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Can we predict which wheezy infants will continue to wheeze?
J B Clough1, K A Keeping, L C Edwards
1Child Health, University of Southampton, Southampton General Hospital, Southampton, United Kingdom. jbc@soton.ac.uk
Insights
Predicting persistent infant wheeze is crucial for early intervention. Older children with atopy and both parents having atopy are more likely to have persistent wheeze, with age and soluble IL-2 receptor levels being key predictors.
Area of Science:
- Pediatrics
- Allergy and Immunology
- Respiratory Medicine
Background:
- Infant wheezing poses a challenge for early intervention due to difficulties in predicting disease persistence.
- Identifying predictive factors for persistent wheeze is essential for developing targeted treatment strategies.
Purpose of the Study:
- To prospectively identify factors that predict the persistence of wheeze in infants.
- To develop a predictive model for persistent wheeze in young children.
Main Methods:
- A prospective longitudinal study of 107 children (3-36 months) with at least one atopic parent, recruited within 12 weeks of their first wheeze.
- Assessment of factors including personal and parental atopy, age at first wheeze, serum-soluble IL-2 receptor (sIL-2R), and immune cell responses.
- Univariate and multivariate logistic regression analyses were used to identify predictor variables.
Main Results:
- Persistent wheeze was observed in 49.5% of the children.
- Older age at presentation, personal atopy, and biparental atopy were associated with a higher likelihood of persistent wheeze.
- A predictive model combining age at presentation and serum-soluble IL-2 receptor levels offered the best prediction of persistent wheeze.
Conclusions:
- Early intervention strategies for infant wheezing can be enhanced by predicting disease persistence.
- Age at presentation and serum-soluble IL-2 receptor levels are significant predictors of persistent wheeze.
- The developed predictive model can aid in patient recruitment for early intervention trials.
Abstract:
Early intervention strategies in infant wheezing will be dependent on the ability to predict persistence of disease. We undertook a prospective longitudinal study to determine which factors might be predictive for the persistence of wheeze. We examined a group of 107 children 3 to 36 mo of age with at least one atopic parent. Children were recruited within 12 wk of first wheeze. Factors assessed included: personal atopy (IgE > 1 SD above age-related normal and/or eczema and/or positive skin tests); parental atopy; number of siblings; age at first wheeze; sex; serum-soluble IL-2R; proliferation of peripheral blood mononuclear cells (PBMC) to beta-lactoglobulin and to D. pteronyssinus; production of IFN-gamma on stimulation of PBMC with beta-lactoglobulin and with D. pteronyssinus. A positive clinical outcome (child requiring prophylactic antiasthma treatment after 1 yr) was observed in 53 (49.5%) children. Predictor variables were assessed by univariate and multivariate logistic regression. Wheeze was more likely to be persistent in older, atopic children with biparental atopy. The model offering best prediction of persistent wheeze with least risk of including asymptomatic subjects was age at presentation + sIL-2R. Trials of early intervention strategies using a logistic regression equation based on this model for patient recruitment can now be designed.