The association of smoking with sensitization to common environmental allergens: Results from the European Community Respiratory Health Survey,☆☆,,★★

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Abstract

Background: Smoking is a risk factor for sensitization to some occupational allergens, but its association with sensitization to common environmental allergens remains unclear. Objective: We sought to determine the association of smoking with total IgE levels and with sensitization to 3 common environmental allergens in data from the European Community Respiratory Health Survey. Methods: A detailed smoking history and blood sample for determination of serum total IgE and specific IgE levels to house dust mite, grass, and cat allergens was obtained from 13,002 randomly selected young adults living in the areas served by 34 centers in 14 countries. Associations with smoking status and amount smoked were determined. Because there was evidence of heterogeneity between centers in the association of age, sex, and smoking with sensitization, odds ratios (ORs) were determined for each center and combined by using random-effects meta-analysis. Results: Compared with lifetime nonsmokers, current smokers were at an increased risk of sensitization to house dust mite allergen (OR, 1.13; 95% confidence interval [CI], 1.02-1.26) but a decreased risk of sensitization to grass (OR, 0.76; 95% CI, 0.67-0.88) and cat allergens (OR, 0.69; 95% CI, 0.59-0.80). Exclusion of those with symptoms suggestive of current asthma strengthened the association of smoking with sensitization to house dust mite allergen (OR, 1.29; 95% CI, 1.11-1.50). The geometric mean total IgE level was higher in smokers and was higher among those who currently smoked the most compared with those who smoked less than 5 cigarettes per day. Conclusion: The association between smoking and sensitization to common environmental allergens is different for different allergens. (J Allergy Clin Immunol 1999;104:934-40.)

Section snippets

METHODS

The methods used in the ECRHS have been described in detail elsewhere.15, 16 Briefly, participating centers selected areas for study that were predefined by existing administrative boundaries, had populations of at least 150,000 people, and had up to date sampling frames of 20 to 44 year old subjects where possible. In the first stage of the study, at least 1500 people of each sex were sent questionnaires enquiring about respiratory symptoms and attacks of asthma in the previous 12 months and

RESULTS

Subjects from 34 centers in 14 different countries were included in the analysis.

Total and specific IgE levels were available from 13,002 (76.1%) of the 17,096 subjects who took part in the second stage of the survey. There was variation in the response to blood testing between centers (43.3% in Portland, USA, to 98.2% in Erfurt, Germany). In the sample there were 5526 lifetime nonsmokers, 2766 exsmokers (2433 with full and consistent information on pack-years of smoking), and 4710 current

DISCUSSION

This study has shown that smoking was associated differently with sensitization to 3 common environmental allergens while being consistently associated in a dose-dependent fashion with high total IgE levels. Because of the cross-sectional design of the study and the potential for healthy-smoker bias, analyses have been conducted including and excluding those with current respiratory symptoms. These analyses confirm that current smoking is an important risk factor for sensitization to house dust

Acknowledgements

We thank Dr Jonathan Sterne for his support and advice. We also thank the late Colette Baya and Dr Manuel Hallen for their help during the study and Professor K. Vuylsteek and the members of the COMAC for their support.

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    *The names and location of participants in the European Community Respiratory Health Survey can be found in the appendix.

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    Supported by the European Commission and the following grants for local studies: Australia: Allen and Hanbury’s, Australia; Belgium: Belgian Science Policy Office, National Fund for Scientific Research; France: Ministère de la Santé, Glaxo France, Insitut Pneumologique d’Aquitaine, Contrat de Plan Etat-Région Languedoc-Rousillon, CNMATS, CNMRT (90MR/10, 91AF/6), Ministre delegué de la santé, RNSP; Germany: GSF, and the Bundesminister für Forschung und Technologie, Bonn; Greece: The Greek Secretary General of Research and Technology, Fisons, Astra and Boehringer-Ingelheim; India: Bombay Hospital Trust; Italy: Ministero dell’Università e della Ricerca Scientifica e Tecnologica, CNR, Regione Veneto grant RSF n. 381/05.93; New Zealand: Asthma Foundation of New Zealand, Lotteries Grant Board, Health Research Council of New Zealand; Norway: Norwegian Research Council project no. 101422/310; Portugal: Glaxo Farmacêutica Lda, Sandoz Portugesa; Spain: Ministero Sanidad y Consumo FIS grants #91/0016060/00E-05E and #93/0393, and grants from Hospital General de Albacete, Hospital General Juan Ramón Jiménenz, Consejeria de Sanidad Principado de Asturias; Sweden: The Swedish Medical Research Council, the Swedish Heart Lung Foundation, the Swedish Association against Asthma and Allergy; Switzerland: Swiss national Science Foundation grant 4026-28099; United Kingdom: National Asthma Campaign, British Lung Foundation, Department of Health, South Thames Regional Health Authority; USA: United States Department of Health, Education and Welfare Public Health Service Grant #2 S07 RR05521-28.

    Reprint requests: Deborah Jarvis, MRCP, MFPHM, Department of Public Health Medicine, 5th Floor, Capital House, 42 Weston St, London SE1 3QD.

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