Percutaneous Immediate Hypersensitivity to Eight Allergens · most common drug prescribed to those 11–14 years of age and the second most common drug prescribed to those 15-20 years

PercutaneousImmediateHypersensitivity toEight AllergensUnited States, 1976-80

This report describes the distribution ofimmediate cutaneous hypersensitivityreactions to eight selected unstandardizedallergens for the civilian noninstitutionalizedU.S. population ages 6-74 years. The ratesof hypersensitivity, computed from datacollected in the second National Health andExamination Survey (NHANES 11)1976-80,are presented by selected demographic andsocioeconomic factors.

Data From the National Health SurveySeries 11, No. 235

DHHS Publication No. (PHS) 8f3-16&5

U.S. Department of Health and Hum@Services

Public Health ServiceNational Center for Health StatisticsHyattsville, Md..hty 1986

All material appearing in this report is in the public domain and may bereproduced or copied without permission; citation as to source, however, isappreciated.

National Canter for Health statistics, P. J. Gergen and P. C. Turkeltaub:Percutaneous immadkste hyparaansitiv~ to eight allergens, United States,1976-60. Vita/ and Health Stafrstba. Series 11, No. 235. DHHS Pub. No. (PHS)

66-1S65. Public Health Sawioe. Washington. U.S. Government Printing Dffica,

July 1986.

Gergan, Paler J.Percutaneous immadale hy~raansitivity to eight allergens, Unfiad States,

1976-60.(Series 11, Data from the national health suwey; no. 235) (DHHS

publication; no, (PHS) 66-1665)“Computed from data collected in the second National Health and Nutrition

Examination Survey (NHANES 11)1976-60.”Authors Peter J. Gergen and Paul C. Turkeltaub.Bibliography: p.Supt. of Dots. no.: He20.6209;l 1/2351. Allergy-United Stataa-SWtiics 2. Health suweye-Unitad States.

1.Turkeltaub, Paul C. Il. National Cater for Health Statistics (U.S.), Ill. Ttie.IV. series Vil and health atatiatics. series 11, Data from the national healthsurvey; no. 236. V. Series: DHHS publication; no. 66-16S5. [DNLM: 1.Allergens-united Stataa+3tatiatii. 2. Hypersensitivity, lmmedat~

occurrence-Unitad States. 3. Skin Teats-united State~atistica.W2 A N146vk no. 235]

RA407.3.A347 no. 235 362.1 ‘0s73021 s 85-600323[RA645.A44] [614.5’9S3]

I For sale by the Superintendent of Documents, U.S. Qo}-ernment Printing Office, Washington, D,C. 20402I

National Center for Health Statistics

Manning Feinleib, M. D., Dr.P. H., Director

Robert A. Israel, Deputy Director

Jacob J. Feldman,’ Ph. D., Associate Director for Arudysis and

Epidemiology

Garrie J. Losee, Associate Director for Data Processing and

Services

Alvan 0. Zarate, Ph. D., Assistant Director for International

Statistics

Peter L. Hurley, Acting Associate Director for Interview and

Examination Statistics

Stephen E. Nieberdlng, Associate Director for Management

Gail F. Fisher, Ph. D., Associate Director for Program Pkmning,

Evaluation, and Coordination

Monroe G. Sirken, Ph. D., Associate Director for Research artd

Methodology

Peter L. Hurley, ~ssociate Director for Vital and Hea[th Care

Statistics

Alice Haywood, Information Oficer

Interview and Examination Statistics Program

E. Earl Bryant, Associate Director

Mary Grace Kovar, Dr. P.H., Special Assistant for Data Policy andAnalysis

Division of Health Examination Statistics

Robert S. Murphy Director

Catherine E. Woteki, Ph. D., Deputy Director

Clifford L. Johnson, Chief, Nutrition Statistics Branch

Suzanne G. Haynes, Ph. D., Chief, Medicai Statistics Branch

Kurt R. Maurer, Chiej Survey Planning and Development Branch

Wilbur Hadden, Acting Chief, Programming Stati

Cooperation of the U.S. Bureau of the Cwrsus

Under the legislation establishing the National Health Survey, the PublicHealth Service is authorized to use, insofar as possible, the services cr facilitiesof other Federal, State, or private agencies.

In accordanea with specifications established by the National Center forHealth Statistics, the U.S. Bureau of the Census participated in the design andselection of the sample and carried out the initial household interview stage ofthe data colieotion and certain parts of the statistical processing.

Acknowledgments

Many persons outside the National Center for HealthStatistics contributed to the design and execution of the skintesting portion of the second National Health andExamination Survey, 1976-80. The authors wish to expresstheir gratitude to those involved in this effort, especially thefollowing persons: Harold Baer, Phillip Norman, DavidMathison, Charles Reed, Sheldon Siegel, Joanne Tignall,Sheldon Spector, and Albert Sheffer.

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . I

Highlights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...3

Source and limitations ofthe data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...4NHANESII sample design and data collection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...4Skin testing procedures and allergenic extracts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Method of analysis....,,. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .......7Analytic strategies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...7Statistical methods .,..... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...7

Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...10Overall prevalence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......1oVariations in reactivity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...10Age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...11Pollination location and season . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Sex and race comparisons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...,..I4Socioeconomic status (SEA) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Residency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Geographic region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...18

Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , 24

List of detailed tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...28

Appendixes

I, Statistical notes .,,.... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . ...6211. Data quality......,.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...68111.Definition of terms . . . . . . . . . . . . . . . . . . . , . . . . . .. . , . . .. . . , . . . . . . . . . . . . 72

Listof text figures

l, Allergy skin test form.,. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,, ...,.52. Size distribution for house dust at the 20-minute reading for persons ages 6-74 years: United States,

1976-80 ..,,........,., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83. Overall skin-test reactivity by age and sex for white persons: United States, 1976-80 . . . , , . . . . . . . . 124. Skin-test reactivity by age and sex for black persons: United States, 1976-80 , . , . . , . . . . . . , , . . . 135. Age-adjusted skin-test reactivity by sex for persons ages 6-74 years: United States, 1976-80 . , . . , , . , . 166. Age-adjusted skin-test reactivity by race and sex: United States, 1976-80 , , , . . . . . . , . , . . , , . , , 16

Listof text tables

A. Selected studies on prevalence of allergies....,,..,.. . . . . . . . . . . . . . . . . . . . . . . . . . 1B, Suggested grading systems for skin tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...7C, Percent of positive skin-test reaction for persons ages 6-74 years by allergen groups; with standard errors:

United States, 1976-80 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

v

D. Percent distributions and mean size of positive reaction for persons ages 6-74 years by number of positive skintests; with standard errors: United States, 1976-80 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

E. Mean size of histamine reaction for persons ages 6-74 years by number of positive skin tests; with standarderrors: United States, 197680.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

F. Mean size of histamine reaction for persons ages 6-74 years by mean size of rye grass reaction; with standarderrors: United States, 1976-80, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

G. Percent of positive skin-test reactions for persons ages 6-74 years by allergen and pollen area; with standarderrors andpvalues: United States, 197&80 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .,, ,,. .

H. Percent of positive skin-test reactions for persons ages 6-74 yearsby allergen, geographic region, and pollen season;with standard errors and p values: United States, 1976-80 . , . . . . . . , . . . . . , . , . . . . . . . , . .

J. Percent of positive skin-test reactions for persons ages 6--741years by allergen, geographic region, and pollenseason; with standard errors: United States, 1976-80 . . . . . . . . . . . . . , . , . . . . . . . . , , , . . .

K. Age-adjusted prevalence rates of skin-test reactivity for persons ages 6-74 years by selected allergens, sex,,andrace; with standard errors: United States, 1~~76--80 . . . . . . . . . . . . . . . . . . . . . . . . . . . .,

L. p values of two-sided t-tests by selected allergens, sex, and race for persons ages 6-74 years: UnitedStates, 1976-80 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

M. Skin-test reactivity for persons ages 6-74 years by poverty level and selected allergens; with standard errors andpvalues: United States, 1976-80 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

N. Skin-test reactivity for persons ages &74 ye,ars by family income level; with standard errors: UnitedStates, 197&80 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0. Skin-test reactivity for persons ages 6-74 years by education level; with standard errors: UnitedStates, 1976-80 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

P, Skin-test reactivity for persons ages 6-74 years by selected allergens and urban or rural residence; with standarderrors andpvalues: United States, 1976-80 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .,

Q. Skin-test reactivity for white persons ages 6-74 years who are above the poverty level by place of residence;with standard errors: United States, 1976-80 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,., ,

R. Skin-test reactivity for persons ages 6-74 years by allergen group and geographic region; with standard errors:United States, 1976-80 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

S. Skin-test studies of community samples or nonallergic populations . . . , . . . . . . . . . . . . . . . . . . .T. Skin-test studies of allergic populations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11

11

14

14

15

15

17

17

17

18

18

181920

Symbols--- Data not available

.,. Category not applicable

Quantity zero

0.0 Quantity more than zerc} but less than0.05

z Quantity more than zercl but less than500 where numbers are rounded tothousands

* Figure does not meet stiandard ofreliability or precision

# Figure suppressed to comply withconfidentiality requirements

Percutaneous immediateHypersensitivityto Eight Allergensby Peter J. Gergen, M.D., M.P.H., Division of HealthExamination Statistics, National Center for Health Statistics,and Paul C. Turkeltaub, M.D., Office of Biologics Researchand Review, Food and Drug Administration

Introduction

Allergic diseases are important causes of morbidity inthe United States. The 1980-81 National Ambulatory MedicalCare Survey reported that allergic rhinitis, asthma, and contactdemlatitis or eczema were among the 15 most common diag-noses made by physicians in their patients 11–20 years ofage. In addition, injections of allergenic extracts were themost common drug prescribed to those 11–14 years of ageand the second most common drug prescribed to those 15-20years of age.’

Estimates of the prevalence of allergic diseases have variedwideiy. A selection of studies that have attempted to estimatethe prevalence of allergic disease is given in table A.2-’3The majority of the estimates since 1960 fall in the 19–34-percent range.

Tabio A. Salaotsd studies on prevalence of allergies

Differences in data collection techniques prevent readycomparisons among the studies listed in table A. These differ-ences include first, the lack of uniformity as to which dkeaseswere included in the allergic syndrome. All of the studiesincluded at a minimum asthma and various forms of rhinitis.Certain studies included varying numbers of other allergicdiseases (such as eczema, food allergies, and urticaria) intheir definitions .2+s8>‘-” Increasing the number of allergic

diseases, however, did not necessarily yield an increase inthe reported prevalence rate. Second, there was no uniformityin the definitions for the diseases (such as asthma and hayfever)that make up the allergic syndrome. And third, the ages ofthe subjects and geographic locations varied greatly amongstudies. Further studies using uniform criteria for the diagnosis

ReportedAuthor Age Study prevalence

of study group Location year Size of allergy

London’ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Croc,kz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .AW.M3.. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Freeman’ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Arbeite? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Beck . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hag~ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Maternowski’O . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .VanArsdel’’ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Sherry’* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Smith’3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Broder’4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ChildhoodChildhood14years or under14years or under14years or under8th grade12th grade5-15 years5-13 years

16-2U yearsMedian 20yearsUnder 25 years15-25 yearsUnder 20 years20years and over6-60 years and over

N.C.Term.N.Y, Corm., MontrealCorm.N.Y.Colo.

lrrd.6 U.S.cities

R.LMich.Wash.D.C.Iowa

Mich.

1937

19541%1

19611%1

19E4

19671$?83

1%91962185919661964

1959-60

1,5001,2252,1691,7372,130

w1,2751,6421,703

1,650434

5,8181,7292,6663,0966,995

6.614.023.721.625.425.331.024.1

asthma 74.4hay fever %0.4

34.8

19.116.7

26.05.8

11.0asthma 74.1

hay fever 86.3

1Seereference2 at end of text.‘See reference3 at end of text3Seereference4 at end of text.4Sce reference5at end of text.5Scereference6 at end of text.%e reference7atend of text.7RMeis indicative of asthma only,‘Rate is indicative of hay feveronly,‘See reference8 at end of text.

1°Sc:ereference9 at end of text.11%e reference10at end of text.‘Z%e reference 11at end of text,‘3.% reference12at end of text.14S&areference 13at end of text.

of allergic disease are needed to clarify the actual prevalencerate.

The determination of whether a clinical syndrome mayhave an allergic etiology can be studied by the use of allergyskin tests. Introducing an allergen into the skin of an allergicindividual will result in a cutaneous inflammatory reactionwithin 10 to 20 minutes. This immediate hypersensitivity isdue to the release of inflammatory mediators from tissue mastcells and basophils that have attached to their cell surfacesIgE antibodies specifically directed against the allergen in-jected. “”5 In reactive persons, the intensity of the cutaneousreaction is dependent on the dose of allergen injected.’6

The size of the skin reaction, the dose of allergen requiredto produce a given skin reaction size, and the number ofpositive skin tests are associated with other laboratory andclinical indicators of immediate hypersensitivity. Positive skintests are positively correlated with total serum IgE17)’8 andspecific serum IgE levels. ‘9’20 Skin-test sensitivity is alsohighly correlated to basophil sensitivity’9 and tissue sensitivity(both bronchial’ ’22and nasa123)to the allergen.

Clinically, the skin test reaction has been demonstratedto have predictive diagnostic value. Persons with a historyof an allergic syndrome occurring during allergen exposureand skin-test reactivity at low doses to that allergen are ata very high risk of experiencing a recurrence of the allergicsyndrome when re-exposed to the allergen.’9>24The degreeand number of positive skin tests to a battery of allergenshas been shown to be positively associated with the reportedprevalence of allergic diseases (for example, hayfever, asthma,or atopic dermatitis) in the population. 25’26Asymptomaticpersons, who are skin-test positive, are at higher risk of de-veloping an allergic syndrome (especially under the age of40 years)27 compared with persons who are skin-testnegative. 28

In summary, allergy skin testing is a useful method for

evaluating the prevalence of immediate hypersensitivity. Aclearer understanding of the prevalence of immediate hypersen-sitivity in the U. S. population will help advance our knowledgeof alllergicdiseases.

Most studies of skin-test reactivity have been done onselect populations who presented themselves at clinics or hospi-tals for evaluation of allergic symptoms. In a few studiesresea~chers have attempted to evaluate groups living in definedgeographic areas. The second National Health and NutritionExamination Survey (NHANES II) offered the first opportunityto study skin-test reactivity in a systematic way on a nationalsample of the civilian noninstitutionalized population. Skintesting by the prick-puncture method was performed on allpersons 6-74 years of age in NHANES II. Each participantwas skin tested against eight allergens (house dust, alternaria,cat, dog, mixed giant and short ragweed, oak, perennial ryegrass, and Bermuda grass), a positive control (histamine phos-phate), and a negative control (50 percent glycerol saline).Positive reactions were based on a mean erythema diametergreatm than or equal to 10.5 millimeters (mm) at the 20-minutereading.

This report will present the results of allergy skin testingcarried out in NHANES II for the individual allergens andoverall reactivity to at least one of the eight allergens byage, race, sex, income, education, and urbanization.

A variety of individuals can use the estimates in thisreport. Epidemiologists can compare the reactivity found intheir local studies with a national sample. Researchers inter-ested in the etiology of immediate hypersensitivity can usethe results pointing out differing levels of reactivity betweencertain subgroups to plan studies on these subgroups to deter-mine the reasons for these differences. And health servicesplanners can use these results to identify the groups in whichallergic conditions are likely to be the greatest problem.

The following summary highlights the findings fromprick–puncture skin testing performed on persons 6-74 yearsof age in NHANES II, 1976-80.

. The prevalence rate of skin-test reactivity to at least oneof eight selected allergens was 20.2 percent for personsages 6-74 years in the U.S. civilian noninstitutionalizedpopulation.

. Among the individual allergens, ragweed and rye grasshad the highest individual rates of reactivity with approxi-mately 10percent of the population reacting to each one.

. The age-adjusted prevalence rate of skin-test reactivityto at least one of eight selected allergens in persons ages6-74 years was higher in men (22.2 percent) than inwomen (18.4 percent).

. The age-adjusted prevalence rate of skin-test reactivityto at least one of eight selected allergens was higherin black persons (23.2 percent) than in white persons

●

●

●

●

●

(19.5 percent), but this difference did not reach statisticalsignificance.Peak reactivity to at least one of eight selected allergensoccurred in the group 18–24 years of age. The peakreactivities were 33.3 percent for men and 25.2 percentfor women. Reactivity rates were lower in the youngerand older age groups.Ragweed allergen had higher rates of reactivity in high-pollen areas as compared with low-pollen areas (13.3percent versus 7.2 percent).Skin-test reactivity was greater with higher income andeducation.Skin-test reactivity was greater in urban dwellers (22 per-cent) than in rural dwellers ( 16.5 percent).Skin-test reactivity was greatest in the Northeast (25.4percent) and lowest in the South (14.2 percent).

3

Source and limitations ofthe data

NHANES II sample design and data In NHANES 11 the total sample size was 27,801; ofcollection these sample persons, 25,286 (91.0 percent) were interviewed

NHANES II, conducted between February 1976 and Feb-ruary 1980, was a probability sample (n= 27,801) selectedto represent the U.S. civilian noninstitutionalized population(including Alaska and Hawaii) 6 months through 74 yearsof age. Certain groups of special interest were oversampledin the survey: Children 6 months through 5 years of age,adults 60-74 years of age, and persons living in low incomeareas. 29

During the examination period, mobile examination cen-ters were set up in 64 locations in the United States. Theexamination sites were selected from 1,924 primary samplingunits (PSU’S) into which the United States was divided. EachPSU is a standard metropolitan statistical area (SMSA), acounty, or a group of two or three contiguous counties. Theareas and persons for the survey were chosen by complexsampling techniques, in cooperation with the U.S. Bureauof the Census.

NHANES II consisted of two components. The householdinterview component involved the collection of socioeconomicand demographic information on the family, as well as amedical history questionnaire for each sample person. TheU.S. Bureau of the Census performed the initial householdinterviews and aided in the scheduling of appointments forthe examination component. The examination component wasperformed on the sample persons in mobile examination centersspecially designed for this study. Examination teams werespecifically trained to follow the study protocols. The require-ment for standardizing the environment, equipment, materiaIs,and methods minimized unwanted variation in the data collec-tion resulting from changes in location, techniques, and mate-rials over the course of the survey. The standardization alsoallowed the performance of the individual examiners to beevaluated.

The examination consisted of a series of tests and proce-dures that included

● A general medical examination and screening by a physi-cian, including additional medical history information.

● Body measurements.. A dietary interview.● Selected diagnostic tests such as electrocardiograms and

x rays.. Laboratory tests on whole blood, serum, and urine speci-

mens.

and 20,322 (73. 1 percent) were examined. In the skin-testsample (6-74 years of age) there were 22,732 sample persons;20,L!I0 (89.8 percent) were interviewed and 16,204 (71.3percent) were examined. Overall, 95.8 percent of the examinedskin-test sample received 5 to 8 skin tests; 0.2 percent received1 to 4 skin tests; and 3.9 percent received O skin tests. Thesepercents remained fairly constant when examined usingselected demographic variables (appendix I).

Skin testing procedures andallergenic extracts

To optimize the interpretation and replicability of theskin-test results, a number of variables must be controlled,,30’31The following paragraphs describe the procedures used inNHANES 11to optimize the interpretability and replicabilityof the skin-test results.

The most commonly employed methods of skin testingare the intradermal and prick–puncture tests. 32The prick testwas chosen for a variety of reasons. It is simple to petiormand considered safer to use than the intradermal test in termsof poten@d for anaphylactic reaction because the prick–puncture method introduces only 0.01 to 0.0001 of the doseof extract used in the intradermal method. 33’34It also hasbeen recommended as the screening method of choice.35

‘The allergy skin test component consisted of a prick testwith eight selected, commercially available, FDA-licensedallergens and two controls-positive and negative. Figure 1shows the allergy skin test form.

The extracts used included indoor allergens (house dust,cat, dog) and outdoor allergens (altemaria, mixed giant andshort ragweed, oak, perennial rye grass, Bermuda grass).The concentration of the extracts was 1:20 weight by volume(W/V) in 50 percent glycerol saline. The labeled value simplydescribes the weight of the starting material (such as pollenor dust) and the volume of the extracting solution used tomalw the final extract (that is, 1 gram of pollen in 20 milliliters(mL) of extraction fluid), and is not a measure of allergenicpotency. The positive control was histamine phosphate andthe negative control was 50 percent glycerol saline.

Two batteries of allergens, identical in type but differingin bo,th method of manufacture and manufacturer, were usedduring the course of the survey as a result of a mixup inthe purchase order at the beginning of the survey. The first

Fgure 1. Alfergy ekin test form

5

allergens purchased were from a different manufacturer thanoriginally intended. When replacement allergens were orderedduring the survey, they were purchased from the initiallydesignated manufacturer.

The first extracts were 1:20 W/V in 50 percent glycerin.The second extracts were freeze-dried and reconstituted with50 percent glycerin to 1:20 W/V prior to use. After the complet-ion of 38 stands with the first extracts, the type of allergenicextracts used was switched. During the remaining 26 stands,the second allergenic extracts were used exclusively in 4stands. In 22 stands both the first and second extracts wereused, The dual-use stands were carried out to compare thereactivity between the two allergen batteries. In these dual-usestands, study persons with odd case numbers received thefirst extracts; those with even case numbers received the secondallergenic extracts. This selection process is equivalent torandom assortment of the sample persons.

Ideally, allergens used for testing should be stand-ardized,3&38 to maximize comparability between studies.However, in 1976-80 when NHANES II was carried out,standardized allergens were not commercially available. Dif-ferences in allergenic potency can cause rates of reactivityto vary. With the use of two different batteries of allergensin NHANES II, the authors were able to evaluate the potentialvariability in skin-test reactivity due to differences in allergenicpotency, This analysis was carried out by comparing ratesof reactivity to the individual allergens in the dual-use stands.The results of this analysis are fully presented in appendix11.In brief, the sample persons receiving freeze-dried extractshad increased rates of reactivity for house dust, oak, andBermuda grass as compared with those sample persons receiv-ing the glycerinated extracts. The absolute increase in reactivityranged from 3.5 percent to 4.7 percent. Only for the dogextract did the sample persons receiving the glycerinated ex-tracts have a higher rate of reactivity (absolute increase: 2.2percent). No differences in reactivity were found for altemaria,cat, ragweed, and rye grass. The small observed differencesin reactivity demonstrated that variations in allergenic potencybetween the two allergen batteries had relatively small effectson the prevalence estimates of the NHANES II survey. Thedifferential in reaction rates does not affect the subgroup com-parisons made in this report as the two types of antigen extractswere used in a uniform manner across all examined subgroupsexcept region. During the evaluation of regional rates of skin-test reactivity, the method of allergen manufacture was takeninto account.

Fresh vials of antigen were provided at the beginningof each stand, All vials, opened or unopened, were discardedat the end of each stand. When not in use, the vials werestored at a temperature between 24 degrees centigrade. Dur-ing use, the vials were maintained in a cool state by placingthem in a cold pack.

The recommended histamine-base concentration for prickskin testing is 1 milligram per milliliter (mg/mL) .32 In the

first 48 stands, 0.1 mg/mL histamine base (0.275 mg/mLhistamine phosphate) was used as the positive control, Forthe last 16 stands, 1 mg/mL histamine base (2.75 mg/mLhistamine phosphate) was used. The increase in histamineconcentration led to an increased rate of histamine reactivity.At the lower dose, the expected biologic variability of theresponse is so great as to make any comparisons meaningless.Thus the authors did not analyze the data collected on histaminereactivity in the first 48 stands. Interexaminer variability wasexamined only in the last 16 stands, which used 1.0 mg/mLhistamine base.

The procedure for carrying out the allergy-skin testingwas as follows .39 The inside of either forearm was cleanedwith alcohol and allowed to air-dry. Two rows of five dotseach were made with a black marking pen on the forearm.The skin over the elbow and wrist was avoided. A dropof each allergen solution was placed next to a different dotuntil all 10 components had been used. The tip of a 25-gaugeneedle was held at approximately a 45-degree angle to theskinl and was inserted simultaneously through the drop andtop layers of the epidermis. The tip of the needle was thengently lifted as it was removed, resulting in a slight tentingof the skin.

As soon as the first puncture was made, a timer wasset. At 10 minutes, the initial readings were taken and thetimer reset for an additional 10 minutes. During the firstreading, the length and width of the erythema and whealfor leach antigen was measured with a millimeter ruler, Thelength was defined as the largest diameter parallel to thelength of the arm. The length, therefore, did not necessarilyrepresent the largest diameter of the wheal or flare. The widthwas the diameter perpendicular to the length. If one reactionoverlapped another, “confluence” was checked for both anti-gens on the record sheet. If the wheal was greater than6 mm in length or width, the antigen solution was wipedoff. At 20 minutes, an identical set of readings was recorded.The times of the readings were noted only if they differedfrom 10 or 20 minutes. To enhance the demarcation of theborder of the erythema, the area was wiped with alcoholand a bright light was used.

Before testing began, the study persons were asked ifthey had ever had a positive skin test or a history of allergyto cat, dog, or ragweed. If the study person gave a positiveresponse to either question, the dog, cat, and ragweed allergenswere not applied initially. At the 10-minute reading the physi-cian reviewed the results of the remaining five antigens, Ifless than three showed a positive reaction, then dog, cat,and ragweed were applied to the other arm. If three or moreantigens were positive, only ragweed was applied.

The allergy skin tests were both performed and read bya he~althtechnician. A physician was consulted only whenthere was doubt as to the safety of the test administration,or if the patient experienced an untoward reaction to theskin test.

Method of analysis

Analytic strategies

Although two readings were taken during the exam, onlythe second reading was used for analytic purposes. The criteriaemployed to select between the two readings were based ondetection of the maximum amount of reactivity. The 20-minutereading found 18–25 percent more reactivity of the whealand erythema, depending on the antigen, than the 10-minutereading. All of the increases were statistically significant.Thus, the 20-minute reading was chosen for the analysis.

The size of the wheal and erythema was determined bytaking the average of the recorded length and width to computethe mean diameter. When only a length or width was recorded,this dimension was used as the mean diameter.

No uniformly agreed upon criteria exist to define a posi-tive, percutaneous hypersensitivity reaction. In the NHANESII survey, the cutaneous response was quantified by measuringboth the wheal and erythema at 10 and 20 minutes afterallergen administration. The size distributions for the whealand erythema reaction at 20 minutes for house dust are shownin figure 2. The size of the erythema reaction was largerthan the wheal reaction. The size relationship between thewheal and erythema as demonstrated here was typical of therelationship found with the other allergens used in this study.

The size of both the wheal and erythema can be measuredwith similar precision. “4’ However, the erythema responsewas chosen because of two important considerations. First,the precision of a bioassay is dependent upon the slope ofits dose-response curve-the steeper the curve, the greaterthe precision. 42 The slope of the wheal dose-response curveis flat,’6 significantly flatter than the slope of the erythemadose-response curve. a Second, small reactions (less than4 mm) are difficult to measure and highly variable.43’aErythema reactions are usually larger than wheal reactions4s(as was found in this study), and thus would have less ofa tendency to fall within this unreliable range (see figure 2).

Systems for grading skin-test reactivity have beensuggested for both the intradermal and prick-puncture testmethods, as shown in table B .32146NO criteria are uniformlyaccepted or used. The flatter dose-response curve for thewheal is readily apparent by the grading criteria used in bothsystems. The 1+ reaction in the intradermal grading systemhas been used as a lower cutoff point for skin-test positivity.32Using this grading system, patients with 1+ to 2+ skinreactions at high dilutions of allergens have been shown tohave high levels of specific IgE and a high correlation ofsymptoms following allergen exposure. 19

TableB. Suggestedgradingsyatemafor akintests

Intradermal’ PriclF

Grade Erythema (mm) Wheal(mm) Erythema (mm) Wheal(mm)

o... . . . . . <5 <5 Absent Absent+1- . . . . . 5-1o 5-1o (3) (3)l+ . . . . . . 11-20 5-1o <21 Absent2+ . . . . . . 21-30 5-1o >21 Absent3+ . . . . . . 31-40 10-15 Present Present (no

pseudopods)4+ . . . . . . >40 >15 Present Present

(pseudopods)

1Sss reference32at snd of text.2Seerefersnce46 at end of text.3Not part of the grading system.

