Earlier identification of children at high risk of persistent asthma
Sensitization to inhalants in preschoolers is recognized as a significant risk factor for subsequent development of persistent asthma, but Holt et al (p 653) have now demonstrated that potentially useful prognostic information on their atopy and asthma risk can be gleaned from IgE measurements of less than the conventional 0.35 kU/L IgE threshold. Notably, 86.1% of high-risk 2-year-olds who attained house dust mite–specific IgE titers of 0.2 kU/L or greater progressed to beyond the sensitization threshold by age 5 years. Moreover, their risk for subsequent asthma increased progressively from 11.3% to 59.2%, with specific IgE titers attained (see the left column of the Table), and, consistent with earlier studies, asthma risk appears markedly amplified if they also experienced early severe lower respiratory tract infections. This effect was again evident using the lower 0.2 kU/L cutoff (log –0.699), where asthma risk at 5 years increased from 20.5% in infection-free children to 92.4% in those experiencing multiple severe lower respiratory tract infections. These findings point to the potential value of quantitative information on early IgE status and infection history in prediction of risk for persistent asthma in children, and the development of a robust clinical tool for this purpose based on this approach might be an achievable aim for the midterm future. Read the full article here.

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