Atopic diseases and type I sensitization from adolescence to adulthood in an unselected population (TOACS) with focus on predictors for allergic rhinitis

Abstract

Background: While much is known on childhood atopic diseases, knowledge about persistence of atopic diseases from childhood to adulthood is limited. We therefore aimed to study the clinical course of atopic diseases and type I sensitization prospectively in an unselected cohort of adolescents followed into adulthood.Methods: A cohort of unselected 8th-grade school children (mean age 14 years) established in 1995 and followed up in 2010 were evaluated with questionnaire, clinical examination, skin prick tests and measurements of specific IgE. Results:The lifetime prevalence of atopic diseases was high and increased significantly from adolescence (31%) to adulthood (57%); particularly allergic rhinitis increased with an incidence rate of 17.5/1000 person-years. Childhood predictors for adult allergic rhinitis were atopic dermatitis, asthma and asymptomatic sensitization to pollen and house dust mite. Among those with asymptomatic sensitization in adolescence, 53%-78% developed allergic rhinitis in adulthood. Furthermore, type I sensitization increased significantly from adolescence to adulthood mostly due to increased sensitization to pollen. Type I sensitization was found mainly in those with allergic rhinitis. A high number of adults had oral allergy symptoms due to the high number of birch pollen allergic individuals.Conclusion: Persistence of atopic diseases in adulthood is common, and a high proportion of the adult population is sensitized giving a high prevalence of allergic rhinitis. Many with asymptomatic sensitization in adolescence will develop allergic rhinitis in adult life. The focus should be on prevention of atopic diseases and sensitization already in childhood. K E Y W O R D S allergic rhinitis, asthma, atopic dermatitis, cohort study, sensitization 1 | INTRODUCTION Atopic diseases are among the most common chronic diseases in children and adolescents, and an increasing prevalence has been observed over several decades. 1,2 Due to the cohort effect, this increase should now appear in adulthood. An increase in allergic rhinitis and asthma among young adults has been shown in different cross-sectional studies over time. 3-5 A few studies have also reported an increased prevalence of sensitization over time when comparing different cohorts. 3,6-8 A recent cross-sectional study in

Safety and reproducibility of nasal allergen challenge

“…The paucity of data about NAC safety and reproducibility might also account for this low implementation. Nevertheless, the description of allergic phenotypes of rhinitis without systemic atopy (LAR) and the progressively increasing prevalence of AR patients with multiple positive SPTs indicate the need to include NAC in the diagnostic work‐up of rhinitis patients . In this regard, our group described a shortened protocol (NAC‐M) to test multiple allergens in a single session, and demonstrated its good diagnostic performance in LAR patients …”

“…Nevertheless, a proportion of healthy subjects also display positivity for either test . Additionally, in many AR patients it is difficult to establish the clinical relevance of IgE‐sensitizations due to a lack of consistency with the symptom pattern, or due to multiple positive SPTs . In these situations, it is challenging to design the composition of allergen immunotherapy (AIT) .…”

Advances and novel developments in allergic rhinitis

“…46 Indeed, many adolescent individuals are asymptomatic and develop AR in adulthood. 47 Diet is also related to AR, and studies have indicated that dietary changes can lead to increased incidence of allergic diseases and asthma. 48 Similarly, changes in environmental factors, such as temperature and climate change, can lead to changes in allergens such as pollen, which can induce or aggravate the symptoms of AR.…”

Mechanisms of Allergen Immunotherapy in Allergic Rhinitis

“…Allergic rhinitis (AR) is a chronic inflammatory disease of the lining of nasal mucosa induced by type I hypersensitivity response upon exposure to common inhaled allergens in sensitized individuals [1]. AR affects up to 40% of worldwide population with an increasing prevalence over the past 20 years [2][3][4][5][6][7][8]. It is associated with significantly lower quality of life due to impaired sleep, learning difficulties, deterioration of at-work performance and social functioning, which highlights AR as a substantial economic burden and a serious global health problem [8][9][10][11].…”