Conventional vs endobronchial ultrasound-guided transbronchial needle aspiration of the mediastinum.

We appreciate the interest of Dr. Joseph and colleagues in our recent article in CHEST (January 2004)1 on ethnicity and skin test reactivity to allergens among children with asthma. We thank them for bringing their article on racial differences in physiologic parameters related to asthma2 to the attention of the readers of CHEST. We would like to point out that the results of our recent study and those of the study conducted by Joseph and colleagues2 are not comparable. Whereas our study included only children with asthma (791 children), their study included children with and without asthma. In the study conducted by Joseph et al, there was no difference in total serum levels of IgE between AfricanAmerican children with asthma (8 children) and EuropeanAmerican children with asthma (49 children). In their study, African-American children without asthma had a higher total serum IgE level than did European-American children without asthma. For the analysis of the relation between sensitization to specific allergens and ethnicity, Joseph et al did not present the results of an analysis that had been stratified by asthma status. Thus, it is not clear whether the reported association between African-American ethnicity and sensitization to two outdoor allergens was present in children with or without asthma. It should also be noted that our analysis of the relation between ethnicity and allergen sensitization among children with asthma was adjusted for health insurance status, area of residence, asthma severity, and other potential confounders. In the study by Joseph et al, the analysis of the relation between ethnicity and allergen sensitization was not adjusted for potential confounders. What the findings of both our study and those of the study conducted by Dr. Joseph and colleagues suggest is that allergy skin testing should be considered more often in African-American children with symptoms that are suggestive of allergic diseases such as asthma. Finally, allergen sensitization in minority populations is deserving of further study, as it may provide important clues to asthma health disparities.