NOTE mm = millimeter.

A conservative approach, aimed at the selection of onlythe more reactive individuals, was taken in deciding upona grading criteria for the erythema response in NHANESII. Because the prick test is 0.001 to 0.0001 times less sensitivethan the intraderrnal test (due to the lesser amount of allergenintroduced), the adoption of the lower limit of the intradermalcriteria for a 1+ reaction (Z 10.5 mm) for a positive pricktest in this study is a conservative cutoff point for establishingcutaneous reactivity to allergens. In support of this choice,others have used a 10 mm erythema reaction following aprick test as the threshold for detecting cutaneous allergicreactions .47 Thus, intradermal criteria for the categorizationof the erythema response were used.

For the purposes of this analysis, skin reactions weregraded according to the mean diameter of their intraderrnalerythema criteria, as specified in table B as follows: O mm(negative); 0.5-10.4 mm (+ or -); 10.5-20.4 mm (1 +);20.5–30.4 mm (2+); 30.540.4 mm (3 +); 40.5-99.5 mm(4+).

Statistical methods

The findings in this report are national estimates of skin-test reactivity in the U.S. civilian noninstitutionalized popula-tion 6-74 years of age as based on weighted observations.The weights were calculated as though the examined personsin each of the age, sex, and income classes were a randomsubsarnple of all sample persons (examined and nonexarnined)in the same class.

Initial analyses of the data revealed a marked changein skin-test reactivity with age. Direct age standardization

7

50

40

30

20

10

— Erylhema

---- Wheal

10 20 30 40 50 60

Mean diameter in millimeters

F~ure 2. Sie distribution for house dust at the 20-minute reading for pereons agaa 13-74 yeare: United States, 1976-60

was used to remove potential age confounding in the intergroupcomparisons made for this report. The reference populationused for standardization was the U.S. civilian nonin-stitutionalized population as of March 1, 1978, the midpointof the NHANES II survey.

The region of the country in which the skin testing occurredwas also found to be an important confounder for ragweed.Therefore, ragweed intergroup comparisons were adjusted forboth age and region of the country.

Observed differences in skin-test reactivity by demo-graphic and socioeconomic variables were tested for statisticalsignificance. Most of the analyses presented here are basedon t-tests comparing two population subgroups for meansor prevalence of certain conditions or characteristics. Thet-test consists of dividing the difference between the two meansor prevalence by the standard error of the difference. Thestandard error of a difference of estimates can be calculatedas follows. Let s be the standard error of the difference;

8

S1 (and S2 are the standard errors of the estimates xl andX2.Then

s = sqrt (sqr (S1) + sqr (s2) -2 (cov(xl ,xz))).

All the statistical testing in this report incorporate the calculatedcovariance in the estimation of the standard error of the differ-ence. However, covariances are not given in this report becausethey would take a great deal of space. Readers, therefore,wil’1have to perform their statistical testing without the useof the covariance term. Thus, when two groups or measuresare positively or negatively correlated, the standard error ofthe difference computed without the benefit of the covarianceterms will give an overestimate or underestimate, respectively,of the actual standard error of the difference. The use ofthis standard error will affect the calculated t statistic, eitherdecreasing, if the calculated standard error is increased, orincreasing it, if the calculated standard error is decreased.

This in turn could cause readers to come to differing conclu-sions concerning the statistical significance of a comparisonif the p value is near 0.05. The standard errors given inthis report will, however, allow readers to calculate confidenceintervals around the point estimates.

The standard errors of means and proportions in thisreport, not requiring age-adjustment, are calculated by a repli-cation technique that yields overall variability through observa-tion of variability among random subsamples of the totalsample, and which is appropriate to the complex survey designand estimation procedure. 48 The standard errors of meansand proportions, requiring age-adjustment, were crdculatedby a two-stage method: First, SURREGR49 to calculate the

variance-covariance matrix using Taylor series linearizationand second, passing the variance-covarktnce matrix into GEN-CAT50’5] a program for generalized least-squares categoricaldata analysis. Unless otherwise specified, tests for statisticalsignificance are two-sided tests and use a probability levelof 0.05 as the limit of statistical significance.

Statistical notes on the sample design, including samplesize and national population estimates, reliability of data,and sampling and measurements are included in appen-dix I. Sources of variation affecting the reliability of theskin-test data are discussed in appendix II. Demographic andsocioeconomic terms are defined in appendix IN.

9

Overall prevalence

Detailed tables 1–30 present the percent positive, thepopulation estimates of the number of positives in thousands,and the distribution of reactivity by age, race, and sex forthe individual allergens. Table 31 presents the median valuesfor the positive reactions by race and sex. These tables arepresented as reference for readers wishing to compare theirfindings with the reactivity found in the various age-sex-racesubgroups in NHANES II. Caution must be used when intm-pre-ting the skin-test results given for black persons in the detailedtables as many of the estimates are unstable because of smallsample size. Despite this problem, the data are presentedbecause no other data on skin-test reactivity in a sample ofthe U.S. black population exist. The analyses performed forthis report are based on overall reactivity with age-adjustmentand adjustment for region, when appropriate. The use of overallreactivity for all age groups combined allows stable estimatesto be made for black persons during the subgr’oup analysescarried out in this report.

Table C presents the overall prevalence rates for positiveskin-test reactivity to the allergens used in this study. Theallergens were divided into two groups: Indoor allergens—house dust, cat, and dog; and outdoor allergens—altemaria,ragweed, oak, rye grass, and Bermuda grass.

Rye grass and ragweed elicited the most positive reactionswith about 10 percent of the population reacting to each

Table C. Percent of positive skin-test reaction for persons ages 6-74 years byallergen groupq with standard errors United States, 1976-60

Allergen group Percent positive’ Standard error

Allallergensz . . . . . . . . . . . . . . . . . . ,. 20.2 0.83

lndoorallergens3 . . . . . . . . . . . . . . . . . 7.6 0.62

House dust. . . . . . . . . . . . . . . . . . . . . . 6.2 0.86

Cat . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.3 0.26

Dog . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.3 0.25

0utdoorallergens4 . . . . . . . . . . . . . . 17.7 0.74

Ryegrass . . . . . . . . . . . . . . . . . . . . . . . 10.2 0.56

Ragweed . ., . . . . . . . . . . . . . . . . . . . . 10.1 0.57

Oak . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.7 0.36

Bermuda grass . . . . . . . . . . . . . . . . . . 4.4 0.42

Alternaria . . . . . . . . . . . . . . . . . . . . . . 3.6 0.26

1Mean diameter of the erythema reaction greater than or equal to 10.5 millimeters.2At least one allergen positive.3At least one indoor aeroallergen positive.4At least one outdoor aeroallergen positive.

allergen. Reactivity to house dust, oak, Bermuda grass, alter-naria, cat, and dog ranged from 2.3 percent to 6.2 percent.Outdoor aeroallergens, in general, caused a higher rate ofreactivity than indoor aeroallergens (17.7 percent versus 7.6percent, p< O.001).

Among persons who reacted to at least one allergen fromthe indoor allergen group, 84.4 percent reacted to house dust.The addition of either cat or dog to the house dust raked thepercent positive to 92.9 percent and 93.8 percent, respectively.Among persons who reacted to at least one allergen fromthe outdoor allergen group, 59.3 percent reacted to eitherra~gweedor rye grass separately. Reaction to ragweed and/orrye grass occurred in 88.1 percent. The addition of alternariaincreased the reaction rate to 95.5 percent. Thus, it is possibleto detect a majority of the skin-test reactors in the populationby using only a small subset of the allergens (house dust,rye grass, and ragweed).

Variations in reactivity

Skin-test reactivity can be used to dichotomize a popula-tion into allergic and nonallergic groups. In addition, skintests can also be utilized to study the variations in reactivityvAthin the allergic group. The degree of reactivity can beranked by the size of the reaction to allergenic skin testsand histamine. This section will examine the variations ofre~activityin the skin-test-positive group.

Overall, 20.2 percent of the population had at least onepolsitive skin test. An examination of the percent distributionof the number of positive skin tests revealed a rapid dropoffin the percent reactive as the number of positive skin testsincreased (9.0 percent reacted to only one allergen whereas0.9 percent reacted to 6-8 allergens—table D). The percentdistribution of the number of positive skin tests did not changewhen dermatographism was controlled by eliminating all sam-ple persons who reacted to the saline control.

The mean size of the positive reaction ranged from22.6 mm for persons reacting to just one skin test to 26.6mm for persons reacting to 6-8 skin tests. A positive relation-ship was found between the number of positive skin testsand the mean size of the allergic reaction (p<0,05).

The changing size of the histamine reaction with an in-creasing number of positive skin test reactions is shown intable E. The recommended histamine concentration for skinpuncture testing is 1 mg/mL. 32 only the last 16 stands of

the survey, in which a 1 mg/mL histamine base was used,

10

TableD. Pementdistributionsand mean size of positivemactlonfor personsages 6-74 Yeatsby numberof positiveskin tests;with standarderrors:UnitedStatea, 1976-80

Mean sizeNumber of Percent Standard of positive Standard

posifive skin tests’ distribution error reaction (mm) error

o. . . . . . . . . . . . . . . . 79.8 0.83 0 01 . . . . . . . . . . . . . . . . 9.0 0.37 22.6 0.392................ 4.7 0.24 24.0 0.323................ 2.6 0.21 24.2 0.434................ 1.8 0.15 25.7 0.455................ 1.2 0.16 27.3 0.686-8.............. 0.9 0.13 28.6 0.58

i Meandlsmeterof theerythemareactiongreaterthanoraqual to 10.5mm.

NOTE mm = millimeter.

TableE Mean sizeof histaminerasotionfor pereonsages 6-74yearsbynumberof positiveskintest!%with stendstderrors UnitedStates, 1976-60

Number of Mean size of Standardpositithzskin tests’ histamine (mmF3 error

o. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18.1 0.701................................. 19.5 0.692................................. 20.2 0.843................................. 18.6 0.894................................. 19.1 0.825................................. 2!?2 0.876-8............................... 22.3 2.46

1Meandiameterof theerythemareactiongraaterthanorequalto 10.5mm.2Limltedtostandsusing1mg/mLhistaminebaseas the positivecontrol.3MeandlameteroftheerythemareactiongrsaterthanOmm.

NOTES mm = millimeter.m9 = milligram.mL = milliliter.

TableE Mean size of histaminetsraotlonfor personaages 8-74 yearsby meansizeof ye grass teactiow with standardemors:UnitedStatea, 1976-80

Mean sizeMean size of of histamine Standard

rye grass reaction reaction (mm)’,2 error

0-10.4mm . . . . . . . . . . . . . . . . . . . . . . . . . . 18.4 0.7010.5 -30.4 mm . . . . . . . . . . . . . . . . . . . . . . . . 18.4 0.8830.5-88.9 mm . . . . . . . . . . . . . . . . . . . . . . . . 20.3 0.94

1Limitedtostandsualng1mg/mLhistaminebaseas the positivecontrol.2Meandiameterof theerjthema reactiongraatarthanOmm.

NOTES mm = millimeter.m9 = milligram.mL = milliliter.

are included in analyses of histamine reactions. The previous48 stands used a 0.1 mg/mL histamine base. At this lowerdose, the expected biological variability of the response is

so great as to make any comparisons meaningless. See appen-dix II for further details. The size of the histamine reactionranged from 18.1 mm for persons with zero-positive skintests to 22.3 mm for persons with 6-8 positive skin tests.Thus, a statistically significant positive relationship was foundbetween the number of positive skin tests and the mean sizeof the histamine reaction.

Next, the relationship between the size of the histamineand the size of the allergic reaction was examined (ta-ble F). Rye grass was chosen because it was one of themost reactive allergens in our study. No significant associationwas observed between the size of the histamine reaction andthe size of the allergic reaction.

In summary, a statistically significant relationship existedbetween the number of positive skin tests and both the sizeof the positive allergic skin test and the size of the cutaneoushistamine reaction. However, there was no relation betweenthe size of the histamine reaction and the size of the allergenreaction.

Reactivity to at least one allergen differed markedly withage. Peak reactivity occurred in the 18-24 years of age group(men—33.3 percent, women—25.2 percent). The differencesin the prevalence rate of skin-test reactivity to at least oneallergen by age, race, and sex are shown in figures 3 and4. Figure 3 displays the percent of white persons who reactedto at least one allergen by age and sex. Reactivity peakedin the 18-24 years of age group for both white males andwhite females. The peak reactivities were 32.0 percent forwhite males and 24.3 percent for white females. F@re 4displays the percent of black persons who reacted to at leastone allergen by age and sex. Some point estimates, especiallyover age 34 years, me unstable because of small samplesizes, but the results are presented to show in general thatchanges in reactivity with age appeared to be similar in blackand white persons. Reactivity peaked in the 18-24 years ofage group for black males and in the 12-17 years of agegroup for black females. The peak reactivities were 39.5percent for black males and 32.7 percent for black females.

On closer examination of tables 1-30, it is readily apparentthat skin-test reactivity for each individual allergen differedin a similar manner with age. Peak reactivity was in the12–24 years of age group for all of the allergens.

11

40

35

30

25

20

15

10

5

0

Male

---- Female

I 1 I 1 I I I I [

6-11 12–17 18–24 25-34 35-44 45-54 55-64 65-74

Years of age

NOTE: A positive reaction is a mean erythema diameter of greater than or equal to 10.5 millimeters resulting from at least one skin test.

Fiiure 3. Overall skin-test reactivity by age and sex for white persons United States, 1976-60

12

Male

---- Female

40 .

35

30H

*25

~,-,~0Q 20E~3L

15

10 \**

5*

o I I 1 I I 1 I 1

6-11 12-17 16-24 2%34 35-44 45-54 5.5+4 65-74

Years of age

NOTE A positwe reatition is a mean erythema diameter of greater than or equal to 105 mdlimetersresukmg from at least one skm test

Fiiure’?4. Skin-test reaotivily by age and sex for black peraorw UnitedStateaj1976-S0

Pollination location and season

Not all the allergens tested in this survey are uniformlydistributed throughout the United States. Likewise, not allallergens are present throughout the year in their respectivegeographic domains. Thus, the geographic location or seasonof the year in which the skin tests were performed couldpossibly affect the prevalence of reactivity to certain allergens.Therefore, the effects of geographic location and season onskin-test reactivity were further explored for the appropriateallergens.

The skin-test data from three pollen allergens (giant andshort ragweed, oak, and Bermuda grass) were analyzed todetermine the effects of intensity of pollen exposure on cutane-ous reactivity. These allergens were chosen because they havedifferent geographic distribution52’53 and pollen intensities54in the United States.

The percent positive was compared between the high-pol-len areas and the low-pollen areas for each antigen shown

in table G. Only for ragweed did regionality appear to beimportant (13.3 percent in high-pollen areas versus 7.2 percentin low-pollen areas, p<O.001 ). The prevalence rates for skin-test reactivity were essentially identical between high- andlow-pollen areas for oak and Bermuda grass.

Regarding seasonality, the skin-test data from two pollenallergens that have well-recognized pollen seasons wereexamined. The allergens and their pollination seasons aregiant and short ragweed—August through October and oak—April through June. The analyses were carried out on datacollected only within the high-pollen areas for the respectivepollens to eliminate the potential for geographic confounding(table H). No statistically significant seasonal variation wasnoted. However, for both allergens the percent reacting wasincreased in the out season, with ragweed reaching marginalsignificance (11.6 percent in season versus 14.3 percent outof season, p= O.06).

13

Table G. Percent of positive skin-test reactions for pereons ages 6-74 yearaby allergen and pollen are% with standard errore and p valuesUnited Statea, 1976-80

Allergen and Percent Standard Ppollen area positlve”2 error value3

Giant andshort ragweed

High-pollen areaNortheast and

Midwest . . . . . . . . . . . . . . . . . . . . . . 13.3 0.66

Low-pollen area

South and West . . . . . . . . . . . . . . . . 7.2 0.93 <0.001

Oak

High-pollen area

Northeast, Midwest,

and South . . . . . . . . . . . . . . . . . . . . . 4.6 0.46

Low-pollen area

West . . . . . . . . . . . . . . . . . . . . . . . . . 5.0 0.46 0.50

Bermuda grass

High-pollen areaSouth . . . . . . . . . . . . . . . . . . . . . . . . 3.1 0.71

Low-pollen area

Mideast . . . . . . . . . . . . . . . . . . . . . . 3.3 0.64 0.85

1Mean diameter of the erythema reaction greater than or equal to 10.5millimeters.2Age.adjusted to U.S.population, March 1,1978.sHigh pollan araavarsus low pollan area.

Tabfe H. %mentofpositive skln.test reactions forpemonaagea 6-74yeambyailergen, geographic region, and poiien aeaaom with standard errore and pvalues United Statea, 1976-60

Allergen,geographic region, Percent Standard IQand pollen season Positive’ ‘z error values

Giant and short ragwead,

Northaast andMidwest only

In season:Aug.15- 0ot.15 . . . . . . . . . . . . . . 11.6 0.93

Out of season:

0tt.16- Aug.14 . . . . . . . . . . . . . . 14.3 0.90 0.06

Oak, Northeast,

Midwest, and South

In seaeonApr.15- June7 . . . . . . . . . . . . . . . 4.5 1.12

Out of season:June6-Apr.14 . . . . . . . . . . . . . . . 4.6 0.51 0.90

1Mesn dlsmeter of the e~hema reaction greater than or equal to 10.5mllllmaters.2Aga.adjueted to U.S.population, March 1,1978,3In seeson varsusout of aaaaon.

These findings suggest that the change in the skin-testreaction may come after the pollen season, To investigatethis further, the out season was divided into two parts (ta-ble J). The first part covered a period of time immediatelyfollowing and of the same duration as the pollen season;the second part encompassed the remaining time in the outseason. It appeam that reactivity in the out season was highestin the period immediately following the pollen season. How-ever, none of the differences reached statistical significance.

Tabfe J. Percant of positiva akin-test reactions for persons ages 6-74 years byafiargen, geographic region, and poiien aeaaom with standard errorsUnited States, 1976-60—

Allergen,geographic region, Percent Standardand pollen season positive”2 error

Giant and short ragweed,Northeast andMidwest oniy

In season:

Aug.15- oct.15 . . . . . . . . . . . . . . . . . . . . . . . . 11.6 0.93

Out of season:0tt.16- Jan.15 . . . . . . . . . . . . . . . . . . . . . . . . 16.4 2.60Jan.16- Aug.14 . . . . . . . . . . . . . . . . . . . . . . . . 13.3 0.91

Oak, Northeast, Midwest,

and South only

In season:

Apr.15- June7 . . . . . . . . . . . . . . . . . . . . . . . . . 4.5 1.12

Out of eeason:

Jlune6- Sept.15 . . . . . . . . . . . . . . . . . . . . . . . . 5.5 0.68~ept.16-Apr.14....................... 4.1 0.76

1Mean diametsrof ths srythsma reaction greater than or equal to 10.5mlllimetsrs.2Age.adjusbd to U.S.population, March 1,197&

Sex and race comparisons

Differences in skin-test reactivity by sex and race wereexamined and the results reported in table K. The resultsof tlhe statistical testing done among the various subgroupsare reported in table L. Given the changes in reactivity withage, the sex- and race-specific analyses were controlled forage. When examining ragweed, one must also control forregion of the country in addition to age. The prevalence rateof skin-test reactivity to at least one allergen was higher inmales, as compared with females (22.2 percent versus 18,4percent, p<O.001). (See figure 5.) When the difference inreactivity by sex was stratified by race, white males hada higher prevalence rate than white females (21.6 percentversus 17.5 percent, p<0,001-figure 6), but the prevalencerate in black males and females was approximately equivalent(23.2 percent versus 23,3 percent—figure 6). Examining indi-vidual allergens for all races, data showed that males hadhigher rates of reactivity than females for house dust, alter-naria,, ragweed, oak, rye grass, and Bermuda grass. The abso-lute increases ranged from 0.7 percent to 3.3 percent. Amongwhite persons, males had higher rates of reactivity than femlalesfor house dust, ragweed, oak, rye grass, and Bermuda grass.The i~bdute increases ranged from 1 percent to 3.5 percent,p< O.05. Among black persons, females had a higher rateof reactivity than males for dog allergen (absolute increase=’ 1.8percent; p= Oo04).

Differences in skin-test reactivity by race were examined.The prevalence rate of reactivity to at least one allergen washigher in black persons as compared with white persons forboth sexes combined, but the difference was not statisticallysignificant (23. 2 percent versus 19.5 percent). Looking atthe individual allergens by sex, data showed that black femaleshad a higher rate of reactivity as compared with white<females(23.3 percent versus 17.5 percent, p= 0.03). Among males,the rate of reactivity was higher in black persons as compared

14

TableK. Age-adjustedprevalenceratesof skin-testreactivityfor personsages 6-74 yearaby seleded allergens,sex,and ractywith standarderrorsUnitedStates,1976-60

Both sexes Male Female

Race and Percent Standard Percent Standard Percent Standardselected allergen positive”2 error positive’,2 error positive’,2 error

All races3

Allallergens4 . . . . . . . . . . . . . . . . . . . . . 20.2 0.83 222 1.06 18.4 0.87

House dust . . . . . . . . . . . . . . . . . . . . . . 6.2 0.62 8.8 0.81 5.6Alternaria . . . . . . . . . . . . . . . . . . . . . . . .

0.643.6 0.26 4.1 0.36 3.2

Cat . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.30.92

0.26 2.2 0.30 2.5 0.27Dog . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.3 0.25 2.3 0.30Ragweed5

2.3 0.25. . . . . . . . . . . . . . . . . . . . . . . 10.1 0.57 11.6 0.70 8.7

Oak . . . . . . . . . . . . . . . . . . . . . . . . . . . .0.56

4.7 0S6 5.4 0.44 4,1 0.36Ryegrass, . . . . . . . . . . . . . . . . . . . . . . . 10.2 0.56 11.9 0.68 8.6Bermuda grass . . . . . . . . . . . . . . . . . . . 4.4

0.620.42 4.8 0.47 4.1 0.45

White

Allallergens’ . . . . . . . . . . . . . . . . . . . . .

HOUSedust . . . . . . . . . . . . . . . . . . . . . .Altemaria. . . . . . . . . . . . . . . . . . . . . . . .Cat . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Dog . . . . . . . . . . . . . . . . . . . . . . . . . . . .Ragweed. . . . . . . . . . . . . . . . . . . . . . .Oak, . . . . . . . . . . . . . . . . . . . . . . . . . . .Ryegrass . . . . . . . . . . . . . . . . . . . . . . . .Berrnudagrass, . . . . . . . . . . . . . . . . . .

Black

Allallergens’ . . . . . . . . . . . . . . . . . . . . .

House dust . . . . . . . . . . . . . . . . . . . . . .Altemaria . . . . . . . . . . . . . . . . . . . . . . . .Cat,.. . . . . . . . . . . . . . . . . . . . . . . . . . .Dog . . . . . . . . . . . . . . . . . . . . . . . . . . . .Ragweed. . . . . . . . . . . . . . . . . . . . . . .Oak . . . . . . . . . . . . . . . . . . . . . . . . . . . .Ryegrass . . . . . . . . . . . . . . . . . . . . . . . .Bermuda grass, . . . . . . . . . . . . . . . . . .

19.5

5.93.62.32.29.64.5

10.04.3

23.2

7.03.62.32.7

13.05.5

10.44.8

0.600.560.270.270.240.510.330.540.44

2.52

1.760.460.500.782.171.141.390.62

21.6

6.53.92.12.3

11.45.3

11.74.8

23.2

7.64.32.11.7

12.55.5

11.54.1

1.01

0.650.410.310.290.640.430.670.50

3.10

2.340.950.720.602.561.461.731.04

17.5

5.43.22.42.07.93.88.33.8

23.3

6.529273.5

13.55.59.55.5

0.79

0.620.320.280.220.4s0.350.570.44

2.84

1.500.640.560.942.231.251.621.06

1Ag&sdjusted to U.S.population, March 1,1978.2Me.andiameter of the erythema reaction greater than or equal to 10.5millimeters.slnclu~s data for racesnot shcwn Separately.‘Rea:tion to at least one of the allergens.5Aga and region adjustd.

TableL p valuesof twmsldedt.tests byselectedallergens,$e& and race for pereonsages6-74 yearx UnftedStater&1976-60

Male versus female White versus black persons

Allergen All races’ White Black Both sexes Male Female

Allallergens2 . . . . . . . . . . . . . . . . . . . < O.fx)l <0.031 0.99 0.14 0.58 0.03

House dust, . . . . . . . . . . . . . . . . . . . .

Alternaria . . . . . . . . . . . . . . . . . . . . . .Cat . . . . . . . . . . . . . . . . . . . . . . . . . . .Dog... . . . . . . . . . . . . . . . . . . . . . . . .Ragweed . . . . . . . . . . . . . . . . . . . . . .Oak. . . . . . . . . . . . . . . . . . . . . . . . . . .Ryegrass . . . . . . . . . . . . . . . . . . . . . .Bermuda grass. . . . . . . . . . . . . . . . . .

0.040.050<150.85

< O.CQ10.093O.CQ10.05

0.160.420.25

<0.0010.001

<0.0010.009

0.460.320.430.040.560.96O.f?a0.28

0.510.920.920.500.100.400.770.53

o.5a0.700.680.460.630.86O.ea0.47

0.470,630.660.15o.cFxl0.210.490.15

1Includas data for races not shown separately.2Re,actionto at least one of theaUer9ens.

15

25

r

20

5

0Female Male Both sexes

NOTE A positive reaction is a mean erythema diameter of greater than or equal to10.5 millimeters reau!ting from at least one skin test,

Fwra 5. Age-adjusted skin-teat reactivity by sex for persons ages 6-74yesm United States, 1976-60

with white persons, but it did not reach statistical significance(23.2 percent versus 21.6 percent, p= O.52). Data for theindividual allergens showed that black persons had a tendencyto have higher rates of reactivity than white persons, butnone of the differences reached statistical significance exceptfor black females as compared with white females for ragweed(13.5 percent versus 7.9 percent).

Socioeconomic ststus (SES)

The age-adjusted differences in skin-test reactivity be-tween people living below poverty level and those livingat or above poverty level are shown in table M. Overallreactivity was greater in persons living at or above the povertylevel (21.0 percent versus 15.8 percent, p< O.001). Data forthe individual allergens revealed that higher rates of reactivityexisted for people living at or above the poverty level foraltamaria, ragweed, oak, rye grass, and Bermuda grass. Theabsolute increases ranged from 1.3 percent to 3.7 percent.

The relationship between poverty and skin-test reactivitywas further investigated by examining a more detailed incomedistribution and the effects of education. The prevalence ratefor reactivity to at least one allergen increased from 15.3percent with $0-5,999 income to 24.7 percent with $20,000or more (table N). Controlling for age, there is a statisticallysignificant positive relationship between reactivity and income.

Female Male Both sexes Female Male Both sexes

White persons Black persons

NOTE: A positive reaction is a mean erythema diameter of greater than or equal to 105 millimeters resulting f mm at least one skin test

F~ure 6. Age-adjusted sldn-test reactivity by race and sex: United States, 197H0

16

Table M. Skin-test reactivity for persons ages 6-74 yeara by poverty level and selected allergenq with standard errore and p values United States, 1976-60

Below poverty level At or above poverty level

Percent Standard Percent StandardA//ergen

Ppositive’,2 error positive’,z error value

Allallergens3 . . . . . . . . . . . . . . . . . . . . . . . .

House dust . . . . . . . . . . . . . . . . . . . . . . . . .

Alternana. . . . . . . . . . . . . . . . . . . . . . . . . . .Cat . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Dog . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ragweed. . . . . . . . . . . . . . . . . . . . . . . . . .

Oak . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ryegrass . . . . . . . . . . . . . . . . . . . . . . . . . . .Bermuda grass . . . . . . . . . . . . . . . . . . . . . .

