A European-Japanese study on peach allergy: IgE to Pru p 7 associates with severity.

BACKGROUND: Pru p 3 and Pru p 7 have been implicated as risk factors for severe peach allergy. This study aimed to establish sensitization patterns to five peach components across Europe and in Japan, to explore their relation to pollen and foods and to predict symptom severity. METHODS: In twelve European (EuroPrevall project) and one Japanese outpatient clinic, a standardized clinical evaluation was conducted in 1231 patients who reported symptoms to peach and/or were sensitized to peach. Specific IgE against Pru p 1, 2, 3, 4 and 7 and against Cup s 7 was measured in 474 of them. Univariable and multivariable Lasso regression was applied to identify combinations of parameters predicting severity. RESULTS: Sensitization to Pru p 3 dominated in Southern Europe but was also quite common in Northern and Central Europe. Sensitization to Pru p 7 was low and variable in the European centers but very dominant in Japan. Severity could be predicted by a model combining age of onset of peach allergy, probable mugwort, Parietaria pollen and latex allergy, and sensitization to Japanese cedar pollen, Pru p 4 and Pru p 7 which resulted in an AUC of 0.73 (95% CI 0.73-0.74). Pru p 3 tended to be a risk factor in South Europe only. CONCLUSIONS: Pru p 7 was confirmed as a significant risk factor for severe peach allergy in Europe and Japan. Combining outcomes from clinical and demographic background with serology resulted in a model that could better predict severity than CRD alone.

Component-resolved diagnosis and beyond: Multivariable regression models to predict severity of hazelnut allergy.

BACKGROUND: Component-resolved diagnosis (CRD) has revealed significant associations between IgE against individual allergens and severity of hazelnut allergy. Less attention has been given to combining them with clinical factors in predicting severity. AIM: To analyze associations between severity and sensitization patterns, patient characteristics and clinical history, and to develop models to improve predictive accuracy. METHODS: Patients reporting hazelnut allergy (n = 423) from 12 European cities were tested for IgE against individual hazelnut allergens. Symptoms (reported and during Double-blind placebo-controlled food challenge [DBPCFC]) were categorized in mild, moderate, and severe. Multiple regression models to predict severity were generated from clinical factors and sensitization patterns (CRD- and extract-based). Odds ratios (ORs) and areas under receiver-operating characteristic (ROC) curves (AUCs) were used to evaluate their predictive value. RESULTS: Cor a 9 and 14 were positively (OR 10.5 and 10.1, respectively), and Cor a 1 negatively (OR 0.14) associated with severe symptoms during DBPCFC, with AUCs of 0.70-073. Combining Cor a 1 and 9 improved this to 0.76. A model using a combination of atopic dermatitis (risk), pollen allergy (protection), IgE against Cor a 14 (risk) and walnut (risk) increased the AUC to 0.91. At 92% sensitivity, the specificity was 76.3%, and the positive and negative predictive values 62.2% and 95.7%, respectively. For reported symptoms, associations and generated models proved to be almost identical but weaker. CONCLUSION: A model combining CRD with clinical background and extract-based serology is superior to CRD alone in assessing the risk of severe reactions to hazelnut, particular in ruling out severe reactions.

The EuroPrevall outpatient clinic study on food allergy: background and methodology.

BACKGROUND: The EuroPrevall project aimed to develop effective management strategies in food allergy through a suite of interconnected studies and a multidisciplinary integrated approach. To address some of the gaps in food allergy diagnosis, allergen risk management and socio-economic impact and to complement the EuroPrevall population-based surveys, a cross-sectional study in 12 outpatient clinics across Europe was conducted. We describe the study protocol. METHODS: Patients referred for immediate food adverse reactions underwent a consistent and standardized allergy work-up that comprised collection of medical history; assessment of sensitization to 24 foods, 14 inhalant allergens and 55 allergenic molecules; and confirmation of clinical reactivity and food thresholds by standardized double-blind placebo-controlled food challenges (DBPCFCs) to milk, egg, fish, shrimp, peanut, hazelnut, celeriac, apple and peach. RESULTS: A standardized methodology for a comprehensive evaluation of food allergy was developed and implemented in 12 outpatient clinics across Europe. A total of 2121 patients (22.6% <14 years) reporting 8257 reactions to foods were studied, and 516 DBPCFCs were performed. CONCLUSIONS: This is the largest multicentre European case series in food allergy, in which subjects underwent a comprehensive, uniform and standardized evaluation including DBPCFC, by a methodology which is made available for further studies in food allergy. The analysis of this population will provide information on the different phenotypes of food allergy across Europe, will allow to validate novel in vitro diagnostic tests, to establish threshold values for major allergenic foods and to analyse the socio-economic impact of food allergy.

