{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T08:13:31Z","timestamp":1791274411257,"version":"4.1.0"},"reference-count":34,"publisher":"American Academy of Pediatrics (AAP)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2001,8,1]]},"abstract":"\n Background.<\/jats:title>\n Atopy is defined as the genetic propensity to develop immunoglobulin E antibodies in response to exposure to allergens and assessed by skin prick test responses to common allergens. Although it is generally agreed that atopy is an important risk factor for allergic diseases such as asthma, rhinitis, and eczema, the extent to which atopy accounts for these diseases is controversial.<\/jats:p>\n <\/jats:sec>\n \n Objective.<\/jats:title>\n We aim to describe the prevalence of sensitization to common allergens and investigate the degree of association of atopy (as defined by positive skin prick test to 1 or more common allergens) to asthma, rhinitis, and eczema in a birth cohort at the age of 4 years.<\/jats:p>\n <\/jats:sec>\n \n Methods.<\/jats:title>\n A birth cohort of 1456 children was recruited over a 14-month period (1989\u20131990). These children have been seen previously at 1 and 2 years of age. At 4 years, 1218 children were reviewed and an interview was administered or postal questionnaire was completed for the presence of allergic diseases (asthma, rhinitis, and eczema). Additionally, in 981 children, skin prick tests with a battery of 12 common allergens were performed. Allergens were house dust mite (Dermatophagoides pteronyssimus), grass pollen mix, cat, dog, Alternaria alternata, Cladosporium herbarum, cow's milk, hen's egg, soya, cod, wheat, and peanut. A mean wheal diameter of at least 3 mm greater than the negative control was taken as positive. This analysis is confined to the 981 (67% of the original population) who also had skin prick tests to the standard battery.<\/jats:p>\n \u03c72 tests were used to test the univariate association between each allergic disease and positive skin test. Multiple logistic regression analysis was performed to obtain the adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for the independent effect of sensitization to each allergen on allergic disease, adjusting for the effect of sensitization to other allergens. To ascertain how much of allergic disease is attributable to atopy, we estimated the population-attributable risk. This was calculated with the formula: P(R \u2212 1) where R is the OR for the allergic disease under consideration and P is the proportion of atopy in children with that disease.<\/jats:p>\n <\/jats:sec>\n \n Results.<\/jats:title>\n Children who were skin prick-tested at 4 years were similar in most characteristics to the rest of the population, except that they had a higher prevalence of allergic disease. Allergic disorders (asthma, rhinitis, and eczema) were present in 276 (28.1%) of 981. One hundred ninety-two (19.6%) children were atopic (positive reaction to 1 or more allergens). Sensitization to inhalant allergens was relatively common (19.2%) as compared with food allergens (3.5%). House dust mite (11.9%), grass pollen (7.8%), and cat (5.8%) were the most common positive reactions. A test to the 4 most common allergens (house dust mite, grass pollen, cat, and A alternata) could detect 94% of the atopic children. Sensitization to the 4 most common allergens was strongly associated with the presence of allergic disorders. There was a graded effect with the potent allergens, such as house dust mite, having the greatest impact. For example, 50% of children sensitized to house dust mite had asthma as opposed to 44% sensitized to cat, 42% sensitized to grass pollen, and 32% sensitized to A alternata. Overall, 68.4% of children sensitized to house dust mite had asthma, eczema, and\/or rhinitis. The respective figures for grass pollen, cat, andA alternata were 64.9%, 66.7%, and 57.4%. The proportion of children sensitized to cat was not higher in households with cat ownership (households with cats: 5.1% [19\/374]; households without cats: 6.2% [36\/580]; not significant [NS]). Similarly, no difference was seen in sensitization to dog in households with and without dogs (households with dogs: 1.8% [5\/282]; households without dogs: 2.8% [19\/673]; NS). Boys were atopic more often than girls at this age (male: 112 of 497 [22.5%] vs female: 80 of 484 [16.5%]; OR: 1.47, 95% CI: 1.07\u20132.02). Male preponderance was observed with most allergens, but this was statistically significant only for house dust mite (male: 75\/497 [15.1%] vs female: 42\/484 [8.7%]; OR: 1.87; CI: 1.25\u20132.79) and grass pollen (male: 51\/497 [10.3%] vs female: 26\/484 [5.4%]; OR: 2.01; CI: 1.23\u20133.29).