Fractional exhaled nitric oxide measurements are most closely associated with allergic sensitization in school-age children

Daniel J. Jackson, Christine M. Virnig, Ronald E. Gangnon, Michael D. Evans, Kathy A. Roberg, Elizabeth L. Anderson, Ryan M. Burton, Lisa P. Salazar, Douglas F. DaSilva, Kathleen M. Shanovich, Christopher J. Tisler, James E. Gern, Robert F. Lemanske

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63 Scopus citations


Background: Factors affecting fractional exhaled nitric oxide (FeNO) in early childhood are incompletely understood. Objective: To examine the relationships between FeNO and allergic sensitization, total IgE, atopic dermatitis, rhinitis, asthma, and lung function (spirometry) in children. Methods: Children at high risk of asthma and other allergic diseases because of parental history were enrolled at birth and followed prospectively. FeNO was measured by an online technique at ages 6 and 8 years. Relationships among FeNO, various atopic characteristics, and asthma were evaluated. Results: Reproducible FeNO measurements were obtained in 64% (135/210) of 6-year-old and 93% (180/194) of 8-year-old children. There was seasonal variability in FeNO. Children with aeroallergen sensitization at ages 6 and 8 years had increased levels of FeNO compared with those not sensitized (geometric mean; 6 years, 10.9 vs 6.7 parts per billion [ppb], P < .0001; 8 years, 14.6 vs 7.1 ppb, P < .0001). FeNO was higher in children with asthma than in those without asthma at 8 years but not 6 years of age (6 years, 9.2 vs 8.3 ppb, P = .48; 8 years, 11.5 vs 9.2 ppb, P = .03). At 8 years of age, this difference was no longer significant in a multivariate model that included aeroallergen sensitization (P = .33). There were no correlations between FeNO and spirometric indices at 6 or 8 years of age. Conclusion: These findings underscore the importance of evaluating allergen sensitization status when FeNO is used as a potential biomarker in the diagnosis and/or monitoring of atopic diseases, particularly asthma.

Original languageEnglish (US)
Pages (from-to)949-953
Number of pages5
JournalJournal of Allergy and Clinical Immunology
Issue number5
StatePublished - Nov 2009
Externally publishedYes

Bibliographical note

Funding Information:
Supported by National Institutes of Health grants R01 HL61879 , P01 HL70831 , T32 AI007635 and M01 RR03186 .

Funding Information:
Disclosure of potential conflict of interest: R. M. Burton is a consultant for Cardinal Health. J. E. Gern receives grant support from AstraZeneca and Merck. R. F. Lemanske, Jr, is a speaker for Merck, AstraZeneca, Doembecher Children's Hospital, Washington University, the Medicus Group, the Park Nicolet Institute, the American College of Allergy, Asthma & Immunology, the Los Angeles Allergy Society, the Michigan Allergy/Asthma Society, the Medical College of Wisconsin, the Fund for Medical Research and Education (Detroit), the Children's Hospital of Minnesota, the Toronto Allergy Society, the American Academy of Allergy, Asthma & Immunology, Beaumont Hospital (Detroit), the University of Illinois, the Canadian Society of Allergy and Clinical Immunology, and New York Presbyterian; is a consultant for AstraZeneca, Smith Research, Inc, the Merck Childhood Asthma Network, Novartis, Quintiles/Innovax, RC Horowitz & Co, Inc, International Meetings and Science, and Scienomics; is an author for Up-to-Date; is a textbook editor for Elsevier, Inc; and receives grant support from the National Heart, Lung, and Blood Institute. The rest of the authors have declared that they have no conflict of interest.


  • Fractional exhaled nitric oxide (FeNO)
  • allergic sensitization
  • asthma
  • atopic dermatitis
  • atopy
  • children
  • lung function
  • seasonality


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