Pleistocene genetic legacy suggests incipient species of Sebastes mentella in the Irminger Sea.

To investigate a possible speciation event within the redfish (Sebastes mentella) complex in the Irminger Sea, we examined genetics, traditional morphology, geometric morphometrics and meristics of individuals sampled throughout the Sea. Tissue samples from 1901 fish were collected in 1995 and 1996 and from 1999 to 2002, and the fish were genotyped at nine microsatellite loci, two of which were developed for this study. Individual-based genetic analyses showed that two different gene pools exist in the Irminger Sea. Although these groups overlap extensively geographically, they segregate according to depth: those above and below 550 m. This signal of genotype distinction with depth was evident in both the earlier and later sampling. Historical imprints in the genetic data indicated that the redfish in the Irminger Sea are likely to represent a case of an incipient speciation event that began in allopatry during the Pleistocene glaciations followed by secondary contact. Although hybridization was observed between groups, an analysis of traditional and geometric morphometrics and of meristic variables suggested that restricted gene flow between the currently parapatric deep- and shallow-mesopelagic incipient species may be maintained by ecological isolation mechanisms.

The socio-economic burden of asthma is substantial in Europe.

BACKGROUND: Few data are available on the asthma burden in the general population. We evaluated the level and the factors associated with the asthma burden in Europe. METHODS: In 1999-2002, 1152 adult asthmatics were identified in the European Community Respiratory Health Survey (ECRHS)-II and the socio-economic burden (reduced activity days and hospital services utilization in the past 12 months) was assessed. RESULTS: The asthmatics with a light burden (only a few reduced activity days) were 13.2% (95% CI: 11.4-15.3%), whereas those with a heavy burden (many reduced activity days and/or hospital services utilization) were 14.0% (95% CI: 12.1-16.1%). The burden was strongly associated with disease severity and a lower quality of life. Obese asthmatics had a significantly increased risk of a light [relative risk ratio (RRR) = 2.17; 95% CI: 1.18-4.00] or a heavy burden (RRR = 2.77; 95% CI: 1.52-5.05) compared with normal/underweight subjects. The asthmatics with frequent respiratory symptoms showed a threefold (RRR = 2.74; 95% CI: 1.63-4.61) and sixfold (RRR = 5.76; 95% CI: 3.25-10.20) increased risk of a light or a heavy burden compared with asymptomatic asthmatics, respectively. Moreover, the lower the forced expiratory volume in 1 s % predicted, the higher the risk of a heavy burden. The coexistence with chronic cough/phlegm only increased the risk of a heavy burden (RRR = 1.88; 95% CI: 1.16-3.06). An interaction was found between gender and IgE sensitization, with nonatopic asthmatic females showing the highest risk of a heavy burden (21.6%; 95% CI: 16.9-27.1%). CONCLUSIONS: The asthma burden is substantial in Europe. A heavy burden is more common in asthmatics with obesity, frequent respiratory symptoms, low lung function, chronic cough/phlegm and in nonatopic females.

Comparison of the oral and intravenous routes for treating asthma with methylprednisolone and theophylline.