<\/jats:p>\n An independent effect of allergen sensitization on asthma was observed only with house dust mite with an OR of 8.07 (CI: 4.60\u201314.14). The highest independent risk for rhinitis was sensitization to grass pollen (OR: 5.02; CI: 2.21\u201311.41), and for eczema, sensitization to peanut (OR: 4.65; CI: 1.02\u201321.34).<\/jats:p>\n The majority of children (98\/192) were sensitized to &gt;1 allergen. A graded effect was observed with the risk of allergic disease in the child increasing with the number of positive skin prick test reactions. This effect was consistent throughout the spectrum of allergic diseases (asthma, eczema, and rhinitis). Nearly 80% of the children with positive skin test reactions to 4 or more allergens had asthma, eczema, and\/or rhinitis compared with 20%, if they were nonatopic.<\/jats:p>\n The prevalence of atopy in asthmatic children was 44%. With an OR of 4.56, the population-attributable risk was calculated to be 35%. Fifty-five percent of children with rhinitis were atopic, and the OR of rhinitis was 5.85. Therefore, 46% of the cases of rhinitis could be attributable to atopy. The population-attributable risk of atopy for eczema was 32% (the prevalence of atopy in children with eczema: 43%; and the OR for the development of eczema: 3.86).<\/jats:p>\n <\/jats:sec>\n \n Conclusion.<\/jats:title>\n Atopy is closely associated with asthma, rhinitis, and eczema at 4 years of age, with a direct and linear relationship. However, the proportion of cases of allergic disease attributable to atopy is &lt;50%. We propose a model for the development of allergic disorders, where 30% to 40% of cases of allergic disease (asthma, eczema, and rhinitis) in early childhood are attributable to atopy and 60% to 70% of cases could be accounted for by organ-based and other factors.<\/jats:p>\n <\/jats:sec>","DOI":"10.1542\/peds.108.2.e33","type":"journal-article","created":{"date-parts":[[2004,8,13]],"date-time":"2004-08-13T23:55:51Z","timestamp":1092441351000},"page":"e33-e33","source":"Crossref","is-referenced-by-count":308,"title":["Sensitization to Common Allergens and Its Association With Allergic Disorders at Age 4 Years: A Whole Population Birth Cohort Study"],"prefix":"10.1542","volume":"108","author":[{"given":"Syed Hasan","family":"Arshad","sequence":"first","affiliation":[{"name":"1 From the David Hide Asthma and Allergy Research Centre, St. Mary's Hospital, Newport, Isle of Wight, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Syed Mohammed","family":"Tariq","sequence":"additional","affiliation":[{"name":"1 From the David Hide Asthma and Allergy Research Centre, St. Mary's Hospital, Newport, Isle of Wight, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharon","family":"Matthews","sequence":"additional","affiliation":[{"name":"1 From the David Hide Asthma and Allergy Research Centre, St. Mary's Hospital, Newport, Isle of Wight, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eluzai","family":"Hakim","sequence":"additional","affiliation":[{"name":"1 From the David Hide Asthma and Allergy Research Centre, St. Mary's Hospital, Newport, Isle of Wight, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2001,8,1]]},"reference":[{"key":"2021121003494797800_B1"},{"key":"2021121003494797800_B2"},{"key":"2021121003494797800_B3","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1136\/thx.54.3.268","article-title":"How much asthma is really attributable to atopy?","volume":"54","author":"Pearce","year":"1999","journal-title":"Thorax"},{"key":"2021121003494797800_B4","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1016\/S0091-6749(98)70164-2","article-title":"The prevalence of and risk factors for atopy in early childhood: a whole population birth cohort study.","volume":"101","author":"Tariq","year":"1998","journal-title":"J Allergy Clin Immunol"},{"key":"2021121003494797800_B5","doi-asserted-by":"crossref","first-page":"808","DOI":"10.1111\/j.1398-9995.1994.tb00779.x","article-title":"Prevalence of positive skin prick tests, allergic asthma, and rhinoconjunctivitis in teenagers in northern Sweden.","volume":"49","author":"Norman","year":"1994","journal-title":"Allergy"},{"key":"2021121003494797800_B6","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1542\/peds.92.4.535","article-title":"Risk factors for acute wheezing in infants and children: viruses, passive smoke and IgE antibodies to inhalant allergens.","volume":"92","author":"Duff","year":"1993","journal-title":"Pediatrics"},{"key":"2021121003494797800_B7","doi-asserted-by":"crossref","first-page":"1392","DOI":"10.1016\/S0140-6736(00)02842-7","article-title":"Early exposure to house-dust mite and cat allergen and development of childhood asthma: a cohort