EPIDEMIOLOGY AND GENETICS
Relationship of serum cholesterol levels to atopy in the US
M. B. Fessler1, R. Jaramillo2, P. W. Crockett2& D. C. Zeldin1
1Laboratory of Respiratory Biology, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health
and Human Services, Research Triangle Park, NC;2SRA International, Durham, NC, USA
To cite this article: Fessler MB, Jaramillo R, Crockett PW, Zeldin DC. Relationship of serum cholesterol levels to atopy in the US population. Allergy 2010; 65:
Atopic sensitization and disease appear to have increased in
the United States in recent decades, suggesting a possible
interaction of allergy with prevalent environmental factor(s)
that have evolved over the same timeframe (1). Dyslipidemia
[i.e., high serum low density lipoprotein-cholesterol (LDL-C)]
has declined since 1960 (2) and is known to potently impact
the development of atopy (3–6), but reports differ on
thedirection of the effect.
pro-atopic Th2 immunity and allergic inflammation in
rodents (6), and cholesterol enhances latex-specific IgE and
Th2 cytokine production by mononuclear cells of patients
with atopy (3). Allergic sensitization is also related directly to
LDL-C, and inversely to high density lipoprotein-cholesterol
(HDL-C) in Chinese men (7). On the other hand, serum total
cholesterol (TC) is inversely related to atopy in Finnish
children (4) and in German adults, no independent rela-
tionship with atopic disease was found for LDL-C, and a
direct relationship was observed for HDL-C (5). These few
human studies addressing the association between serum cho-
lesterol and atopy have each been limited to demographically
narrow populations. Collectively, their divergent results raise
the interesting possibility of important interactions of the
atopy; cholesterol; high density lipoprotein;
immunoglobulin E; low density lipoprotein.
M. B. Fessler, MD
National Institute of Environmental Health
Sciences, 111 T.W. Alexander Drive, PO
Box 12233, Maildrop D2-01, Research
Triangle Park, NC 27709, USA.
Tel.: +91 9 541 3701
Fax: +91 9 541 4133
Accepted for publication 1 November 2009
Edited by: Thomas Bieber and
Background: Cholesterol promotes Th2 immunity and allergic inflammation in
rodents; whether this occurs in humans is unclear. Reports of both direct and
inverse associations between serum cholesterol and atopy in different populations
suggest that race and/or other demographic variables may modify these relation-
Aims of the study: To determine the relationships between levels of three serum cho-
lesterol measures [total cholesterol (TC), high density lipoprotein-cholesterol (HDL-
C), and non-HDL-C] and atopy in a sample representative of the US population.
Methods: Cross-sectional study of 6854 participants aged ‡6 years from the 2005–
2006 National Health and Nutrition Examination Survey.
Results: In the overall population, adjusted odds ratios (AORs) per two-standard
deviation increase in TC and non-HDL-C for biochemical atopy (defined as ‡1
allergen-specific IgE to 19 allergens) were 1.17 [95% confidence interval (CI), 1.00–
1.38] and 1.19 (95% CI, 1.03–1.39), respectively. Interactions by race were noted for
the two relationships (interaction P = 0.004 and P = 0.009, respectively) with non-
Hispanic Whites (NHWs) having direct relationships [TC: AOR 1.27 (95% CI,
1.03–1.57); non-HDL-C: AOR 1.27 (95% CI, 1.03–1.56)] and non-Hispanic Blacks
(NHBs) inverse relationships [TC: AOR 0.77 (95% CI, 0.62–0.95); non-HDL-C:
AOR 0.86 (95% CI, 0.69–1.08)]. The adjusted HDL-C–atopy relationship was non-
significant for NHWs and inverse for NHBs [AOR 0.77 (95% CI, 0.61–0.96)]. Rela-
tionships were independent of body mass index and serum C-reactive protein and
unmodified by corticosteroid or statin usage. Results were similar using current hay
fever/allergy as the atopy outcome.
Conclusions: There are marked inter-racial differences in the relationship between
serum cholesterol and atopy in the US population.
Allergy 65 (2010) 859–864 ª 2009 John Wiley & Sons A/S
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Serum cholesterol-atopy association in the US
Fessler et al.
Allergy 65 (2010) 859–864 ª 2009 John Wiley & Sons A/S