To compare intravenous and orally administered corticosteroids and theophylline in treating acute episodes of airways obstruction, patients with recent worsening of obstructive symptoms were randomly divided into two groups. Group A received methylprednisolone, 80 mg/24 h, and aminophylline by continuous infusion. Group B received a comparable dose of a sustained-release theophylline and methylprednisolone, 80 mg in two equally divided doses, by mouth. Assessment of response was based on daily spirometric tests and evaluation of dyspnea and wheezing. Arterial blood gas and serum theophylline levels were also measured. The groups were comparable with respect to age, sex distribution, smoking history, and spirometric evidence of obstruction. Initial spirometric test results showed moderate obstruction, equal in the two groups. Obstruction improved markedly by both spirometric and clinical criteria in the four-day study period. The improvement in FEV1 and dyspnea index was slightly greater for group B, but the differences were not significant. We conclude that oral administration of steroids and theophylline is as effective as intravenous use in treating hospitalized patients with moderate exacerbations of airways obstruction.

Eczema, atopy and allergen exposure in adults: a population-based study.

BACKGROUND: There are few published studies on geographical variation in prevalence of eczema in adults or its association with recognised risk factors for allergic disease. OBJECTIVE: To describe the geographical variation in prevalence of eczema in adults, assess the associations with sociodemographic risk factors, serum-specific IgE and IgG, and exposure to allergen. METHODS: A community-based sample of 8206 adults aged 27-56 years, in 25 European centres and Portland, USA, provided questionnaire information on symptoms of eczema. Serum-specific IgE to house dust mite (HDM), cat, grass and Cladosporium, and IgG and IgG4 to HDM and cat were measured. Mattress levels of mite and cat allergen were assessed. RESULTS: Overall prevalence of eczema was 7.1% (range between countries of 2.2-17.6%). Eczema was associated with female gender [odds ratio (OR) 1.25; 95% confidence interval (CI) (1.01-1.55)], family history of atopic disease (OR 1.43; 95% CI 1.18-1.74), IgE sensitization to at least one allergen (OR 1.50; 95% CI 1.19-1.90), particularly Cladosporium (OR 3.65; 95% CI 1.81-7.37), and total IgE. Eczema was negatively associated with age and no clear associations were observed with sibship size, mattress mite and cat allergen levels or with cat and HDM-specific IgG or IgG4. CONCLUSIONS: There is geographical variation in the prevalence of eczema in adults both within and between countries. Although the disease is associated with IgE sensitization, in this study it was not related to mattress mite or cat allergen levels.

Hormone replacement therapy, body mass index and asthma in perimenopausal women: a cross sectional survey.

BACKGROUND: Hormone replacement therapy (HRT) and obesity both appear to increase the risk of asthma. A study was undertaken to investigate the association of HRT with asthma and hay fever in a population of perimenopausal women, focusing on a possible interaction with body mass index (BMI). METHODS: A postal questionnaire was sent to population based samples in Denmark, Estonia, Iceland, Norway, and Sweden in 1999-2001, and 8588 women aged 25-54 years responded (77%). Pregnant women, women using oral contraceptives, and women <46 years were excluded. Analyses included 2206 women aged 46-54 years of which 884 were menopausal and 540 used HRT. Stratified analyses by BMI in tertiles were performed. RESULTS: HRT was associated with an increased risk for asthma (OR 1.57 (95% CI 1.07 to 2.30)), wheeze (OR 1.60 (95% CI 1.22 to 2.10)), and hay fever (OR 1.48 (95% CI 1.15 to 1.90)). The associations with asthma and wheeze were significantly stronger among women with BMI in the lower tertile (asthma OR 2.41 (95% CI 1.21 to 4.77); wheeze OR 2.04 (95% CI 1.23 to 3.36)) than in heavier women (asthma: p(interaction) = 0.030; wheeze: p(interaction) = 0.042). Increasing BMI was associated with more asthma (OR 1.08 (95% CI 1.05 to 1.12) per kg/m2). This effect was only found in women not taking HRT (OR 1.10 (95% CI 1.05 to 1.14) per kg/m2); no such association was detected in HRT users (OR 1.00 (95% CI 0.92 to 1.08) per kg/m2) (p(interaction) = 0.046). Menopause was not significantly associated with asthma, wheeze, or hay fever. CONCLUSIONS: In perimenopausal women there is an interaction between HRT and BMI in the effects on asthma. Lean women who were HRT users had as high a risk for asthma as overweight women not taking HRT. It is suggested that HRT and overweight increase the risk of asthma through partly common pathways.

