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Clinical and immunological characteristics of pre-school asthma
Insights
This study on pediatric asthma found that while many children exhibited atopy and allergic markers, only a quarter had clearly identified allergic triggers for their asthma attacks. Management decisions were minimally impacted by allergy testing.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
- Child Health
Background:
- Frequent asthma in children aged 18 months to 6 years is common.
- Many children present with early-onset asthma, chest deformities, eczema, and rhinitis.
- Upper respiratory infections and exercise are frequent asthma attack triggers.
Purpose of the Study:
- To investigate the characteristics of children with frequent asthma.
- To assess the role of allergic factors and immunological markers in pediatric asthma.
- To evaluate the influence of diagnostic tests on asthma management.
Main Methods:
- Study included 92 children (18 months–6 years) with frequent asthma.
- Evaluated clinical features, comorbidities (eczema, rhinitis), triggers (infections, exercise), and atopy.
- Assessed serum IgE, skin-prick tests, eosinophilia, immunoglobulin deficiencies, and yeast opsonization.
- Followed 82 children for 1 year, noting treatment with inhaled steroids.
Main Results:
- Most children had early-onset asthma, with 63% showing chest deformities.
- 88% experienced exercise-induced asthma; infections were common triggers.
- While 74% had elevated IgE and 61% positive skin tests, only 24% had clearly identified allergic triggers.
- Immunoglobulin deficiencies and defective yeast opsonization were noted in some children without distinct differences.
Conclusions:
- Pediatric asthma is multifactorial, with allergic factors identified in a minority of cases.
- Standard allergy and immunological tests had limited impact on clinical management decisions.
- Further research is needed to understand the diverse pathophysiology of childhood asthma.
Abstract:
Ninety-two children, sixty-two boys and thirty girls, aged 18 months to 6 years with frequent asthma were studied. Nine were born prematurely and two were ventilated in the neonatal period; two had been admitted to hospital with acute bronchiolitis. Most had an early onset of symptoms, forty-two developing asthma in infancy. Although overall growth was normal, 63% had some chest deformity. Half had past or present eczema and just over half had chronic rhinitis. Upper respiratory infection appeared to be an important precipitant of attacks in all, and 88% had exercise-induced asthma. The majority were atopic, 74% had elevated serum IgE levels, skin-prick tests were positive in 61 of 77 tested and half had eosinophilia. However, allergic factors were clearly identified as causing asthma attacks in only 24%. Immunoglobulin deficiencies were found in thirteen and defective yeast opsonization in eighteen; these children showed no other obvious differences from the remainder. Eighty-two children were followed up and after 1 year fifty-one were receiving inhaled steroids. Measurement of serum immunoglobulin, eosinophil count and skin-prick testing had little influence on management.