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ICD Code: 493. Asthma



ICD Code: 493. Article Review
Title: Arbes SJ et al; "Asthma Cases Attributable to Atopy: Results From the Third National Health and Nutrition Examination Survey." Journal of Allergy and Clinical Immunology; V.120; No.5; 11/07; p1139
      STUDY DESIGN: Atopy, defined as “the genetic propensity to develop immunoglobulin E (IgE) antibodies in response to exposure to allergen,” is an established risk factor for asthma. In the Third National Health and Nutrition Examination Survey (NHANES III), conducted from 1988 to 1994, prick-puncture allergy skin tests to 10 allergens were administered to subjects aged 6 to 59 years. This nationally representative survey provided the opportunity to estimate the percentage of asthma cases in the U.S. population attributable to skin test positivity, an indirect measurement of atopy (serum IgE was not measured in NHANES III). Data were obtained from NHANES III, a complex survey designed to represent the civilian noninstitutionalized population of the U.S. Questionnaires were adminstered to and medical examinations and laboratory tests conducted on 31,311 individuals age 2 months to 90 years. A subsample of 12,106 subjects consisting of all subjects age 6 to 19 years and a random half-sample of subjects age 20 to 59 years were selected for allergy skin testing. The number of subjects with a valid test and results for all 10 allergens was 10,508. The disease outcome for this analysis was doctor-diagnosed current asthma assessed by questionnaire.
      ASTHMA AND ATOPY: The prevalence of asthma in the U.S. population age 6 to 59 years was 5.2%. The prevalence of atopy in the U.S. population age 6 to 59 years, defined as at least one positive skin test response, was 54.2%. Atopy differed significantly by age, sex, race-ethnicity, census region, and body mass index (BMI).
      Among the U.S. population age 6 to 59 years, 56.3% of the asthma cases were attributable to atopy. For selected characteristics, the percentage with asthma was reported as follows, with the percentage of cases attributable to atopy in parentheses: overall, 5.2% (56.3%); ages 6-19 years, 6.4% (55.2%); ages 20-39 years, 4.6% (60.6%); ages 40-59 years, 4.9% (52.1%); males, 4.8% (74.1%); females, 5.5% (43.2%); non-Hispanic whites, 5.3% (54.8%); non-Hispanic blacks, 6.0% (49.3%); Mexican Americans, 3.3% (55.8%); BMI 11.2-18.4 (underweight), 5.0% (61.0%); BMI 18.5-24.9 (normal weight), 5.1% (68.6%); BMI 25.0-29.9 (overweight), 3.7% (45.4%); BMI 30.0-79.6 (obese), 7.5% (37.7%).
      DISCUSSION: Of the 10 allergens included in the skin test panel, only cat, Alternaria, and white oak showed significant, positive associations with asthma after adjustment by the subject characteristics and all other allergens.
      If atopy could be prevented, reversed, or blocked, then a large percentage of current asthma cases could be prevented. Atopy, by definition, is the result of gene-environment interactions; therefore, at least in theory, intervention at either the genetic or environmental level could prevent atopy.
     

Search Criteria: Text - Journal of Allergy and Clinical Immunology; V.120; No.5; 11/07; p1139