Prevalence and incidence of respiratory symptoms in relation to indoor dampness: the RHINE study.

BACKGROUND: An association between indoor dampness and respiratory symptoms has been reported, but dampness as a risk factor for the onset or remission of respiratory symptoms and asthma is not well documented. METHOD: This follow up study included 16 190 subjects from Iceland, Norway, Sweden, Denmark, and Estonia who had participated in the European Community Respiratory Health Survey (ECRHS I). Eight years later the same subjects answered a postal questionnaire that included questions on respiratory symptoms and indicators of indoor dampness. RESULTS: Subjects living in damp housing (18%) had a significantly (p<0.001) higher prevalence of wheeze (19.1% v 26.0%), nocturnal breathlessness (4.4% v 8.4%), nocturnal cough (27.2% v 36.5%), productive cough (16.6% v 22.3%) and asthma (6.0% v 7.7%). These associations remained significant after adjusting for possible confounders. Indoor dampness was a risk factor for onset of respiratory symptoms but not for asthma onset in the longitudinal analysis (OR 1.13, 95% CI 0.92 to 1.40). Remission of nocturnal symptoms was less common in damp homes (OR 0.84, 95% CI 0.73 to 0.97). CONCLUSIONS: Subjects living in damp housing had a higher prevalence of respiratory symptoms and asthma. Onset of respiratory symptoms was more common and remission of nocturnal respiratory symptoms was less common in subjects living in damp housing.

C reactive protein levels are increased in non-allergic but not allergic asthma: a multicentre epidemiological study.

BACKGROUND: High sensitivity C reactive protein (HsCRP) is an inflammatory marker known to be related to smoking, obesity, and cardiovascular disease. A study was undertaken to determine whether HsCRP is related to respiratory symptoms, asthma, atopy, and bronchial hyperresponsiveness in population samples from three countries. METHODS: HsCRP was measured in 1289 subjects from three centres in ECRHS II: Reykjavik, Uppsala and Tartu. The HsCRP values ranged from <0.01 mg/l to 70.0 mg/l and were divided into four equal groups (< or = 0.45, 0.46-0.96, 0.97-2.21, and >2.21 mg/l). RESULTS: HsCRP increased with increasing body mass index (r = 0.41; p<0.0001) and was higher in smokers than in never smokers (p = 0.02). A significant relationship was found between increased HsCRP levels and respiratory symptoms such as wheeze, attacks of breathlessness after effort, and nocturnal cough (p<0.0001). The crude odds ratio (95% CI) for the probability of non-allergic asthma was 3.57 (1.83 to 6.96) for subjects in the 4th quartile compared with the 1st quartile of HsCRP. This association remained significant after adjusting for study centre, age, sex, body weight, and smoking history (OR 2.19 (95% CI 1.04 to 4.63)). No significant relationship was observed between HsCRP and allergic asthma or bronchial responsiveness. CONCLUSIONS: Raised levels of HsCRP are significantly associated with respiratory symptoms and non-allergic asthma but not with allergic asthma.

Changes in the use of anti-asthmatic medication in an international cohort.

The aim of this study was to describe changes in pharmacotherapy for asthma since the early 1990s in an international cohort of young and middle-aged adults. A total of 28 centres from 14 countries participated in a longitudinal study. The study included 8,829 subjects with a mean follow-up time of 8.7 yrs. Change in the prevalence of use for medication was expressed as absolute net change (95% confidence interval) standardised to a 10-yr period. The use of anti-asthmatics was found to have increased by 3.1% (2.4-3.7%) and the prevalence of symptomatic asthma by 4.0% (3.5-4.5%). In the sample with asthma in both surveys (n=423), the use of inhaled corticosteroids increased by 12.2% (6.6-17.8%). Despite this, only 17.2% were using inhaled corticosteroids on a daily basis at follow-up. Females with continuous asthma were more likely, compared with males, and smokers with asthma, to have started using inhaled corticosteroids since the first survey. The use of anti-asthmatics has increased in a pattern consistent with current consensus on treatment. However, despite increased use of inhaled corticosteroids, a large majority of subjects with symptomatic asthma do not use this treatment on a daily basis, particularly males and smokers with asthma.

