Allergen-Specific Immunoglobulin E Antibodies in Wheezing Infants: The Risk for Asthma in Later Childhood

Abstract

ABSTRACT. Objective. To evaluate whether the measurement of specific immunoglobulin E (IgE) antibodies to food and/or inhalant allergens in infants who are hospitalized for wheezing can be used to predict later asthma.Methods. Eighty-two children who were hospitalized for wheezing at <2 years of age were followed prospectively until early school age. The baseline data and the characteristics of infancy had been collected at enrollment. At school age, the children were evaluated for asthma and allergic manifestations, including skin prick tests to common inhalant allergens. Frozen serum samples obtained during the index episode of wheezing were available for 80 children for determination of food and inhalant allergen-specific serum IgE antibodies by fluoroenzyme-immunometric assay, UniCAP, applying the Phadiatop Combi allergen panel.Results. Asthma was present in 32 (40%) children at school age. Food-specific IgE antibodies of >0.35 kU/L were found in 37 (46%) wheezing infants, but only specific IgE to wheat and to egg white at the level of >0.35 kU/L were significantly associated with later asthma. In regard to specific IgE to the mixture of food allergens, the cutoff level of >0.70 proved to be significant. Inhalant allergen-specific IgE of >0.35 kU/L was found only in 14 cases (18%), but when present, it was significantly predictive of asthma. Elevated levels of specific IgE antibodies to food or inhalant allergens were significantly associated with allergic rhinitis and skin-test reactivity at school age.Conclusions. When present in wheezing infants, specific IgE of >0.35 kU/L to wheat, egg white, or inhalant allergens are predictive of later childhood asthma. Consequently, detection of those specific IgE antibodies in wheezing infants may facilitate the early diagnosis of asthma, especially in cases with no clinically evident atopic manifestations. A pproximately 20% of all children experience wheezing in infancy, 1 and these children are at increased risk for asthma in later childhood. On the basis of recent prospective follow-up data, up to 40% of them experience asthma at school age. 2 The majority of children with asthma have clinically evident atopic manifestations in later childhood, although allergies may not be apparent in infancy. 2,3 Total serum immunoglobulin E (IgE), 2 blood eosinophilia, 2 and serum eosinophil cationic protein (ECP) 4 are markers that are often used to determine subclinical atopy and susceptibility to respiratory allergy. However, these markers are nonspecific, and to point out the allergen-specific responses, skin prick tests (SPTs) or radioallergosorbent tests (RAST) thus far have had to be performed. Both of these tests are qualitative, and for technical reasons, only a restricted number of allergens are applicable in SPTs in young children. These tests may also be susceptible to technical errors and variations as a result of either nonstandardized or nonautomated methods. Consequently, new approaches are needed to screen those prone to atopy or allergen-induced asthma among ...

Screening for hen’s egg and chicken meat specific IgE antibodies in Saudi patients with allergic disorders

“…These allergens are known for their potential to cause food hypersensitivities in children and adults.15 Diagnostic utility of serum levels of specific IgE against egg white has been evaluated and it was recommended that a level of 1.3 kU/l corresponding to RAST score 2 or above does not require additional investigations to establish the diagnosis of egg allergy.16 A study investigating wheezing children has shown that RAST test score of 1 and above for specific IgE against egg white is significantly associated with later development of asthma. 17 Although this observation appears to be relevant in context of patients with clinical evidence of allergic disorders the presence of high levels of specific IgE in asymptomatic individuals may also serve as a useful indicator for future development of allergic diseases. In addition, the serum levels of specific IgE antibodies against egg white are believed to be influenced by persistent exposure to the allergen.…”

Phadiatop® no diagnóstico de alergia respiratória em crianças: Projeto Alergia (PROAL)

“…Phadiatop ® has been widely used as a screening test for respiratory allergies. 5,14,15 In principal Phadiatop ® is an in vitro test that allows individuals who are sensitive to multiple inhalant allergens to be identified simultaneously. In order to be a useful and sensitive method Phadiatop ® must be constituted of the aeroallergens that are most prevalent in the area of study.…”

“…24,25 The rate of positivity among patients with respiratory allergies was 77.3%, which is comparable to those observed by others. 5,15,21 Another use of a allergy diagnostic test would be its use as a predictive method for later allergic disease development. A number of different researchers studied the positivity of Phadiatop ® as a marker for allergic disease, in particular respiratory ones.…”

“…Blood samples were taken at this point and stored until the children were at least five years old. 15 They were then followed until school age at which point they were assessed for asthma and/or other allergic manifestations and levels of serum IgE specific to inhalant and food allergens were assayed. Forty percent of the initial population progressed to asthma and Phadiatop ® was positive in 18% of the entire group and all of these patients became asthmatic.…”

Sensibilização a alérgenos inalantes e alimentares em crianças brasileiras atópicas, pela determinação in vitro de IgE total e específica: Projeto Alergia (PROAL)

“…18 In children less than two years old hospitalized for wheezing, the presence of R+ for wheat, egg white and domestic dust mites was associated with an increased frequency of asthma later in life. 19 Despite this, specific IgE serum assay is not an available test at the majority of health care services, whether governmental or private. When assessing allergic patients it is important to bear the concept of the allergic march in mind.…”