It has been hypothesized that allergy is associated with an increased risk of developing chronic irreversible airflow obstruction. We have investigated the relation between immediate cutaneous hypersensitivity to common aeroallergens and the subsequent rate of decline of lung function in 1,025 men participating in the Normative Aging Study; subjects had a mean age of 61 +/- 8 (SD) yr and denied any history of asthma. Subjects performed spirometry and underwent allergen skin testing at a baseline visit and performed repeat spirometry after a median of 3.1 yr. Skin prick tests were performed using four glycerin-preserved allergens (house dust, mixed grasses, mixed trees, and ragweed); wheal size was measured at 20 min. Multiple linear regression analysis was used to examine the annual rate of change of lung function in relation to skin test reactivity, defined as a mean wheal size to the 4 allergens > or = 2 mm, after adjustment for age, height, smoking status, and initial lung function. Skin test reactivity was a significant predictor of the annual rates of decline of FEV1 and FEV1/FVC ratio. The regression model predicted an excess decline of FEV1 of 9.45 ml/yr for subjects with mean wheal diameter > or = 2 mm (p < 0.05); the excess rate of decline of FEV1/FVC ratio was 0.29 percent/yr (p = 0.001). There was no significant relation between mean wheal diameter and rate of decline of FVC. The magnitude of the effects of a mean wheal diameter > or = 2 mm on rates of decline of FEV1 and FEV1/FVC ratio are 34% and 49%, respectively, of the magnitude of the effects of current cigarette smoking in these models. We conclude that cutaneous hypersensitivity to common aeroallergens is a significant independent predictor of subsequent decline of lung function among middle-aged and older men with no history of asthma.