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Predictors of response to bronchial allergen challenge in 5- to 6-year-old atopic children
T A Douglas1, M Kusel, E M Pascoe
1Division of Clinical Sciences, Telethon Institute for Child Research, Centre for Child Health Research, The University of Western Australia, Perth, WA, Australia.
Insights
Atopy is quantitatively linked to bronchial allergy in young children. Combining immune markers with clinical history improves prediction of respiratory allergy in children.
Area of Science:
- Pediatric Allergy and Immunology
- Respiratory Medicine
- Immunology
Background:
- The link between atopy and bronchial allergy in young children remains unclear.
- Atopy, a predisposition to allergic diseases, may influence the development of respiratory symptoms.
Purpose of the Study:
- To investigate the association between bronchial allergen challenge response, atopy immune markers, and clinical features in 5- to 6-year-old children.
- To identify predictors of bronchial allergen challenge response in atopic children.
Main Methods:
- Recruited children from a high-risk birth cohort, including those with positive skin prick tests (SPT) to aeroallergens and controls.
- Administered allergen challenges (house dust mite or grass) to 37 children (26 atopic, 11 SPT negative).
- Analyzed wheal size, allergen-specific and total immunoglobulin E (IgE), current wheeze, and persistent eczema as predictors.
Main Results:
- 46% of atopic children responded to allergen challenge.
- Wheal size, specific IgE, total IgE, current wheeze, and persistent eczema were significant independent predictors of response.
- Combining immune markers (especially wheal size) with clinical history improved prediction of allergen challenge response.
Conclusions:
- The relationship between atopy and bronchial allergy is quantitative in this age group.
- Quantitative assessment of immunological markers of atopy, alongside clinical history of allergic disease, can enhance indicators for respiratory allergy in young children.
Background:
The relationship between atopy and bronchial allergy in young children is not completely understood.
Objective:
To examine the association between response to bronchial allergen challenge, immune markers of atopy and other clinical characteristics in 5- to 6-year-old children.
Methods:
Children with positive skin test (SPT) to aeroallergen, together with a proportion of SPT negative children (as controls), were recruited from a birth cohort of 198 children at high risk of developing atopic disease and underwent allergen challenge.
Results:
Thirty-seven children (26 atopic and 11 SPT negative), median age 74.5 months, were challenged: 31 with house dust mite and six with grass allergen. Only atopic children responded to challenge: n = 12/26 (46%). Wheal size [odds ratio (OR) 2.5 (1.2-5.3), P = 0.01], allergen-specific immunoglobulin E (IgE) [OR 3.4 (1.23-9.61), P = 0.02], total IgE [OR 8.6 (1.1-68.7), P = 0.04], current wheeze [OR 12 (1.7-81.7), P = 0.006] and persistent eczema [OR 11.0 (1.7-68.3), P = 0.006] emerged as the strongest independent predictors of response to allergen challenge. Prediction of response to allergen challenge was significantly improved when immune markers of atopy, and in particular wheal size, were combined with clinical characteristics.
Conclusion:
The relationship between atopy and bronchial allergy is quantitative at this age. There may be potential to create more powerful indicators of the presence of respiratory allergy in young children when immunological markers of atopy are considered quantitatively and when combined with clinical history of coexistent allergic disease.
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