Impact of atopy on asthma and allergic rhinitis in the cohort for reality and evolution of adult asthma in Korea

Abstract

Purpose: Atopy is an important cause of asthma. Few data on the prevalence of atopy or comparisons with clinical characteristics of asthma in Korean patients have been published. We evaluated the effects of atopy on clinical profiles and airway inflammation in Korean asthmatics.

Methods: We retrospectively enrolled 1,492 asthmatics from the Cohort for Reality and Evolution of Adult Asthma in Korea (COREA) cohort who had undergone skin prick tests for aeroallergens. The patients' clinical characteristics, lung function, PC20, and sputum and blood inflammatory cell counts were compared based on the presence or absence of atopy. Atopy was defined as one or more positive reactions (A/H ratio >1) on a skin prick test.

Results: Among 11 aeroallergens, house dust mites (Dermatophagoides farinae and Dermatophagoides pteronyssinus) were the most prevalent cause of a positive skin prick test. As compared with non-atopic asthmatics, atopic asthmatics showed early onset of the disease. Atopic patients with asthma had a higher FEV1, FVC, and FEV1/FVC as compared with non-atopic patients with asthma. In addition, asthmatics without atopy had more uncontrolled asthma (P=0.001) and severe rhinitis (P<0.05) as compared with atopic asthmatics. Smoking, as measured in pack years, was higher in the non-atopic asthmatics than in the atopic asthmatics. The erythrocyte sedimentation rate was higher in non-atopic asthmatics than in the atopic asthmatics and patients with non-atopic asthma had a higher sputum neutrophil count than did those with atopic asthma.

Conclusions: Our data indicate that atopic asthmatics had an early onset of disease and high IgE levels, while the non-atopic asthmatics had decreased lung function and a high sputum neutrophil count, suggesting that a different approach is needed to treat atopic asthma.

Keywords: Asthma; allergens; allergic rhinitis.

Fig. 1

Allergen prevalence according to an allergy skin test.

Fig. 2

Differences in erythrocyte sedimentation rate (ESR) between atopic and non-atopic asthmatics.

Fig. 3

Relationship between asthma severity and atopy status. 1=mild intermittent, 2=mild persistent, 3=moderate persistent, 4=severe persistent.

Fig. 4

Relationship between rhinosinusitis severity and atopy status. Symptoms of rhinosinusitis: 1=absence, 2=1x/week, 3=2x/week, 4=3-4x/week, 5=>5x/week.