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Published by: srust2792 on May 24, 2011
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The Largest Study of AllergyTesting in the United States
Ars Arss Amra
Qust Dasts Hath Trds
 Allergy Report 2011
Th arst study  ary tst  th Utd Stats
I am pleased to present to you the rst Quest Diagnostics Health Trends™ allergy report,
 Allergies Across America
. This report is the largest analysis o allergy testing o patients inthe United States under evaluation or medical symptoms associated with allergies.Allergies are a major public health concern, aecting the healthcare system, employers,and, indeed, patients. By the time you nish reading this report, you may be surprisedby the dynamic nature o allergies in the United States. We ound evidence that allergensensitization is increasing, and that the type o allergens aecting Americans evolved duringthe 4 years we examined. We also ound that allergens have a disproportionate negativeeect on children. A novel nding is that men experience higher rates o sensitization toallergens than women. Even the way allergies are diagnosed is changing, with a clear shittowards greater allergy testing by pediatricians and other primary care physicians.We ound evidence supporting the pattern o allergy progression known as the “allergymarch,” in which allergen sensitization oten evolves rom ood to environmental allergens.Our analysis identied a connection between allergies and asthma, building on priorresearch, but using our much larger data set. In addition, we revealed disparities in ourhealthcare system that should be cause or alarm or any policy maker, physician, or parent.Our allergy report adds to our collection o Quest Diagnostics Health Trends reportsdeveloped in recent years on health concerns aecting large numbers o patients in theUnited States. Based on analyses o our national database – consisting o more than 1.5billion patient encounters since January 2000 – previous reports have ocused on chronickidney disease, diabetes, heart disease, H1N1 (2009) Inuenza A, and rotavirus. I encourageyou to read these reports, which can be ound at QuestDiagnostics.com/HealthTrends.With mounting demands on our healthcare system, our nation must devise new, innovativemethods o providing high quality services. Greater knowledge o the patient impact andclinical management o chronic diseases, such as allergies, will be increasingly vital to theability o healthcare proessionals to deliver the best possible care.Best regards,Surya N. Mohapatra, Ph.D.Chairman and Chie Executive OfcerQuest DiagnosticsP.S. A PDF o this report and additional content about allergies and IgE testing are available at
Hath Trds
 Allergy Report 2011
Table of Contents
AboUT AlleRgieS
7Allergies and Their Symptoms 7Impact o Allergies 7Diagnosing Allergies 8Treating Allergies 9The Allergy March 10
AMeRicA’S AlleRgY PRobleM
12Allergies are Increasing 12Ragweed and Mold Increasing the Fastest 13Worst Cities or Allergies 16
genDeR: DoeS iT MAke A DieRence?
HigH iMPAcT o AlleRgieS on cHilDRen
24Food Allergies in Children 24Evolution rom Food to Environmental Allergens 27
link beTween AlleRgieS AnD ASTHMA
DiSADvAnTAgeD cHilDRen: DelAYeD DiAgnoSiS
cHAnging PHYSiciAn TeSTing PATTeRnS
32Primary Care Physicians Play a Larger Role in Diagnosing Allergies 32Adoption o Blood-Based Allergy Testing Varies by Region 33
ReSeARcH MeTHoDologY
35Quest Diagnostics Health Trends™ Reports 35Allergies Across America™ Study Population 35
“The Quest Diagnostics
 Health Trends Report studiesthe eect o allergies on auniquely massive scale. Itrepresents people across theUnited States using a highly respected and standardizedlaboratory methodology.” 
Adr H. lu, M.D.
 Assciat PssAlly and Clinical IunlyNatinal Jish HalthDn, Clad
Hath Trds
 Allergy Report 2011
Qust Dianstics
Sstzat t 2 mm rmta ars s ras, ssttth prr mat ha rsarh. 
Sensitization to common ragweedgrew 15% – more than any other allergen we analyzed – with the Southwest,Mountain, and Plains States experiencing the highest sensitization rates. Thesendings are consistent with other research suggesting climate change maycontribute to an increase in certain environmental allergens, such as ragweed.Mold sensitization grew 12%, a nding that is potentially clinically importantgiven other research showing that molds may trigger allergic sensitization andaggravate asthma (see page 13).