[Asthma in Iceland]. / Astma i Island.

Hay fever has been a recognised and common disease in Iceland since the early 17th century, and is still frequent. Figures obtained in the few epidemiological studies hitherto carried out in Iceland suggest that the frequency of asthma may be higher than in other Scandinavian countries.

[Airborne immediate allergy in Mid-North Iceland.].

OBJECTIVE: To investigate main causes of airborne immediate allergy in a region of one primary health care center with about 17,000 inhabitants in the northern part of Iceland, both in general and with special reference to diagnoses. MATERIAL AND METHODS: Totally 600 individuals with symptoms indicating airborne immediate allergy were investigated under the periode 1988-1995. Skin prick test (SPT) was used in a standardized way and with standardized solutions. Histamine 10 mg/ml was used as a positive control and positive results were defined as at least half as big as the histamine reaction. RESULTS: 47% of investigated individuals had positive SPT. Grass gave most often positive response and animal dander from cat were in the second place. The allergy symptoms start in more than half of the cases under the age of 16. House dust mites allergy are confirmed in only about 10% of the cases. Mean age of patients who came to the health care center with allergy is 23+/-13 years and 34+/-17 years of those without allergy and the difference is significant in both sexes (p<0.001). When patients with grass pollen allergy are divided into two groups, those with and those without a family history (parents or siblings) of allergy, it is evident that those with a family history get their allergic disease significantly earlier in life than those without a family history (p<0.01). CONCLUSIONS: Immediate airborne allergy is, as is quite well known, mostly a disease of children and young people. By far the most common cause in Mid-North Iceland is grasspollen as in South-West Iceland. Birch pollen is more common in the northern part, probably because of a different vegetation. Age distribution in the whole group without regard to diagnosis is the same as in South-West Iceland where patients with chronic rhinitis were investigated. Storage mite Lepidoglyphus destructor is often positive in those working with hay and it should be included in standard panel for skin prick tests in Northern Iceland.

IgE-mediated allergy to Lepidoglyphus destructor in an urban population--an epidemiologic study.

BACKGROUND: The aim of this study was to estimate the prevalence of IgE-mediated allergy to Lepidoglyphus destructor and its clinical importance in Reykjavik, Iceland. METHODS: All Icelandic participants in the European Community Respiratory Health Survey in Reykjavik and suburbs were skin prick tested (SPT) for L. destructor. They also participated in a structured interview including questions about exposure to hay and symptoms related to hay exposure. Spirometry and methacholine tests were also performed. RESULTS: Altogether, 540 individuals underwent SPT with 12 allergens. Among them, 137 (25.4%) had positive skin tests, defined as at least one mean wheal reaction of > or =1 mm. By this definition, 34 (6.3%) were positive to L. destructor. These 34 individuals were significantly (P < 0.001) more often allergic to D. pteronyssinus (24/34), grass (14/34), cat (13/34), dog (12/34), Alternaria (11/34), Cladosporium (9/34), horse (8/34), and olive (8/34) than those not allergic to L. destructor. Those SPT positive to L. destructor had a higher total IgE (geometric mean: 40.9 kU/I vs 12.3 kU/I, P < 0.001) than those who were negative to L. destructor, but their lung function was comparable to that of the others. Asthma during the preceding 12 months or asthma ever suffered was not overrepresented among those SPT-positive to L. destructor. Individuals with symptoms associated with hay exposure were more often SPT positive to L. destructor than those not having symptoms (P < 0.01). CONCLUSIONS: In a random urban population, 6.3% showed IgE-mediated allergy to L. destructor. These were often polysensitized atopics with a high prevalence of clinical symptoms associated with exposure to hay.

