ACAAI 2011: Smoking and Alcohol Affect Asthma and Allergies

BOSTON—Everyone knows the risks of heart disease and cancer due to smoking but researchers are looking at the association between smoking and allergic disease. Sami Bahna, MD, PhD, professor of pediatrics and medicine, chief of allergy and immunology section, Louisiana State University Health Sciences Center, Shreveport, La., spoke on the topic at the American College of Allergy, Asthma & Immunology’s annual meeting this morning.

Smoke can induce degranulation of lung mast cells. Light to moderate smoking increases serum IgE, smoking facilitates sensitization to inhalant allergens and causes increased permeability of alveoli. Smoke also causes increased bronchial hyperreactivity. There is a high risk of asthma development and severity in children of smoking parents, Bahna said.

Amazingly, Bahna said, the relationship between total IgE and smoking is very dose-dependent. Those who smoke less than 10 cigarettes a day had a much higher rate of IgE than those who smoked 20 or more cigarettes a day. In other words, “light smoking enhances IgE and heavy smoking suppresses IgE.”

Other research found that prenatal exposure to maternal smoke was more deleterious than postnatal exposure. And, infants who wheezed before age 3 and are still wheezing at age 6 are likely to have a smoking mother, high serum IgE level, affected lung function, atopic dermatitis, and family history of allergy/asthma.

Bahna also reported on a study conducted in Scotland after smoking was banned in all public spaces in 2006. Before the ban, hospitalization for asthma was increasing by 5.2 percent a year. Afterward, hospitalizations for asthma decreased by 18.2 percent per year.

Research has found that maternal smoking during pregnancy led to increased collagen deposition in the airway of the fetus, decreased lung function in the newborn, decreased maturation of T cells in the fetus and newborn, and increased asthma and atopy in infants. Exposure to tobacco smoke during childhood led to decreased lung function, increased bronchial hyperreactivity and airway inflammation, increased total IgE and increased incidence of asthma and allergy.

There also is a positive association between alcohol consumption and total IgE, Bahna said. Alcohol consumption during pregnancy is associated with increased total IgE in umbilical cord blood. There also is a positive association between alcohol consumption and testing positive on skin prick test for aeroallergens. On the other hand, alcohol consumption was associated with less incidence of delayed-type contact hypersensitivity.

Bahna reviewed a case involving a 12-year-old who experienced a rash after using a compress containing alcohol. “Never underestimate sensitization through the skin,” he said. “The skin as a route for sensitization is very strong.”