15.8

5.3

1.91.82.5

7.2

3.6

7.12.8

1.51

0.95

0.350.440.5S

0.95

0.61

0.72

0.43

21.0

6.34.0

2.42.3

10.64.9

10.8

4.8

0.85

0.65

0.300.260.25

0.590.37

0.63

0.49

<0.001

0.12

<0.0010.180.82

<0.001

0.04

< O.(XI10.032

1Ag&adjusted to U.S.population, March 1,197S.2Mean dismeter of the erythema reaction greater than or equal to 10,5millimeters.3Reaction to at least one of the allergens.4Ageand region adjusted.

Table N, Skin-test raasth’ity for persons ages 6-74 yeare by family incomelev~ wiftr standard errors United States, 1976-S0

Family Percent Standard

income level positive”2 error

$0-$5,%39 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15.3 1.36

$6,000 -$9,999 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17.9 1.14

$10,030 -$19,999 . . . . . . . . . . . . . . . . . . . . . . . . . . . 19.6 0.97

$20,0000rmore . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24.7 0.97

lAge-sd@sted to U.S.population, March 1, 197S.‘Mean diamster of the erythema reaction greater than or equal to 10.5millimeters to at leastone allergen.

Table O. Skin-fest mactivityforpersons ages6-74yeare byeducationlava~with standard errors United States, 1976-60

Percent StandardEducation level’ positive2,s error

0-8years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13.0 1.33

9-12years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17.9 0.66

13yeara orrrwre . . . . . . . . . . . . . . . . . . . . . . . . . . 25.5 1.07

1Number of years attended by head of household for sample persons 19yearaof age andunder.Numberof years attended by sample persons XI yearaof age or over.

2Age-adjustedto the U.S.population, March 1,1976.3Mean diameter of the erythema reaction greater than or equal to 10,5millimeters to at leastone allergen,

Next, the effects of education on overall skin-test reactivitywere examined (table O). Education level was defined inone of two ways depending on the age of the sample person.If the sample person was under 20 years of age, the educationlevel of the head of the household was used. If the sampleperson was 20 years of age or over, the individual’s educationlevel was used. The prevalence rate for reactivity to at least

, one allergen increased with increasing education level (13.0percent with O-8 years of education to 25.5 percent withat least some college). Controlling for age, there is a statisti-cally significant positive relationship between reactivity andeducational level. The effects of income and education re-mained constant in males and females.

Residency

Urban or rural differences in skin-test reactivity areexplored in table P. Higher rates of reactivity were notedin urban areas for all allergens. Overall reactivity was greaterin the urban areas versus the rural areas (22.0 percent versus16.5 percent, p<O.001 ). For the individual allergens, higherrates of reactivity occurred in urban dwellers for altemaria,cat, dog, ragweed, oak, and rye grass. The absolute increasesranged from 0.7 percent to 3.2 percent.

The increase in reactivity in urban areas was investigatedfurther by subdividing residency into four parts: standard met-ropolitan statistical area (SMSAjcentral city, SMSA–not cen-tral city, not SMSA–not rural, and not SMSA–rural (ta-ble Q). To control for race and income effeets, this analysiswas limited to white persons above the poverty level. Reactiv-ity remained higher in the SMSA (21.1 percent and 23.5percent) than outside SMSA areas (17.6 percent and 15.6percent). The difference between areas in the central cityand not in the central city within SMSA was not statisticallysignificant. However, results suggest that the higher ratesof reactivity in urban areas appear to lie outside of the centralcity.

17

Table P. Skin-test reactivity for pereons ages 6-74 yeare by selected allergens and urban or rural residence; with standard emors and pvafue~ United States, 1976-80

Urban Rural—

Percent Standard Percent Standard PSe/ected a//ergen pOsitive’,2 error positive’,2 error value

Allallergens3.. . . . . . . . . . . . . . . . . . . . . .

House dust . . . . . . . . . . . . . . . . . . . . . .

Alternaria .,..,.....,..,..,..,.. . . .

Cat . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Dog . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ragweed . . . . . . . . . . . . . . . . . . . . . . . . .

Oak . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ryegraaa . . . . . . . . . . . . . . . . . . . . . . . . .Bermuda grass, . . . . . . . . . . . . . . . . . . .

22,0

6.54.12.52.6

10.65.1

11.24.7

1.08

0.840.310.3.20.33().7!3

0.460.740.5’1

16.5

5.4

2.5

1.81.6

8.53.9

8.03.9

1.12

0.73

0.35

0.290.26

0.720.42

0.65

0.49

<0.001

0.27< O.OQ1

0.050.01

0.020.05

<0.0010.16

1Age-adjusted to U.S.population, March 1,1978.2Meandiameter of the erythema reaction greater than or equal to 10.5millimeters.3Reaction to at least one of the ellergens.4Ageand region adjusted.

Table Q. Skin-test reactivity for white pereons agea 6-74 years who areabova the poverty Iaval by place of residencq with standard errorsUnited Statee, 1976-80

P/aca of Percent Standardresidence posithfe”2 error

SMSA

Central ity . . . . . . . . . . . . . . . . . . . . 21,1 1.74

Noncentral city..........,,..,.. 23.5 1.16

Not SMSA

Nonrural . . . . . . . . . . . . . . . . . . . . . . 17,6 1.46

Rural . . . . . . . . . . . . . . . . . . . . . . . . . 15.6 1.43

I Ageadjuated to US. population, March 1,1976.2Mean diameter of the erythema reaction greater than or equal to 10.5millimeters.

NOTE SMSA = Standard metropolitan atatlatical area.

Geographic region

Reactivity to at least one allergen by geographic regionof the country is examined in table R. The Northeast wasconsistently the highest area of reactivity (25,4 percent); theSouth was the lowest (14.2 percent); and the Midwest (20.6percent) and West (20.6 percent) were in an intermediateposition. The rates of overall reactivity by region were rerunexcluding ragweed. This approach was used to determineif the difference seen could be explained by the geographicdistribution of ragweed—an important factor in ragweed’sreactivity. The removal of ragweed had little effect on theresults other than that of lowering the rate of reactivity. Thegeographic ranking of reactivity remained unchanged if onlythe indoor allergens (house dust, cat, and dog) or only theoutdoor allergens (alterrtaria, ragweed, oak, rye grass, andBermuda grass) were examined. It was previously noted thatfor four allergens (house dust, dog, oak, and Bermuda grass)

Table R. Skin-test reactivity for pereons agee 6-74 years by allergen group andgmgraphic region; with stsndard errore: United Ststee, 1976-60

Allergen group Percent Standardand geographic region positive”2 error

—

All allergens

Northeast. . . . . . . . . . . . . . . . . . . . . 25.4 1.47

Midwest . . . . . . . . . . . . . . . . . . . . . . 20.6 1.87

west . . . . . . . . . . . . . . . . . . . . . . . . . 20.6 1.10South . . . . . . . . . . . . . . . . . . . . . . . . 14.2 2.40

Indoor allergens3

Northeast . . . . . . . . . . . . . . . . . . . . . 10.1 1.47

Midwest . . . . . . . . . . . . . . . . . . . . . . 8.1 1.21

Wee. . . . . . . . . . . . . . . . . . . . . . . . . 6.5 0.90

South . . . . . . . . . . . . . . . . . . . . . . . . 6.0 1.65

0utdoorallergens4

Northeast . . . . . . . . . . . . . . . . . . . . . 22.2 1.32

Midwest . . . . . . . . . . . . . . . . . . . . . . 17.4 1.47

West . . . . . . . . . . . . . . . . . . . . . . . . . 18.7 1.26

SOIJth . . . . . . . . . . . . . . . . . . . . . . . . 12.1 2.06

1Age-adjusted to the U.S.population, March 1,1978.2Mf>andiameter of the arythema reaction greater than or equal to 10.5millimeters to at leastone allergen.

3Hc,usedust, cat, dog,4Alternarla, ragweed,oak, ryegrasa, Bermuda graaa.

there was a difference in reactivity between the two typesof allergens (based on manufacture) used in this study. Also,the use of the allergens was not uniform in all four regions(see appendix II for more detail). To examine the possibilitythat the interregional differences were due all or in part todifferential allergen use, the four allergens in which therewas a difference in reactivity were excluded and the regionalanalyses were rerun. The regional differences remained thesame.

18

Discussion

The overall prevalence of skin reactivity to one or moreof the eight allergens in this study is 20.2 percent. Thisis a conservative estimate of the prevalence of immediatehypersensitivity for a number of reasons. A conservative cutoffpoint was used to define a positive reaction. Also, approxi-mately 11.3 percent of the eligible sample persons in NHANESII did not receive alI eight allergen skin tests and histaminefor a variety of reasons, such as a past history of allergies,a history of pmwious allergy shots, use of allergy medication,and patient retkd. These nontested individuals reported ahigher rate of asthma, hayfever, and other allergies than theskin-tested individuals (table V). Thus, it is likely that theexclusion of these individuals from our survey &creased therates of reactivity found. The loss of the nontested individualsdid not introduce any significant amount of bias when makingsubgroup analyses as it was spread fairly evenly over allage, race, sex, urban or rural, and poverty level groups.

Prevalence rates for reactivity reported in the literaturecan be divided into two groups according to whether the

Tdrlr)S. Skin-tsststdlssof ~fW-@ss cfrfmnde@c popdstbm3

population studied was or was not allergic. Studies completedon a wide variety of populations consisting of either randomsamples of communities or nonallergic persons are summarizedin table S.8’5- A wide range of prevalence rates of skin-testreactivity has been reported (5 percent to 64 percent). Studiesconducted on allergic populations are summarized in ta-ble T.8’26’57’59$W’62’65The range of prevalence estimates issimilar (27. 1 percent to 87 percent), but the estimated ratesof reactivity are higher. In both allergic and nonallergic popula-tions, the rates of reactivity reported in international studiesare higher than those reported in domestic studies. This in-crease in reported reactivity maybe due to a variety of reasons,such as differences in allergens used, varying criteria forpositivity, or true differences in reactivity. Our overall preva-lence rate of 20.2 percent is approximately equal to the approxi-mate mean value found in table S for domestic studies onnonallergic populations.

The reactivity of the U.S. population to the allergenicextracts tested was highest to pollens-16.5 percent, followed

Author Years Number of Typeof percentof study Location Subjects of age extracts test positive

Domestic studies

Currant’ . . . . . . . . . . . . . . . . . . Ikston 100 nonallergic 16-80 +Hag# . . . . . . . . . . . . . . . . . . . .

9 scratch 5.0Providence 765 nonallergic 16-20

Lindblad3. . . . . . . . . . . . . . . . . .15 scratch 17.4

Pittsburgh 100 nonallergic 16-81Freidhofi . . . . . . . . . . . . . . . . .

5 intradermal 424.0Saltlmom 115 random subjects la-55 7 prick 24.3

from industrial plantBarbee6. . . . . . . . . . . . . . . . . . . Tucson 3102 community sample 3-75 + 5 prick 34.0

international studies

Bandele’ . . . . . . . . . . . . . . . . . . Nigeria lCOnonallergicTana

10-60 22 not stated 10.0. . . . . . . . . . . . . . . . . . . . . . Singapore 50 nonallergic 10-73

Haahtelag . . . . . . . . . . . . . . . . .21 prick 12.0

Finland 70Ssample of 15-17 16 prick 49.09th gradera

Herxheimer’” . . . . . . . . . . . . . . London 100 nonallergic 5-75Haahtela’’ . . . . . . . . . . . . . . . . .

12Finland

prick 50.0295 nonallergic 18-19 16 prick 50.0

army conscriptsCserhati’z . . . . . . . . . . . . . . . . . Hungary 300 nonallergic 2-16 20 prick 64.0

1seereference56atandof text.‘see reference 8 at end of text.3% reference 56 at end of text.4Results from 1:10 concentration.5Sea mfemrme 57 at end of text.‘% rafemnoe 58 at end of text.7Sss raference E4 at and of text.%x3 mfemince EOat end of text.‘sea mfemnca 61 at end of text.

‘OSs-s reference 62 at and of text.‘‘ 8ss reference &3 at end of text.‘2S-9s mfemnce 64 at end of text,

19

by house dust-6.2 percent, animal allergens—3. 8 per-cent, and mold—3. 6 percent. Other studies have report-ed differing percents of reactors and/or different orders ofrelative reactivity to some of the allergens testecl inNHANES 11.56’58’6’‘G346However, comparison of skin-testresults between different studies must take into account thenumber and type of allergenic extracts used for testing, themethod of test administration, the criteria for test positivity,the demographic and atopic characteristics of the populationstested, and the locales in which the testing was carried out.

The potency and composition of the allergenic extractsused to detect immediate hypersensitivity are critical determin-ants of the presence and degree of cutaneous reactivity tothose extracts in allergic persons. 67–73In the estimate of preva-lence in NHANES 11 the effect resulting from the putativedifferences in allergenic potency and composition was deter-mined by testing two batteries of allergens, manufacturedby two different methods and obtained from different manufac-turers (see appendix II). In the dual-use stands, where thetwo batteries of allergen extracts were applied by the sameexaminers to subsamples in the same locale, the absolutedifferences in estimated reactivity did not exceed 5 percent(table XII). The small observed differences in reactivity dem-onstrated that variations in potency between the two allergenbatteries had relatively small effects on the prevalence esti-mates of the NHANES II study. Until standardized extractsare employed for large scale screening by standardizedmethods, the NHANES II prevalence estimates reflect thelargest experience in estimating immediate cutaneous hyper-sensitivity in U.S. population; and these estimates have beenshown to be relatively robust, in spite of differencesin manufacture of the allergenic extracts used. The marlceddiscrepancies between the prevalence estimates in NHANESII and many of the studies reported in table S thus maybe attributable more to differences in skin-test technique and

criteria for skin-test positivity rather than to differences inpotency of the allergens used.

A positive relationship was found between the numberof positive skin tests and the size of the histamine reaction.However, no significant association was found between aller-gic-reaction size and histamine-reaction size. This suggeststhat multiple positive allergy skin tests are required to influencehistamine-reaction size. In prior studies,58>74researchers ob-served no association between histamine and allergen reactiv-ity, suggesting that before acceptance of a causal associationbetween histamine and allergen skin reactivity, local skininteractions due to proximity and intensity of positive allergenand histamine skin reactions75’76 will need to be exploredfurther.

The total number of positive skin tests appears to beassociated with the degree of immune responsiveness, becausea positive relationship was found between the number of posi-tive skin tests and the intensity of the allergic response. Allergicpersons with multiple positive allergen skin tests and/or largerskin reactions tend to have higher total and specific IgElevels 23This suggests that the association of allergen reaction. .size and multiple allergen reactivity may indicate immunologi-cal hyperresponsivity, as indicated by IgE, in this subset ofthe population. In contrast, no significant association existsbetween histamine skin-reaction size and total IgE in skin-testpositive allergic patients .23

The use of positive and negative control skin-test solutionsdemonstrated that cutaneous reactivity was specifically relatedto the allergen, because the response to the diluent was uni-formly less than 2 percent except for one examiner who re-ported 2.2 percent reactivity (table VI). Similarly, the preva-lence rate of 91 percent of cutaneous reactivity to 1.0 mg/mLhistamine base demonstrated cutaneous responsiveness to oneinflammatogr mediator of the immediate hypersensitivity reac-tion (histamine) in most patients, indicating end-organ

Table T. Skin-test studies of allergic populations

Author Years Number of Type of Percent

of study Location Subjects of age extracts test positive

Domestic studies

Freidhoff’ . . . . . . . . . . . . . . . . . Baltimore 262 reporting allergies 18-55 7 prick 55.0

Hagyz . . . . . . . . . . . . . . . . . . . . Providence 478 reporting allergies 18-20 15 scratch 363.9%26.7

International studies

Bandele5 . . . . . . . . . . . . . . . . . Nigeria 221 asthmatics 10-60 22 not stated 57.0

TanG . . . . . . . . . . . . . . . . . . . . . Singapore 138 asthmatics 10-73 21 prick 69.0

Hendrick . . . . . . . . . . . . . . . . . London 656 asthmatics < 10-30+ 22 prick a4.o

Haahtelaa . . . . . . . . . . . . . . . . . Finland 292 reporfing allergies 15-17 16 prick ‘87.0%3.o

“69.0

Herxheimer’z . . . . . . . . . . . . . . London 300 with respiratory allergies 5-75 12 prick 95.0

1See reference 57 at end of text.‘See reference Sat end of text.3Asthma, hayfever, and/or nonseasonal allergic rhinitis.40ther allergies.

5See reference 59 at end of text.6See reference S0 st end of text.7See reference 65 st end of text.8See reference 26 at end of text.‘Aathmatica.

10Allergic rhinitls.11Atopic dermatitis.12Sse rsfersnce 62 at end of text.

20

responsiveness to this mediator. The optimal concentrationof histamine base to be used as a positive control for pricktesting is still in question42 and differs between the UnitedStates32and Europe. 77In this regmd, NHANES II data relevantto the size of the cutaneous reaction to 1.0 mg/mL histaminebase, as reported in table XI, can serve as reference valuesfor histamine skin testing.

Because development of immediate hypersensitivity fol-lows allergen exposure, the prevalence of immediate hypersen-sitivity to selected pollen allergens was evaluated with respectto the geographic distribution of the appropriate plants .53 Inall instances, the regions of “dense” and “sparse” pollen expo-sure are relative, because the plants were not entirely absent

‘4 Only ragweed had increased reactivity inin any region.areas reported to have high plant density.

Despite the reported differences in the geographic distribu-tion and density of oak trees and Bermuda grass, no differencesin the prevalence of skin reactivity to oak and Bermu& grasspollens wem found in these regions. This lack of geographicvariation in cutaneous reactivity parallels the airborne pollendata for grasses and oak. Similar peak levels of airbornegrass and oak pollen have been found in regions with highand low densities of these plants.w However, a caution ininterpreting pollen counts needs to be stres~d. Grass pollencounts reflect all grasses—not just Bermuda grass, and oakpollen counts include data on all species of oak. Thus, regionaldifferences among the species of these plants will be obscuredby the pollen counts. In addition, Bermuda grass cross-reactsto some degree with other grasses. Thus, Bermuda grass maycontain sufficient allergenic components that cross-react withother grasses78to obscure regional differences in the prevalenceof Bermuda grass specific allergens. There is lithe previousstudy of regional differences in skin-test reactivity to a specificplant among areas with high- and low-pollen densities. Inves-tigators in Sweden have found small differences in skin reactiv-ity to selected tree allergens concordant with the density ofthe respective tree pollen sources.79

The effect of seasonality on prevalence of skin reactivitywas examined because boosts in allergen-specific IgE andskin reactivity have been noted in allergic patients followingnatural exposure to the allergen. “81 Oak and ragweed, which

have relatively well-defined seasons,54 were selected forevaluating the effect of season of the year on the prevalenceestimates. In neither instance was a statistical] y significantincrease in the prevalence of reactivity noted during the seasonof exposure (table H). However, for both allergens, a smallbut statistically insignificant increase was noted in the periodof time immediate] y following the pollen season (table J).This suggests a slight booster effect in skin-test reactivitythat lags behind the pollen season, consistent with the im-munological observations .80

Despite methodologic problems in comparing prevalenceestimates of skin reactivity to specific allergens with otherepidemiologic studies, the effects of age, race, and sex onprevalence of cutaneous immediate hypersensitivity shouldbe more comparable because they reflect internal comparisonsfrom the same study.

Age had an important influence on immediate hypersen-

sitivity reactions. In general, the 12–24-year-old age groupdemonstrated peak reactivity to all allergens used in this study.Both the younger and ol&r age groups were less reactiveto the allergens tested. Diminished end-organ responsivenessto inflammatory mediators is one contributory mechanism inthe decreased prevalence and &gr* of allergen skin-test reac-tivity in older individuals because there is age-associated lossof vascular bed, 50 percent reduction of mast cells, 35 percentreduction of venular cross-sections, and a reduction in his-tamine release observed in the skin of old aduhs.82 The overalleffect of age on allergen reactivity (greater than 10 percentabsolute difference in prevalence at the extremes of age) isnot explained solely by the inability of the skin to respondto histamine, because there is little or no decrease in theprevalence of reactivity to histamine with age until after age55 (table XII), whereas the prevalence of allergen reactivitypeaks in the second and third &cades of life.

Another explanation for the effect of age on reactivitymay be a link between immediate hypersensitivity and survival.In recent studies researched reported a positive associationbetween IgE levels and cardiovascular disease in men afteradjusting for smoking, fasting glucose, blood pressure, andcholesterol. 83 In contrast, Vena et al. reported an inverseassociation between the reported history of allergic diseasesand cancer.w However, no scientists have studied the questionof survival as related to the presence of imtnedatehypersensitivity.

Several other studies have reported decreased prevalenceof skin reactivity with age. 65,85,86 pe~ skin.~st reactivity

previously has been reported to be highest in the 15-30-year-old age group, *7 20-34-yew-old age gmuP, w the first halfof the third decade,ss and in people under the age of 40years.65

Age changes seen in skin-test reactivity parallel thechanges seen in IgE levels. The highest total IgE levels arenoted in males 6-24 years of age and in females 6-14 years

88Similarly, the highestof age with a gradual fall off thereafter.allergen specific IgE levels are found betwem 12 and 20years of age. w The increase in IgE antibody levels duringthese years may reflect the higher proliferative capacity andnumber of clonable T and B cells seen in people 24-35 yewsof age, declining in later years.89

Consistent sex differences in prevalence of skin reactivitywere also noted in NHANES II. Males &monstrated a higherprevalence of reactivity than females (22.2 percent versus18.4 percent, p<O.05). However, females had higher ratesof reactivity to 1 mg/mL histamine than males (92 percentversus 89.9 percent, p<O.05). Thus, the lower reactivity infemales does not appear to be due to decreased end-organreactivity to histamine. Researchers have also reported, inother studies, the tendency for males to have larger skinreactions at lowe# or equa16] concentrations of allergen orto have significantly more positive skin tests or a higherrate of reactivity to the allergens tested than females have.61‘w

The male predominance in allergen skin-test reactivityis in keeping with tlie higher levels of total IgE88’w andearlier manifestations of allergic syndromes in males, withfemales not equaling the prevalence of males until the third

21

or fourth decade of life.91–94When tables 1–30 are examinedfor sex differences by age, females do not equal males inskin-test reactivity until approximately 45 years of age. Inter-estingly, cat and dog were the only allergens in which malesand females of all races did not have a statistically significantdifference in reactivity. This discrepancy in reactivity maybe related to the higher frequency and intensity of domesticpet exposures for females to cat allergens,95 which partially

96 Because house dust maycross-react with dog allergens. ,contain many allergens other than cat and dog allergens, suchas dust mite and cockroach ,97 which were not included inthe battery of skin-test allergens, the higher prevalence ofreactivity to house dust among males is not inconsistent withthe higher reactivity to cat and dog allergens among females.

No statistically significant differences were found in al-lergen skin-test reactivity by race, although black personsdemonstrated a consistently higher rate of allergic skin reactiv-ity than white persons. These findings are consistent withthe observed higher total IgE levels in the U.S, black popula-

98This higher reactivitytion versus the U.S. white population.to allergens in black persons was discordant with the lowerdegree of skin reactivity to histamine observed in black per-sons. If the lower rates of histamine reactivity in the blackpopulation represent an underreading of the skin-test reactionssecondary to skin color, then the increased rates of allergenskin reactivity noted in the black population may be veryconservative estimates of much higher prevalence rates ofimmediate hypersensitivity. Another explanation for the dis-cordance between allergen and skin reactivity may be end-organ unresponsiveness to histamine (one of many inflamma-tory mediators released in the allergic reaction) in black persons.

Few researchers have compared racial differences in skin-test reactivity in the United States. Lindblad and others56found no difference between the races. Freidhoff and others57found black persons more reactive than white persons, butthe difference reached significance (y= .046) only in womenreporting allergies.

Socioeconomic factors were correlated with skin-test reac-tivity. Overall reactivity is greater in persons living at orabove the poverty index than in those below the povertyindex (21.0 percent versus 15.8 percent, p< O.05). Furtheranalysis found overall reactivity increased as education levelor family income increased.

Barbee et al.58 found increasing skin-test reactivity with99found statistically significantincreasing income levels. Linna

increases in reactivity in white-collar children as comparedwith blue-collar children for grass pollens (in urban dwellers)and tree pollens (in urban and rural dwellers), but also astatistically significant increase in reactivity in blue-collar chil-dren for house dust. Reactivity to house dust mite also wasfound to be associated positively with family size, regardlessof income. No controlling for family size was attempted inthe Linna analyses. Thus, it is unclear whether the increasein reactivity in blue-collar children is due to larger familysizes,

Urban dwellers were more reactive than rural dwellers(22.0 percent versus 16.5 percent, p< O.001). The relationshipbetween location of residency and reactivity was further

analyzed by subdividing location into 4 parts: SMSA-centralcity, SMSA—not central city, not SMSA—not rural, andnot SMSA—rural. After controlling for race and income,it appears that the urban hyperreactivity may be located outsideof the central city. This suggests that factors in the urbanenvironment, especially outside the central city, may potentateimmunologic (IgE) reactivity to aeroallergens.

Linna9g found reactivity to tree pollens increased in urbanblue-collar dwellers versus rural dwellers @<O.0001) andhouse dust mite reactivity more common in rural blue-collarversus urban dwellers (p< O.05). Again, family size was notcontrolled for in the house-dust comparison. No differencesin skin reactivity were found between white-collar workersin urban versus rural settings. Rhyne as quoted by Smithet al.lm reported significantly less skin reactivity to ragweed(8.3 percent) and grass (6.7 percent) in rural children thanin urban children (15.3 percent and 9.9 percent, respectively).Similarly, comparative studies of rural and urban populationssuggest “the same or lower incidence” for rural populations. ‘mThe cause for this increased prevalence of reactivity in urbanpopulations is not apparent, but may be related to pollutantsin the urban environment, urban clustering of families withpositive allergic histories, or cultural differences between,urbanand rural groups that may have an effect on the developmentof immediate hypersensitivity.

Increasing socioeconomic status (SES) levels as diemon-stmted by increasing income or education appear to be as-sociated with increasing tendencies to develop cutaneous im-mediate hypersensitivity. Controlling for urbanization will noterase the effect of income or education on skin-test reactivity.Nor will control of income or education erase the effect ofurbanization. This leads one to postulate that the developmentof cutaneous hypersensitivity may be dependent upon lifestyiles involved in higher SES urbanized environments. It hasbeen noted in animals and humans that exposure to an antigeneady in life will promote the development of tolerance tothis antigen. 101’102It is possible that by growing up in anupper SES urbanized environment, exposure to the aero-allergens used for testing is reduced and tolerance is notdeveloped as it would be in a lower SES environment. Onthe other hand, there may be some environmental factor thatis a~ssociatedwith the upper SES lifestyle that makes peoplemore susceptible to the development of hypersensitivity.Further research is needed to answer these questions.

Overall reactivity was examined according to geographicregilon. The Northeast had the most reactors, with the Southcontaining the lowest number and the West and Midwestbeing in the middle. These differences could not be explainedby the differential reactivity by region to ragweed. Controllingfor urbanization, education, and income also could not explainthe observed differences. One speculation as to the explanationfor the observed differences in reactivity, at least for theoutdoor aeroallergens, may be the prevailing winds in thecontinental United States during the year. 103 The 10-year

(195 1-60) mean surface wind direction in the United Statesfor the spring (April), summer (July), and fall (October) wassuch that the prevailing winds in the Northeast were eitherfrom the South or the West; whereas in the South the prevailing

22

winds were from the Gulf of Mexico or the Atlantic Ocean. pollen because of the prevailing winds coming over largeThus, an individual in the Northeast would be exposed to bodies of water where little pollen exists. This differentialheavier and more persistent aeroallergen loads secondary to pollen exposure could be a partial explanation for the differingpolIens carried into the the Northeast from the West and levels of reactivity in different geographic regions. A fullSouth by the prevailing winds. In the South, on the other exploration of these regional differences will require furtherhand, an individual would be exposed to a lighter load of study.