[Latex allergy - an emerging health care problem.].

Since immediate hypersensitivity reaction to natural rubber was described 17 years ago, the incidence of latex allergy has been increasing rapidly. This is in part due to a growing awareness of the problem along with improved diagnostic methods. Additionally, in accordance with universal health care plans and the HIV epidemic, more rubber products such as latex gloves and condoms are in general use. Changes in methods of rubber production may also contribute to the increasing prevalence in latex allergy. Individuals at greatest risk for developing latex allergy are patients who have undergone multiple operations. These include children with myelomeningocele (spina bifida) and congenital defects of the urinary tract. Another high risk group includes health care providers and individuals working in rubber production. Latex containing products are in general use in the hospital setting as well as in the home environment. They can therefore pose a great risk to sensitized patients if prophylactic measures are not undertaken. Defining high risk patients and subsequent diagnosis with appropriate skin tests are important. Patients with latex allergy must then be provided with self-administered adrenalin (Epi-pen) and instructed in avoidance measures. In this article we describe 23 individuals who have been diagnosed allergic to latex in Iceland.

[Allergic and pseudo-allergic reactions to drugs in an Icelandic urban population 20-44 years of age.].

OBJECTIVE: Allergic or pseudo-allergic reactions to drugs are common complaints. The symptoms vary from mild to life threatening. Although the mechanisms for most drug reactions are unknown or uncertain such reactions are believed to be more common among atopic individuals. Our goal was: 1) To estimate the prevalence of allergic and pseudo-allergic drug reactions in a random urban Icelandic population 20-44 years of age. 2) To search for the characteristics of symptoms and which drugs were involved in such reactions, 3) their association to atopy and atopic diseases and 4) to find possible risk factors. MATERIAL AND METHODS: In the second stage of the European Community Respiratory Health Survey an urban population 20-44 years of age was invited to participate. In Iceland altogether 545 answered an additional question: Have you at any time had allergic reaction to drugs? Those who answered yes to this question were contacted later by telephone and asked further about drug allergy. RESULTS: Altogether 77 (14%) replied yes to the question, more females (19%) than males (9%) (p<0.001). Atopic individuals (with one or more positive prick tests) and those with nasal allergies, eczema, urticaria and illness caused by eating a particular food or foods reported allergic drug reactions more often (p<0.05). IgE geometric mean value was 17.5 kU/L for those who reported allergic drug reaction compared to 12.6 kU/L among the others (p=0.08). The most common symptoms associated with drugs were skin symptoms (urticaria, angioneurotic edema), symptoms from respiratory organs and fever. With further inquiries by telephone 13/64 denied drug allergy. Thus 51/64 (80%) withheld their questionnaire answers. Antibiotics were most often blamed for drug reactions, followed by anaesthetics, NSAID and opiates. CONCLUSION: There was a correlation between reported drug reactions and atopy and/or atopic diseases. The drug reactions were more than twice as common in women as in men. The only comparable study we know of, shows the prevalence of drug reactions on the same level as in Iceland.

[Bronchial asthma and respiratory symptoms among Icelanders 20-44 years of age.].

OBJECTIVE: To estimate the prevalence of asthma and respiratory symptoms in an urban population. MATERIAL: Eight hundred men and women aged 20-44 years, living in the capital Reykjavik and suburbs. METHODS: Participants answered a questionnaire, underwent skin prick testing for atopy, spirometry and a test for bronchial hyperresponsiveness (BHR) by methacholine challenge. RESULTS: There was 77% attendance. Altogether 16.6% reported wheezing or whistling at any time in the last 12 months. Altogether 32 (5.6%)answered yes to "Have you ever had asthma?" and the diagnosis had been confirmed by a doctor in all but four. Fourteen (2.5%) had suffered from an attack of asthma in the last 12 months wheras only 0.9% were currently using anti asthmatic drugs. BHR was found among 8.7% and atopy on skin testing among 20.5%. BHR was more common among those with airflow obstruction and three times more common among the atopic participants (18% vs. 6%, p%lt;0.01). By using a history of wheezing during the last 12 months together with BHR and/or a history of doctor confirmed asthma the prevalence of current asthma was found to be 5% in our sample. The main predictive factors for asthma were a history of breathlessness and nighttime breathing symptoms, but also atopy, airflow obstruction and a maternal history of asthma. CONCLUSION: Even by using a conservative defination, asthma is a common disorder among 20-44 years old Icelanders whereas the use of asthma medication is rather uncommon in this population.

