The relationship of serum immunoglobulin E, allergy skin tests, and smoking to respiratory disorders.

In this study of a general population sample in Tucson, Ariz., smokers showed higher levels of serum IgE despite having a lower rate of allergy skin-test reactivity to common aeroallergens than nonsmokers. The prevalence of rhinitis was closely related to the level of serum IgE in atopic subjects regardless of smoking habits. In nonatopic smokers, elevated IgE levels were not associated with high rhinitis rates. However, high IgE levels in nonatopic smokers were related to increased rates of diagnosed asthma, wheeze, and chronic cough and/or sputum (C/S). These relationships were especially striking in subjects over the age of 54. In older nonatopic smokers, reported prevalences of "chronic bronchitis" and of functional impairment also increased in relation to the level of serum IgE. Reduced ventilatory function showed this relationship to IgE only when accompanied by C/S. It is suggested that the excess IgE related to smoking is qualitatively different than that found in subjects reacting to aeroallergens, is not important in the pathogenesis of upper respiratory tract disease, but may play a role in the development of some lower respiratory tract disorders.