IgE is an independent risk factor, is unknown.
METHODSA random
sample of 1864 men and women aged 20-44 years, drawn from family
health service registers in Cambridge, Ipswich and Norwich, was invited
to answer a detailed questionnaire, undergo skin prick tests and
methacholine bronchial challenge, and provide a serum sample for
measurement of total and specific IgE. The relation of bronchial
responsiveness to risk factors was studied in 749 subjects (40.2%)
with complete data.
RESULTSBronchial
responsiveness was increased in those sensitised to cat,
D pteronyssinus, Timothy grass and
Cladosporium, but decreased in subjects also
positive to birch allergen. Additional skin prick tests added little
information. Serum total IgE was not significantly related after
adjustment for specific IgE to the five allergens. Increasing titres of
specific IgE to D pteronyssinus were
associated with increasing bronchial responsiveness. Specific IgE to
Cladosporium had a prevalence of around 3%,
but was associated with greatly increased responsiveness. Decreased
baseline lung function was related (p<0.001) to increased
responsiveness. There was an interaction between age and smoking
status, with lower responsiveness in older non-smokers.
CONCLUSIONAtopy is
the most important risk factor for bronchial responsiveness in this age
group, but effects are not additive across all allergens. Research in
reducing exposure to house dust mite should also address the role of
Cladosporium sensitisation and exposure to
indoor moulds.
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