Questionnaire predictors of atopy in a US population sample: findings from the National Health and Nutrition Examination Survey, 2005-2006

Am J Epidemiol. 2011 Mar 1;173(5):544-52. doi: 10.1093/aje/kwq392. Epub 2011 Jan 27.


Allergic conditions and biochemical measures are both used to characterize atopy. To assess questionnaires' ability to predict biochemical measures of atopy, the authors used data on 5 allergic conditions (allergy, hay fever, eczema, rhinitis, and itchy rash) and serum-specific immunoglobulin E (IgE) levels from the 2005-2006 National Health and Nutrition Examination Survey. Atopy was defined as 1 or more positive specific IgEs (≥0.35 kU/L). Questionnaire responses were assessed for sensitivity, specificity, and positive and negative predictive values for atopy. In this population-based US sample, 44% of participants were specific IgE-positive and 53% reported at least 1 allergic condition. Discordance between atopy and allergic conditions was considerable; 37% of persons with atopy reported no allergic condition, and 48% of persons who reported an allergic condition were not atopic. Thus, no combination of self-reported allergic conditions achieved both high sensitivity and high specificity for IgE. The positive predictive value of reported allergic conditions for atopy ranged from 50% for eczema to 72% for hay fever, while the negative predictive value ranged from 57% for eczema to 65% for any condition. Given the high proportion of asymptomatic participants who were specific IgE-positive and persons who reported allergic conditions but were specific IgE-negative, it is unlikely that questionnaires will ever capture the same participants as those found to be atopic by biochemical measures.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, N.I.H., Intramural

MeSH terms

  • Adolescent
  • Adult
  • Biomarkers / blood
  • Child
  • Child, Preschool
  • Eczema / epidemiology*
  • Eczema / immunology
  • Female
  • Health Surveys / statistics & numerical data*
  • Humans
  • Hypersensitivity / epidemiology*
  • Hypersensitivity / immunology
  • Hypersensitivity, Immediate / epidemiology
  • Immunoglobulin E / blood*
  • Immunologic Factors / blood*
  • Infant
  • Male
  • Middle Aged
  • Nutrition Surveys / statistics & numerical data
  • Predictive Value of Tests
  • Rhinitis, Allergic, Seasonal / epidemiology
  • Sampling Studies
  • Sensitivity and Specificity
  • Surveys and Questionnaires
  • United States / epidemiology


  • Biomarkers
  • Immunologic Factors
  • Immunoglobulin E