23

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26

sgM M B Kay: Effect of age on human immunological parameters.,.including T and B cell colony formation, in H. Orimo, K. Shimada,M. hriki, and D. Maeda, eds. Recent Advances in Gerontology Pro-ceedings, International Congress, Series 469. Amsterdam. ExcerptsMedics, 1979. pp. 442-443.

~L, R, Freidhoff, D, A, Meyers, and D. G. Marsh: A geneticepidemiologic study of human immune responsiveness to allergens inan industrial population H. The association among skin sensitivity,total serum IgE, age, sex, and the reporting of allergies in a stratifiedrandc,m sample. J. Allergy Clin. Immunol. 73:490499, 1984.

911 Gregg. Epidemiology, in T, J. H. Clark and S. Godfrey, eds. ~

As~/una. London. Chapman and Hall, 1977. pp. 214-240,

92B IDawson, G. Horobin, R. Illsley, et al.: A survey of childhoodasthma in Aberdeen, Lancer 1:827-830, 1969,

gsp ,ALpedersen and E. R. Weeke: Asthma in Danish general practice.

Allergy 36:175-181, 1981.

94P A. Pedersen and E. R. Weeke: Allergic rhinitis in Danish generalpra;tice. Allergy 36:375–379, 1981.

95L W Lewis: Who loves cats? Cat fancy. Mission Viejo, Calif.Fancy Publication Inc., March 1982. pp. 16-20.

9GJ L Ohman, K. J. Bloch, S. Kendall, et al.: Allergens of mam-. .malian origin IV. Evidence for common allergens in cat and dogserum. J. Allerg,yClin. Immunol. 57:560-568, 1976.

97s DI car]5en, B. Weeke, at-d H, Lowenstein: Analysis of antigens. .in a commercial house-dust extract by means of quantitative im-munoelectrophoresis. Allergy 34: 155–166, 1979.

98F. J. Grundbacher: Causes of variation in serum IgE levels in normalpopulations: J. Allergy Clin. Immunol. 56:104-111,1975.990 ]<inna: Environmental and social influences On skin testresults

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tolerance to urushiol in humans. J. Allergy Clin. Immunol. 68:20-25,1981.

’03US Department of Commerce, NOAA: Climatic Atlas ojthe U.S.. .1st ed. U.S. Environmental Data Service, Environmental ScienceServices Administration, U.S. Department of Commerce, June1968. p. 78.

I04R Goodman and L. Kish: Controlled SdeCdOII-Zt technique inprobability sampling. J. Am. Star. Assn. 45(25 1):350-373, 1950.

loSNati,]nalCenter for Health Statistics, E. R. Black: CUmentestimatesfrom the Health Interview Survey, United States, 1976. Vital andHealth Statistics. Series 10, No. 119. DHEW Pub. ”No. (PHS) 78-1547. Phblic Health Service. Washington. U.S. Government PrintingOffice, Nov. 1977.

‘MR. N. Forthofe~ Investigation of nonresponse bias in NHANES H.Am. J, Epidemiol, 117:507-515, 1983.

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‘08Health Services and Mental Health Administration: The HANESStudy. Final Repott. Prepared by The Institute for Survey Research,Temple University. Philadelphia. Apr. 1975.

i~ationa] Center for Health Statistics: Factors related to resPonse ‘n

the Health Examination Survey, United States, 1960-62. Vital andHealth Statistics. Series 2, No. 6. DHES Pub. No. 36 (HSM) 73-1263.Health Services and Mental Health Administration. Washington. U.S.Government Printing Office, Aug. 1969.

110NationalCenter for Health Statistics: Memorandum from Wesley L.Schaible, Acting Chief, Methodological Research Branch, to ArthurJ. h4cDowell, Director, Division of Health Examination Statistics.June 21, 1974.

‘‘ ‘J. Pepys and R. J. Davies: Allergy, in Asthma. T. J. H. Clark andS. Godfrey, eds. London. Chapman and Hall, 1977. pp. 126-161.

112[J s Bureau of the Census: Money income and povertystatusof. .families and persons in the United States, 1976 (Advance Report).Current Population Reports. Series P-60, No. 107. Washington.U.S. Government Printing Office, 1977.

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I I5u s Bureau of the Census: Money income and poverty status of. .families and persons in the United States, 1979 (Advance Report).Current Population Reports. Series P-60, No. [25. Washington. U.S.Government F%ntingOffice, 1980.

‘‘%J.S. Bureau of the Census: Money income and poverty status offamilies and persons in the United States, 1980 (Advance Data fromthe March 1981 Current Population Survey). Curren/ Population Re-ports. Series P-60, No. 127. Washington. U.S. Government PrintingOffice, 1981.

IlTNational Center for Health Statistics: Total Nutrient Intake, FoodFrequency, and Other Related Dietary Data Tape. Public Use DataTape Documentation. Tape No. 5701–NHANES, 1976-80. PublicHealth Service. Feb. 1982.

27

List of detailed tables

1. Sample size, percent positive, standard errors of percentpositive, and percent distributions of the erythema reactionfor persons ages 6-74 years, to house dust allergen, byrace and age: United States, 1980-81 . . . . . . . .

2. Sample size, percent positive, standard errors of percentpositive, and percent distributions of the erythema reactionfor males ages 6-74 years, to house dust allergen, byrace and age: United States, 1976-80 . . . . . . . .

3. Sample size, percent positive, standard errors of percentpositive, and percent distributions of the erythema reactionfor females ages 6-74 years, to house dust allergen, byrace and age: United States, 1976-80 . . . . . . .

4. Sample size, percent positive, standard errors of percentpositive, and percent distributions of the erythema reactionfor persons ages 6-74 years, to akemaria allergen, byrace and age: United States, 1976-80 . . . . . . . . . .

5. Sample size, percent positive, standard errors of percentpositive, and percent distributions of the erythema reactionfor males ages 6-74 years, to akemaria allergen, by raceand age: United States, 1976-80 . . . . . . . . . . . . . .

6. Sample size, percent positive, standard emors of percentpositive, and percent distributions of the erythema reactionfor females ages 6-74 years, to altemaria allergen, byrace and age: United States, 1976-80 . . . . . . . .

7. Sample size, percent positive, standard errors of percentpositive, and percent distributions of the erythema reactionfor persons ages 6-74 years, to cat allergen, by race andage: United States, 197&80.. . . . . . . . . . . . . . . .

8. Sample size, percent positive, standard errors of percentpositive, and percent distributions of the erythema reactionfor males ages 6-74 years, to cat allergen, by race andage: United States, 197&80. . . . . . . . . . . . . . . . .

9. Sample size, percent positive, standard errors of percentpositive, and percent distributions of the erythema reactionfor females ages 6-74 years, to cat allergen, by race andage: United States, 1976-80 . . . . . . . . . . . . . . . . .

10. Sample size, percent positive, standard errors of percentpositive, and percent distributions of the erythema reactionfor persons ages r5--74years, to dog allergen, by race andage: United States, 197&80.. . . . . . . . . . . . . . . .

11. Sample size, percent positive, standard errors of percentpositive, and percent distributions of the erythema reactionfor males ages 6-74 years, to dog allergen, by race andage: United States, 197&80. . . . . . . . . . . . . . . . .

12. Sample size, percent positive, standard errors of percentpositive, and percent distributions of the erythema reactionfor females ages 6-74 years, to dog allergen, by raceand age: United States, 1976-80 . . . . . . . . .

13. SampIe size, percent positive, standard errors of percentpositive, and percent distributions of the erythema reactionfor persons ages 6-74 years, to oak allergen, by race and

30 age: United States, 197G80 . . . . . . . . . . . . . . . . . 42

14. Sample size, percent positive, standard errors of percentpositive, and percent distributions of the erythema reactionfor males ages 6-74 years, to oak allergen, by race and

31 age: United States, 1976-80, . . . . . . . . . . . . . . . . 43

15. Sample size, percent positive, standard errors of percentpositive, and percent distributions of the erythema reactionfor females ages 6-74 years, to oak allergen, by race and

32 age:UnitedS tates,1976-80. . . . . . . . . . . . . . . . . 44

16. Sample size, percent positive, standard errors of percentpositive, and percent dkributions of the erythema reaction .for persons ages 6-74 years, to rye grass allergen, by

33 race and age: United States, 1976-80 . . . . . . . . . . 45

17. Sample size, percent positive, standard errors of percentpositive, and percent distributions of the erythema reactionfor males ages 6-74 years, to rye grass allergen, by race

34 alnd age: United States, 1976--80 . . . . . . . . . . . . . . 46

18. Sample size, percent positive, standard errors of percentpositive, and percent distributions of the erythema reactionfor females ages 6-74 years, to rye grass allergen, by

35 ralce and age: United States, 1976-80 . . . . . . . . . . 47

19. Sample size, percent positive, standard errors of percentpositive, and percent distributions of the erythema reactionfa,r persons ages 6-74 years to Bermuda grass allergen,

36 by race and age: United States, 1976-80 . . . . . . . . 48

20. Sample size, percent positive, standard errors of percentpositive, and percent distributions of the erythema reactionfor males ages 6-74 years, to Bermuda grass allergen,

37 by race and age: United States, 1976-80 . . . . . . . .. 49

21. Sa\mple size, percent positive, standard errors of percentpositive, and percent distributions of the erythema reactionfor females ages 674 years, to Bermuda grass allergen,

38 by race and age: United States, 1976-80 . . . . . . . . 50

22. Sample size, percent positive, standard errors of percentpositive, and percent distributions of the erythema reactionfor persons ages 6-74 years, to ragweed allergen, by race

39 and age: United States, 1976-80 . . . . . . . . . . . . . . 51

23. Sample size, percent positive, standard errors of percentpositive, and percent distributions of the erythema reactionfor males ages 6-74 years, to ragweed allergen, by race

40 and age: United States, 1976-80 . . . . . . . . . . . . . . 52

24. Sample size, percent positive, standard emors of percentpositive, and percent distribution of the erythema reactionfor females ages 6-74 years, to ragweed allergen, by race

41 ancl age: United States, 1976-80 . . . . . . . . . . . . . . 53

28

25. Sample size, percent positive, standard errors of percentpositive, and percent distributions of the erythema reactionfor persons ages 6-74 years, to ragweed allergen (highpollen regions-Northeast and Midwest), by race and age:LJnited States 1976-80 . . . . . . . . . . . . . . . . . . . .

26. Sample size, percent positive, standard errors of percentpositive, and percent distributions of the erythema reactionfor males ages 6-74 years, to ragweed allergen (high pollen

—Northwest and Midwest), by race and age: UnitedregionsStates, 1976-80 . . . . . . . . . . . . . . . . . . . . . . . . .

27. Sample size, percent positive, standard errors of percentpositive, and percent distributions of the erythema reactionfor females ages 6-74 years, to ragweed allergen (highlmllen regions-Northwest and Midwest), by race and age:United States, 1976-S0 . . . . . . . . . . . . . . . .

28. Sample size, percent positive, standard errors of percentpositive, and percent distributions of the erythema reaction

for persons ages 6-74 years, to ragweed allergen (lowpollen regions-South and West), by race and age: UnitedStates, 197&80 . . . . . . . . . . . . . . . . . . . . 57

29. Sample size, percent positive, standard errors of percent54 positive, and percent distributions of the erythema reaction

for males ages 6-74 years, to ragweed allergen (low pollenregions-South and West), by race and age: United States,1976-S0 . . . . . . . . . . . . . . . . . . . . . . . . 58

30. Sample size, percent positive, standard errors of percent55 positive, and percent dis~butions of the erythema reaction

for females ages 6-74 years, to ragweed allergen (lowpollen regions-South and West), by race and age: UnitedStates, 197&80 . . . . . . . . . . . . . . . . . . . . 59

31. Median size of positive skin-test reaction to individual al-56 Iergens for persons ages 6-74 years, by race and sex:

United States, 1976-80 . . . . . . . . . . . . . . . . 60

29

Table 1. Sample size, percent positive, standard er?ore of percent positive, and percent distnlmtions of the erythema reaction for pereons ages 6-74 years, to house dustallergen, by race and sga United States, 1976-80

Race and aae

Positive skin-test

reactiorzl Percent distribution of erytherna reaction2

0.1- 1o.5- 20.5- 30.5- 40.5 andSample Standard 10.4 mm 20.4 mm 30.4 mm 40.4 mm more

size Percent error Omm ( +/-) (l+) (2+) (3+) {4+)

All races3

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-n years . . . . . . . . . . . . . . . . . . . . . . . . . .12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18-24 yeare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

White

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-n years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Black

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-n years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

15,519

1,6231,8971,9612,1551,5221,3882,4642,509

13,267

1,3171,5451,6631,8311,3211,2092,1832,198

1,942

268308251272166155253269

6,2

5,2

6.510.08.56.83.33.32.2

5.9

4.76.29.58.06.63.4.3.32.0

7,2

5.8

8.013.5

8.9

‘6.8‘1.9

‘3.7

●2.7

0.66

0.820.661.430.921.080.580.580.41

0.58

0.700.891.300.861.100.640.620.41

1.83

1.602.344.632.57

“2.53“1.15*1.44“ 1.07

89.9

90.4

89.286,287,689.4

91.8

93.9

94.5

90.3

91.390.0

66.7

88.489.2

91.5

93.8

94.6

89.0

66.166.6

63.087.3

91.794.9

94.4

94.8

3.9

4.4

4.33.8

3.93.8

4.9

2.8

3.3

3.8

4.0

3.83.8

3.6

4.2

5.0

2,9

3.4

3.7

6.1

5.4

3.5

3.8

1.53.2

1.8

24

3.3

3.7

3.75.24.72.7

1.51.91.4

3.1

3.13.3

4.84.7

2.7

1.5

1.91.2

4.7

4.3

5.98.9

6.1

2.00.8

2.4

2.5

2.3

1.32.53.72.9

3.1

1.41.0

0.7

2.1

1.42.6

3.52.6

2.8

1.5

0.90.7

2.4

1.1

1.44.6

2.8

4.81.1

1.30.2

0.6

0.20.4

1.00.81.0

0.4

0.50.1

0.6

0.2

0.31.2

0.8

1.0

0.4

0.50.1

0.2

0.3

0.7

0.1

0.1

0.1

0.1

-

1Mean diameter of the erythema reaction greater than or equal to 10.5 mm.2Figurea may not add to 100 percent becauae of rounding.31ncludes data for races not shown separately.

NOTE mm = millimeter.

30

Table 2. sample size, percent pos”tie, standard errora of percent positive, and percent diatributfons of the erythema reaction for males ages +74 year~to house dust allergen, by race and age: United States, 1976-60

Positive skin-test

reaction’ Percent distribution of erythema reactionz

0.1- 1o.5- 20.5- 30.5-Sample

40.5 andStandard 10.4 mm 20.4 mm 30.4 mm 40.4 mm

Race and agemore

size Percent error Omm ( +1-) (1+) (2+) (3+) (4+)

All races3

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-n years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

White

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-n years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Black

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-llyears . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7,534

823

999

943

1,038718663

7,~87

1,163

6,469

675

818811879

628

594

1,0491,017

898

125

152

112

1327060

126121

6.6

6.7

6.811.0

9.77.7

3.3

2.6

2.1

6.5

6.36.4

10.2

9.2

7.4

3.6

2.72.0

“7.9

‘5.9

“8.5

‘17.5

*8.5

●7.8*1.1*3.O*3.5

0.79

1.15

0.92

1.631.261.460.92

0.60

0.54

0.65

1.050.991.701.19

1.53

1.03

0.870.56

‘2.41

*26JI

*3.14

‘6.69

“3.23

‘4.1840.96● 1.79“2.44

89.0

6a.5

66.6

85.486.467.2

92.4

94.2

94.1

89.4

89.369.885.7

87.2

66.9

92.0

94.094.3

66.4

86.6

83.7

82.1

87.7

90.595.195.994.4

4.2

4.9

4.6

3.63.95.14.3

3.1

3.8

4.1

4.53.94.1

3.6

5.7

4.5

3.33.7

3.7

5.5

7.8

0.4

3.7

1.73.81.12.1

3.2

4.3

3.8

5.04.72.11.3

1.4

1.3

2.9

3.5

3.34.3

4.6

2.2

1.3

1.41.1

5.2

5.4

6.4

10.0

6.8

2.11.11.43.0

2.7

2.0

2.7

4.34.04.1

1.3

0.5

0.7

2.6

2.32.94.03.6

3.7

1.5

0.40.7

2.5

0.5

1.1

7.5

1.7

5.7

1.6

0.5

0.8

0.4

0.3

1.60.91.4

0.7

0.7

0.1

0.9

0.50.21.8

0.9

1.4

0.8

0.70.1

0.2

1.0

0.1

0.1

0.10.1

0.1

0.1

0.1

0.1

0.1

0.1

lMean ,dlameterof the erythema reaction greater than or equal to 10.5mm.2Figuresmay not add to 100percent because of rounding.31ncludesdata for races not ahown separately.

NOTE:mm = millimeter.

31

Table 3. Srm@e size, percent positive, standard errora of percent pwitiie, and percent rfhtributions of the erythema reaction for females sges 6-74yeare, to house dust allergen, by race and ageu United State$ 197WJ0

Positive skin-tesf

reaction’ Percent distribution of erythema reaction2

o.7- 1o.5- 20.5- 30.5- 40.5 andSample Standard ?0.4 mm 20.4 mm 30.4 mm 40.4 mm more

Race and age size Percent error Omm (+ l-) (1+) (2+. ) (3+) (4-!-)

All races3

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-llyears . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-64 years . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

White

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-n years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .36-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Black

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-llyears . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .36-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7,985

800898

1,0181,117

604725

1,277

1,346

6,798

642727

652952

695

6151,1341,161

1,044

143156139140

9696

127148

5.6

3.86.2

9.17.46.03.44.0

2.2

5.3

3.26.08.7

6.95.8

3.3

3.920

6.7

●5.77.5

“1O.39.2

“6.0‘2.6

“4.4“2.2

0.63

0.861.14

1.380.971.030.660.60

0.53

0.61

0.631.23

1.370.91

1.11

0.710.860.51

1.56

‘2.202.19

‘4.462.66

‘2.08“2.04

‘1.66‘0.91

90.7

92.3

89.8

66.988.891.591.2

83.6

94.6

91.1

93.490.3

87.7

89.5

71.4

91.1

93.694.9

69.5

87.6

89.663.787.0

92.794.6

93.195.2

3.7

3.94.0

4.03.82.65.42.5

3.0

3.6

3.53.73.6

3.5

2.85.52.53.1

3.8

6.72.96.03.81.42.6

2.62.6

3.4

3.03.6

5.44.73.21.72.3

1.4

3.2

2.73.45.24.7

3.1

1.72.31.3

4.2

3.35.38.05.51.90.6

3.32.2

1.8

0.72.2

3.21.92.21.51.4

0.7

1.7

0.52.23.01.5

2.0

1.51.30.7

2.3

1.81.72.33.74.02.0

1.1

0.4

0.10.4

0.40.70.60.10.3

0.1

0.4

0.40.5

0<7

0.70.10.30.”1

0,2

0.7

0.5

‘Mean diameter of the erythema reaction greatar than or equal to 10.5 mm.2Figures may not add to lW percent because of rounding.31ncludes data for races not shown separately.

NOTE mm = millimeter.

32

Table 4. Sample size, percent positive, standard errore of percent positive, and percent distributions of the erythema reaction for persons ages 6-74 years, to altemanaallergen, by race and age United States, 1976-80

Positive skin-testreactionl Percent distribution of erythema reactionz

0.7- 1o.5- 205- 30.5- 40.5 andSamr31e Standard 10.4 mm 20.4 mm 30.4 mm 40.4 mm more

Race and age size Percent error Omm (+/-) (l+) (2+) (3+) (4+)

All races3

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-llyears . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12-17 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

White

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-n years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Black

All ages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-llyears . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

16-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-W years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

85-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

15,543

1,6241,696

1,987

Z1611,5251,3892,485

2,514

13,287

1,3191,545

1,8891,834

1,324

1,210

2,1642,202

1,945

267

309251275188155%3269

3.6

5.16.45.33.43.71.61.20.6

3.5

4.7

6.05.3

3.4

3.91.8

1.20.6

4.0

‘7.0

7.7

‘3.8

3.5

*2.3“1.8

“1.4

0.26

0.580.79

0.68

0.550.650.500.35

0.17

0.27

0.580.900.65

0.84

0.670.55

0.360.16

0.48

‘2.49

1.44

‘ 1.41

0.62

●1.29‘1.24

“0.69

95.1

92.9

923

93.7

95.495.297.097.6

96.3

95.2

93.492.893.6

95.4

94.996.8

97.5

96.3

94.9

90.3

90.4

94.595.8

97.7

96.296.6

99.7

1.3

2.01.3

1.0

1.2

1.21.21.2

1.1

1.3

1.91.20.9

1.21.3

1.4

1.41.1

1.1

2.7

1.9

1.80.7

0.3

1.5

2.8

3.0

1.9

1.31.01.00.2

0.3

1.4

2.62.41.9

1.1

1.01.1

0.20.2

2.1

4.5

5.6

0.92.0

0.4

0.8

1.5

1.9

2.6

2.4

1.3

1.20.60.8

0.3

1.4

1.72.72.3

1.3

1.3

0.5

0.90.3

1.5

25

1.7

2.1

1.5

0.31.8

0.2

0.5

0.2

0.6

0.9

0.6

1.10.10.1

0.5

0.30.60.9

0.7

1.1

0.2

0.1

0.4

0.4

0.7

1.6

0.4

0.2

0.1

0.2

0.2

0.2

0.40.1

0.2

0.10.30.2

0.3

0.40.1

1Mean diameter of the erythema reaction greater than or equal to 10,5mm.‘Figures may not add to 103percent because Ofrounting.3includes data for races not ahown separately.

NOT~ mm = millimeter.

Table 5. Sampla size, percent poaitiva, standard errors of parcent poaitlve, and percent diatrfbutions of the erythema mactlon for males agaa 6-74 yeara, to alternariaallergen, by rata and age United Statea, 1976-60

Pos/t/ve skin-testreact/on’ Percent distribution of erythema reaction2

o.1- 1o.5- 20.5- 30,5- 40,5 andSample Standard 10.4 mm 20.4 mm 30.4 mm 40.4 mm more

Race and age size Percent error O mm ( +/-) (l+) (2+) (3+) (4+)

All races3

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-n years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

White

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-n years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12-17 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 yaars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Black

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-n years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12-17 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

16-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-84 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7,546

623

999945

1,042

721863

1,187

1,166

6,478

676

817813

881

629

594

1,0491,019

900

124

153

112

134

70

60

126121

4.1

6.7

7.1

5.73.64.6

“1.5

‘1.3

‘0.3

3.9

5.9

6.”1

6.13,4

4.6

●1.7

‘1,3“0.4.

5.0

* 10.9

9.9‘2.6

“4.5

*2.7

‘2.0

0.39

1.03

1.08

0.95

0.590.95

“0.81

‘0.48

“0.19

0.41

0.64

1.13

1.C6

0.62

1.03

“0.91

*0.52“0.21

1.05

●5.42

2.15

● 1.23

*2.13

‘2.54

* 1.26

94.6

91.5

91.6

92.9

95.393.897.5

97.7

98.4

94.8

92.4

92.692.7

95.4

93.5

97.2

97.698.4

94.0

87.2

88.4

94.8

95.4

97.310Q.O

98.0100.0

1.3

1.8

1.3

1.4

1.11.5

1.0

1.0

1.2

1.3

1.7

1.3

1.21.2

1.6

1.1

1.21.2

0.9

1.9

1.6

2.4

1.6

3.2

3.9

2.21.31.4

1.3

0.3

0.1

1.6

2.8

2.7

2.41.1

1.3

1.5

0.20.1

3.0

6.3

8.0

0.7

2.5

1.1

1.4

3.0

2.4

2.4

1.01.0

0.9

0.1

1.4

2.5

2.52.5

1.0

1.1

1.00.1

1.5

4.6

1.2

2.1

2.0

0.6

0!4

0.7

0.9

0.81.7

0.1

0.1

0.7

0.5

0.70.9

0.9

1.6

0.2

0.5

0.7

2.7

0.9

0.2

0.2

0,2

0.2

0.40.6

0.1

0.3

0.2

0.30.2

0.5

0.7

0.1

1Mean diameter of the srythsma reaction greater than or squal to 10.5mm.‘Figures may not add to 100percent because of rounding.31ncludeadata for races not shown separately.

NOTE mm = millimeter.

34

Table6. Samplesize,percentpositive,standarderroraof percentpositive,and psrcentdiatrtbutlonsof the erythemareaction for fernaleaagaa 6-74 years,to altemariaallergen,by race and agrxUnitedStatea, 1978-86

. ..—Positive skin-test

reaction’ Peroant distribution of erythema reactionz

o.1- 70.5- 20.5- 30.5- 40.5andSample Standard 10.4mm 20.4 mm 3(I4 mm 40.4 mm more

Race and age size Percent error Omm (+/-) (l+) (2+) (3+) (4+)

All races3

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-llyears . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-84 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .85-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

White

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-llyears . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-84 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .85-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Black

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

O-llyears . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12-17 yeare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1844yeare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 yaars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-84 yaars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .85-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7,997

801899

1,0221,119

S04728

1,2781,348

6,E!J19

843728858953695616

1,1351,183

1,045

143158139141S685

127148

3.2

3.45.75.03.22.82.11.0

‘0.8

3.1

3.55.94.53.33.02.0

‘1.1‘0.8

3.1

●3.3‘5.4●4.5“2.6●1.9*3.4“0.8

0.29

0.751.020.850.950.780.610.44

“0.30

0.32

0.881.120.751.050.890.65

‘0.49‘0.31

0.80

“1.83“1.64‘2.26‘1 .69“1.09“2.32‘0.48

95.6

94.493.194.495.488.498.597.598.3

95.6

64.463.094.995.498.198.497.368.2

95.6

93.392.494.298.198.198.6S9.299.4

1.2

221.20.61.40.81.41.40.9

1.2

211.00.61.21.01.61.61.0

1.3

3.42.21.31.3

0.6

1.2

2.52.11.51.20.70.60.20.4

1.1

2.52.01.31.20.70.70.20.3

1.4

283.21.01.50.7

0.4

1.5

0.92.92.31.61.41.20.70.5

1.5

1.03.02.11.71.50.90.80.5

1.4

0.62.22.21.10.63.40.4

0.4

0.10.50.90.40.50.10.1

0.4

0.10.60.90.40.60.20.2

0.3

1.3

0.6.

0.1

0.20.20.10.20.2

0.1

0.30,20.10.20.2

lMenn diameter of the erythema reaction greater than or equal to 10.5 mm.‘Figuresmay not add to 100percant because of rounding.31nclweS data for races not shown separately.

NOTE mm = millimeter.

35

Table 7. Sample size, percent positive, standard errors of percent positive, and percent distributions of the erythema reaction for persons ages 6-74 yeare, to catallergen, by race and age United States, 1976-80

Positive skirr-tesfreaction’ Percent distribution of erythema reactionz

0.1- 70.5- 20.5-Sample

30.5- 40.5 andStandard 10.4 mm 20.4 mm 30.4 mm 40.4 mm more

Race and age size percent error Omm ( +/-) (l+) (2+) (3+) (4+)

Ail races3

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-n years....,.....,........,.. . . . . . . . . .12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

16-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

White

Ailages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-n years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12-17 years, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Black

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-n years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

15,474

1,617

1,8881,948

2,1501,515

1,382

2,461

2,531

13,229

1,3131,5371,653

1,825

1,315

1,205

2,180

2,201

1,939

267

306248273

166155

253

289

2.3

1.62.2

4.0

3.4

2.7

1.7

‘0.70.6

2.2

1.62.24.1

3.2

2.6

1.4

“0.80.6

2.4

“1.9

‘1.9

●3.6“3.4‘1.0“5.0

“0.2

0.26

0.37

0.49

0.50

0.55

0.46

0.35“0.26

0.17

0.27

0.410.520.52

0.550.49

0.35

‘0.300.18

0.53

‘0.90

“0.95

“1 .31“1 .30*1 .05“2.34

“0.19

96.0

97.298.4

94.3

94.1

96.3

96.198.0

97.7

96.1

97.298.494.3

94.5

98.3

98.3

97.897.6

98.4

96.9

96.794.395.2

98.494.1

99.0

98.7

1.7

1.21.4

1.7

2.4

1.1

2.21.3

1.7

1.7

1.21.41.7

23

1.2

2.3

1.41.8

1.2

1.3

1.4

2.11.3

0.60.9

0.8

0.3

1.2

1.1

0.9

2.0

1.71.0

1.1

0.6

0.4

1.1

1.2

0.8

2.1

1.6

0.9

0.7

0?70.4

1.3

1.2

1.31.31.6

4.6

1.0

0.41.2

1.71.4

1.4

0.60.1

0.1

0.9

0.41.31.6

1.4

1.3

0.6

0.10.1

0.9

0.7

0.61.9

1.11.00.4

0.2

0.2

0.1

0.3

0.40.3

0.2

0.1

0.3

0.3

0.4

0.2

0.30.7

0.1

0.1

1Meandiameter of the erythema reaction greater than or equal to‘Figures may not add to 100percent because of mundlng.31ncludeadata for races not shown separately.

