Exposure and sensitization to indoor allergens: association with lung function, bronchial reactivity, and exhaled nitric oxide measures in asthma
Open accessAbstract
Background Exposure to high levels of allergens in sensitized asthmatic patients causes worsening of pulmonary function in experimental studies. Chronic exposure to lower, naturally occurring levels of allergens might increase the severity of asthma.Objective We sought to study the associations between sensitization and exposure to common indoor allergens (dust mite, cat, and dog) in the home on pulmonary function, exhaled nitric oxide (eNO), and airway reactivity in asthmatic patients.Methods Dust samples were collected from the living room carpet and mattress of 311 subject's homes, and Der p 1, Fel d 1, and Can f 1 concentrations were measured by using ELISAs. Spirometry, nonspecific bronchial reactivity, and eNO were measured.Results Subjects both sensitized and exposed to high levels of sensitizing allergen had significantly lower FEV(1) percent predicted values (mean, 83.7% vs 89.3%; mean difference, 5.6%; 95% CI, 0.6%-10.6%; P =.03), higher eNO values (geometric mean [GM], 12.8 vs 8.7 ppb; GM ratio, 0.7; 95% CI, 0.5-0.8; P =.001), and more severe airways reactivity (PD(20) GM, 0.25 vs 0.73 mg; GM ratio, 2.9; 95% CI, 1.6-5.0; P <.001) compared with subjects not sensitized and exposed. No significant effect of the interaction between sensitization and exposure was found for FEV(1) percent predicted and eNO values. However, there was a significant effect of the interaction between sensitization and exposure to any allergen (P =.05) and between sensitization and exposure to cat allergen (P =.04) for nonspecific bronchial reactivity.Conclusion Asthmatic subjects who are exposed in their homes to allergens to which they are sensitized have a more severe form of the disease.
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Despite interventions and treatments aimed at addressing modifiable factors and comorbidities, some children with difficult asthma and Asthma plus may not improve because of continued poor adherence with medications or ongoing high exposure to allergens, in which case they should be considered as having refractory difficult asthma or refractory Asthma plus.
“However, despite interventions and treatments aimed at addressing modifiable factors and comorbidities, some children with DA and Asthma plus may not improve [e.g., because of the continued poor adherence with medications (50, 68), or ongoing high exposure to allergens (69–71)], in which case they should be considered as having refractory DA or refractory Asthma plus (46, 72).”
From Epidemiology of Asthma in Children and Adults (2019) · cites this paper as [69]
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Kita, H. (2015) · Allergology International · doi:10.1016/j.alit.2015.04.004 · Cited by 42 · see citing works
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Exposure to Mouse Allergen in U.S. Homes Associated with Asthma Symptoms
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Genetic susceptibility to severe asthma with fungal sensitization
Overton, N. L. D., Simpson, A., Bowyer, P., & Denning, D. W. (2017) · International Journal of Immunogenetics · doi:10.1111/iji.12312 · Cited by 39 · see citing works
Bronchial Responsiveness in Atopic Adults Increases with Exposure to Cat Allergen
Chinn, S., Heinrich, J., Antó, J. M., Janson, C., Norbäck, D., Olivieri, M., Svanes, C., Sunyer, J., Verlato, G., Wjst, M., et al. (2007) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200612-1840oc · Cited by 39 · see citing works
Update on indoor allergens and their impact on pediatric asthma
Maciag, M. C., & Phipatanakul, W. (2022) · Annals of Allergy Asthma & Immunology · doi:10.1016/j.anai.2022.02.009 · Cited by 38 · see citing works
Environmental influences on childhood asthma: allergens
Custovic, A., de Moira, A. P., Murray, C. S., & Simpson, A. (2023) · Pediatric Allergy and Immunology · doi:10.1111/pai.13915 · Cited by 37 · see citing works
Seasonal variation and environmental predictors of exhaled nitric oxide in children with asthma
Spanier, A. J., Hornung, R., Kahn, R. S., Lierl, M. B., & Lanphear, B. P. (2008) · Pediatric Pulmonology · doi:10.1002/ppul.20816 · Cited by 36 · see citing works
Rapid Allergen Inactivation Using Atmospheric Pressure Cold Plasma
Wu, Y. H., Liang, Y., Wei, K., Li, W., Yao, M., & Zhang, J. (2014) · Environmental Science & Technology · doi:10.1021/es5003988 · Cited by 35 · see citing works
Controversial role of pets in the development of atopy in children