[Atopy and allergic disorders among Icelandic medical students.].

OBJECTIVE: To compare the prevalence of IgE-mediated sensitization, allergic disorders and possible risk factors for atopic sensitization among Icelandic medical students (n=113) to a randomly chosen age matched group previously investigated in the Icelandic part of the European Community Respiratory Health Survey. MATERIAL AND METHODS: Altogether 100 medical students participated and 102 in the control group. They were skin prick tested and they answered questions about respiratory symptoms, smoking habits, family history and home environment in childhood. RESULTS: Only 4% of medical students reported daily smoking compared to 27% of the controls. The medical students also had a significantly lower number (mean +/- SD) of siblings (2.2+/-1.3) compared to the controls (3.9+/-1.7). The controls also shared bedrooms with older siblings in childhood three times as often. Atopic sensitization, defined as a positive (3 mm or more) reaction to at least one of nine common airborne allergens used in testing, was found in 41% of the medical students compared to 26.5% of the controls. The prevalence of asthma and urticaria was also significantly higher among the medical students. CONCLUSIONS: Medical students have more often IgE-mediated sensitization and allergy related diseases than a controlgroup of the same age. A possible explanation to this is a lower number of siblings among medical students and a different household situation in childhood.

[Allergy and intolerance to food in an Icelandic urban population 20-44 years of age.].

OBJECTIVE: Symptoms related to the intake of certain food items are common. In most of these cases food allergy/intolerance can not be confirmed. In the Icelandic part of the European Community Respiratory Health Survey the prevalence of food-related symptoms was assessed among adult Icelanders. MATERIAL AND METHODS: Three thousand and six hundred men and women, 20-44 years, were studied, among them 800 were randomly chosen for a more detailed investigation. Additionally, all those using asthma medication or having asthma symptoms were investigated. A questionnaire inquired about chest symptoms, symptoms related to food-intake and eating habits. In Iceland additional questions were asked concerning drug intolerance, urticaria, Quincke oedema, childhood eczema, migraine and psoriasis. All subjects underwent skin prick tests against 12 common allergens, spirometry and methacholine challenge. Specific IgE antibodies against five airborne allergens and six common food allergens were measured. RESULTS: Among subjects with food-related symptoms, 68% reported complaints from the GI-tract, 22% had skin rash or pruritus, 15% severe headache, 11% breathlessness, 8% a running/stuffy nose and 4% fatique. Altogether 42 food items were considered likely causes of the reported symptoms. Twenty-two percent of the random sample had symptoms related to the intake of a particular food and 15% reported always having the same symptom after intake of this food. Women reported food-related symptoms somewhat more often that men (17% and 13% respectively (p=0.21)). In the random sample only 1.8% had antibodies to one or more of the foods measured. There was a significant relationship between food-related symptoms and reported migraine, urticaria and Quincke oedema and a particularily strong relationship with drug intolerance. Migraine, urticaria, Quincke oedema and drug intolerance were significantly more common among women (p<0.0001, p<0.01, p<0.05 and <0.002 respectively). No relationship was seen between food-related symptoms and positive methacholine tests. CONCLUSIONS: In conclusion this study reveales a large group of subjects reporting food-releated symptoms. This group also reported a big prevalence of unrelated symptoms such as drug intolerance and migraine. Type-1 allergy is unlikely to be the cause to more than a small part of these symptoms.