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Whole population or high-risk group? Childhood asthma
1Pediatric Dept, Charité-Virchow-Klinikum of the Humboldt University, Berlin, Germany.
Insights
Predicting allergic diseases in children is challenging. Current risk factors have low predictive value, necessitating better predictors for effective asthma prevention strategies in high-risk infants and children.
Area of Science:
- Pediatric Allergy and Immunology
- Clinical Epidemiology
Background:
- Allergen avoidance is a logical strategy for preventing allergic diseases in high-risk children.
- Predicting specific allergic diseases at defined ages is crucial for effective prevention.
Purpose of the Study:
- To evaluate the predictive capacity, clinical value, and population prevalence of risk factors for allergic diseases in children.
- To identify the need for improved predictors and age-specific intervention policies.
Main Methods:
- Analysis of predictive values of family history and cord blood immunoglobulin E (IgE) in newborns.
- Evaluation of asthma prevalence in children with parental asthma (Multicentre Allergy Study MAS-90).
- Assessment of risk factors like food antibodies and atopic dermatitis for aeroallergen sensitization.
Main Results:
- Positive predictive value for atopic disorders in newborns was under 50%.
- 40% of children aged 3-5 with two asthmatic parents had asthma, but most asthmatic children lack parental asthma.
- Risk factors predict up to 80% of aeroallergen sensitization but have low sensitivity.
Conclusions:
- Current predictors for allergic diseases, including asthma, have limited accuracy and sensitivity.
- There is a critical need for enhanced predictive markers and tailored intervention strategies for pediatric allergic diseases.
Abstract:
Allergen avoidance seems to be a logical way to protect high-risk children from the development of allergic diseases. If we assume that allergic diseases are predictable, we firstly need to define which allergic disease and what age we are discussing. Then the predictive capacity of risk factors, their clinical value and their prevalence in the population has to be considered. In newborns, the positive predictive value of family history and an elevated cord blood immunoglobulin E for atopic disorders in the first 2 yrs of life was well under 50% in high-risk cohorts. In the multicentre allergy study (MAS)-90 in Germany, 40% of children 3-5 yrs of age whose parents both had asthma, also had asthma themselves. However, when extrapolated to the population as a whole, most children with asthma would have no parent with asthma. Risk factors suitable for secondary prevention, such as presence and persistence of food antibodies or early atopic dermatitis together with an atopic family history may predict up to 80% of aeroallergen sensitization by 5 yrs. However, the sensitivity of these factors is also low. We therefore need better predictors for asthma and a policy for intervention strategies according to age and risk.