10.5

NOTE mm = millimeter.

36

Tebfe8. Semplesize,percent positive,standarderrorsof percentpoeMve,end percentdiatrilxrfiorrsof the wytheme reactbn * males ages 6-74 years,to cat altMwn,by raw and ag@UnitedStates, 1976-88

P&tin? skin-testreaction’ Percent distribution of erythema reaction2

o.1- 1o.5- 20.5- 3r25-Sample

40.5andStandard 10.4mm 2Q.4mm 304 mm 40.4 mm more

Race and age size Percent error Omm (+/-) (1+) (2+) (3+) (4+)

All races3

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-llyears . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .S&f4years. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 yeare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

White

Allages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

O-llyears . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18-24 yeers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 ysars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .85-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Black

Alla{]es . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-llyears . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18-24 years...............................,..25-34 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 Wars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7,518

821895837

1,036716881

1,1881,166

6,455

674815807876624592

1,0481,019

8%

1241521101337060

126121

22

1.61.54.43.52.0

‘1.8“0.4“0.2

22

1.9‘1.44.53.41.7

“1.7“0.4‘0.2

20

●0.5“0.5●4.3●4.1●21●24

0.30

0.380.440.850.710.58

“0.70“027“0.15

0.32

0.48“0.43O.cm0.840.48

“0.77‘0.31‘0.17

0.68

“0.57“0.48●231“1.54“231●1.3a

S6.O

97.197.583.993.8%.5w397.997.9

%.1

96.897.393.884.398.588.397.897.7

S9

97.698.593.394.997.995.7w.4

Im.o

1.8

1.31.11.72.71.51.91.71.9

1.8

1.31.31.7241.81.91.820

1.1

1.8

251.0

1.91.6

1.2

1.20.823200.41.20.40.1

1.2

1.40.6251.90.41.10.40.1

1.1

0.50.51.53.2

24

0.8

0.40.71.71.41.00.6

0.8

0.40.81.71.40.60.7

0.7

2.10.921

0.1

0.1

0.3

0.6

0.1

0.1

0.30.10.7

0.1

0.7

0.1

0.1

0.1

0.1

1Meandiameterof theetytharrrareactiongreeterthanore@al to 10.5mm.2FigurssmaynotaddtolCOpercart because of rounding.

31ncludeedataforracesnofshcwnsaperstely.

NOTE mm = millimeter.

37

Table 9. Sample size, percent positive, standard errors of paraent positive, and percent distrflbutiona of the erythema reaction for femalas ages 6-74 years, to catallergen, by race and age United States, 1976-80

Positive skin-testreaction’ Percent distribution of erythema reaction2

0.1- 1o.5- 20.5- 30.5- 40.5andSample Standard 10.4mm 20.4mm 30.4mm 40.4mm more

Race and age siza Percent error Omm (+/-) (7+) (2+) (3+) (4+)

All racea3

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-n years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

White

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-llyears . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . .. c. . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Black

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-n years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 yeare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7,956

769693

1,0111,114

799721

1,2751,347

6,774

839722848949691613

1,1321,162

1,043

1431561381409895

127148

2.5

●1.62.93.73.43.3

.,.7,

‘1.1(),$)

2.3

“1.33.03.63.13.3

●1.1●1.10.9

2.7

●3.1“3.33.1

“29

“7.2‘0.4

0,27

“0.510.830.530.860.73

“0.55“0.370.28

0.28

“0.580.910.610.590.77

“0.40“0.420.29

0.80

●1.65‘1.800.92

●1.55

‘4.18“0.38

98.0

97.395.494.694.4S6.195.998.097.6

68.1

97.595.594.794.798.198.297.897.5

98.0

98.193.995.195.598.692.899.699.6

1.6

1.11.71.62.20.62.40.91.4

1.6

1.21.51.72.20.52.71.01.6

1.3

0.72.91.91.61.2

0.4

1.2

1.11.17.71.31.61.00.60.7

1.1

1.00.91.71.31.30.30.90.7

1.5

1.82.11.20.4

6.4

1.1

0.51.71.71.31.70.60.30.2

1.1

0.31.91.51.31.90.60.30.2

1.0

1.4 ‘1.11.91.3

0.80.4

0.2

0.10.30.80.1

0.2

0.20.40.50.1

0.2

1.2

0.1

0.2

1Meandiameter of the erythema raactlon greater than or squal to2Flgurasmay not add to 10Cpercant because of mundirrg.31ncludesdata for races not shown separately.

10.5

NOTE mm = millimeter.

38

Table10. Sample size,peroentpositive,atendarderrorsof percentpositive,and psroentdistributionsof the erythemareactionfor personsages 6-74 yasre,to dogallergen,by race snd agesUnitedStates, 1976-60

Positive skin-testreaction’ Percent distribution of erythema reaction2

o.1- 1o.5- 205- 30.5- 40.5andSample Standard 10.4mm ~.4 mm 30.4mm 40.4mm more

Race and age size Percent error Omm (+/-) (l+) (2+) (3+) (4+)

All races3

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-n years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-84 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

White

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-llyears . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12-17 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-84 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Black

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-llyears . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12-17 yaars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-84 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

15,465

1,618

1,8435

1,951

~ms1,513

1,381

2,458

2,511

13,225

1,314

1,5331.6561;6251;315

1,205

2,177

2,200

1,934

26730924s271164154

253

268

2.3

1.42.34.03.32.91.40.9

‘0.6

2.2

1.4

2.14.12.92.51.3

0.9

“0.6

2.7

“0.8

*3.6*3.6

●4.3

“3.5‘2.6

‘0.6

0.25

0.360.440.550.580.57

0.34

0.24

“0.22

0.24

0.38

0.460.540.510.54

0.36

0.25

‘0.23

0.77

80.83

81.29

*1.45

“1.71

●1.53“1 .28

“0.53

96.0

97.3

98.1

94.394.794.9

98.6

98.1

97.7

88.1

97.5

68.384.495.094.9

96.6

98.0

97.6

98.2

97.6

95.664.6

94.6

96.295.7

89.4

88.1

1.7

1.3

1.6

1.7

2.02.2

2.0

1.1

1.6

1.8

1.2

1.61.5212.52.1

1.2

1.7

1.1

1.6

0.9

1.71.2

0.41.7

0.9

1.3

1.0

1.4

2.3

1.61.1

0.9

0.6

0.3

1.2

0.9

1.22.51.31.1

0.8

0.6

0.3

1.6

0.8

2.8

1.6

2.5

0.826

0.4

0.9

0.4

0.5

1.61.51.3

0.4

0.2

0.3

0.8

0.4

0.41.51.51.1

0.4

0.2

0.3

0.9

0.82.0

1.5

1.7

0.2

0.2

0.4

0.1

0.20.5

0.1

0.2

0.50.10.20.3

0.1

0.1

0.2

1.0

—1Mean diameter of the erythema reaction greater than or equal to 10.5mm.‘Figures may not add to lW percent beaause of rounding.31ncludesdata for races not shown separately.

NOTE mm = millimeter.

39

Table 11. Sample size, percent poaltive, standard enws of percent positive, and percent distributlona of the afytffama reaction for males ages 8-74 yearq to dogallergen, by race and ag~ United States, 1976-80

%sitiw skin-testreaction’ Percent distribution of erythema reactionz

—o.1- 1o.5- m.5- 305- 410.5and

Sample Standard 10.4 mm M4 mm 30.4 mm 40.4 mm moreRace and age size Percent error O mm ( +/-) (l+) (2+) (3+) (4+)

All races3

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-llyears . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-2-4years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-84 yaars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

White

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-llyears . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Black

Allagea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-llyears . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 yeers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-84 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 yeare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7)510

821892939

1,038713659

1,1841,186

6,450

674811809877623591

1,0461,019

893

1241531101328859

128121

.2.3

211.64.43.43.0

“0.9“0.7‘0.4

2.3

2.12.04.73.3

●2.4“0.9“0.7“0.4

“1.7

“1.0‘0.9“2.7●2.2“3.9“1.1“0.5

0.31

0.880.430.800.700.60

“0.42“0.31“0.20

0.300.670.510.260.73

“0.82‘0.48“0.34“0.22

“0.78

‘1.09“0.77●1.43‘1.17●2.88●0.97“0.45

95.7

98.2 .98.793.894.064.7%.298.293.1

95.6

98.588.793.793.894.988.198.097.8

97.2

%.998.595.197.498.198.099.5

100.0

2.0

1.61.51.82.62.2291.11.6

2.1

1.41.41.63.0263.01.21.8

1.1

210.62.20.4

2.6

1.1

1.50.82.31.40.60.80.60.3

1.2

1.30.82.61,30.70.80.60.3

0.7

1.00.50.51.7

1.10.5

1.0

0.70.62.01.81.80.10.10.1

1.0

0.80.61.91.81.50.20.10.1

0.6

0.522

1.8

0.2

0.40.20.20.6

0.2

0.50.20.20.2

0.3

0.521

1Msandiameterof theerythemareaction greater than or equal to 10.5 mm.2Figurea may not add to 1133percent besauae of rounding.31ncludes data for races not shown separately.

NOTE mm = mitlimster.

40

Table 12. Sample size, percant positive, standard errors of percent positive, and percent distributions of the erythema reaction for females ages 6-74 years, to dogallergen, by race and ag% United States, 1976-66

Positive skin-testreaction’ Percent distribution of erythema reactionz

o.1- 1o.5- 205- 30.5- 40.5andSample Standard 10.4mm 20.4 mm 30.4 mm 40.4 mm more

Race and age size Percent error Omm (+/-) (l+) (2+) (3+) (4+)

All race??

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-11 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

White

All ages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-n years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Black

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-n years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 yeare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7,955

797

893

1,012

1,11260)

7221,2741,345

6,775

640722647

946

692

614

1,1311,181

1,041

143

156

136139

96

95

127

147

2.3

0.6

2.8

3.6

3.22.8

1.81.00.8

2.0

0.72.33.6

2.5

2.6

1.6

‘1.0‘0.8

3.6

“0.7

‘6.2

●4.3‘5.9

“3.1

●3.9

‘0.7

0.24

0.30

0.74

0.57

0.76

0.650.44

0.330.36

0.22

0.330.720.530.62

0.70

0.42

‘0.36‘0.36

0.94

“0.72

●2.51

*1.75“2.46

*1.56

●2.32

‘0.61

96.3

96.4

95.5

94.9

95.3

95.097.0

96.097.5

S6.5

96.495.995.096.2

94.9

97.1

97.997.5

95.3

96.2

92.6

94.392.4

96.2

95.3

99.3

96.5

1.5

0.9

1.7

1.6

1.42.2

1.21.01.7

1.5

0.91.91.41.2

2.5

1.2

1.11.7

1.1

1.1

1.2

1.41.7

0.7

0.8

1.5

1.4

0.6

2.0

2.3

1.81.6

1.1

0.60.4

1.2

0.61.52.41.3

1.5

0.6

0.60.3

2.4

0.7

5.2

24

3.21.4

3.9

0.3

0.7

0.1

0.4

1.2

1.3

0.9

0.60.30.4

0.7

0.10.31.11.2

0.8

0.7

0.30.5

1.2

1.1

1.92.7

1.7

0.4

0.1

0.4

0.1

0.10.3

0.1

0.1

0.2

0.50.1

0.1

0.4

0.2

1Mean diameter of the erythema reaction greater than or equal to2Figurcs may not add to 103p-arcentbecause of rounding.31ncludesdata forracesnot shown separately.

NOTE mm = millimeter.

10,5Imm.

Table 13. Sample size, percent poaltlve, standard errore of percent positive, and percent dlatributiona of the erythema reaction for pereons ages 6-74 yeare, to oakallergen, by race and age United States, 1976-60

PositWe skin-testreaction’ Percent distribution of erythema reactionz

0.1- 1o.5- 20,5- 30.5-Sample

40.5 andStandard 10.4 mm 20.4 mm 30.4 mm 40.4 mm

Race and agemore

size Percent errcv O mm (+ /-) (1+) (2+) (3+) (4+)

All races3

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-n years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

White

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-llyears . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3544years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Black

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-n years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

15,507

1,626

1,890

1,981

2,1521,524

1,383

2,462

2,5)9

13,265

1,321

1,5411,664

1,8271,3241,207

2,182

2,199

1,932

267

306

250

273

165152

252

267

4.7

3.9

6.07.7

4.75.7

3.8

2.5

1.3

4.5

3.5

5.77.4

4.55.53.8

2.5

1.1

5.8

5.5

7.8

10.4

●4.9

●6.1

‘2.4‘2.2

“1.8

0.36

0.600.930.910.480.760.730.450.27

0.33

0.610.65o.6a0.540.770.770.530.24

1.23

1.562.27

2.81

“1.69

●2.35

“1.28●1.19

‘0.90

92.7

93.9

91.4

89.5

92.491.4

94.4

95.1

95.8

92.9

94.591.4

89.892.791.7

94.3

95.195.9

92.1

92.2

90.3

68.5

91.1

91.397.2

96.1

95.9

2.6

2.2

2.62.8

2.92.8

1.8

2.4

2.9

2.6

2.1

2.92.8

2.82.8

1.9

2.32.9

2.1

2.2

1.9

1.0

4.0

2.50.41.7

2.3

2.0

2.62.83.31.71.81.41.10.6

1.9

2.62.83.11.71.41,2

1.10.5

2.6

2.13.15.41.62,22.41.91.0

1.7

0.82.12.51.72.51.60.80.6

1.7

0.42.02.51.72.51.90.90.5

1.8

2.62.42.21.53.1

0.40.9

0.8

0.31.01.51.11.00.50.50.2

0.8

0.30.91.51.01.20.50.60.2

0.9

0.52.01.81.3

0.2

0.10.10.40.30.40.2

0.2

0.1

0.30.20.30.2

0.5

0.30.31.10.60.8

1Meandiameter of the erythema reaction greater than or equal to‘Figures may not add to lCOpercent because of rounding.31ncludeadata for races not shown separately.

NOTE mm = millimeter.

10.5mm.

42

Table 14. sample size, pement positive, stsndsrd errors of percentpositive, snd percentdlstrfbutfonsof the erythemsrwctlon for msfesages 6-74 yssrs,to osksilergen,by race and sgo UnitedStstes, 1976-60

Wiitlva skin-testreaction’ Fwcant distribution of erythema reactionz

o.1- 1o.5-Sample

20.5- 30.5- 40.5 andStandard 10.4 mm 204 mm 304 mm 40,4 mm more

Race and age size Paroant error O mm (+/-) (l+) (2+) (3+) (4+)

All races3

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-n years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years,., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years...........,..........,.. . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

White

Ailages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-llyears . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-84 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Biack

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-n yews . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .85-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7,531

825983943

1,037721E&

1,1881,165

6,469

678813812878629593

1,0481,018

895

1241521111327059

128121

5.4

4.06.79.45.86.74.41.61.3

5.3

3.76.39.85.66.44.51.7

“1.0

5.9

●4.310.1“8.2“5.9‘8.7“1.1‘0.4●2.1

0.43

0.831.111.300.750.981.200.450.39

0.43

0.850.931.430.831.191.310.s

“0.26

1.45

*1.983.20

“2.83“2.22“3.64“0.97“0.39‘1.83

92.0

93.391.487.191.5S0.494.295.995.8

92.1

93.291.986.791.790.793.995.898.0

92.6

94.387.360.491.390.398.9

S6.8

2.6

2.81.93.62.63.01.42.62.9

27

3.11.93.62.73.01.5253.0

1.5

1.4261.4281.0

1.2

2.3

3.13.03.62.22.81.30.80.7

22

3.02.83.92.1231.10.80.4

26

2.14.61.92.34.81.10.41.4

1.9

0.52.33.42.02.32.30.50.4

1.9

0.32.23.31.92.42.60.60.4

2.1

2.12.84.32.32.1

0.7

1.0

0.41.32.11.31.30.70.30.2

1.1

0.41.22.11.31.50.80.30.2

0.7

2.02.00.5

0.2

0.10.30.40.3

0.1

0.10.40.40.1

0.5

0.6

0.91.7

lMean diameter of the erythema reaction greater than or equal to 10.5 mm.2Figures may not add to 100 percent because of rounding.31ncludes data for races not shown separately.

NOTEmm = millimeter.

43

Table 15. Sample size, percent positive, standard errors of percent positive, and percent distributions of the arythema reaction for femafee ages 6-74 yeare, to oakallergen, by race and age United Statea, 1976-80

Positive skin-test

reaction’ Percent distribution of erythema reactionz

o.1- 1o.5- 20.5- 30.5- 40.5 andSample Standard 10.4 mm 20.4 mm 30.4 mm 40.4 mm more

Race and age size Percent error Omm (+ l-) (1+) (2+) (3+) (4+)

All races3

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-n years . . . . . . . . . . . . . . . . . . . . . . . . . . .12-17 yeara . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Whita

Alleges . . . . . . . . . . . . . . . . . . . . . . . . .

6-n years . . . . . . . . . . . . . . . . . . . . . . . . . .

12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18-24 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Black

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-n yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7,976

801

897

1,018

1,115

803

722

1,276

1,344

6,796

643

726

852949695

614

1,134

1,181

1,037

143

154

139

141

9593

126

146

4.1

3.8

5.2

6.1

3.6

4.9

3.2

3.3

1.4

3.8

3.2

5.2

5.23.54.6

3.1

3.3

1.2

5.7

‘6.7

*5.5

12.2

●4.1

‘4.0“3.4“3.9

*1.7

0.3.5

0.95’1.19

0.84

0.560.95

0.87

0.75

0.32

0.35

0.91

1.32

0.81

0.590.89

0.78

0.89

0.33

1.38

‘2.30

‘1 .98

3.98

“2.21

‘2.43‘2.35

‘2.20

‘1.07

93.4

94.6

91.4

91.9

93.3

92.4

94.6

94.4

95.8

93.7

95.6

90.9

92.893.792.7

94.6

94.5

95.9

91.7

90.2

93.3

87.091.0

92.295.892.9

95.2

2.6

1.6

3.4

2.0

3.2

2.7

2.2

2.3

2.8

2.5

1.0

3.82.02.82.7

2.3

2.2

2.9

2.6

3.0

1.2

0.8

4.9

3.80.83.2

3.1

1.7

2.2

2.6

3.0

1.2

0.9

1.5

1.5

0.5

1.6

2.3

2.82.31.30.6

1.3

1.4

0.5

2.7

2.1

1.4

8.1

1.0

3.43.2

0.7

1.5

1.0

1.91.7

1.42.7

1.0

1.1

0.6

1.4

0.6

1.91.8

1.42.6

1.2

1.2

0.5

1.6

3.0

2.1

0.5

0.9

4.0

0.7

1.0

0.6

0.3

0.8

1.0

0.80.8

0.3

0.7

0.2

0.6

0.2

0.60.9

0.70.9

0.2

0.8

0.2

1.0

1.0

2.0

1.6

1.9

0.2

0.2

0.5

0.10.5

0.3

0.2

0.2

0.20.10.6

0.4

0.5

0.6

2.0

0.4

1Meandiameter of the erylhema reaction greater than or squal to 10.5mm.2Figurasmay not add to 100percent because of rounding.31ncludesdata for races not shown separately.

NOTE mm = millimeter.

44

Ta41aI& Sampb siza,paroantpoalti~ standardamxa of parcantpoaftivqand parcantdistdtrutionsof tha atyhama maotionforparaons ages 6-74 yeara,to ryegrassallatgfen,t3yma and agm UnitadStatas, 197S-60

PrxWbeskin-testraactlonf FWcant distribution oferythema mactionz

o.t- 1o.5- a.5- 305- 40.5andSample Standard 10.4mm 204 mm 3.4 mm 40.4mm

Raoa and agemore

siza Percent error Omm (+/-) (l+) (2+) (3+) (4+)

All races3

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-llyaara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12-17 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .lS-24yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .KF44yaarxi. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 yaara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 Ware . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

White

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-11 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18-24 yaare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 yaara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 yaara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .W%64yeam... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .&3-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Black

AIIwIs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

a-llyeare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16-24 yearn . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .36-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .S64yeare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 yeare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

15,497

1,6271,6671,9622,1551,5201,3632,457&ala

13,253

1,3231,5361,6641,6291,3191,2062,1792,195

1,934

266306251274166153250266

10.2

9.514.116.11279.46.14.63.7

9.9

8.612915.912.89.56.14.83.7

11.4

14.022016.410.2●7.3●29●2.4●26

0.560.661.271.370.781.130.870.630.36

0.53

0.941.311.310.601.110.91O.ea0.37

1.45

2042.783.621.66

●2.39“1.41“0.s7‘0.95

87.9

86.764.481.965.366.891.693.894.2

66.1

69.665.481.865.166.491.8&3.494.3

87.5

85.377.363.367.992.792.897.6%.1

1.9

1.71.52.0201.9231.721

20

1.91.7232.021211.720

1.1

0.70.70.31.9

4.3

1.3

2.3

2.93.23.024231.31.21.2

2.2

2.8253.124231.41.21.1

2.6

277.42.21.32.40.50.90.8

3.3

3.94.45.04.22.82.11.41.1

3.1

3.33.74.54.22.52.11.41.2

4.6

6.98.06.83.53.30.41.20.9

3.0

2.44.14.93.92.81.91.31.0

3.0

214.05.03.93.11.81.41.1

3.1

4.45.44.13.50.921

0.8

1.6

0.3253.22.21.40.70.70.3

1.7

0.32.83.22.31.60.80.70.4

1.1

1.23.31.90.7

0.2

lMearrdlmnstsroftheerythsmsmsctiorrgrsatsrthanorsqualto IDSmm.2FQumsMSynot●dd to 100 p8HIt bCSUSS Of rounding.

%ICIWOS dataformcaaM2tShOWnS$PSmt8~.

NOTBmm = mlllimster,

45

Table 17. Sample size, percent positive, standard er?ors of percent positive, snd percent distributions of the erythema reaction for males ages 6-74 yeare, to rye grassallergen, by race and age United States, 1976-60

Positive skin-testreaction’ Percent distribution of erythema reaction2

—o.1- 1o.5- 20.5- 30.5- 40.5 and

Sample Standard 10.4 mm 20.4 mm 30.4 mm 40.4 mm moreRace and age size Percent error Omm (+ l-) (l+) (2+) (3+) (4+)

All races3

Alleges, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-n years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12-17 years . . . . . . . . . . . . . . . . . . . . . .

16-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

White

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-n years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

16-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years, . . . . . . . . . . . . . . . . . . . . . . . . ..7......

55-64 years, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Black

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-n years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

16-24 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7,527

626

993943

1,040

718

6601,1831,164

6,463

679613611679626592

1,046

1,017

897

124

152

112

13470

59

125

121

12.0

11.515.5

20.1

14,1

11.0

7.74.5

4.3

11.6

11.0

14.3

19.9

14.1

11.3

7.9

4.7

4.3

12.6

12.2

23.2

18.2

13.5

‘9.6

“1.6

*2.9

●2.6

0.68

1.14

1.40

2.07

1.15

1.39

1.60

0.66

0.63

0.67

1.23

1.35

1.98

1.181.43

1.68

0.930.61

1.70

3.034.13

4.91

2.93

‘3.69“ 1.26

*1.56

● 1.95

85.8

67.2

83.077.2

63.167.5

89.5

93.2

93.2

85.9

87.6

84.1

77.1

63.087.0

89.4

92.693.2

68.5

67.376.1

81.1

64.9

90.2

95.0

97.1

96.6

2.2

1.31.4

2.7

271.5

2.6

2.4

2.5

2.3

1.4

1.6

2.92.8

1.7

2.7

2.52.5

0.9

0.5

0.7

0.6

1.6

3.2

0.6

2.6

3.7

3.0

3.5

2.62.4

2.01.4

0.6

2.5

3.8

2.2

3.92.5

2.3

2.1

1.40.6

3.1

26

8.1

0.9

1.6

4.51.0

2.0

4.1

4.7

5.4

6.8

4.43.3

2.7

1.6

1.8

3.8

4.6

4.75.7

4.4

3.0

2.5

1.71.9

5.0

5.0

8.9

9.1

4.4

3.30.8

0.91.4

3.6

2.7

4.1

6.14.93.5

2.6

1.0

1.3

3.7

2.4

4.2

6.34.8

3.9

2.9

1.11.3

3.4

4.6

4.4

5.4

5.4

1.3

1.2

1.8

0.43.0

3.62.21.8

0.40.5

0.4

1.9

0.2

3.3

4.02.3

2.1

0.4

0.50.5

1.1

1.8

2.8

1.9

0.7

1Meandiameter of the erythema reaction greater than or equal to 10.5mm,2Flgurssmay not add to 10Qparcant bacause of rounding,31ncludesdata for racea not shown separately.

NOTE mm = millimeter.

46

Table 18. Sample size, percent positive, standard errore of pement positive, and percent distributions of the erythema reaction for fematea ages 6-74 yeare, to ry@graasallergen, by raoe and ag~ United States, 1976-86

Positive skin-testreaction’ Percent distribution of erythema reactionz

o.1- 1o.5- 2i15- 30,5- .W5 andSample Standard 10.4mm 20.4 mm 30.4 mm 40.4mm more

Race and age size Percent error Omm (+/-) (l+) (2+) (3+) (4+)

All races3

Allagas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-11 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

White

Allagm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-n years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 yeare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Black

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-n years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-84 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7,970

801894

1,0191,115

802723

1,2741,342

6,7!30

644725853950693614

1,1331,178

1,037

1421541391409894

125147

8.5

7.512.612311.37.84.64.73.1

8.2

6.111.512.111.67.94.45.03.3

10.4

15.620.714.9‘7.6“5.2●3.8“1.9“2.6

0.61

1.131.611.240.871.291.040.930.51

0.56

1.111.761.290.931.231.021.010.53

1.71

3.783.164.41

“2.89“2.49●2.34“0.80“1.44

89.6

90.286.7S6.367.489.993.594.395.0

30.1

91.688.788.287.289.794.194.095.1

88.3

83.478.585.190.294.691.098.195.8

1.7

221.61.41.322

1.9

1.01.8

1.7

2.31.61.71.22.51.61.01.6

1.3

0.80.8

2.2

5.2

1.6

20

203.42.52.32.10.71.01.5

1.9

1.82.82.42.22.30.61.11.6

2.3

296.73.20.90.7

1.4

2.6

3.03.33.43.92.41.51.20.5

2.4

2.1273.34.12.01.81.20.5

4.1

8.77.24.92.93.4

1.50.6

2.5

2.24.13.72.92.21.31.60.8

2.4

1.93.83.83.12.30.81.70.9

2.9

4.26.33.12.00.63.8

0.6

1.4

0.31.92.62.11.11,00.90.2

1.5

0.32.22.52.21.11.20.90.3

1.1

0.63.71.90.6

0.4

1Meandiameterof the erythema reaction greater than or equal to 10.5mm.2Figuresmay not add to 100percent because of rounding.31ncludeadata for racesnot shown separately.