Fretzayas, A., Kotzia, D., & Moustaki, M. (2013) · World Journal of Pediatrics · doi:10.1007/s12519-013-0412-6 · Cited by 34 · see citing works
Reduction in mouse allergen exposure is associated with greater lung function growth
Grant, T. L., Phipatanakul, W., Perzanowski, M. S., Balcer-Whaley, S. L., Peng, R. D., Curtin-Brosnan, J., Newman, M. G., Cunningham, A., Divjan, A., Bollinger, M. E., et al. (2019) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2019.08.043 · Cited by 34 · see citing works
Aeroallergen sensitization in childhood asthmatics in Northern India
New Delhi Childhood Asthma Study Group, Raj, D., Lodha, R., Pandey, A., Mukherjee, A., Agrawal, A., & Kabra, S. K. (2013) · Indian Pediatrics · doi:10.1007/s13312-013-0304-9 · Cited by 33 · see citing works
Environmental Effects on Fractional Exhaled Nitric Oxide in Allergic Children
Grutta, S. L., Ferrante, G., Malizia, V., Cibella, F., & Viegi, G. (2011) · Journal of Allergy · doi:10.1155/2012/916926 · Cited by 33 · see citing works
Environmental exposures and exhaled nitric oxide in children with asthma
Spanier, A. J., Hornung, R., Lierl, M. B., & Lanphear, B. P. (2006) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2006.04.001 · Cited by 33 · see citing works
Gore, R. B., Curbishley, L., Truman, N. J., Hadley, E., Woodcock, A. A., Langley, S. J., & Čustović, A. (2006) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2005.12.1351 · Cited by 33 · see citing works
Self-citationAlmqvist, C., Garden, F. L., Kemp, A. S., Li, Q., Crisafulli, D., Tovey, E. R., Xuan, W., & Marks, G. B. (2010) · Paediatric and Perinatal Epidemiology · doi:10.1111/j.1365-3016.2010.01095.x · Cited by 32 · see citing works
Lack of association between indoor allergen sensitization and asthma morbidity in inner-city adults
Wisnivesky, J. P., Sampson, H. A., Berns, S. H., Kattan, M., & Halm, E. A. (2007) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2007.03.044 · Cited by 32 · see citing works
Allergen avoidance in the secondary and tertiary prevention of allergic diseases: does it work?
Marinho, S., Simpson, A., & Čustović, A. (2006) · Primary Care Respiratory Journal · doi:10.1016/j.pcrj.2006.02.005 · Cited by 32 · see citing works
Early exposure to pets: Good or bad?
Bufford, J. D., & Gern, J. E. (2007) · Current Allergy and Asthma Reports · doi:10.1007/s11882-007-0057-4 · Cited by 31 · see citing works
Smith, N. L. D., Bromley, M. J., Denning, D. W., Simpson, A., & Bowyer, P. (2015) · The Journal of Infectious Diseases · doi:10.1093/infdis/jiu490 · Cited by 29 · see citing works
Tsolakis, N., Malinovschi, A., Nordvall, L., Mattsson, L.-Å., Lidholm, J., Pedroletti, C., Janson, C., Borres, M. P., & Alving, K. (2018) · Clinical & Experimental Allergy · doi:10.1111/cea.13135 · Cited by 29 · see citing works
House Dust Mite Extract Induces Interleukin-9 Expression in Human Eosinophils
Fujisawa, T., Katsumata, H., & Kato, Y. (2008) · Allergology International · doi:10.2332/allergolint.o-07-498 · Cited by 29 · see citing works
Rastogi, D., Reddy, M., & Neugebauer, R. (2006) · Annals of Allergy Asthma & Immunology · doi:10.1016/s1081-1206(10)61093-9 · Cited by 28 · see citing works
Skin Test Reactivity to Indoor Allergens Correlates with Asthma Severity in Jeddah, Saudi Arabia
Koshak, E. A. (2006) · Allergy Asthma and Clinical Immunology · doi:10.1186/1710-1492-2-1-11 · Cited by 31 · see citing works
Association of Atopy to Asthma Severity and Medication Use in Children
Schwindt, C. D., Tjoa, T. T., Floro, J. N., McLaren, C. E., & Delfino, R. J. (2006) · Journal of Asthma · doi:10.1080/02770900600758234 · Cited by 26 · see citing works
Determinants of asthma and its clinical course
Chipps, B. E. (2004) · Annals of Allergy Asthma & Immunology · doi:10.1016/s1081-1206(10)61388-9 · Cited by 26 · see citing works
Parent report of pests and pets and indoor allergen levels in inner-city homes
Curtin-Brosnan, J., Matsui, E. C., Breysse, P. N., McCormack, M. C., Hansel, N. N., Tonorezos, E. S., Eggleston, P. A., Williams, D. L., & Diette, G. B. (2008) · Annals of Allergy Asthma & Immunology · doi:10.1016/s1081-1206(10)60291-8 · Cited by 24 · see citing works
Ookawara, T., Aihara, R., Morimoto, A., Iwashita, N., Kurata, K., Takagi, Y., Miyasaka, A., Kushiro, M., Míyake, S., & Fukuyama, T. (2020) · Toxicological Sciences · doi:10.1093/toxsci/kfaa168 · Cited by 24 · see citing works
Quantification of atopy, lung function and airway hypersensitivity in adults
Marinho, S., Simpson, A., Marsden, P., Smith, J. A., & Čustović, A. (2011) · Clinical and Translational Allergy · doi:10.1186/2045-7022-1-16 · Cited by 24 · see citing works
