Asthma diagnosis and treatment
IgE antibody quantification and the probability of wheeze in preschool children

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Background

IgE-mediated sensitization is usually considered a dichotomous variable (either sensitized or not). Quantitative IgE antibody analysis may better predict the expression of wheeze.

Objective

Within the context of a population-based birth cohort, we investigated the association among wheeze, lung function, and specific IgE antibody levels.

Methods

Children (n = 521) were followed to age 5 years with repeated questionnaires, skin testing, and measurement of lung function (specific airway resistance) and specific serum IgE (ImmunoCAP).

Results

Using specific IgE as a continuous variable, the risk of current wheeze increased significantly with increasing IgE to mite, cat, and dog (P < .0001). When IgE levels to these 3 allergens were summed, the probability of current wheeze increased 1.33-fold (95% CI, 1.21-1.47; P < .0001) per logarithmic unit increase, corresponding to an odds ratio of 3.1 at 10 and 4.25 at 30 kUA/L (kilo units of Allergen per liter). Similarly, increasing sum of mite-specific, cat-specific, and dog-specific IgE was associated with reduced lung function (P = .004). Among sensitized children (n = 184), the sum of mite, cat, and dog IgE was the strongest associate of current wheeze (odds ratio, 1.28; 95% CI, 1.13-1.46; P < .001), corresponding to an odds ratio of 2.56 at 10 and 3.32 at 30 kUA/L. There was no association between current wheeze and the size of skin test wheal. Furthermore, the sum of IgE to mite, cat, and dog at age 3 years increased the risk of persistent wheeze by age 5 years (2.15-fold/logarithmic unit increase in the specific IgE).

Conclusion

IgE-mediated sensitization is not an all or nothing phenomenon. The probability of wheeze and reduced lung function increases with increasing specific IgE antibody levels.

Section snippets

Study population

The Manchester Asthma and Allergy Study is an unselected population-based birth cohort study.12, 13 Subjects were recruited from the antenatal clinics within the first trimester of the pregnancy when all pregnant women were screened for eligibility. Both parents completed a questionnaire and skin prick testing to common inhalant allergens. Multiple births were excluded. Children were followed prospectively and attended review clinics at ages 3 and 5 years (±4 weeks). The study was approved by

Results

Of 1211 couples who initially agreed to take part, 1085 had a successful full-term pregnancy (>36 weeks of gestation; child did not need intensive care) and gave consent to a further follow-up. Of those, 128 were prenatally randomized to environmental control19, 20 (excluded from this analysis), and 957 children were followed in the observational cohort. Of the children in the observational cohort, 840 (87.8%) attended the 5-year follow-up. All of these children had questionnaire data, and 521

Discussion

Our observations confirm that sensitization to inhalant allergens is a risk factor for wheezing. However, we have extended this observation in demonstrating that the absolute specific IgE antibody levels offer more information than just the presence of specific IgE. We found total IgE to be a poorer predictor of wheeze than the sum of specific IgEs. In addition, increasing specific IgE antibody levels were associated with reduced lung function in preschool children. Our data also suggest that

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    Disclosure of potential conflict of interest: L. Soderstrom is employed with Pharmacia Diagnostics AB. S. Ahlstedt is employed with Pharmacia Diagnostics AB. The rest of the authors have none to disclose.

    Supported by Asthma UK grant number 01/012, Pharmacia Diagnostics and Moulton Charitable Trust.

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