Fractional exhaled nitric oxide measurements are most closely associated with allergic sensitization in school-age children

• Published in: Journal of allergy and clinical immunology 2009-11, Vol.124 (5), p.949-953
• Main Authors: Jackson, Daniel J., MD, Virnig, Christine M., MD, Gangnon, Ronald E., PhD, Evans, Michael D., MS, Roberg, Kathy A., BSN, MS, Anderson, Elizabeth L., BSN, MA, Burton, Ryan M., MS, Salazar, Lisa P., BA, DaSilva, Douglas F., BS, Shanovich, Kathleen M., BA, Tisler, Christopher J., MT, Gern, James E., MD, Lemanske, Robert F., MD
• Format: Article
• Language: English
• Subjects: Age; Allergic diseases; allergic sensitization; Allergies; Allergy and Immunology; Asthma; Asthma - diagnosis; Asthma - immunology; atopic dermatitis; atopy; Biological and medical sciences; Biomarkers; Child; Child, Preschool; children; Chronic obstructive pulmonary disease, asthma; Dermatitis, Atopic - diagnosis; Dermatitis, Atopic - immunology; Exhalation - immunology; Female; Follow-Up Studies; Fractional exhaled nitric oxide (FeNO); Fundamental and applied biological sciences. Psychology; Fundamental immunology; Humans; Hypersensitivity, Immediate - diagnosis; Hypersensitivity, Immediate - immunology; Immunoglobulin E - blood; Immunopathology; Infant; Infant, Newborn; Linear Models; lung function; Male; Medical sciences; Nitric Oxide - analysis; Pneumology; Prospective Studies; Rhinitis - diagnosis; Rhinitis - immunology; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; seasonality; Skin allergic diseases. Stinging insect allergies; Spirometry
• ISSN: 0091-6749; 1097-6825
• DOI: 10.1016/j.jaci.2009.07.024

Background Factors affecting fractional exhaled nitric oxide (FeNO) in early childhood are incompletely understood. Objective To examine the relationships between FeNO and allergic sensitization, total IgE, atopic dermatitis, rhinitis, asthma, and lung function (spirometry) in children. Methods Children at high risk of asthma and other allergic diseases because of parental history were enrolled at birth and followed prospectively. FeNO was measured by an online technique at ages 6 and 8 years. Relationships among FeNO, various atopic characteristics, and asthma were evaluated. Results Reproducible FeNO measurements were obtained in 64% (135/210) of 6-year-old and 93% (180/194) of 8-year-old children. There was seasonal variability in FeNO. Children with aeroallergen sensitization at ages 6 and 8 years had increased levels of FeNO compared with those not sensitized (geometric mean; 6 years, 10.9 vs 6.7 parts per billion [ppb], P < .0001; 8 years, 14.6 vs 7.1 ppb, P < .0001). FeNO was higher in children with asthma than in those without asthma at 8 years but not 6 years of age (6 years, 9.2 vs 8.3 ppb, P = .48; 8 years, 11.5 vs 9.2 ppb, P = .03). At 8 years of age, this difference was no longer significant in a multivariate model that included aeroallergen sensitization ( P = .33). There were no correlations between FeNO and spirometric indices at 6 or 8 years of age. Conclusion These findings underscore the importance of evaluating allergen sensitization status when FeNO is used as a potential biomarker in the diagnosis and/or monitoring of atopic diseases, particularly asthma.