NOTE mm = millimeter,

47

Table19. Samplesize,peroentpositive,standarderrorsof percentpositive,and percentdl~trfbufionsof the erythemareactionfor personaagee6-74 yearn,to Bermudagraaaallargen,by race and afyx UnitedStates, 1976-80

Positive skin-testreaction’ Fement distribution of erythema reactionz

—o.1- 1o.5- 205- 30.5- 40.5 and

Sample Standard 10.4 mm 20.4 mm 30.4 mm 40.4 mmRace and age

moresize Percent error O mm (+ /-) (l+) (2+) (3+) (4+)

All races3

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-llyears . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

White

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-llyears . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Black

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-llyears . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

15,523

1,628

1,8941,984

2,1551,523

1,3852,464

2,510

13,277

1,3231,5431,387

1,831

1,323

1,207

2,1842,199

1,937

267

308

250

272

165

154

253

268

4.4

3.06.77.05.24.73.12.01.2

4.2

2.66.66.6

5.34.3

2.7

2.11.2

5.1

*4.4

6.4

“1O.7

4.3

“5.4

● 2.8

‘0.6

‘0.2

0.42

0.471.10

0.99

0.520.92

0.83

0.400.28

0.43

0.451.20

0.92

0.570.92

0.88

0.450.30

0.8s

“1.37

1.67

●3.65

0.98

‘ 1.92

“1.44

‘0.38

“0.21

93.9

95.7

91.7

91.1

92.7

93.7

94.998.6

97.3

94.0

96.091.591.6

92.7

93.995.1

98.397.2

93.8

95.2

92.7

87.2

93.5

94.0

98.2

99.4

88.8

1.7

1.3

1.6

1.8

2.01.6

2.01.4

1.5

1.8

1.41.81.8

1.9

1.7

2.1

1.61.5

1.1

0.4

0.9

2.2

2.2

0.61.0

0.9

1.5

1.625201.71.40.80.70.5

1.4

1.42.31,81.91.20.50.70.5

1.8

1.93.12.70.71.72.40.20.2

1.8

1.2

2.5

3.1

2.11.9

1.30.8

0.4

1.7

0.92.33.0

2.11.8

1.0

0.90.3

2.1

2.1

3.0

5.0

1.3

2.20.4

0.2

1.0

0.3

1.4

1.8

1.20.9

0.80.5

0.3

1.0

0.31.71.6

1.1

1.0

0.9

0.50.3

1.0

0.5

0.3

2.9

2.3

0.2

0.2

0.3

0.2

0.20.5

0.2

0.2

0.3

0.2

0.2

0.3

0.2

0.2

1.6

lMean diameter of the erythema reaction greater than or equal to2Figureamay not add to lGOpercent because of rounding.31ncludesdata for races not shown separately.

NOTE mm = millimeter.

10,5mm.

48

Table 20. Sample size, percent positive, standard errors of percent positive, and persent distributions of the erythems reaction for males ages 6-74 yesrs, to Bermudagrass allergen, by race and age United States, 1976-60

Positive skin-test

reaction’ Percent distribution of erythems resctionz

0.7- 1o.5- 2115- 30.5- 40.5 andSample Standard 10.4 mm 204 mm 30.4 mm 40.4 mm more

Race and age size Percent error Omm (+/-) (7+) (2+) (3+) (4+)

All races3

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-llyei]rs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 yaars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

White

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-llyears . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12-17 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Black

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-llyears . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

16-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 yaars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7,536

826

996

9441,039

721

660

1,187

1,165

6,475

679

815813

8=W

629

592

1,0491,018

896

124

153

111

132

7059

126121

4.9

3.4

7.0

7.9

6.44.6

*3.5

“1.3‘1.2

4.8

3.2

6.97.8

6.64.3

*3.3

*1.41.3

4.3

●3.2

*6.4

*8.5

●4.2

“6.4

0.46

0.651.18

1.48

0.750.91

‘1.20

‘0.39

‘o.%

0.51

0.661.221.53

0.81

0.97

*1.25

“0.440.39

1.06

“1.93

●2.36

●4.32

‘1.94

●3.23

93.2

95.1

91.2

89.8

91.593.3

94.3

97.0

96.8

93.2

95.291.290.1

91.4

93.5

94.4

98.796.7

93.9

96.8

92.7

87.2

924

923

97.9

100.0

96.6

2.0

1.5

1.7

2.3

2.22.1

2.2

1.7

2.0

20

1.62021

2.0

2.2

2.2

1.9

2.0

1.8

0.9

4.3

3.3

1.3

21

1.4

1.4

1.7

2.0

1.7

2.40.8

0.6

0.70.6

1.4

1.9

1.81.5

2.6

0.7

0.4

0.80.7

1.2

0.6

2.3

2.1

1.0

2.0

2.2

1.5

3.0

4.0

2.82.7

1.5

0.4

0.4

2.2

1.2

2.64.2

2.7

2.5

1.3

0.50.5

20

26

3.5

2.8

2.2

1.7

0.9

0.1

1.5

1.9

0.90.7

1.4

0.1

0.2

1.0

0.21.71.8

1.0

0.8

1.6

0.10.2

0.6

0.6

3.6

1.0

0.2

0.5

0.3

0.30.5

0.1

0.2

0.70.3

0.3

0.3

0.1

0.3

2.7

1Mean diameter of the erythema reaction greater than or equal to 10.5mm.‘Figures may not add to 100percent because of rounding.31nclud(?sdata for races not shown separately,

NOTE mm = millimeter.

49

Tabla21, Sampla aiza,percentposltiva,standardarroraof percentposltiva, and parcant diatributlons of tha erythamareactionfor femalasagaa 6-74 yaara, to Bermudagraaa allergen, by race and age Urrltad Statea, 1976-80

Positive skin-test

reactionl Percent dlstrlbutlon of erythema reactlonz—

0.1- 1o.5- 20.5- 30.5- 40.5 andSample Standard 10.4 mm 204 mm 30.4 mm 40.4 mm more

Race and age size percent error Omm (i- /-) (1+) [2+) (3+) (4+)

All racas3

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8-n yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12-17 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18-24 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-84 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .85-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

White

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-llyaara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18-24 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-84 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Black

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-llyears . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7,985

802

8981,020

1,116

802725

1,277

1,345

6,802

644728854

951

694

615

1,1351,181

1,041

1431551391409595

127147

4.1

2.66.46.34.14.72.82.61.2

3.7

2.0

6.45.54.0

4.3

2.12.8

“1.2

5.8

‘5.7

“6.4* 12.4

“4.3

‘4.6‘5.3

*1.1‘0.4

0.44

0.69

1.28

0.94

0.581.14

0.880.65

0.35

0.43

0.661.40

0.87

0.561.090.580.72

“0.40

1.08

*1.83

‘2.38“4.01

“2.10

●2.46*2.68

“0.69

“0.37

94.5

98.4

92.1

92.4

93.9

94.195.4

96.2

97.7

94.7

98.9

91.993.0

94.1

94.4

95.8

95.997.6

93.7

93.6

92.787.2

94.3

95.494.7

98.9

99.0

1.4

1.01.51.31.91.21.81.21.1

1.5

1.11.61.51.91.32.0

1.31.2

0.6

0.7

0.90.5

1.4

0.6

1.5

1.4

3.0

2.3

1.11.91,00.60.4

1.4

1.02.82.11.21.60.70.70.4

2.3

3.13.93.20.51.54.40.30.4

1.4

0.8

2.0

2.3

1.51.21.11.20.3

1.3

0.62.01.71.41.10.81.30.2

2.2

1.62.56.70.52.50.80.4

1.0

0.51.41,61.51.10.20.80.4

1.0

0.41.61.51.21.30.30.80.5

1.1

1.0

2.43.3

0.4

0.1

0.10.10.40.4

0.2

0.10.10.40.5

0.1

0.6

1Mesndiametarof theerythsmareactiongreaterthsnorequalto 10.5mm,2Figurea may not add to 1W percent because of rounding.31ncludes data for races not shown separately.

NOTE mm = mllllmster.

50

. .

Table 22. Sample size, percent positive, standard errors of percent positive, and percent distributions of the erythema reaction for persons ages 6-74 yeare, to ragweedallergen, by race and agtx United States, 1976-80

Positive skin-testreaction’ Percent distribution of erythema reactionz

o.f- 1o.5- 20.5- 30.5- 40.5andSample Standard 10.4mm 20.4 mm 30.4 mm 40.4 mm more

Race and age size Percent error Omm ( +/-) (l+) (2+) (3+) (4+)

All races3

All ages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-n years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

White

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-llyears . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18-24 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-84 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Black

Allagea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-llyears . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12-17 years i . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

15,450

1,6201,84331,9512,1401,5131,3802,4542,509

13,214

1,3161,5311,6581,8161,3131,2072,1762,199

1,930

2673092482731681502.50287

10.1

8.712.014.512.610.77.35.74.5

9.7

7.511.913.912.110.47.25.74.4

13.5

15.014.821.117.111.34.8

“6.35.4

0.57

0.701.031.130.791.040.970.660.48

0.51

0.620.980.980.881.041.04O.m0.51

2.34

2.473.254.403.392951.41

“3.021.17

86.9

88.685.082.484.288.189.891.392.2

87.2

89.385.382.884.686.690.091.392.2

84.2

64.462.177.579.684.892192192.6

3.0

2.83.03.13.23.22.82.93.3

3.1

3.12.93.33.33.02.8293.4

24

0.63.11.43.14.03.11.72.1

3.6

4.74.05.23.73.72.92.01.6

3.4

3.93.75.03.53.32.92.11.4

5.2

8.25.98.15.14.61.01.32.7

3.7

254.94.75.63.227231.7

3.6

2.25.04.75.52.82.62.41.8

4.7

4.65.45.36.85.53.21.41.5

2.1

1.22.23.42.72.61.61.01.0

2.1

1.22.33.22.53.01.51.01.0

2.5

1.62.55.04.8

0.61.21.2

0.6

0.30.81.10.61.20.10.40.2

0.6

0.20.90.90.71.20.10.20.3

1.1

0.60.92.80.41.2

2.4

lMearr diameter of the erylhema reaction greater than or equal to 10.5 mm.2Flguras may not add to 1W percent because of rounding.31ncludes data for races not shown separately.

NOTE mm = millimeter.

51

Table 23. Sample size, percent po$itive, standard errore of percent positive, and persent cfktnbutiona of the erythema reaction for males ages 6-74 yeara, to ragweedallergen, by race and age United States, 1976-60

Positive skin-test

reactionl Percent distribution of erythema reactionz

o,7- 70.5- 20.5- 30.5- 40.5 andSample Standard 10.4 mm 20.4 mm 30.4 mm 40.4 mm

Race and agemore

size Percent error Omm (+ /-) (1+) (2+) (3+) (4+)

Al I races3

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-n years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

White

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8-n years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Black

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-n years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12-17 years, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7,508

822

991939

1,032716

659

1,183

1,166

6,447

675810808873

624

592

1,0461,019

895

124

153

111

13370

56125

121

11.6

9.6“12.817.6

14.811.8

9.2

5.8

5.1

11.6

8.713.017.614.9

11.7

9.1

6.05,2

12.7

14.1

14.4

21.717.2

‘9.5

‘3.5●4.6

‘3.7

0.70

1,09

1.341.62

1.141.50

1.66

0.99

0.74

0.65

1.14

1.241.461.311.53

1.65

1.100.76

2.91

3.60

4.57

6.014.17

“4.04

“1 .88“2.41

‘2.80

85,3

87.9

84.379.3

81.785.1

87.8

90.8

91,4

85.3

68.684.279.3

81.4

85.5

87.5

90.691.0

85.2

85.5

82.2

75.880.8

86.195.2

95.4

95.6

3.1

2.5

2.93.1

3.43.1

3.1

3.4

3.5

3,2

2.7

2.73.1

3.72.8

3.3

3.43.8

2.1

0.4

3.4

2.62.0

4.41.4

0.8

4.0

5.1

4.77.3

3.23.1

3.4

1.7

1.7

3.6

4.04.46.7

3.3

2.3

3.4

1.81.6

6.3

9.7

7.5

13.03.8

4.82.1

1.1

1.3

4.4

2.8

4.1

5.67.73.4

3.3

2.9

2.0

4.5

2.84.46.07.7

3.4

3.3

3.02.2

3.9

3.2

3.6

4.38.7

3.01.3

3.0

1.1

2.8

1.5

2.8

3.53,33.7

2.4

1.2

1.1

2.8

1.6

3.03.7

3.4

4.3

2.5

1.31.2

1.6

1.2

2.3

2.43.7

1.2

0.7

0.2

1.21.3

0.51.6

0.3

0.7

0.31.21.2

0.5

7.7

0.3

0.9

1.0

2.11.0

1.7

0.5

1Mean diameter of the efyth ema reaction greater than or equal to‘Figures may not add to 100 percent because of rounding.31ncludes data for races not shown separately.

NOTE mm = millimeter.

10.5 mm.

52

Table 24. Sample size, percent positive, standard errora of percent positive, and pwcent distributions of the erythema reaction for females ages 6-74 yeare, to ragweedallergen, by race and age United States, 1976-80

Positive skin-test

reacfiorr’ Percent distribution of erythema reaction2

0.1- 1o.5- 20.5- 30.5- 40.5 and

Sample Standard 10.4 mm 20.4 mm 30.4 mm 40.4 mm moreRace and age size Percent error Omm ( +/-) (7+) (2+) (3+) (4+)

All races3

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-n years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

White

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-n year s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Black

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-n years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7,942

796

692

1,0121,108

797

7211,271

1,343

6,767

641721

848943

689

615

1,1301,160

1,035

143

156

137

140

96

92125146

8.6

7.8

11.1

11.5

10.49.6

5.65.64.1

7.9

6.410.710.3

9.4

9.15.3

5.5

3.7

14.1

15.9

15.2

20.6

17.0

12.7

‘6.0“7.86.6

0.54

1.09

1.311.240.921.150.950.940.62

0.47

0.941.311.241.011.20

0.99

0.970.67

2.14

4.36

3.53

5.27

3.97

3.46

‘2.06

‘3.671.97

88.4

89.2

85.7

85.4

66.667.191.891.6

92.8

89.1

90.186.386.2

87.887.6

92.3

92.093.2

83.3

83.3

62.178.9

79.1

83.7

89.489.190.4

3.0

3.0

3.2

3.13.0

3.22.62.6

3.2

3.0

3.5

3.03.52.8

3.3

2.4

2.53.1

2.6

0.72.7

0.5

3.9

3.6

4.7

3.13.0

3.3

4.2

3.2

3.34.14.4

2.42.3

1.5

3.1

3.9

3.13.33.7

4.32.5

2.4

1.3

4.2

6.84.3

4.1

6.0

4.5

1.43.7

3.1

2.2

5.7

3.9

3.62.9

2.21.81.4

2.8

1.5

5.63.6

3.22.2

2.0

1.91.4

5.4

5.9

7.4

6.1

5.4

7.6

4.9

1.7

1.6

1.0

1.7

3.3

2.01.6

0.80.9

0.9

1.4

0.81.52.8

1.61.6

0.6

0.80.8

3.2

2.1

2.8

7.0

5.6

1.1

2.31.1

0.6

0.3

0.5

1.0

0.70.8

0.20.70.2

0.5

0.10.50.7

0.80.8

0.2

0.40.3

1.2

1.2

0.7

3.4

0.7

4.0

I Meand!ameter of the erythema reaction greater than or equal to 10.5mm.‘Figures may not add to lIYJpercent because of rounding.31ncludesdata for races not shown separately.

NOTE mm = millimeter.

53

Table 25. Sample size, percent positiie, standard errors of percent Positive, and Percent diatnbutions of the erythema reaction for persons sgea 6-74years, to ragweed allergen (h~h pollen regions-Northeast and IWdweat), by rase and age: United States, 1976-8o

Positive skin-test

reaction’ Percent distribution of erythema reactionz

o.1- 1o.5- 20.5- 30.5- 40.5 andSample Standard 10.4 mm 20,4 mm 30.4 mm 40.4 mm

Race and agemore

size Percent error Omm ( +/-) (l+) (2+) (3+) (4+)

Al I races3

Alleges ...,..,..,..,..,..,..,.. . . . . . . . . . . . . .

6-n years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12-17 years.............,..,..,.. . . . . . . . . . . . .

18-24 years ., . ., . ., . ., . .,..,..,. . . . . . . . .

25-34 years ., . ., . ., . ., . .,..,..,. . . . . . . . . .

35-44 years.,..,..,..,..,..,..,.. . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . ., . ., . ., . . . . . . . . . . . . . . . . . . . . .

White

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-n years..........,........,.. . . . . . . .12-17 years...,..,..,..,..,..,.. . . . . . . . . . . . . .18-24 years...,..,..,..,..,..,.. . . . . . . . . . .

25-34 years, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years.......,..,..,..,..,.. . . . . . . . . . . .

Black

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-n years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years................,..,.. . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7,613

783

912

1,015

1,061752

6891,216

1,185

6,703

648772907

929

665

617

1,089

1,076

849

129

130

100

12079

67

122

102

13,2

13,3

16.0

19.4

15.513.7

10.1

6.7

5.7

13,0

17,615,619.2

15.1

13.4

10.3

7.2

5.8

15.6

21,6

19.6

21.319.315.8

“6.1

“2.0

5.0

0.67

1.”10

1.55

1.60

0.[151,46

1.76

0.97

0.70

0.66

1.011.541,52

0.91

1.54

1.91

1.0,3

0.74

2.26

4.12

4,165,29

3.253.8$)

‘2.6zI

“1.41

1.54

83.6

83,3

80.777.7

81.484.2

66.689.4

91.1

83.9

84.481.577.9

81.6

84.4

86.3

86.8

90.9

82.7

77.6

77.5

76.778.283.3

90.6

95.0

93.4

3.1

3.33.32.9

3.12.13.33.9

3.2

3.2

3.82.92.93.2

2.23.44.0

3.4

2.1

0.8

2.8

2.02.51.0

3.3

3.1

1.6

4.5

7.4

5.1

6.4

4.34.73.0

2.0

1.7

4.2

6.24.66.2

4.3

4.4

3.2

2.11.6

6.6

12.8

9.2

9.33.96.5

1.1

0.8

2.9

5.1

3,8

7.4

6.7

7.23.64.1

2.9

2.3

4.9

3.27.16.9

6.7

3.1

4.1

3.12.3

6.9

7.7

9.3

4.612.06.7

5.0

1.1

2.1

3.0

1.8

3.1

4.9

3.24.02.7

1.6

1.6

3.2

1.93.44.8

3.3

4,5

2.8

1.71.8

1.7

1.2

1.3

5.23.3

0.7

0.4

0.5

1.4

0.71.50.2

0.3

0.1

0.7

0.40.51.3

0.8

1.4

0.2

0.30.2

0.6

2.2

2.5

1Mean diameter of the erythema reaction greater than or equal to 10,5 mm,2Figures may not add to 100 percent because of rounding.31ncludes data for races not shown separately.

NOTE mm = millimeter.

54

Table 26. Sample size, percent poeitiie, standard errors of percent pm-tie, end percent distributions of the erytherna reaction for males ages 6-74yea~ to ragweed eHergen (high @en regions-krtheaat and hliiest~ by race end agfx United Stateq 1976-60

Positive skin-testreaction’ Percent distribution of erythema reactionz

o.1- 1o.5- 20.5- 30.5- 40.5andSample Standard 10.4mm 20.4 mm 30.4 mm 40.4mm more

Race and age size Percent error Omm (+/-) (l+) (2+) (3+) (4+)

All races3

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-n years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

16-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

White

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-llyears . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-84 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Black

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-n years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12-17 year s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 yaars, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .85-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3,691

397

471

4$9

501

365336

5a5

537

3,280

336

404452

441

328313520

484

380

5461

44

53

3222

6549

15.3

15.3

17.4

22.0

18.9

74.8

122

7.0

7.0

15.3

13.5

17.221.818.7

15.513.1

7.5

7.5

16.2

*24.9

20.3

“25.3

25.4

“8.7●

*2.2“1.1

0.80

1.52

1.33

2.39

0.99

2.16

2.87

1.51

1.15

0.83

1.71

1.512.22

1.01

2.312.981.66

1.28

2.85

●6.644.28

*1O.12

3.74

“5.81.

“2.26

“1.08

81.5

81.4

79.7

75.8

77.5

83.0

84.5

8a.5

88.7

81.4

82.6

80.076.1

77.8

62383.4

87.6

87.8

81.9

75.1

77.371.9

69.2

89.2*

97.698.9

3.2

3.3

2.9

2.2

3.52.1

3.3

4.5

4.3

3.3

3.92.8

2.1

3.42.23.6

4.9

4.7

1.9

24

2.9

5.4

2.2●

5.1

7.9

6.7

8.4

4.2

4.33.2

1.8

2.0

4.7

6.2

6.07.6

4.6

4.13.320

22

8.3

16.5

12.8

17.7

1.1

4.7.

5.7

4.8

6.0

7.6

9.7

28

4.9

3.5

2.6

5.7

4.5

6.17.9

9.1

3.25.3

3.62.8

6.0

7.5

5.9

5.0

19.6

.

2.21.1

3.8

2.0

3.8

4.9

4.55.2

4.2

1.7

2.0

4.1

2.3

4.15.2

4.5

5.84.5

1.922

1.2

0.91.6

1.1

4.7

*

0.8

0.5

0.9

1.2

0.5

2.5

0.3

0.8

0.6

1.11.2

0.52.4

0.4

0.7

1.5

4.0●

1Mean diameter of ths srythsma reaction greater than or equal to 10.5mm,+igurss ~lay not add to i m percent bscause OfrOundin9.

31ncludesdata for races not shown separately.

NOTE mm = millimeter.

55

Table 27. Sample size, percent pos”tie, standard errore of percent positiie, and peroent distributions of the erythema reaction for females ages 6-74yeare, to ragweed allergen (hiih pollen region~ortheast and Mkhvest), by race and agfx United States, 1976-S0

Positive skin-test

reaction’ Percent distribution of erythema reactionz

o.7- 1o.5- 20.5- 30.5- 40.5 andSample Standard 10.4 mm 20.4 mm 30.4 mm 40.4 mm more

Race and age size Percent error Omm ( +/-) (7+) (2+) (3+) (4+)

All races3

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-n years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

White

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-n years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Black

Ailages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-llyears . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3,922

366

441

516

560

387353

631846

3,423

310368455

488

337

304

569

592

489

75

69

56

6747

45

57

53

11.3

11.4

14.6

16,8

12.2

12,7

7.96.44.7

10.7

10.014.016.511.6

11.4

7.6

6.94.5

15.5

‘19.0

●19.3

18.0

●15.7

21.3

●8.5

‘1.7

‘8.0

0.74

1.90

2.11

2.04

1.37

1.771.60

1.330.83

0.6!>

1.79

1.972.07

1.61

1.8[1

1.87

1.47

0.87

2.3[1

*6.7$1

●6.81

2.71‘6.15

5.ICI

*3.91

“1.43

“2.84

85,6

85.2

81.7

79.6

85.0

85.38a.790.2

92.9

86.2

86.283.079.9

85.3

86.3

89.3

69.993.2

62.3

79.6

77.6

80.8

83.6

78.7

85.9

92.0

89.2

3.1

3.4

3.7

3.6

28

2.03.3

3.43.4

3.1

3.73.13.6

3.1

2.3

3.1

3.22.4

2.3

1.5

3.11.3

0.8

5.5

6.3

2.8

3.9

6.8

3.5

4.5

4.35.1

2.82.1

1.4

3.8

6.3

3.14.8

4.1

4.8

3.2

2.21.1

5.2

9.7

6.2

2.3

5.6

7.9

1.7

5.0

4.5

2.9

8.7

5.9

4.94.3

3.42.4

2.0

4.0

2.0

8.25.94.4

3.0

2.8

2.61.9

7.7

7.8

12.1

4.2

7.6

12.08.5

2.9

2.3

1.5

2.3

4.9

2.12.8

1.31.41.4

2.3

1.52.64.4

2.0

3.2

1.1

1.61.5

2.0

1.5

1.0

8.62.5

0.6

0.2

1.6

0.9

0.50.4

0.5

0.6

0.3

1.4

1.1

0.3

0.5

0.6

0.6

2.8

1.4

1Mean diameter of the erythema reaction greater than or aqual to 10.5 mm.‘Figures may not add to 100 percent because of rounding.31ncludes data for racea not shown separately.

NOTE mm = millimeter.

56

Table 28. Sample size, percent posithre, standard errors of percent poeitiwj and percent dMibutm“ ns of the erytheme reeotion for pereons ages 8-74yeara, to ragweed sffergen (low pollen ragione-south and West), by raoe and sw United Stetesj 1978-80

Positive skin-testreaction’ percent distribution of erythema reaction2

o.1- 1o.5- 20.5- 30.5- 40.5andSample Standard 10.4mm .Z14mm 30.4 mm 40.4mm more

Race and age size Percent error Omm (+/-) (1+) (2+) [3+) (4+)

All races3

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-n years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

White

Ailages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-llyears . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Black

Allages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-llyears . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7,837

637971936

1,079761691

1,23a1,324

6,511

6887597498678485SQ

1,0871,123

1,081

13a1791481538783

126185

7.2

4.66.59.8

10.07.94.94.83.4

6.5

3.68.58.39.37.54.24.43.0

*11.7

9.3“11.221.0

*15.5‘7.5“3.9

*1O.35.6

0.91

0.741.371.831.271.490.980.820.61

0.78

0.651.321.151.361.480.930.760.65

●3.66

2.22●4.636.54

‘5.51●4.31‘1.72‘4.371.84

89.8

93.266.688.668.787.992.893.193.2

90.5

93.966.787.987.568.793.593.883.6

65.7

90.365.578.081.086.093.169.3921

3.0

2.32.83.33.34.2232.03.4

3.0

2.52.83.83.33.8231.93.4

2.6

0.43.31.13.56.53.00.32.3

2.8

2.33.04.13.2292.82.01.5

26

1.83.03.7282.22.72.21.3

4.2

4.33.67.35.93.10.91.72.6

2.5

1.42.9284.22.81.51.81.1

2.4

1.23.12.44.32.51.21.71.2

3.1

1.92.75.73.04.41.91.71.1

1.3

0.81.52.02.11.40.50.50.4

1.0

0.61.21.51.71.60.30.40.1

3.1

2.03.44.85.9

1.02.41.9

0.6

0.21.20.90.50.9

0.50.3

0.5

1.20.60.51.1

0.10.4

1.4

1.11.53.10.8

4.6

lMean diamster of the erythema reaction greater than or equal to 10.5mm.‘Figures maynotadd to 1(XIpercent because of rounding.31ncludesdata for races not shown separately.

NOTE mm = millimeter.

57

Table 29. SSMple size, peroent positive, standard emors of percent positive, and percent distnbutiona of the erythema reaction for males ages 6-74yeare, to ragweed allergen (low pollen regions-south and West), by race and age: United States, 1978-60

Positive skin-testreact/onl Percent distribution of erythema reaction2

—0.1- 1o.5- 20.5- 30.5- 40.5and

Sample Standard 10.4mm 20.4mm 30.4 mm 40.4mm moreRace and age size Percent error Omm (+ /-) (l+) (2+) (3+) (4+)

All races3

Allages . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-n years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12-17 years . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

White

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-n years . . . . . . . . . . . . . . . . . . . . . . .12-17 years . . . . . . . . . . . . . . . . . . . . .18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 yeara . . . . . . . . . . . . . . . . . . . . . . . . . .

