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Introduction: Respiratory symptoms are common in preschool children. However, which of these wheezers will develop asthma at school age, and what phenotype they will develop remains difficult to predict. Current models such as the asthma prediction index (API) are based on clinical parameters and have only modest predictive accuracy. Expression levels of well replicated asthma genes could potentially form novel biomarkers for asthma prediction. IL1RL1 is an asthma susceptibility gene, and has also been linked to eosinophilia. Therefore, we hypothesized that expression levels of IL1RL1 in the form of soluble IL-1RL1-a measured in serum from wheezing preschool children contribute to the prediction of asthma at school age. Moreover, since IL1RL1 was previously associated with blood eosinophilia, our second aim was to determine whether serum IL-1RL1-a levels predict eosinophilic asthma. Method: We used logistic predictive modeling in a prospective Dutch birth cohort (n = 202 wheezers), and calculated the area under the curve (AUC) of the sensitivity/1-specificity curves of potential models. Results: Neither IL-1RL1-a serum levels at age 2-3 years alone nor its combination with the API had predictive value for doctors' diagnosed asthma at age 6y (IL-1RL1-a alone: AUC = 0.50 [95 CI 0.41-0.59, P = 0.98], API + IL-1RL1-a: AUC = 0.57 [95 CI 0.49-0.66, P = 0.12]). However, IL-1RL1-a serum levels at age 2-3 years correlated with the severity of airway eosinophilia (determined by levels of exhaled fraction of NO, [FeNO]) in children who had developed asthma at age 6y (Pearson's R = −0.24, P = 0.046, N = 59). Logistic predictive modeling of eosinophilic asthma at age 6y (asthma with FeNO ≥ 20 ppb) showed that IL-1RL1-a serum levels itself and in combination with the API could predict this eosinophilic subphenotype of asthma

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The impact of breastfeeding on food allergy has been extensively examined, but there is little in the literature regarding the role of breastfeeding in eosinophilic esophagitis (EoE). Our study examines the rate of breastfeeding in EoE patients in our suburban-based academic clinic. METHODS: After IRB approval, a survey regarding feeding practices during infancy was completed by parents of patients with EoE in our Pediatric Allergy and Immunology clinic. We sought to determine the duration of breast and formula feeding, and age at introduction of solids. The data was entered into RedCap for evaluation by descriptive statistics. RESULTS: Thirty-seven patients were surveyed. Sixteen percent (n56) did not respond regarding feeding habits. Fifty-five percent (17/31) of patients initiated breastfeeding; 16% (5/31) were exclusively breastfed. The mean duration of breastfeeding was 6.4 months, and 13% (4/31) were breastfed at least 12 months. This is compared to 84% (26/31) of patients who were formula fed at any time. CONCLUSIONS: The breastfeeding rate in our EoE patients was low (55%) compared to the national average of 81.1% of children who are ever breastfed. The breastfeeding rate at 12 months is also low (13%) compared to the national average of 30.7%. While the Food Allergy Practice Parameter recommends the encouragement of breastfeeding for the first 4 to 6 months for prevention of food allergy (Category C), the lower rate of breastfeeding in this small cohort of EoE patients than the general population suggests that we should further explore the impact breastfeeding on the development of EoE.