Non-IgE-mediated asthma in children

Among 586 children with asthma, 484 (82%) were found to have IgE-mediated ("extrinsic") asthma, and seventy-two (12%) non-IgE ("intrinsic") asthma. The remaining 30 patients (6%) were classified as "intermediate", as they had serum IgE within or above serum IgE levels of healthy children but no allergy to common allergens. During a three-year study period, the seventy-two patients with intrinsic asthma as opposed to 84 patients with extrinsic asthma had significantly more hyperinflation of the lungs, more episodes of acute hospital admissions due to asthma and/or pneumonia, more elevated serum IgG and IgM, and more cultures from secretions of lower airways of Haemophilus influenzae and pneumococci. Further, although treated with corticosteroids, eleven of the children with intrinsic asthma showed progressive disease, judged from fixed and/or declining forced vital capacity followed by signs of lung fibrosis on repeated pulmonary X-rays. It is emphasized that children with intrinsic asthma may represent an entity of childhood asthma, in some cases with severe progression of disease within a few years.