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Specific-IgE tests may indicate asthma risk
and the possibility of prevention
795 infants (aged 1–2 years) with atopic dermatitis (AD) received
placebo or cetirizine for 18 months.
This report from the ETAC study group shows that specific-IgE screening
of infants with AD indicates those who are at risk of developing asthma.
566 of these children were followed for a further 18 months.
Notably, this is the first study to show that early sensitization to grass
Infants sensitive to house dust mite, grass pollen or both were
pollen in these children is a risk factor for asthma (relative risk: 1.7,
significantly less likely to develop asthma during the treatment
The study also shows that preventative treatment with the antihistamine,
This difference was sustained in the grass pollen-sensitized group
cetirizine, may protect children with certain sensitizations (particularly
grass pollen) against the development of asthma. If supported by further
Early sensitization (egg, grass pollen, house dust mite or cat) was
studies, specific IgE screening of infants with AD may identify those who
associated with an increased risk of asthma in the placebo group.
are likely to benefit from preventative treatment.
Citation: Warner JO. A double-blinded, randomized, placebo-controlled trial of
cetirizine in preventing the onset of asthma in children with atopic dermatitis: 18
months’ treatment and 18 months’ posttreatment follow-up. J Allergy Clin Immunol
2001; 108: 929–37.
Atopy in childhood predicts the risk of wheeze
498 children (aged 8–10 years at baseline) were surveyed every 2
The findings of this study add further support to the claim that atopy in
years over a period of 10 years and then after a further 5 years.
childhood increases the risk of asthma. However, the data also suggest that
there can be a delay of several years before the presence of atopy manifests
Atopy at the age of 8–10 years was associated with an increased
itself as atopic disease. Indeed, atopy in childhood was a risk factor for the
risk (odds ratio: 2.8, confidence interval: 1.5–5.1) of developing
onset of wheeze in adolescence or even early adulthood.
The prevalence of atopy and wheeze increased in the cohort during the
Only 3.2% of the population showed remission of atopy, whereas
course of the study. The authors suggest that this may reflect to some extent
a general increase in atopy that has occurred over the last 10–20 years.
Citation: Xuan W et al. Risk factors for onset and remission of atopy, wheeze, and
airway hyperresponsiveness. Thorax 2002; 57: 104–9.
Sensitization to food allergens in infancy
predicts aeroallergen sensitization
Children born to at least one atopic parent were followed annually
Atopy in infancy is a clear risk factor for asthma in later life. The study
for 5 years and then at the ages of 11 and 22 years. In total,
indicates that up to 25% of children born to atopic parents may develop
63 individuals remained at the 22-year follow-up.
asthma in later life. Importantly, almost half of those who had a food
allergen (milk or egg) in infancy had wheeze after the age of 5 years.
Annual prevalence of wheeze and atopy increased with age.
A striking result in this study is that all the children who were sensitive to a food
60% of those who had asthma in adulthood were sensitive to
allergen when younger than 2 years also developed sensitivity to aeroallergens,
common allergens by the age of 2 years.
92% by the age of 5 years. Early sensitization was a risk factor for asthma.
Sensitization to dietary allergens waned in infancy, but predicted
None of the children with positive food sensitizations at the age of 2 years or
early sensitization to aeroallergens.
younger showed this allergy in subsequent years. Thus, the authors stress that
Citation: Rhodes HL et al. A birth cohort study of subjects at risk of atopy: twenty-two-
a single set of sensitization tests cannot safely predict the life-long atopic status
year follow-up of wheeze and atopic status. Am J Respir Crit Care Med 2002; 165:
of an individual. Regular testing is justified to chart the allergy march.
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