Jo, E., Kim, M., Lee, S. E., Lee, S., Kim, M., Song, W., Kim, S., Kang, H., Chang, Y., Cho, S., et al. (2013) · Allergy Asthma and Immunology Research · doi:10.4168/aair.2014.6.1.39 · Cited by 23 · see citing works
Room-specific characteristics of suburban homes as predictors of indoor allergen concentrations
Perry, T. T., Wood, R. A., Matsui, E. C., Curtin-Brosnan, J., Rand, C. S., & Eggleston, P. A. (2006) · Annals of Allergy Asthma & Immunology · doi:10.1016/s1081-1206(10)61092-7 · Cited by 23 · see citing works
Advances in environmental and occupational diseases 2003
Frew, A. J. (2004) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2004.03.039 · Cited by 23 · see citing works
Agarwal, R., Devi, D., Gupta, D., & Chakrabarti, A. (2014) · Lung India · doi:10.4103/0970-2113.135762 · Cited by 21 · see citing works
Gore, R., Boyle, R., Gore, C., Custovic, A., Hanna, H., Svensson, P., & Warner, J. O. (2015) · Indoor Air: International Journal of Indoor Environment and Health · doi:10.1111/ina.12122 · Cited by 19 · see citing works
Mediators of the Socioeconomic Gradient in Outcomes of Adult Asthma and Rhinitis
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Su, K., Chiu, C., Tsai, M., Liao, S.-L., Chen, L., Hua, M., Yao, T., Huang, J., & Yeh, K. (2019) · World Allergy Organization Journal · doi:10.1016/j.waojou.2019.100056 · Cited by 19 · see citing works
Nonnenmann, M. W., Gimeno, D., Levin, J. L., Douphrate, D. I., Boggaram, V., Schaeffer, J. W., Gallagher, M., Hornick, M. K., & Reynolds, S. J. (2017) · American Journal of Industrial Medicine · doi:10.1002/ajim.22680 · Cited by 19 · see citing works
Correlation between inhalant allergen-specific IgE and pulmonary function in children with asthma
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Effects of Cysteine Donor Supplementation on Exercise-Induced Bronchoconstriction
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Dust-mite inducing asthma: what advice can be given to patients?
Čustović, A., Murray, C. S., & Simpson, A. (2019) · Expert Review of Respiratory Medicine · doi:10.1080/17476348.2019.1651647 · Cited by 17 · see citing works
Allergy is an important factor in asthma exacerbation: A Pro/Con Debate
Čustović, A., Simpson, A., Bardin, P. G., & Souëf, P. N. L. (2010) · Respirology · doi:10.1111/j.1440-1843.2010.01826.x · Cited by 17 · see citing works
A mouse model for in vivo tracking of the major dust mite allergen Der p 2 after inhalation
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Correlation between fungal sensitisation in childhood persistent asthma and disease severity
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Consensus document on the diagnosis of severe uncontrolled asthma.
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The complex link between severity of asthma and rhinitis in mite allergic patients
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Association of food allergy and decreased lung function in children and young adults with asthma
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- Authors
- Langley, S. J., Goldthorpe, S., Craven, M., Morris, J., Woodcock, A., & Custovic, A.
- Affiliations
- Wythenshawe Hospital (GB)
- Medicines Evaluation Unit (GB)
- Venue
- Journal of Allergy and Clinical Immunology
- Publisher
- Elsevier BV
- Published
- 2003-08
- Volume
- 112
- Issue
- 2
- Pages
- 362-368
- ISSN
- 0091-6749 (ISSN-L)
- OpenAlex
- W2164740939
- Cited by
- 171
- References
- 36
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 3 · 2023: 4 · 2022: 7 · 2021: 5 · 2020: 6 · 2019: 9 · 2018: 7 · 2017: 6 · 2016: 9 · 2015: 9 · 2014: 13 · 2013: 11 · 2012: 9
- FWCI
- 5.37
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Allergy and Clinical Immunology (publishedVersion)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
- Health Sciences › Medicine › Immunology and Allergy › Allergic Rhinitis and Sensitization
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Occupational exposure and asthma
- Keywords
- asthma, indoor allergens, allergen sensitization, allergen exposure, house dust mite allergens, cat allergen, dog allergen, lung function, FEV1, exhaled nitric oxide, Der p 1, Fel d 1, Can f 1, disease severity
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Allergens, Asthma, Child, Environmental Exposure, Female, Housing, Humans, Immunization, Lung, Male, Middle Aged, Nitric Oxide, Respiration, Respiratory Function Tests, Bronchial Hyperreactivity, Air Pollution, Indoor
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