study.","volume":"356","author":"Lau","year":"2000","journal-title":"Lancet"},{"key":"2021121003494797800_B8","doi-asserted-by":"crossref","first-page":"752","DOI":"10.1016\/S0140-6736(00)04168-4","article-title":"Sensitisation, asthma, and a modified Th2 response in children exposed to cat allergen: a population-based cross-sectional study.","volume":"357","author":"Platts-Mills","year":"2001","journal-title":"Lancet"},{"key":"2021121003494797800_B9","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1111\/j.1365-2222.1989.tb02408.x","article-title":"The relative risks of sensitivity to grass pollen, house dust mite and cat dander in the development of childhood asthma.","volume":"19","author":"Sears","year":"1989","journal-title":"Clin Exp Allergy"},{"key":"2021121003494797800_B10","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1111\/j.1365-2222.1993.tb00279.x","article-title":"Atopy in childhood. I. Gender and allergen related risks for development of hay fever and asthma.","volume":"23","author":"Sears","year":"1993","journal-title":"Clin Exp Allergy"},{"key":"2021121003494797800_B11","doi-asserted-by":"crossref","first-page":"949","DOI":"10.1111\/j.1365-2222.1993.tb00280.x","article-title":"Atopy in childhood. II. Relationship to airway responsiveness, hay fever and asthma.","volume":"23","author":"Sears","year":"1993","journal-title":"Clin Exp Allergy"},{"key":"2021121003494797800_B12","doi-asserted-by":"crossref","first-page":"1042","DOI":"10.1046\/j.1365-2222.1999.00594.x","article-title":"Elevated cord IgE increases the risk of aero-allergen sensitisation without increasing respiratory allergic symptoms during early childhood.","volume":"29","author":"Tariq","year":"1999","journal-title":"Clin Exp Allergy"},{"key":"2021121003494797800_B13","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1016\/0091-6749(92)90077-F","article-title":"Effect of environmental factors on the development of allergic disorders in infancy.","volume":"90","author":"Arshad","year":"1992","journal-title":"J Allergy Clin Immunol"},{"key":"2021121003494797800_B14","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1111\/j.1365-2222.1993.tb03238.x","article-title":"The effect of genetic and environmental factors on the prevalence of allergic disorders at the age of two years.","volume":"23","author":"Arshad","year":"1993","journal-title":"Clin Exp Allergy"},{"key":"2021121003494797800_B15","doi-asserted-by":"crossref","first-page":"22","DOI":"10.5694\/j.1326-5377.1995.tb126083.x","article-title":"Prevalence and severity of childhood asthma and allergic sensitisation in seven climatic regions of New South Wales.","volume":"163","author":"Peat","year":"1995","journal-title":"Med J Aust"},{"key":"2021121003494797800_B16","doi-asserted-by":"crossref","first-page":"1173","DOI":"10.1016\/S0091-6749(99)70195-8","article-title":"Natural course of sensitization to food and inhalant allergens during the first 6 years of life.","volume":"103","author":"Kulig","year":"1999","journal-title":"J Allergy Clin Immunol"},{"key":"2021121003494797800_B17","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1016\/S0091-6749(97)70021-6","article-title":"Sensitization to hen's egg at twelve months is predictive of allergic sensitization to common indoor and outdoor allergens at the age of three years.","volume":"99","author":"Nickel","year":"1997","journal-title":"J Allergy Clin Immunol"},{"key":"2021121003494797800_B18","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1111\/j.1398-9995.1993.tb04758.x","article-title":"Skin tests for diagnosis of IgE-mediated allergy.","volume":"48","author":"Pastorello","year":"1993","journal-title":"Allergy"},{"key":"2021121003494797800_B19","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1016\/S0140-6736(97)01151-3","article-title":"Prevalence of wheeze and asthma and relation to atopy in urban and rural Ethiopia.","volume":"350","author":"Yemaneberhan","year":"1997","journal-title":"Lancet"},{"key":"2021121003494797800_B20","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1016\/S0091-6749(05)80015-6","article-title":"Early childhood risk factors for sensitization at school age.","volume":"90","author":"Keur","year":"1992","journal-title":"J Allergy Clin Immunol"},{"key":"2021121003494797800_B21","doi-asserted-by":"crossref","first-page":"594","DOI":"10.1016\/S0091-6749(97)70018-6","article-title":"Sensitization to inhaled allergens as a risk factor for asthma and allergic disease in Chinese population.","volume":"99","author":"Leung","year":"1997","journal-title":"J Allergy Clin Immunol"},{"key":"2021121003494797800_B22","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1034\/j.1399-3038.1999.00033.x","article-title":"Indoor environment, atopy and the risk of asthma in children in New