In a previous report, the association of atopic status as determined by questionnaire and the acute overshift change in FEV₁ and annual change in baseline FEV₁ and FVC was evaluated in cotton textile workers. There was a trend of a greater annual decline in FEV₁ in workers identified as atopic, however, this trend was not significant. The lack of significance may have been related to misclassification of atopic status by the questionnaire. To determine if workers were misclassified as atopic, a cohort of 92 workers from the 1991 study was reevaluated using the original questionnaire. In addition, 71 of these workers were skin tested for allergies using a battery of six common inhalant antigens. The reproducibility of the questionnaire was evaluated by comparing the 1991 responses to those obtained in 1994. Thirty-three percent of the 1994 population were classified as atopic on the basis of personal and family history of atopy or asthma. Comparison of the questionnaires indicated that 18% of the population reporting atopic status differently in 1994 versus 1991. Skin testing identified 22/71 workers as atopic. Relative to the skin test, the 1994 questionnaire was found to have a sensitivity of 68% and a specificity of 82%. Analysis of pulmonary function data showed that atopics as described by skin test have more frequent declines in overshift change in FEV₁ than non-atopics, however, the differences were small and, at the low dust levels in these mills, atopic status is not a strong predictor of responsiveness to cotton dust.