These results give new insights into the contrasts between clinical features of allergic and nonallergic asthma. The terminology of extrinsic asthma was first introduced by Rackeman in 1947 (1) and referred to the triggering role of allergens in asthma. By symmetry, he described intrinsic asthma as a disease characterized by later onset in life, female predominance, higher degree of severity, and more frequent association to nasosinusal polyposis. As these asthmatics were not improved by conventional treatment, this author considered their disease as caused by a nonallergic, unknown phenomenon. It is now widely admitted that nonallergic asthma can be objectively distinguished from allergic asthma based on negative skin tests to usual aeroallergens. On the other hand, positive skin test shows a tendency to produce IgE antibodies in response to low doses of allergens. "Atopy" and "atopic" are the terms used to describe this clinical trait and predisposition (2). Allergic clinical manifestations of atopy are of various types, for example rhinitis and asthma. Nowadays the terminology of "extrinsic" and "intrinsic" asthma should no longer be used, and should be replaced by the terminology of "allergic" or "nonallergic" asthma (2).
To further investigate the possibility of a cause and effect relationship between exposure to house-dust mite (HDM) allergens and respiratory disease associated with dust mite sensitivity, we compared schoolchildren living in the Alps, where exposure to HDM is low, with those living at sea level, where it is high. The study included 933 schoolchildren from the fourth and fifth grades. The protocol included the standardized 1978 American Thoracic Society (ATS) questionnaire for children, skin testing using common aero-allergens and controls, and antigenic measurements of dust samples from mattresses (Group I antigen). The prevalence of asthma with positive skin test to HDM and the overall prevalence of positive skin test to HDM were significantly lower in mountain schoolchildren. The mean geometric HDM antigenic level in mattresses was much lower in the Alps (0.36 micrograms/g dust) than at sea level (15.8 micrograms/g dust). In contrast, the prevalence of hay fever and positive skin test to grass pollens as well as the overall prevalence of positive skin tests to grass pollens were significantly higher in the Alps. These data illustrate a striking relationship between exposure to environmental allergens and atopic sensitization.
Oxidative damage is increasingly recognized as playing an important role in the pathogenesis of several diseases such as cancer and cardiovascular diseases. Using a biologic test based on whole blood resistance to free-radical aggression, we sought to evaluate lifestyle factors that may contribute to the normal variability of the overall antioxidant status. We assessed this global antiradical defense capacity in 88 men and 96 women in relation to information on lifestyle obtained by questionnaire. In our relatively young, healthy population, we found a weak negative relation between male sex or aging and the resistance to oxidant stress. Among the factors studied, nonsmoking, vitamin and/or mineral supplementation, and regular physical activity were closely associated with an increased overall antioxidant capacity. Conversely, the antioxidant potential was negatively related to tobacco smoking; psychologic stress; alcohol consumption; moderate vegetable, low fruit, and low fish consumption; and, to a lesser extent, high natural ultraviolet light exposure. Thus, we were able to determine "unhealthy" and "healthy" lifestyle patterns that truly contributed to the variation of individual antioxidant capacity. We conclude that lifestyle determinants of cancer and cardiovascular risks were associated with a decreased overall antioxidant status as dynamically measured by means of a biologic test. Thus, the evaluation of the total human resistance against free-radical aggression, taking into account nutritional habits, lifestyle, and environmental factors, may be useful in preventive medicine as a precocious diagnosis to identify healthy subjects who are at risk for free-radical-mediated diseases.
To elucidate whether systemic reactions (SR) to drugs should be included in the atopic status in epidemiological studies, we compared the distribution of atopy in subjects with or without a history of SR to drugs. The studied population comprised 2067 adults, 20 to 60 years old, visiting a health care center for a check-up examination. The protocol included a questionnaire related to history of SR to drugs and a Phadiatop test which evaluates on a blood sample the presence of specific IgE against common aeroallergens. Overall, 14.7% of the study group, including 66% women, reported reliable histories of SR to drugs. The cumulative prevalence of asthma, hay fever and childhood dermatitis was higher in the SR group. By contrast, the percentage of positive Phadiatop tests was similar in subjects with or without a history of SR. Thus atopy, defined by an objective criterion, i.e. the presence of specific IgE against common aero-allergens, is not associated with the occurrence of SR to drugs. Such a history should not be included as part of the atopic status.
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