 Ars ar prat thruhut th U.S., urr  ah  th utry’s30 arst ts.
Yet, some cities demonstrated higher rates o sensitizationthan others, with Dallas, Phoenix, Baltimore, Washington, D.C., and Bostonexperiencing the greatest burden (see page 16).
 M had hhr sstzat rats tha m at a as, a  adpttay ay sfat fd.
This novel nding diers rom otherstudies that suggest that allergies are more prevalent among women. Whileadditional research is required, we hypothesize that the criteria or positivespecic-IgE allergic response may dier between males and emales, a ndingo potential clinical signicance. We provide 3 hypotheses or why our researchdiers rom prior studies, including the possibility that the criteria or positivespecic-IgE allergic response may dier between males and emales, andpossibly at dierent ages (see page 19).
chdr had hhr sstzat rats tha aduts.
O children tested between2 and 17 years o age, 53% showed sensitization to 1 or more allergens. Nearly1 in 5 children with sensitization showed a high degree o IgE sensitization,compared to about 1 in 10 adults (see page 21).
 Ars prrss a a pattr  as th ary marh. 
The allergymarch is a well-documented phenomenon by which sensitization to oodsearly in lie may heighten a child’s likelihood o developing more severe allergicdisease, including asthma, later in lie. Our cross-sectional study is the largestto reveal a pattern o allergen sensitization consistent with the allergy march,with high rates o ood-allergen sensitization most commonly ound in earlychildhood and high rates o sensitization to other allergens occurring morerequently with age. To better control the allergy march, physicians mayperiodically evaluate patients with allergies to assess changes in allergensensitization (see page 24).
Allergies are one o the most common health conditions, aecting 1 in 5Americans. Allergies account or more than 17 million physician ofce visits,30,000 emergency room visits, and several hundred deaths each year.
Individualswith allergies are at heightened risk or other diseases, including asthma.As the world’s leading diagnostic testing company, Quest Diagnostics is uniquelypositioned to analyze the largest national database o allergy blood tests and deriveinsights into the impact o allergies on the health o Americans.For this Quest Diagnostics Health Trends report, we analyzed de-identied testresults rom more than 2 million patient encounters over a 4-year period. Ouranalysis included results rom patients o both genders, rom inants to the elderly,residing in every U.S. state and the District o Columbia.Allergies are clinically diagnosed based on actors that include medicalexamination, patient history, laboratory testing, and, as appropriate, allergenexposure testing. Our study is based on testing using the ImmunoCAP
specicimmunoglobulin E (IgE) blood test (ImmunoCAP), the “gold standard” o allergyblood tests.
Each test result identied sensitization to 1 or more o 11 commonallergens. Sensitization reers to a test result that indicates a patient has anallergen-specic IgE, which is important or diagnosing an allergy but may not byitsel be sufcient to prompt symptoms. The allergens we evaluated were 5 oods(egg white, milk, peanut, soybean, and wheat), common ragweed, mold, 2 types ohouse dust mites, cat epithelia (skin), and dog dander.Our study is the largest study o laboratory test results rom a nationallyrepresentative U.S. population seeking medical care or symptoms associated withallergies. In addition to size, our study’s advantages include the use o validatedquantitative laboratory test results o allergy sensitization, rather than surveyresponses rom physicians or patients. As the vast majority o the patients in ourstudy likely presented with new or changing allergy signs and symptoms, ouranalysis does not measure the prevalence o allergies in the general population.
our fds ud:
Amra’s ary prm s ras.
Our analysis ound that the overallallergen-sensitization rate increased by 5.8% over the 4-year study period. Inaddition, the number o patients tested or these 11 allergens increased 19%,signicantly aster than growth in laboratory testing in general (see page 12).
The largest allergy 
 study ever conductedound America’s allergy  problem is both pervasiveand increasing.

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