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Published on: August 7, 2017
Sensitization predicts asthma development among wheezing toddlers in secondary healthcare
Nienke A Boersma1, Ruud W H Meijneke1, Johannes C Kelder2
1Department of Pediatrics, St. Antonius Hospital, PO Box 2500, 3430 EM Nieuwegein, The Netherlands.
Insights
Allergen sensitization in wheezing toddlers strongly predicts childhood asthma development in secondary healthcare. Combining sensitization with factors like eczema improves asthma prediction accuracy.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
- Clinical Epidemiology
Background:
- Wheezing in toddlers can progress to childhood asthma.
- Allergen sensitization is a known asthma predictor in birth cohorts.
- Predictive value of sensitization in secondary healthcare settings is less understood.
Purpose of the Study:
- To assess the predictive value of inhalant allergen sensitization for asthma development in wheezing toddlers.
- To evaluate sensitization's role in secondary healthcare settings.
- To compare sensitization with non-invasive predictors for asthma risk.
Main Methods:
- Prospective study of 1-3 year olds with wheezing in secondary care.
- Asthma screening at school age using the International Study of Asthma and Allergies in Childhood questionnaire.
- Calculation of positive and negative predictive values for sensitization and non-invasive factors (eczema, hospitalization, parental atopy).
- Multivariate analysis and ROC curves to assess combined predictive value.
Main Results:
- 63% of included children developed asthma by school age.
- Inhalant allergen sensitization was a strong predictor (OR 7.4, PPV 86%).
- Eczema (OR 3.4) and hospital admission (OR 2.6) were significant non-invasive predictors.
- Adding sensitization improved asthma prediction (ROC AUC increased from 0.70 to 0.79).
Conclusions:
- Inhalant allergen sensitization is a robust predictor of school-age asthma in wheezing toddlers within secondary healthcare.
- Sensitization provides additional predictive value when combined with non-invasive determinants.
- This finding supports incorporating allergen sensitization testing in asthma risk assessment for wheezing toddlers.
Introduction:
Some wheezing toddlers develop asthma later in childhood. Sensitization is known to predict asthma in birth cohorts. However, its predictive value in secondary healthcare is uncertain.
Aim:
This study examines the predictive value of sensitization to inhalant allergens among wheezing toddlers in secondary healthcare for the development of asthma at school age (≥6 years).
Methods:
Preschool children (1-3 years) who presented with wheezing in secondary healthcare were screened on asthma at school age with the International Study of Asthma and Allergies in Childhood questionnaire. The positive and negative predictive value (PPV and NPV) of specific IgE to inhalant allergens (cut-off concentration 0.35 kU/L) and several non-invasive variables from a child's history (such as hospitalization, eczema, and parental atopy) were calculated. The additional predictive value of sensitization when combined with non-invasive predictors was examined in multivariate analysis and by ROC curves.
Results:
Of 116 included children, 63% developed asthma at school age. Sensitization to inhalant allergens was a strong asthma predictor. The odds ratio (OR), PPV and NPV were 7.4%, 86%, and 55%, respectively. Eczema (OR 3.4) and hospital admission (OR 2.6) were significant non-invasive determinants. Adding sensitization to these non-invasive predictors in multivariate analysis resulted in a significantly better asthma prediction. The area under the ROC curve increased from 0.70 with only non-invasive predictors to 0.79 after adding sensitization.
Conclusion:
Sensitization to inhalant allergens is a strong predictor of school age asthma in secondary healthcare and has added predictive value when combined with non-invasive determinants. Pediatr Pulmonol. 2017;52:729-736. © 2017 Wiley Periodicals, Inc.
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