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Relationships among aeroallergen sensitization, peripheral blood eosinophils, and periostin in pediatric asthma
Halie M Anderson1, Robert F Lemanske1, Joseph R Arron2
1Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, University of Wisconsin School of Medicine & Public Health, Madison, Wis.
Insights
Early life aeroallergen sensitization and elevated blood eosinophils are strong predictors of childhood asthma. Children with multiple biomarkers indicating type 2 inflammation are at the highest risk for developing asthma.
Area of Science:
- Pediatrics
- Allergy and Immunology
- Respiratory Medicine
Background:
- Noninvasive biomarkers to predict asthma inception in children are currently lacking.
- Understanding early-life biomarkers for type 2 inflammation is crucial for predicting asthma development.
Purpose of the Study:
- To evaluate aeroallergen sensitization, peripheral blood eosinophils, and serum periostin as potential biomarkers for asthma in children.
- To assess the relationship between these biomarkers, age, and asthma inception.
Main Methods:
- Prospective follow-up of 244 children from birth in the Childhood Origins of ASThma study.
- Measurement of serum-specific IgE, blood eosinophil counts, and serum periostin levels at ages 2, 4, 6, and 11 years.
- Statistical analysis to determine associations between biomarkers and asthma development.
Main Results:
- Serum periostin levels were higher in children than adults, peaking at age 2 years.
- Elevated periostin (≥150 ng/mL), high eosinophil counts (≥300 cells/μL), and aeroallergen sensitization at age 2 predicted asthma by age 6.
- Children with two or more biomarkers showed a significantly increased risk of asthma by school age.
Conclusions:
- Serum periostin's utility as an asthma biomarker in children is limited by high levels potentially due to bone turnover.
- Early-life aeroallergen sensitization and elevated blood eosinophils are reliable predictors of asthma.
- Children exhibiting multiple indicators of type 2 inflammation in early life face the greatest risk of asthma development.
Background:
Biomarkers, preferably noninvasive, that predict asthma inception in children are lacking.
Objective:
Little is known about biomarkers of type 2 inflammation in early life in relation to asthma inception. We evaluated aeroallergen sensitization, peripheral blood eosinophils, and serum periostin as potential biomarkers of asthma in children.
Methods:
Children enrolled in the Childhood Origins of ASThma study were followed prospectively from birth. Blood samples were collected at ages 2, 4, 6, and 11 years, and serum-specific IgE levels, blood eosionophil counts, and periostin levels were measured in 244 children. Relationships among these biomarkers, age, and asthma were assessed.
Results:
Serum periostin levels were approximately 2- to 3-fold higher in children than previously observed adult levels. Levels were highest at 2 years (145 ng/mL), and did not change significantly between 4 and 11 years (128 and 130 ng/mL). Age 2 year periostin level of 150 ng/mL or more predicted asthma at age 6 years (odds ratio [OR], 2.3; 95% CI, 1.3-4.4). Eosinophil count of 300 cells/μL or more and aeroallergen sensitization at age 2 years were each associated with increased risk of asthma at age 6 years (OR, 3.1; 95% CI, 1.7-6.0 and OR, 3.3; 95% CI, 1.7-6.3). Children with any 2 of the biomarkers had a significantly increased risk of developing asthma by school age (≥2 biomarkers vs none: OR, 6.6; 95% CI, 2.7-16.0).
Conclusions:
Serum periostin levels are significantly higher in children than in adults, likely due to bone turnover, which impairs clinical utility in children. Early life aeroallergen sensitization and elevated blood eosinophils are robust predictors of asthma development. Children with evidence of activation of multiple pathways of type 2 inflammation in early life are at greatest risk for asthma development.
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