Zealand.","volume":"10","author":"Wickens","year":"1999","journal-title":"Pediatr Allergy Immunol"},{"key":"2021121003494797800_B23","first-page":"35","article-title":"Comparison of skin testing and three in vitro assays for specific IgE in the clinical evaluation of immediate hypersensitivity.","volume":"68","author":"Williams","year":"1992","journal-title":"Ann Allergy"},{"key":"2021121003494797800_B24","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/0091-6749(88)90221-7","article-title":"Allergy in asthma. I. The dose relationship of allergy to severity of childhood asthma.","volume":"81","author":"Zimmerman","year":"1988","journal-title":"J Allergy Clin Immunol"},{"key":"2021121003494797800_B25","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/S0091-6749(05)80129-0","article-title":"The relationship of eosinophilia and positive skin test reactivity to respiratory symptom prevalence in a community-based population study.","volume":"86","author":"Mensinga","year":"1990","journal-title":"J Allergy Clin Immunol"},{"key":"2021121003494797800_B26","doi-asserted-by":"crossref","first-page":"1067","DOI":"10.1056\/NEJM199110103251504","article-title":"Relation between airway responsiveness and serum IgE in children with asthma and in apparently normal children.","volume":"325","author":"Sears","year":"1991","journal-title":"N Engl J Med"},{"key":"2021121003494797800_B27","doi-asserted-by":"crossref","first-page":"1493","DOI":"10.1016\/0140-6736(92)91260-F","article-title":"Effect of food and house-dust mite allergen avoidance on development of allergic disorders in infancy.","volume":"339","author":"Arshad","year":"1992","journal-title":"Lancet"},{"key":"2021121003494797800_B28","doi-asserted-by":"crossref","first-page":"794","DOI":"10.1111\/j.1365-2222.1996.tb00610.x","article-title":"Sensitisation to Alternaria and Cladosporium at age 4 years.","volume":"26","author":"Tariq","year":"1996","journal-title":"Clin Exp Allergy"},{"key":"2021121003494797800_B29","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1056\/NEJM198902023200502","article-title":"Association of asthma with serum IgE levels and skin-test reactivity to allergens.","volume":"320","author":"Burrows","year":"1989","journal-title":"N Engl J Med"},{"key":"2021121003494797800_B30","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1016\/S0091-6749(95)70175-3","article-title":"Relationship between serum IgE and airway responsiveness in adults with asthma.","volume":"95","author":"Sunyer","year":"1995","journal-title":"J Allergy Clin Immunol"},{"key":"2021121003494797800_B31","doi-asserted-by":"crossref","first-page":"608","DOI":"10.1111\/j.1398-9995.1998.tb03937.x","article-title":"Current allergic asthma and rhinitis: diagnostic efficiency of three commonly used atopic markers (IgE, skin prick tests, and Phadiatop). Results from 8329 randomized adults from the SAPALDIA Study. Swiss Study on Air Pollution and Lung Diseases in Adults.","volume":"53","author":"Tschopp","year":"1998","journal-title":"Allergy"},{"key":"2021121003494797800_B32","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1046\/j.1365-2222.2000.00790.x","article-title":"Immunoglobulin E and allergic disease in Africa.","volume":"30","author":"Scrivener","year":"2000","journal-title":"Clin Exp Allergy"},{"key":"2021121003494797800_B33","doi-asserted-by":"crossref","first-page":"1280","DOI":"10.1164\/ajrccm.153.4.8616554","article-title":"Allelic association of gene markers on chromosomes 5q and 11q with atopy and bronchial hyperresponsiveness.","volume":"153","author":"Doull","year":"1996","journal-title":"Am J Respir Crit Care Med"},{"key":"2021121003494797800_B34","doi-asserted-by":"crossref","first-page":"1004","DOI":"10.1136\/bmj.314.7086.1003","article-title":"Atopic dermatitis and birth factors: historical follow-up by record linkage.","volume":"314","author":"Olesen","year":"1997","journal-title":"BMJ"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/108\/2\/e33\/1164739\/e33.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/108\/2\/e33\/1164739\/e33.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,10]],"date-time":"2021-12-10T11:06:28Z","timestamp":1639134388000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/108\/2\/e33\/63624\/Sensitization-to-Common-Allergens-and-Its"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2001,8,1]]},"references-count":34,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2001,8,1]]},"published-print":{"date-parts":[[2001,8,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.108.2.e33","relation":{},"ISSN":["1098-4275","0031-4005"],"issn-type":[{"value":"1098-4275","type":"electronic"},{"value":"0031-4005","type":"print"}],"subject":[],"published":{"date-parts":[[2001,8,1]]}}}