Black

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-n years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3,617

425

520440

531

351

323

598

629

3,167

337406356432

296

279

526

535

515

7092678038366072

8.3

4.79.0

13.211.29.16.24.73.4

7.9

4.39.212.811.3

7.9

5.2

4.6

3.0

‘ 10.4

*5.9*1O.8● 19.4“12.5*10.2“4.0“7.3*5.3

1.13

1.14

2.15

2.25

1.942.16

1.88

1.14

0.83

1.01

1.121.931.80

2.29

2.25

1.53

1.30

0.80

‘4.49

*2.81

“7.02

“8.14‘8.22

“5.66

●2.41

*3.78‘4.93

88.6

93.5

66.1

82.7

85.4

87.090.9

93.0

93.9

89.0

94.088.263.084.7

88.7

91.7

93.5

94.1

87.4

93.3

85.1

78.2

87.5

83.6

93.9

92.7

93.5

3.1

1.8

2.9

4.1

3.43.9

2.9

2.3

2.7

3.1

1.62.74.2

4.0

3.4

3.0

1.82.9

2.3

0.8

4.1

2.4

6.22.2

1.3

3.0

2.7

3.0

6.1

2.42.0

3.71.6

1.4

2.6

2.02.95.8

2.1

0.6

3.5

1.61.0

5.0

4.5

4.4

10.1

5.4

4.91.8

2.3

2.2

3.2

1.1

2.6

3.6

6.03.91.8

2.4

1.5

3.2

1.32.93.8

6.4

3.6

1.3

2.31.6

2.6

2.2

3.82.5

5.3

2.1

4.0

1.2

1.6

1.02.0

2.0

2.42.3

0.8

0.7

0.3

1.6

1.0

2.02.0

2.4

2.6

0.4

0.70.1

1.8

1.4

2.7

3.13.1

1.9

0.6

1.4

1.3

0.50.6

0.1

0.2

0.6

1.41.2

0.4

0.9

0.2

1.0

1.6

2.4

1.6

1.1

1Meandiameter of the erythema reaction greater than or equal to 10.5mm.‘Figures may not add to 103percent because of rounding.31ncludesdata for racesnotahown separately.

NOTE mm = millimeter.

58

Tebla 30. sample size, percent positiie, standard errors of percent positive, and percent distributions of the erythema reaction for females agea 8-74years, to ragweed allergen (low pollen region-uth and West), by raoe and age United States, 1976-80

Positive skin-testreaction’ Percent distribution of erythema reactior?

0.1- 1o.5- 20.5- 30.5- 40.5andSample Standard 10.4mm 20.4 mm 30.4 mm 40.4mm more

Race and age size Percent error Omm (+/-) (l+) (2+) (3+) (4+)

All races3

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-llyew’s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

White

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-n years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12-17 years, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Black

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-n years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 )ears . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-84 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4,020

412451498548410368840695

3,344

331353393455352311581588

566

6887817349476893

6.2

4.5

8.1

6.6

8.66.9

3.6

5.03.4

5.2

“297.74.27.37.1

●3.24.1

“2.9

13.0

13.011.6

●22.218.3“5.1‘3.7

‘12.6“5.8

0.79

1.09

1.60

1.441.18

1.48

1.CMJ

1.35

0.93

0.88

“0.89

1.751.17

1.131.55

R1.01

1.30

“1.01

3.26

4.26

3.43*7.92

5.63

‘4.04●2.32

●5.03‘2.80

909

92.8

89.2

90.5

8a.o8&7

94.6

93.3

92.7

91.9

93.7

89.392.4

90.288.7

95.1

94.0

93.2

84.7

67.0

66.077.8

74.9

88.292.4

86.891.1

2.9

2.8

2.8

2.7

3.24.3

1.9

1.8

3.9

2.9

3.42.9

3.4

2.54.2

1.7

1.9

3.9

29

2.4

6.8

6.83.90.6

3.1

2.7

1.9

2.9

2.3

4,03.7

2.0

2.5

1.6

2.6

1.E1

3.01.8

3.4

3.81.9

2.61.5

3.4

4.0

2.6

5.2

6.4

1.4

1.22.9

1.9

1.7

3.1

2.1

2.41,7

1.2

1.3

0.8

1.6

1.1

3.21.2

2.11.5

1.2

1.20.8

3.5

3.9

3.2

7.2

3.4

3.61.7

1.0

1,0

0.6

1.1

1.9

1.90.4

0.4

0.4

0.5

0.5

0.2

0.51.2

1.1

0.50.2

0.1

4.2

2,7

4.4

6.1

8.5

2.0

4.21.8

0.6

0.31.0

0.60,5

1.1

0.9

0.5

0.5

1.0

0.61.3

0.2

0.5

1.8

2.3

1,4

3.7

7.2

1Meanciameter of the erythema reaction greater than or equal to 10.5mm.‘Figures may not add to 1W percent because of roundfng.31ncludEs data for races not shown separately.

NOTE rlm = millimeter.

59

Table 31. Mednn size of positive ekin-test reaction to indtiual alfwgens for perems ages 8-74 yeara, by race and sge United Steteq 1978-80

IndividualAll races’ White Black

a//ergen Both sexes Male Female Both sexes Male Female Both sexes Male Female

Median in millimeters

House dust ., . ., . ., . ., . .,, .,.,,.., ... ..,.. 20,0 20.5 19.0 20.0 21.0 19.0 18.5 18.0 18.5Alternaria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22.0 21.5 22.5 22.5 22.0 22.5 20.0 20.0Cat. ., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

21.020.0 20.0 21.0 20.5 20.0 21.0 18.0 17.0 19.5

Dog . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20.0 20.5 19.0 20.0 20.0 20.0 17.0 23.0 17.0Ragweed —allregions. .,..,..,..,.. . . . 24.0 25.0 23.0 24.5 25.0 22.5 230 20.5 25.0Ragweed — high pollen regionsz, . . . . . . . . 25.0 25.0 24.0 25.0 25.5 24.0 22.5 20.0 24.0Ragweed — low pollen regionsa . . . 23.0 23.5 22.5 22.5 24.0 2Q.5 26.0 21.5 27.5Oak . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23.0 23.0 23.0 23.0 23.5 23.0 22.5 22.5 20.5Ryegrass. .,..,..,..,..,..,..,.. . . . . . . . . . . 29.0 29.0 29.0 29.5 29.5 30.0 27.5 27.5 27.0Bermuda grass,..,.....,..,..,.. . . . . . . . . 24.0 25.0 23.5 25.0 25.5 23.5 23.5 25.0 23.5

~Includes data for races not shown separately.‘Northeast, Midwest.

3South, West.

60

Appendixes

Contents

I. &atisticai notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62lntroductian . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62!Wrveydesign. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..62Estimati,on procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63Nonresponse bias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64Standard deviaticms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...66Wmdarderroas....... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..66Data limitations andreliability. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66.4nalytic methodology .,.... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66

11. Da{a quality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Sinter.e~aminer va~iahility. , ................... ................... ............... 68

Skin ccdor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69Histamine reactivity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69Methodofal?ergenm anufacture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69

HI. Definition ofterms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72

Listofappendixtables

I. Number ofexamined persons intheallergy skin-test sample mdestimated ppulation, by race, sex, andage: SecondNationa[ Health wrd Nutrition Examination Survey, 1976-80 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11. Percent distribution of nonresponse adjustment factors: Second National Health and Nutrition Examination Survey:United States, 1976-80 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

111. Samplesiz eandpercen tresponsefor allergy skin-test subsample, byselected characteristics: Second National Healthand Nutrition Examination Survey, 1976-80 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

IV. Reportedprevalerrce ofselectedallergies forpersons ages &74yems, byintewiewed-nonexaminedversus interviewed-examined sample persons: Second National Health and Nutrition Examination Survey, 1976-80 . . . . . . . . .

v. Reported prevalence of selected allergies for persons ages 6-74 years, by examined nonskin-tested versus examinedskin-tested sample persons: Second National Health and Nutrition Examination Survey, 1976-80 . . . . . . . .

W. Size ofreaction tothenegati\~e control (diluent) atthe20-minute reading adnumber oftests given forpersons ages6-74 years, by examiner number: United States, 1976-80 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

VII. Major examiners forpersons ages &74yews, bystand andhistamine base use: United States, 1976-80 . . . . . . .VIII. Prevalence of skin-test reactivity to 1.0 mg/mL histamine base at the 20-minute reading and number of tests

given for persons ages 6-74 years, by major examiners: United States, 1976-80 . . . . . . . . . . . . . . . . . .IX. Chmgeinreacti\' itytol.Omg/mL histamine baseatthe 20-minutereading bychronological order forselectedexaminers

farpersons ages &74years: United States, 1976-80 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .x. P(:rcent positi\7e andsize ofe~thema andwheal reaction atthe20-minute reading for l. Omg/mLhistarnine base for

pcrscmsages6-74yea rs,byrac eandsex:Uni tedStates, 1976-80 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .XI. Size of wheal and erythema reaction in millimeters at the 20-minute reading for 1.0 mg/mL histamine base for

persons ages 6-74 yems, bysex: United States, 1976-80 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .XII. Prevalence ofskin-test reactivity to l. Omg/mLhistamine base atthe20-minute reading for~rsons ages &74yems,

bvselected characteristics: LTnitedStates, 1976-80 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .XIII. P;.evalence of skin-test reactivity for persons ages 6-74 years, by selected allergens and allergen manufacture in stands

using bath batteries ofextracts: United States, 1976-80 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

63

64

65

65

66

6868

69

69

70

70

71

71

61

Appendix IStatistical notes

Introduction

This report is based on data collected in the seconcl Na-tional Health and Nutrition Examination Survey(NHANES II) from February 1976 through February 1980,NHANES II, conducted by the National Center for HealthStatistics (NCHS), was a survey of the U.S. civilian nonin-stitutionalized population (including Alaska and Hawaii) 6months through 74 years of age. Both interview and examina-tion procedures were used to collect a broad spectrwm ofdemographic, socioeconomic, and morbidity data and relatedmedical and nutritional information. During household inter-views, demographic, socioeconomic, and some medical his-tory data were obtained for sample persons. Dietary interview,medical examination, and related clinical tests and procedureswere performed in specially designed mobile examination cen-ters (MEC’S) that were transported to each sample locationto provide standardized conditions and equipment.

Survey design

NHANES II utilized a stratified, multistage probabilitysample design. In hierarchical order, the stages of selectionwere as follows: Primary sampling units (PSU’s-a PSU isa county or a small group of contiguous counties), segments(a segment is a cluster of eight households), households,and finally, sample persons.

Four hundred sixty-one primary sampling units wereformed in the first design stage from the PSU’S of the NationalHealth Interview Survey (NHIS), another major survey pro-gram of NCHS. These units were counties, groups of smallcontiguous counties, or, in some New England States, areasdefined by minor civil divisions. PSU’S were stratified intoa total of 64 strata on the basis of region, population size,median income, and other social and demographic characteris-tics that varied with region. One PSU was selected fromeach strata using a modified Goodman-Kish controlled-selec-tion technique. 104These 64 PSU’S represented the geographiclocations visited by the MEC’S during the survey period.

The second stage of the design consisted of the selectionof clusters of households (segments) within enumeration dis-tricts (ED’s). An ED is a geographical area that containsapproximately 300 housing units. The U.S. Bureau of theCensus had the major responsibility for selecting householdsand sample persons within each of the PSU’S. Three sampling

frames of housing units were used to select the sample withineach of the PSU’s. The list frame consisted of all housingunits based on the 1970 Census of the Population. An areaframe was used in areas with “rapid” growth (housing unitsbuilt prior to 1970) and in areas with “slow” growth (allhousing units regardless of year built). A new constructionframe was used to supplement the list frame for all placesbuilt since 1970 and in about half of the places in the areasa~mplethat were experiencing rapid growth,

ED’s within each PSU were stratified into poverty andnonpoverty strata. The poverty strata contained ED’s with13 percent or more of persons below the poverty level, andthe nonpoverty strata contained ED’s with less than 13 percentof persons below the poverty level, as determined by the1970 Census. To oversimple persons with low incomes, seg-ments were drawn from the poverty strata with an averageof 2.3 times the probability that segments were drawn fromthe nonpoverty strata, Sampling fractions were determinedwithin PSU’s by a mathematical model to ensure an adequateand manageable sample size and to minimize the varianceof the estimated proportion of persons below the povertylevel. To ensure sampling reliability, clusters of 16 listedadklresses were drawn from the sampling frames and thensystematically subsampled at a rate of 1 out of 2 to producea ilnal set of eight household address listings.

At the third stage of sampling, the interviewer madea list of all eligible sample persons within the selected house-holds. Using instructions and a worksheet in the interviewfolder with the following sampling rates, the interviewerselected sample persons to be examined so that the youngerand older age groups were oversampled, ensuring that approxi-mately one person per sample household was selected

Age Rate

6montha-5 years . . . . . . . . . . . 3146-59 years . . . . . . . . . . . . . . . 1/460-74 years . . . . . . . . . . . . . 314

After a person was selected, the interviewer conducteda medical history interview and then phoned the field officeto make an appointment for the examination. The samplescheduled to receive skin testing included all sample persons6-74 years of age. Table I shows the number of examinedpersons and population estimates at the midpoint of the surveyin the skin-test sample by race according to sex and age.

NOTE: A list of references follows the text,

62

Table L Number of examined persona in the allergy skin-test aarnple and estimated population, by race, sex and age Second National Health andNutri60n Examination Survey, 1978-S0

All rac.es~ White Black

Estimated Estimated Estimatedpopulation pqwlation population

Sample in Sample in Sample inSex and age size thousands sk”e thoussndsz size thousands2

Both sexes

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . .

6-n years . . . . . . . . . . . . . . . . . . . . . . . .12-17years . . . . . . . . . . . . . . . . . . . . . . .18-24years . . . . . . . . . . . . . . . . . . . . . . .2%34years . . . . . . . . . . . . . . . . . . . . . . .3FA4years . . . . . . . . . . . . . . . . . . . . . . .46-54years . . . . . . . . . . . . . . . . . . . . . . .55-64years . . . . . . . . . . . . . . . . . . . . . . .65-74years . . . . . . . . . . . . . . . . . . . . . . .

Male

Ali agea . . . . . . . . . . . . . . . . . . . . . . . . . .

6-n years . . . . . . . . . . . . . . . . . . . . . . . .12-17years . . . . . . . . . . . . . . . . . . . . . . .18-24years . . . . . . . . . . . . . . . . . . . . . . .25-34years . . . . . . . . . . . . . . . . . . . . . . .35-44years . . . . . . . . . . . . . . . . . . . . . . .45-54years . . . . . . . . . . . . . . . . . . . . . . .55-64years . . . . . . . . . . . . . . . . . . . . . . .65-74years . . . . . . . . . . . . . . . . . . . . . . .

Female

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . .

8-n yeara . . . . . . . . . . . . . . . . . . . . . . . .12-17years . . . . . . . . . . . . . . . . . . . . . . .J8-24years . . . . . . . . . . . . . . . . . . . . . . .25-34years . . . . . . . . . . . . . . . . . . . . . . .3544years . . . . . . . . . . . . . . . . . . . . . . .45-54years . . . . . . . . . . . . . . . . . . . . . . .55-64years . . . . . . . . . . . . . . . . . . . . . . .66-74yearti . . . . . . . . . . . . . . . . . . . . . . .

16,204

1,7251,9752,0542,2371,5891,4532,5562,615

7,840

8851,039

9881,067

745690

1,2271,199

8,364

840936

1,0661,170

844763

1,3291,416

186,692

20,88024,08427,44832,75223,65123,03220,35014,496

90,441

10,64612,24113,27515,89511,36711,1149,6076,297

11;84314,17316,85612,28411,91610,7436,198

13,841

1,3971,6101,73a1,9011,3791,2642,2622,280

6,726

725853846901653617

1,0861.045

7,115

672757892

1,OQo726647

1,1761,245

160,785

17,26420,02723,36228,45720,39220,23518,24212,906

76,099

8,76810,13311,44213,8649,8089,6658,6425,576

82,686

8,4869,893

11,91914,49410,58410,3699,6017,329

2,040

288321268284173162264260

942

1361571211397062

129128

1,098

152164147145103100135152

21,269

3,0943,4353,4063,4992,5272,2591,7601,288

9,864

1,5541,7181,5331,5461,1121,044

601555

11,404

1,5401,7171,8731,9531,4151,215

959733

1Includes other racas not stuwin sepsrately.2Estimstsd po@iionasofthemidpAtof thssuwsy,Marchl, 1978.

A more complete description of thesurvey design is in-cludedin ’’Pkm and Operationof the Second National HealthandNutrition Examination Survey, 1976-80,” VitalandHealdzStatistics, Series l, No. 15.29

Estimation procedures

Because the design of NHANES is a complex multistageprobability sample, national estimates are derived througha multistage estimation procedure. The procedure has threebasic components: (l) inflation bythe reciprocal oftheproba-bility of selection, (2) adjustment for nonresponse, and (3)poststratification by age, sex, and race. A brief descriptionof each component is as follows:

● Injlationby thereciprocaloftheprobabilizy ofselection—The probability of selection is the product of theprob-abilities of selection from each stage of selection in thedesign—PSU, segment, sample person, and subsample.

. Adjustmentfor nonresponse—The estimates are inflated

NOTE. AlistofreferencesfolIowsthetext.

by a multiplication factor that brings estimates based onexamined persons up to a level that would have beenachieved ifall sample persons had been examined. Thenonresponse adjustment factor was calculated by dividingthe sumofthe reciprocals of the probability of selectionforall selectedsample persons within each offiveincomegroups (less than $6,000; $6,000-9,999; $10,000-14,999;$15,000-24,999, and $25,000 and more), three age groups(6 months-5 years; &59 years; 60-74 years), four gee-graphic regions, and within or outside standard metropoli-tan statistical areas (SMSA’S) by the sum of the reciprocalsof the probability of selection for examined sample personsin the same income, age, region, and SMSA groups.The percent distribution of the nonresponse adjustmentfactors is shown in table II.

● Poststratij$cation by age, sex, and race-The estimateswere ratio adjusted within each of 76 age-sex-race cellsto independent estimates, provided by the U.S. Bureauof the Census, of the population as of March 1, 1978,the approximate midpoint ofthesurvey. The ratio adjust-ment used a multiplication factor in which the numeratorwas the U.S. population and the denominator was the

63

Tabtell. Percent distnbutionof nonresponse-adjustment factors:Second National Health and Nutrition Examination Suwey, 1976+Nl

Sizeof factor Percent distribution

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0

1.00-1.24 . . . . . . . . . . . . . . . . . 26,81.25-1.49 . . . . . . . . . . . . . . . . . . . . . . . . . 5481,50-1.74 . . . . . . . . . . . . . . . . 10.91,75-1.99 . . . . . . . . . . . . . . . . . . . . . . . . . 442.00-2,49 . . . . . . . . . . . . . . . 222.5C-2.99, , . . . . . . . . . . . . . . . 0,$)

sum of the weights adjusted for rrrmresponse for examinedpersons. This ratio estimation procedure brings the popula-tion estimates into close agreement with the U.S. Census

Bureau’s estimates of the U.S. civilian ncmin-

stitutionalized population, and irr general reduces samplingerrorsofNHANES Ilestimates.

Nonresponse bias

In any health examination survey there exists thepr.rtential

for three levels of nonresponse: ( 1) Household interview nonre-sponse, (2) examination nonresponse, and (3) item nonre-sponse. Household interview nonresponse is defined as theproportion of those sample persons who do not complete

thehousehold medical historyquestionnaire . Examinationnon-

response is the proportion of those sample persons who initiaily

respond to the household demographic questions and someor all of the medical history questionnaire, but who sub-sequentlydo not come to the examination center. Item nonre-

sponse results from sample persons who do not complete

some portion of either the household interview questionnairesor the examination protocol. Intense efforts were undertakenduring NHANES 11 to develop and implement proceduresand inducements that would reduce all types of nonresponse

and thereby reduce the potential for bias in the survey esti-mates. These procedures are discussed in Vital and HealthStatistics Series l, No. 15.29

In NHANES II the total sample size was 27,801; of

these sample persons, 25,286 (91. Opercent) were interviewedand 20,322 (73. I percent) were examined. In the skin-test

sample (6-74 years of age), there were 22.732 sample persons;20,410 (89.8 percent) were interviewed and 16,204 (71.3

percent) were examined. Overall, 95.8 percent of the examinedsample received 5 to 8 skin tests, 0.2 percent received Ito 4 skin tests, and 3.9 percent received O skin tests. Thesepercents remained fairly constant when examined by selecteddemographic variables (see table III).

Acomparison of the 1976 National Health InterviewSur-vey (NHIS)105 and NHANES 11106suggests that there is no

large nonresponse bias in some health-related variables (suchasperceived health status, diabetes, andheart attacks )becauseof the close agreement on selected interview items in NHANESII data with comparable items in the 1976 NHIS data. The

1976 NHIS data were used for the comparison because the

NOTE: A list ofreferences follows the text,

64

Table Ill. Sample size end percent response for akwgy skin-test subsample, by selected charecteriatkzx Second National Health and Nutritiin ExaminationSurvey, 1976-S0

Sample /nterviewe& Examined SampleSkin test23

Selected characteristics size percent percent size o 1-4 5-s

Total . . . . . . . . . . . . . . . . . . . . . . .

Age

B-n years . . . . . . . . . . . . . . . . . . .

12-17 years . . . . . . . . . . . . . . . . . .16-24 years . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . .

3+14years . . . . . . . . . . . . . . . . . .45-54years . . . . . . . . . . . . . . . . . .

55-64years . . . . . . . . . . . . . . . . . .65-74years . . . . . . . . . . . . . . . . . .

Sex

Female . . . . . . . . . . . . . . . . . . . . .Male . . . . . . . . . . . . . . . . . . . . . . .

Race

White . . . . . . . . . . . . . . . . . . . . . .

Black . . . . . . . . . . . . . . . . . . . . . .

Other . . . . . . . . . . . . . . . . . . . . . .

Geographic region

Northeast . . . . . . . . . . . . . . . . . . . .

!Wdwest . . . . . . . . . . . . . . . . . . . . .

South . . . . . . . . . . . . . . . . . . . . . .West . . . . . . . . . . . . . . . . . . . . . .

Residence

Urban . . . . . . . . . . . . . . . . . . . . . .

Rural . . . . . . . . . . . . . . . . . . . . . .

Poverty level

Belowpovertylevel . . . . . . . . . . . . . . .Atorabovepoverly level. .,... . . . . . .Unknown . . . . . . . . . . . . . . . . . . . .

Familymcome

o-$5,999 . . . . . . . . . . . . . . . . . . . .

$6,000-$9,9% 3 . . . . . . . . . . . . . . . .$10,000-$14,988 . . . . . . . . . . . . . . . .$15,000-324,999 . . . . . . . . . . . . . . . .$25,0000rmore . . . . . . . . . . . . . . . .

Unknown . . . . . . . . . . . . . . . . . . . .

22,732

2,085

2,4382,713

3,0312,2362,149

3,6684,212

11,946

10,786

19,4722,807

453

5,499

6,029

6,0435,161

14,937

7,795

3,21317,219

2,300

4,116

4,432

4,0055,147

2,7342,298

89.8

94.294.593.591.589.786.886.186.2

90.1

89.4

89.691.5

87.4

86.2

90.6

91.7

90.1

68.0

93.3

96.7

94.941.5

96.2

94.994.995.4

94.441.5

71.3

82.7

81.075.7

73.871.1

67.6

66.1

62.1

70.0

72.7

71.172.7

71.3

65.771.8

72.275.5

69.4

75.0

76.976.127.4

74.1

74.0

77.579.1

75.727.4

18,204

1,725

1,975

2,054

2,2371,5891,453

2,556

2,615

8,3647,840

13,8412,040

323

3,6154,332

4,362

3,895

10,360

5,844

2,472

13,101631

3/3493,2783,1054,073

2,070

629

3.9

5.5

3.64.2

3.33.84.3

3.53.8

4.3

3.6

3,94.5

3.7

4.3

3.74.5

3.3

4.5

3.0

4.4

3.85.5

4.7

3.33.44.0

4.0

5.2

0.2

0.3

0.4

0.2

0.40.4

0.4

0.10.1

0.2

0.3

0.20.3

0.1

0.1

0.50.2

0.3

0.1

0.2

0.20.2

0.3

0.2

0.10.30.2

0.2

95.8

94.2

96.095.6

96.4!35,0

9s.3

96.4

96.1

95.5

96.2

95.9

95.296.3

95.7

96.2

95.096.5

95.2

96.8

95.3

96.094.6

95,1

96.4

96.495.6

95.894.6

WOmpletadmediial history interview.2Numbsrof skin tesls received.‘Fgures do not add to lrM because of roundiig,

TatrklV. Reportedprwmkmceofeefectedallergi esforparaons eges6-74yeerq byrnterviewed-nonexanimsdvaraus interviawed-exemined eampleperaon.x Sacond National Health and Nutrition Examination Survey, 1976-S0

hrterviewad

Nonexaminad Examined

Selected Sample Standard Sample Standardallergy

Psize Percentl error size Percent’ error value

Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,206 5.5 0.38 16,204 6.5 0.32 <0.05Hayfever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,206 6.0 0.61 16,204 9.1 0.34Otherallergies . . . . . . . . . . . . . . . . . . . . . . . . . .

0.064,206 9.6 0.54 16,204 11.4 0.36 ‘=0.05

‘Age-adjusled to US. population, Marchl, 1978.

65

Table V. Re~tied ~evabnce ofsekct4alleqies tir~rwn!; agea&74yei~rq byexamind nonsKn-tested versus examind sMn-teMed~mpleperaona: Seeond Netionsl Health and Nutrition Examination Sunrey, 1978-S0

Examined

Nonskin-tested Skin-tested

Selected Sample Standard Sample Standard Pallergy size P6rcent1 error size Percent’ error value

Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,822 14.2 1.49 14,382 5.4 0.33 <0.05Haytever . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,822 18.0 1.83 14,382 7.9 0.39 <0.05Otherallergies . . . . . . . . . . . . 1,822 17.8 1.62 14,382 10.7 0.38 <0.05

‘Age-adjustedtoUS. population,March 1, 1976.

and other allergies than the skin-tested individuals (table V).Thus, it is likely that theexclusion of these individuals from

our survey decreased the rates of reactivity found. Their ab-sence did not introduce any significant amount ofbias whenmaking subgroup analyses, as it was spread fairly evenlyover all age, race, sex, urban or rural, and poverty-levelgroups.

Standard deviations

The standard deviation is the square root of the samplevariance. It is ameasure ofdispersionof sample observationsabout the sample mean. If the observations are distributednormally (that is, as in a Gaussian distribution), then thestandard deviation is useful in describing how an individualobservation compares with the sample mean: One standarddeviation above and below the mean includes approximately68 percent of the observations; two standard deviations, ap-proximately 95 percent; and two and a half standard deviations,approximately 99 percent.

Standard errors

Because the statistics presented in this report are basedon a sample, they will differ somewhat from the figures thatwould have been obtained had a complete census been takenusing the same survey instruments, instructions, interviewand examination personnel, and procedures. The probabilitydesign of this survey permits the estimation of standard errorsthat are appropriate for the estimates shown in this report.

The standard error is primarily a measure of samplingvariability, that is, the variation that might occur by chancebecause only a sample of the population is surveyed. Ascalculated for this report, the standard error also reflects partof the variation that arises in the measurement process. Itdoes not include estimates of any bias that might be containedin the data. The chances are about 68 in 100 that an estimatebased on a sample using the same procedures and instrumentswould differ from the value obtained from a complete censusby less than the standard error. The chances are about 95in 100 that the difference would be less than twice the standarderror and about 99 in 100 that it would be less than twoand a half times as large.

The estimates of sampling variability for the detailed tablesin this report were calculated using the pseudoreplicationmethod, a balanced half-sample replication technique that is

based on variability among random subsamples of the totalsample,48 The estimates of standard errors for the age-adjustedvalues in the text were calculated by a two-stage method:First, SURREGR49 was used to calculate the variance-covariance matrix using Taylor series linearization, and sec-ond, the variance-covariance matrix was passed into GEN-CAT,50>5i a program for generalized least-squares categoricaldata analysis. It should be noted that the estimates of standarderrors are themselves subject to error that may be large ifthe number of sample persons on which an estimate is basedis small or if these persons are concentrated in a few strata.

