Importance of allergic sensitisation for normal range of fractional exhaled nitric oxide in adolescents

Background In addition to body anthropometrics, allergen sensitization has been shown to influence the levels of exhaled fractional nitric oxide (FeNO) in adults, but whether this relationship is valid also in younger age groups, how it compares to the fixed cut‐off levels recommended for clinical practice, and relates to respiratory symptoms remains to be confirmed. Method FeNO, sensitization, respiratory symptoms, and spirometry were evaluated in 2054 adolescents taking part in the 16‐year follow‐up of the Swedish BAMSE birth cohort. Results The median and upper limit of FeNO was related to the presence and type of allergic sensitisation and poorly represented by one fixed cutoff. For example, the 95th percentiles for sensitisation to dogs were 89 ppb in females and 87 ppb in males. A FeNO value above the sensitisation‐specific 95th percentile was, in those with allergic sensitisation, related to significantly higher odds for current asthma (OR 4.10, 95% CI 2.44–6.89) and wheeze (OR 2.58, 95% CI 1.44–4.62). In those without allergic sensitisation, a FeNO above the 95th percentile was related to wheeze (OR 3.20, 95% CI 1.37–7.51). The odds for having airway obstruction were not related to any of the FeNO cutoffs for either of the groups. Conclusion We have shown that the FeNO upper limit of normal is dependent on the presence and type of allergic sensitization and that these cutoffs differ from the fixed cutoffs of 25 and 50 ppb recommended in the literature. Sensitization specific rather than fixed limit cutoffs may be more relevant to asthma diagnosis and asthma symptoms in a general adolescent population.