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Published on: August 7, 2017
The predictive value of early life total immunoglobulin E measurement in identifying atopic children in a
Michael R Perkin1, David P Strachan, H C Williams
1Department of Child Health, St George's, University of London, London, UK. m.perkin@sgul.ac.uk
Insights
Total immunoglobulin E (IgE) levels in early childhood do not reliably predict atopy. While higher IgE at 12 months was observed in atopic children, its poor predictive value limits its use as a screening tool.
Area of Science:
- Pediatric Allergy and Immunology
- Epidemiology
- Immunology
Background:
- Atopy is a common allergic condition with rising prevalence in children.
- Early identification of children at risk for atopy is crucial for implementing preventive strategies.
Purpose of the Study:
- To determine if total immunoglobulin E (IgE) levels measured at 12 and 18 months of age can predict the development of atopy by age 5.
- To evaluate the predictive performance of early childhood IgE measurements for atopy.
Main Methods:
- Utilized data from the Children in Focus (CiF) birth cohort study.
- Assessed atopy using skin prick tests (SPT) for 14 allergens at 5 years of age.
- Measured total IgE levels at 12 and 18 months in the study participants.
Main Results:
- Children who later developed atopy had significantly higher total IgE levels at 12 months (p < 0.0005), but not at 18 months.
- A total IgE level >51 kU/l at 12 months showed a positive predictive value of 41%, sensitivity of 13.5%, and specificity of 95.8%.
- Significant overlap in IgE levels between atopic and non-atopic children was observed, indicating poor screening performance.
Conclusions:
- Early life total IgE measurements, particularly at 12 months, demonstrate limited clinical utility as a sole screening tool for predicting childhood atopy.
- The overlap in IgE levels suggests that other biomarkers or factors may be necessary for accurate early prediction of atopy.
Abstract:
Atopy is common and the prevalence amongst children is rising. Measurements in early childhood that can predict subsequent development of atopy could be clinically useful for targeting preventive measures. We used the Children in Focus (CiF) subgroup of a large population-based birth cohort study (the Avon Longitudinal Study of Parents and Children) to investigate whether total immunoglobulin E (IgE) measured at 12 and 18 months could predict subsequent development of atopy at 5 yr of age. Atopy was determined by positive skin prick test (> or = 3 mm wheal) to one or more of 14 inhalant and food allergens. Prevalence of skin prick positivity to any allergen was 14.5% (104 of 715; 95% CI: 12.0-17.1%). Total IgE levels were significantly higher at 12 months of age (p < 0.0005) but not 18 months of age in those children subsequently atopic. The highest positive predictive value was 41% with an IgE measurement of >51 kU/l, with a sensitivity of 13.5% and a specificity of 95.8%. Although significant differences in early life IgE measurements were seen, the extent of overlap was great, such that the overall performance of IgE at 12 months as a screening test for atopy was poor.
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