Data limitations and reliability

The criteria for reliability of estimates shown in this reportconsisted of the following: (1) that the sample size on whichthe estimate is based be at least 30 persons; and (2) thatthe estimated coefficient of variation (that is, the standarderror of the mean divided by the mean) be less than 30percent. Thus, if the sample size was too small or if thevariation regarding the mean was too large, an asterisk wasplaced next to the value on the table. Estimates with asterisksare considered neither precise nor stable enough to meet relia-bility standards. However, the values are shown to give animpression of the observed distribution and to permit usersto combine data into useful categories.

Analytic methodology

The procedure used in this report for testing the signifi-cance of the difference between two means or two rates con-sisted of dividing the difference between the two means orrates by the standard error of the difference; that is, at-statisticwas computed. The standard error of a difference of estimatescan be calculated as follows: Let s be the standard errorof the difference, SI and S2the standard errors of the estimatesx’ and ~, then

s = sqrt (sqr (sl) + sqr (s2) – 2(cov(xI,xJ) ).

All statistical testing in this report used the calculatedcovariance in the estimation of the standard error of the differ-ence. However, covariances are not given in this report becausethey would take a great deal of space. Readers, therefore,

NOTE. A listof referencesfollows thetext.

66

h

will have to perform their statistical testing without the useof the covariance term. Thus, where the two groups or meas-ures are correlated positively or negatively, the standard errorof the difference computed without the benefit of thecovariance term will give an overestimate or underestimate,respectively, of the actual standard error of the difference.The use of this standard error will affect the calculated &statis-tic, either decreasing it, if the calculated standard error is

increased, or increasing it, if the calculated standard erroris decreased. This in turn could cause the reader to cometo differing conclusions concerning the statistical significanceof a finding, if the p value is near 0.05. The standard errorsgiven in this report will, however, allow the reader to calculateconfidence intervals around point estimates. Unless otherwisespecified, tests for statistical significance are two-sided testsand use ap value of 0.05 as the limit for statistical significance.

67

Appendix IIData quality

Inter-examiner variability

More than 31 temporary and permanent examiners partici-pated in the NHANES II skin-test examination. Each examiner

was assigned a separate identification number except for the

temporary examiners, who shared numbers 75 through 79.Thirteen examiner numbers, including the temporary ones,

accounted for 95.7 percent of the skin-test eligible samplepersons. These examiners will be referred to as the major

examiners in this section, Variability in the reporting of skin-

test reactivity was investigated within this group of 13 examin-ers. Inter-examiner variability was estimated by evaluatingthe responses in the population to the negative and positivecontrol skin-test solutions. Because replicate skin testing was

not performed, intra-examiner variability could not be

evaluated.

Ideally, the response of the study participants to the nega-tive control (diluent) should be zero. However, because ap-

proximately 2 percent of the general population is demog-

raphic (having the tendency to form elevated reddish markssecondary to any manipulation of the skin), the anticipatedprevalence of reactivity to the diluent is not zero.’1 ] Two

cut points based on mean erythema diameter at the 20-minutereading were used to define reactivity for the diluent: Greater

than Omillimeters and greater than or equal to 10.5 millimeters.

Overall reactivity was 0.7 percent and 0.3 percent respectively(table VI). No examiner reported over 2 percent reactivityto the diluent except Examiner 16, who reported 2.2 percentreactivity ,at the greater than the O mm cutoff. Thus, it appears

that there was no excessive reactivity within the negative

control.

The positive control (histamine phosphate) was used intwo concentrations during the survey. For the first 48 stands,

0.1 mg/mL histamine base was used. During the last 16 stands,the histamine base concentration was changed to 1.0 mg/mL

to increase the rate of reactivity to the positive control. Therecommended histamine base concentration for prick–punctureskin testing is 1 mg/mL. 32 At the lower concentration, theexpected biologic variability of the histamine response is sogreat that it makes any analyses of this data meaningless.

Therefore, the inter-examiner variability was examined only

within the stands using 1.0 mg/mL histamine base. Ta-ble VH lists major examiner participation by stand and his-tamine use.

NOTE: A list ofreferencesfollows[hetext

68

Table W. Sie of reaction to the negative oontrol (diluent) at the20-rninute reading and number of teats given, for pereons ages 6-74years, by examiner numbe~ Unled States, 1976-S0

Examiner

Size of reaction

> 0 mmlNumber of _

S 10.5 md

number testa given Percent Percent

Totst . . . . . . . . . . . . . . . . 15,066 0.7 0.3

2 . . . . . . . . . . . . . . . . . . 847 0.5 05 . . . . . . . . . . . . . . . . . . 972 0.2 0.2

6. . . . . . . . . . . . . . . . . . 1,918 0.6 0.4

7 . . . . . . . . . . . . . . . . . . 1,339 0.1 0.1

9 . . . . . . . . . . . . . . . . . . 2,371 0.3 0.2

13 . . . . . . . . . . . . . . . . . 450 0.7 0.715 . . . . . . . . . . . . . . . . . 1,128 0.3 0.116 . . . . . . . . . . . . . . . . . 820 2.2 0.5

17 . . . . . . . . . . . . . . . . . 885 0.8 0.2

18 . . . . . . . . . . . . . . . . . 647 0.3 0.3

20 . . . . . . . . . . . . . . . . . 562 0.2 0.2

21 . . . . . . . . . . . . . . . . . 430 1.9 1.6

75-793 . . . . . . . . . . . . . . 2,697 1.2 0.3

1Mean erythema diameter greater than O mm.‘Mean diameter of the erythema reaction greater than or equal to 10.5 mm.3Temporary examiner numbers,

NOTE: mm= millimeter,

Tebfe V1l. Major examiners for persons ages 6-74 yea~ by stand andhistamine base use United Stetea, 1976-60

0.1 mglmL 1.0 mg/mL

histamine histamineTotal survey baee base

Stands . . . . . . . . . . . . . . 64 48 16

Number of sample pereons’ . 16,204 11,612 4,592

Major examiners . . . . . . . ,,, ,2567 2,5,6,7, 6,9,17,16,

9,13,15,16, 9,13,15,16, 20,21,17,16,20,21, 17,16, 75-792

75-792 75-792

Percent of exams done

by major examinere . . . . . 95.7 96.1 92.3

lTotal number of sample persona within the stands regardlessof examiner.~emporary examiner numbers.

The erythema reaction was used to measure inter-examinervariability because the analyses of allergenic reactivity were

based on the erythema reaction. Reactivity to histamine was de-

fined as a mean erythema diameter at the 20-minute reading ofgreater than O mm. The purpose of the positive control was toestablish cutaneous end-organ reactivity to one important in-flammatory mediator of the immedlat~ hypersensitiv-

ity reaction (histamine), l%us, no cut point other than the pres-

ence or absence of a reaction was felt to be appropriate.

-;: . .

Table VIIL Prevalenca ol akin-test macw~y ICI t .i) mg/rnC histamine base at the 20-minlrte r’eading and r~un~ber cii Qtsts given for persons ages 6-74 years, by major exarnimrs: United States, 197680

Examitwr number of tdds yven Percent positive 1

Total . . . . , 4,125 90.6

20 . .

18 . 75-7gL . . . . 21 . . . . . I . . .

9 . . . * . . . ,

17 . . . * . , , ,

6 . s . . . . . . . ,

56-1 al.6 328 136.3

I ,566 89.4 -126 93.7 570 93.9 285 98.2 386 90.7

‘Mean etythema diarnutur qesr qemporary examiner numbws.

Table IX. Change in ;eucii*/ti;, tri i 0 myl’rd. histarnme base at the 20- minute reading by chronolcgical order for seiected examiners for persons ages 6-74 years: United States, 1976-W

----- First half’ Second half

Exammer number

--.

PerCX;t Numbar df Perw7t tests gl ven positive ’ tests gwen positAd

1--__1_1_- c. --

6 ........ .....

9 .............

17 ............. 20 ............ 21 ............

121 96.7 265 99.6

324 94 a 246 92.7 82 100 0 203 97.5

380 75 5 184 94.0 80 90 0 346 94.5

‘Eight stands in each nalf ‘Mean diameter of tht, ary/tttemd

The prevalence ol’skin xactivity by il;tij(>l* examiner for I .O mgl mL histamine base is presented in table VIIl. Inter-examiner differences in reporting reactivity to histamine ranged from .8 I .6 percent to 98.7 percent.

In any examination ~rformt:ci repeatedly over an extended period of time, techniques can chance unintentionally. The au- thors examined thz data for this Yr~t” in technique by looking at the reported results o\#‘er time for j&cted examiners. The stands using I .O n-@n~I, histamine: were divided in half, based on chron&@cal order (8 stands in each half, tabis IX). Note that the prevalence of‘ rescti iii ty , altho\lgh not consistent for each examiner, was generally zquivalsnt between the halves ex- cept for Examiner 20, \s*tiilst: reportcil r-;ltt’ of reactivity increased from 75.5 percent to 9-i percent.

seen among ~xannl111(:1-5,

Skin color

reaction, the histamine reactivity for black persons as compared with white persons was slightly lower in both percent positive (83.6 percent versus 92.2 percent, respectively) and mean size of the positives (17.8 millimeters versus 18.4 millimeters, respectively), but in no case did this difference reach statistical significance. A similar finding was noted for the wheal reac- tion: Black persons again had a lower rate of reactivity (90.9 percent versus 95.4 percent, respectively) and a smaller size (4.2 millimeters versus 4.4 millimeters, respectively) than white persons, but in no case did this difference reach statistical significance.

The observed tendency for a lower rate of reactivity in black persons may be due, in part, to hyporesponsiveness to histamine and/or the tendency to underread the dimensions of the erythema and wheal reaction in dark-skinned individuals. No data on skin color were available in the population tested. Thus, the relation between skin color and cutaneous reactivity cannot further be evaluated.

Histamine reactivity

The size of the wheal and erythema reactions to 1 .O mg/mL histamine are shown in table XT. The data collected on skin-test reactivity to 1 .O mg/mL histamine base in the NHANES II skin-test sample can be used by others as a population standard for histamine reactivity.

.

Variations in histamine reactivity by age, sex, urban or rural, and poverty level were examined in stands using l .O mg/mL histamine (table XII). Reactivity rates were fairly constant within the age groupings used in this study. They ranged from 92.7 percent in persons 6-f 1 years of age to 86.1 percent in persons 65-74 years of age. The rate of reactivity dropped slightly in the age groups 55. years and over, but this change did not reach statistical significance. Females had a higher rate of reactivity than males (92.0 percent versus 89.9 percent). No difference in reactivity was noted for urban or rural residency or for poverty status.

Method of allergen manufacture

Allergens selected for NHANES II W.&-e purchased in- itially from a single U.S. Food and Drug Administration (FDA) licensed manufacturer (Nelco Labs) as 1:20 weight per volume (W/V) extracts in 50 percent glycerin. Later in the survey I :20 W/V freeze-dried extracts, obtained from a different FDA licensed manufacturer (Greer Labs), were used. The use of two different sets of allergens allowed the researchers to determine the variability in the prevalence estimates because of differences in allergenic potency between two commercially available allergenic extracts. The use of the glycerinated and freeze-dried extracts are described fully in the Source and limitations of the data section. In brief, the glycerinated kx- tracts were used exclusively in 38 stands. Freeze-dried extracts were used exclusively in 4 stands and both extracts were useci In 22 stands. To estimate the variability in the prevalence of allergic skin reactivity due to differences in allergenic po- tency between the two batteries of allergens, reactivity rates were compared in the 22 stands in which both extracts were

69

Table X. Percent positiie and size of erythema and whesl reaction at the 20-rnlnute reading for 1.0 mg/mL hiatemine base for persons ages 6-74 yeare,by race and sex: United State% 197G80

Sample Percent Standard P Mean”2 Standard PReaction, race, and sex size positive’,2 error value in mm error value

Erythemareaction

White:

Both sexes . . . . . . . . . . . . . . . . . . . . . . . . . 3,801 92.2 0.94 ... 18.4 0.55 ...

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,862 91.6 1.48 .. 18.2 0.74Female . . . . . . . . . . . . . . . . . . . . . . . . . .

...1,939 92.9 0.79 ... 18.7 0.43 ..

Black:

Both sexes . . . . . . . . . . . . . . . . . . . . . . . . . . 608 83.6 5.87 0.15 17.8 0.62 0.45

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 289 79.3 8.39 0.20 17.4 0.88 0.45Female . . . . . . . . . . . . . . . . . . . . . . . . . . 319 87.7 3.73 0.15 18.3 0.50 0.58

Wheal reaction

White:

Both sexes . . . . . . . . . . . . . . . . . . . . . . . . . 3,801 95.41 1.42 ... 4.4 0.11 ...

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,862 95.4 1.57 ... 4.6 0.12Female . . . . . . . . . . . . . . . . . . . . . . . . . . . .

...

1,939 95.4 1.56 ... 4.2 0.10 ...

Black:

Both sexes . . . . . . . . . . . . . . . . . . . . . . . . . . 608 90.9 3.69 0.15 4.2 0.23 0.33

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 289 91:? 4.11 0.30 4.4 0.31 0.54Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3? 9 90.6 3.57 0.15 4.0 0.17 0.20

lMean erythemaorwheal diameter greater than Omm mean diameter.2Age-adjuatedioU.S. population, Marchl, 1978.

NOTE: mm = millimeter.

Table Xl. Sueofwheal ande@hema raation inmilhmeters atthe2Mntia raadngfor l. Omg/mLMstimine base forpersons ages &74years, by sexUnited States, 1976-S0

Sample StandardPercent distribution

Reaction and sex size Mean Median devi,?tion 5 10 25 50 75 90 95

Wheal

Bothaexes . . . . . . . . . . . . . . 4,199 4.4 4.5 1.65 2.0 2.5 3.0 4.5 5.0 6.5 7.0

Male . . . . . . . . . . . . . . . . . . 2,039 4.5 4.5 1.72 2.0 2.5 3.0 4.5 5.5 6.5 7.5

Female . . . . . . . . . . . . . . . . 2,160 4.2 4.0 1.!57 2.0 2.5 3.0 4.0 5.0 6.0 7.0

Erythema

Both sexes . . . . . . . . . . . . . . 3,992 18.4 18.5 8.!55 4.5 6.5 12.0 18.5 24.5 29.5 32.5

Male . . . . . . . . . . . . . . . . . . 1,915 16.2 18.0 8;76 4.5 6.0 11.0 16.0 24.5 3CI.O 32.5

Female, . . . . . . . . . . . . . . . 2,077 18.7 19.0 8;36 4.5 7.5 12.5 19.0 24.5 29,5 32.0

used. In these 22 stands the sample persons were dividedinto two groups based on their sample numbers. Those withodd sample numbers received glycerinated extracts artd thosewith even sample numbers received freeze-dried extracts .Thisselection process was equivalent to random assortment ofthe sample persons, It was necessary to limit the analysestothesestands,to controlforanumber ofpotentialconfounders(such as geography, examiner, age, race, and sex) for skin-testreactivity.

Reactivitytothetwo batteriesofallergens wasdeterminedbasedon themean diameter of the erythema reaction at the20-minute reading. (See table XIII.) A mean diameter ofthe erythema reaction greater than O mm was considered posi-tive. The freeze-dried extracts had increased rates of reactivity

70

forhouse dust, oak, and Bermuda grass (p<0.05). Theabso-lute increase in reactivity ranged from 3,5 percent through4.7 percent. Only for the dog extract did the glycerinatedextracts have a higher rate of reactivity (absolute increase2,2 percent, pcO.05), No differences in reactivity were foundfor altemaria, cat, ragweed, and rye grass. In the dual-usestands, the distribution of reaction sizes are equivalent forall allergens except Bermuda grass, where the freeze-driedallergen produced larger reactions than the glycerinated extract@< O.05). The small observed differences in reactivity demon-strated that variations in allergenic potency between the twoallergen batteries had relatively small effects on the prevalenceestimates of the NHANES II survey.

Intheabsence ofstandardized extracts, itis notpossible

Tabb X11. Prevalence of skin-test react”~ to 1.0 mg/mL histamine bSSe at the $?O-minutereading for persons ages 6-74 years, by seleotedcharecteristicw United State~ 1976-60

Sample Percent StandardSelected characteristic

Psize positive’ error value

Age

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,443 91.0 2.33

6-n years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

...

425 92.7 2.2612-17years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

...502 91.9 2.49

16-24years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ....

642 92.5 2.0826-34years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

...671 93.1 1.45

35-44years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ....

439 91.5 2.4645-54years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

...370 90.6 4.24

55-64years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ....

696 85.7 3.7465-74years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

...698 86.1 3.18 ...

Sexz

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,167 69.9Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1.35 ...2,276 92.0 1.06 0.03

Residencez

Urban . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,391 90.3 2.76Rural . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

...2,052 91.9 2.25 0.75

Poverty level

Belowpovertyincomeratio(PlR)?,3.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 767 67.5Atorabove PIf32 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.35 ,..3,512 91.4 1.05 0.08

‘Meandiameter of the erythema reaction greater than Omillimeters.‘Age-adjuated to U.S. population, March1, 197S.3Povarty Inmm.a ratio.

TebbXlll. Prevsbncsofskin-tastreatiiforparaonsages&74yesrq bysslectedsilergensandellergen menufectureinstsndsuaingbothbstietiesofextrsct8 UnitedSteta$ 1976-S0

G/ycerinafad’ Fraezedriedz

Percent PercentSelected allergen positive3 Tota14 posr?ive3 Tots/4 p value

Housedust . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10.3 2,871 15.0Alternaria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2,922 <0.0015.8 2,873 5.5

Cat . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2,926 0.60

5.0 2,863 5.5 2,918 0.44Dog . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.5 2,883 4.3Ragweed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2,914 <0.00115.5 2,861 16.8

Oak . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2,919 0.17

7.2 2,86S 10.7Ryegraes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2,926 <0.00112.0 2,871 12.7

Bermudagraas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2,930 0.43

5.6 2,872 9.6 2,925 <0.001

‘ManufactureNelm Iaba, N.Y. (1:20 w/v In 50 percent glycerin).2Manufacfur.xGrearlabs, Lenolr, N.C. (freeze4dW, remnstitutd witi W~rmntglymrin, l:20wiv, phrtiu~).‘ReacfivHy is mean diameter of the erythema reaction greater than Omillimetersat 20-minute reading.~otal number of akin-taatad Indivlduala.

to ascertain whether the rate observed would be equivalentto the rates with standardized extracts. Because this studywasperformed with unstandardized extracts, itcanbe assumedthat some of the observed rates are lower than would befound with currently available standardized extracts, To deter-mine the precise discrepancy in rates, if any, a replicate studywith standardized extracts must be performed, Themethodological concern with the observed difference in ratesofreactivity for this reportliesin thepossibilityof the unequaluse of the two allergen batteries from different manufacturerswithin differing levels of the variables examined in theanalyses. If this occurred, any difference found between groups

could possibly be explained, at least to a partial degree, bya difference in allergen potency between the batteries. Theuse of the two batteries of extracts was evaluated by age,race, sex, family income,poverty level, region, whether urbanor ruralp and head of household education, No differentialusage was noted except for region. The glycennated extractswere usedon approximately 80 percent of the sample personsin the Northeast, South, and West, and on only approximately50percentofthe sample personsin the Midwest. Thus ,duringinter-regional comparisons, it is necessary to account for thedifferentialuseofthe twotypesofextracts amongtheregions,

Appendix 111Definition of terms

Age—Two ages were recorded for each examinee: Ageat last birthday prior to the time of examination and ageat the time of the Census interview. The age criterion forinclusion in the sample used in this survey was defined asage at the time of Census interview. The adjustment andweighting procedures used to produce national estimates werebased on age at the interview. Data in the detailed tablesand text of the report also are shown by age at the timeof interview.

Race—For each individual the observed race was recordedas “white, “ “black,” or “other.” Other includes Jajpanese,Chinese, American Indian, Korean, Eskimo, and all racesother than white and black. Persons of Mexican descent wereincluded with “white” unless definitely known to be AmericanIndian or of another race. Black persons and persons ofmixedblack and other parentage were recorded as black. Whenpersons of mixed racial background were uncertain about theirrace, the race of the father was recorded.

Sex—Sex was recorded by the interviewers and examiners.Poverty Index—The poverty index was determined by

the poverty income ratio (PIR). Poverty statistics publishedin U.S. Bureau of the Census reports] 12-116were based onthe poverty index developed by the Social Security Administra-tion (SSA) in 1969.

The two components of the PIR are as follows: Numera-tor—the total income of the household as defined by themedian income for income groups with incomes of $7,000and above, or the sum of the component parts of the incomequestions for income groups below $7,000; and denominator—a multiple of the total income necessary to maintain alfamilywith given characteristics on a nutritionally adequate foodplan. 112–116The doll~ value of the diet in the denominator

of the PIR is constructed from a food economy plan necessaryto maintain minimum recommended daily nutritionalrequirements.

Poverty thresholds are computed on a national basis only.No attempt has been made to adjust these thresholds for region-al, State, or other variations in the cost of living (exceptfor the farm or nonfarm difference). None of the noncashpublic welfare benefits such as food-stamp bonuses are in-

cluded in the income of the low-income families receivingthese benefits. PIR has been adjusted by year and accountsin some part for inflation.

Tables of weighted average threshold poverty cutoffs for1976-80 have been published. 1‘7

Family income group—The respondent was given a cardlisting categories and was instructed to select the one thatrepresented his or her total combined family income for thepast 12 months. Respondents were asked to include incomefrom all sources such as wages, salaries, social security orretirement benefits, help from relatives, rent from property,and the like.

Place of residence—The place of residence of a memberof the U. S. civilian noninstitutionalized population is classifiedas inside a standard metropolitan statistical area (SMSA) oroutside of an SMSA,

Standard metropolitan statistical areas—The definitionsand titles of SMSA’s are established by the U. S, Office ofManagement and Budget with the advice of the Federal Com-mittee on Standard Metropolitan Statistical Areas, The defini-tion of an individual ShlSA involves two considerations: First,a city or cities of at least 50,000 inhabitants that constitutea central city and identify the county in which they sire locatedas a central county; second, economic and social relationshipswith contiguous counties (except in New England) that aremetropolitan in character so that the periphely of the specificmetropolitan area may be determined. SMSA’s are not limitedby State boundaries. In New England, SMSA’S consist oftowns and cities rather than of counties.

Urban or ruraASize of place classification was derivedfrom the 1970 Decennial Census of the Population. Accordingto the definition used in the 1970 census, the urban populationconsisted of all persons living in (a) places of 2,500 inhabitantsor more incorporated as cities, boroughs (except Alaska),villages, and towns (except towns in New York, New EnglandStates, and Wisconsin), but excluding those persons livingin the rural portions of extended cities; (b) unincorporatedplaces of 2,500 inhabitants or more; and (c) other territoriesincluded in urbanized areas. The remaining population wasclassified as rural.

NOTE: A list of referencesfollowsthe text.

72

Geographic region—The United States was divided into south . . . . . . . .

four broad geographic regions of approximately equal popula-tion. The regions, which deviate somewhat from the groupsused by the U.S. Bureau of the Census, areas follows: ...

Region

Northeast . . . . . .

Midwest . . . . . . .

west. . . . . . . .

States included

Maine, New Hampshire, Vermont, Massachusetts,Connecticut, Rhode Island, New York, New Jaraey,Pennsylvania

Ohio, Michigan, Indiana, Illinois, Wisoonsin,Minnesota, Iowa, Missouri

Delaware, Maryland, Virginia, West Mrginia, Kentucky,Arkansas, Tennessee, North Carolina, South Carolina,Georgia, Florida, Alabama, Mississippi, Louisiana,District of Columbia

Washington, Oregon, Idaho, Montana, Wyoming,Colorado, Utah, Nevada, California, Arizona, NewMexico, Texas, Oklahoma, Kansas, Nebraska, SouthDakota, North Dakota, Alaska, Hawaii.

* U.S. GOVEWNT PRINTING OFFICE:1986-49 1-3 35 / 400 I 1

73

H&Wh, UnitedStates,1985:

Up-to-DateHealthFactsin(he ConvenientSource

Health care competition and cost containmentefforts by the Federal Government may be pay-ing off, according to Health, United States,1985. This tenth annual report to Congress onthe Nation’s health says hospital care expendi-tures declined in 1984,reversing a 20-year trend.The publication from the National Center for

Health (Mel I 1985

II

Health Statistics, a part of the U.S. Departmentof Health and Humfi Services, contains i%ctsandstatistics on many health subjects in easy-to-readfcmn. Data on life expectancy, infimt

Ml

mortality, leading causes of death, and ~h~many other facets of America’s healthare presented in the 1985edition.

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Vital and Health Statisticsseries descriptions

SERIES I.

SERIES 2.

SERIES3.

SERIES4.

SERIES 5.

SERIES 10.

SERIES 11.

SERIES 12.

SERIES 13.

Programs and Collection Procedures-Repoms describing

the general programs of the National Center for Health

Statistics and its offices and divisions and the data col-

lection methods used. They also include definitions and

other material necessary for understanding the data.

Data Evaluation and Methods Research–Studies of naw

statistical methodology including experimental tests of

new survey methods, studies of vital statistics collection

methods, new analytical techniques, objective evaluations

of reliability of collected data, and contributions to

statistical theory. Studies also include comparison ofU.S. methodology with those of other countries.

Analytical and Epidemiological Studies–Reports pre-

senting analytical or interpretive studies based on vital

and health statistics, carrying the analysis further than

the expository types of reports in the other series.

Documants and Committee Reports-Final reports of

major committees concerned with vital and health sta-

tistics and documents such as recommended model vital

registration laws and revised birth and death certificates.

Comparative International Vital and Health Statistics

Repotis-Analytical and descriptive reports comparing

U.S. vital and health statistics with those of other countries.

Data From the National Health Interview Survey –Statis-

tics on illness, accidental injuries, disability, use of hos-

pital, medical, dental, and other services, and other

health-related topics, all based on data collected in the

continuing national household interview suwey.

Data From the National Haalth Examination Suwey and

the National Health and Nutrition Examination Survey–

Data from direct examination, testing, and measurement

of national samples of the civilian noninstitutional ized

population provide the basis for (1) estimates of the

medically defined prevalence of specific diseases in the

United States and the distributions of the population

with respect to physical, physiological, and psycho-

logical characteristics and (2) analysis of relationships

among the various measurements without reference to

an explicit finite universe of persons.

Data Fro”m the Institutionalized Population Su rveys-Dis-

continued in 1975. Reports from thase suweys are in-

cluded in Series 13.

Data on Haalth Resources Utilization-Statistics on the

utilization of health manpower and facilities providing

long-term care, ambulatory care, hospital care, and family

planning services.

SERIES 14.

SERIES 15.

SERIES 20.

SERIES 21.

SERIES 22.

SERIES 23.

Data on Health Resources: Manpower and Facilities–

Statistics on the numbers, geographic distribution, and

characteristics of health resources including physicians,

dentists, nurses, other health occupations, hospitals,

nursing homes, and outpatient facilities.

Data From Special Suweys-Statistics on health and

health-related topics collacted in special suweys that

are not a part of the continuing data systems of the

National Center for Health Statistics.

Data on Mortality-Various statistics on mortality other

than as included in regular annual or monthly reports.

Special analyses by cause of death, age, and other demo-

graphic variables; geographic and time series analyses;

and statistics on characteristics of deaths not availablefrom the vital records based on sample suweys of those

records.

Data on Natality, Marriage, and Divorce-Various sta-

tistics on natality, marriage, and divorce other than as

included in regular annual or monthly reports. Special

analyses by demographic variables; geographic and time

series anal yses; studies of fertility; and statistics on

characteristics of births not available from the vital

records based on sample suweys of those records.

Data From the National Mortality and Natality Surveys-

Discontinued in 1975. Reports from these sample suweys

based on vital records are included in Series 20 and 21,

respective y.

Data From the National Suwey of Family Growth-

Statistics on fertility, family formation and dissolution,

family planning, and related maternel and infant health

topics derived from a periodic suwey of a nationwide

probability sample of ever-married women 1544 years

of age.

For answers to questions about this report or for a list of titles of

reports published in these series, contact:

Scientific and Technical Information Branch

National Center for Health StatisticsPublic Health Service

Hyattsville, Md. 207B2

301-436-8500

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