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Role of exhaled nitric oxide as a predictor of atopy

Karina M Romero12, Colin L Robinson1, Lauren M Baumann1, Robert H Gilman123, Robert G Hamilton4, Nadia N Hansel5, William Checkley235* and PURA Study Investigators

Author Affiliations

1 Asociación Benéfica PRISMA, Lima, Peru

2 CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru

3 Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA

4 Division of Allergy and Clinical Immunology, School of Medicine, Johns Hopkins University, Baltimore, USA

5 Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, 1800 Orleans Street, Suite 9121, Baltimore, MD 21205, USA

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Respiratory Research 2013, 14:48  doi:10.1186/1465-9921-14-48

Published: 2 May 2013



The fractional exhaled nitric oxide (FeNO) is a quantitative, noninvasive and safe measure of airways inflammation that may complement the assessment of asthma. Elevations of FeNO have recently been found to correlate with allergic sensitization. Therefore, FeNO may be a useful predictor of atopy in the general population. We sought to determine the diagnostic accuracy of FeNO in predicting atopy in a population-based study.


We conducted a cross-sectional study in an age- and sex- stratified random sample of 13 to 15 year-olds in two communities in Peru. We asked participants about asthma symptoms, environmental exposures and sociodemographics, and underwent spirometry, assessment of FeNO and an allergy skin test. We used multivariable logistic regression to model the odds of atopy as a function of FeNO, and calculated area-under-the-curves (AUC) to determine the diagnostic accuracy of FeNO as a predictor of atopy.


Of 1441 recruited participants, 1119 (83%) completed all evaluations. Mean FeNO was 17.6 ppb (SD=0.6) in atopics and 11.6 ppb (SD=0.8) in non-atopics (p<0.001). In multivariable analyses, a FeNO>20 ppb was associated with an increase in the odds of atopy in non-asthmatics (OR=5.3, 95% CI 3.3 to 8.5) and asthmatics (OR=16.2, 95% CI 3.4 to 77.5). A FeNO>20 ppb was the best predictor for atopy with an AUC of 68% (95% CI 64% to 69%). Stratified by asthma, the AUC was 65% (95% CI 61% to 69%) in non-asthmatics and 82% (95% CI 71% to 91%) in asthmatics.


FeNO had limited accuracy to identify atopy among the general population; however, it may be a useful indicator of atopic phenotype among asthmatics.

Allergic sensitization; Asthma; Exhaled nitric; Allergic rhinitis