Sensitization predicts asthma development among wheezing toddlers in secondary healthcare.
INTRODUCTION
Some wheezing toddlers develop asthma later in childhood. Sensitization is known to predict asthma in birth cohorts. However, its predictive value in secondary healthcare is uncertain.


AIM
This study examines the predictive value of sensitization to inhalant allergens among wheezing toddlers in secondary healthcare for the development of asthma at school age (≥6 years).


METHODS
Preschool children (1-3 years) who presented with wheezing in secondary healthcare were screened on asthma at school age with the International Study of Asthma and Allergies in Childhood questionnaire. The positive and negative predictive value (PPV and NPV) of specific IgE to inhalant allergens (cut-off concentration 0.35 kU/L) and several non-invasive variables from a child's history (such as hospitalization, eczema, and parental atopy) were calculated. The additional predictive value of sensitization when combined with non-invasive predictors was examined in multivariate analysis and by ROC curves.


RESULTS
Of 116 included children, 63% developed asthma at school age. Sensitization to inhalant allergens was a strong asthma predictor. The odds ratio (OR), PPV and NPV were 7.4%, 86%, and 55%, respectively. Eczema (OR 3.4) and hospital admission (OR 2.6) were significant non-invasive determinants. Adding sensitization to these non-invasive predictors in multivariate analysis resulted in a significantly better asthma prediction. The area under the ROC curve increased from 0.70 with only non-invasive predictors to 0.79 after adding sensitization.


CONCLUSION
Sensitization to inhalant allergens is a strong predictor of school age asthma in secondary healthcare and has added predictive value when combined with non-invasive determinants. Pediatr Pulmonol. 2017;52:729-736. © 2017 Wiley Periodicals, Inc.
['Boersma|Nienke A|NA|', 'Meijneke|Ruud W H|RWH|', 'Kelder|Johannes C|JC|', 'van der Ent|Cornelis K|CK|', 'Balemans|Walter A F|WAF|']
D000485:Allergens D001249:Asthma D002648:Child D002675:Child, Preschool D005260:Female D006801:Humans D006969:Hypersensitivity, Immediate D007073:Immunoglobulin E D007223:Infant D008297:Male D016017:Odds Ratio D012372:ROC Curve D012135:Respiratory Sounds D011795:Surveys and Questionnaires
sensitization asthma wheezing child secondary care