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Systematic Review on the Definition of Allergic Diseases in Children: The MeDALL Study
Mariona Pinart1, Richard Albang, Dieter Maier
1Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.
Insights
This systematic review found that studies on childhood allergic disease phenotypes are highly varied and often lack objective measures. Standardizing methods and terminology is crucial for better understanding and diagnosis of these conditions.
Area of Science:
- Pediatric Allergy and Immunology
- Clinical Epidemiology
- Respiratory Medicine
Background:
- Numerous phenotypes and classifications for allergic diseases have been proposed over decades.
- Significant heterogeneity exists across studies, hindering consistent understanding.
- No prior systematic review has comprehensively analyzed phenotype classification and diagnostic criteria for allergic diseases.
Purpose of the Study:
- To systematically identify and characterize clinically expressed, population-based phenotypes of allergic diseases in children (0-18 years).
- To explore the interrelationships between different allergic disease phenotypes.
- To evaluate the diagnostic measurements and criteria employed in the studies.
Main Methods:
- A comprehensive literature search of MEDLINE was conducted up to December 2012.
- Inclusion criteria focused on original English-language studies examining allergic disease phenotypes or diagnostic measures in children.
- Data extraction and study screening were performed independently by two reviewers.
Main Results:
- Out of 13,767 citations, 197 studies met the inclusion criteria, predominantly cohort studies (54%).
- Asthma was the most studied single allergic disease (81.7%). Up to 33 distinct phenotypes were reported, with transient early, late-onset, and persistent wheeze being most common.
- Questionnaires were the primary data collection tool (78%), while skin-prick tests were the preferred sensitization measure (64%). Objective measures like spirometry were less frequent.
Conclusions:
- Existing research on pediatric allergic disease phenotypes exhibits substantial heterogeneity.
- Many studies lack objective phenotypical measures, leading to diagnostic inconsistencies.
- Standardization of methods and terminology is essential for advancing the field of pediatric allergy research.
Background:
During the last decades, a large number of phenotypes and disease classifications of allergic diseases have been proposed. Despite the heterogeneity across studies, no systematic review has been conducted on phenotype classification and the criteria that define allergic diseases. We aimed to identify clinically expressed, population-based phenotypes of allergic diseases and their interrelationships, to explore disease heterogeneity and to evaluate the measurements employed in disease diagnosis.
Methods:
We conducted a search of MEDLINE up to December 2012, to identify relevant original studies published in the English language that examine at least one objective of this systematic review in subjects aged 0-18 years. The screening of titles and abstracts and the extraction of data were conducted independently by two reviewers.
Results:
From a total of 13,767 citations, 197 studies met the criteria for inclusion, with 54% being cohort studies. Allergic diseases were studied as a single entity in 55% (109/197) of the studies or in the context of multimorbidity in 45%. Asthma accounted for 81.7% of the studies examining single diseases. Overall, up to 33 different phenotypes of allergic disease were reported. Transient early, late-onset and persistent wheeze were the most frequently reported phenotypes. Most studies (78%) used questionnaires. The skin-prick test was the preferred measurement of sensitization (64%). Spirometry and bronchial hyperresponsiveness were assessed in one third of the studies, peak flow rate in 8.6% and disease severity in 35%.
Conclusions:
Studies reporting phenotypes of allergic diseases in children are highly heterogeneous and often lack objective phenotypical measures. A concerted effort to standardize methods and terminology is necessary.
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