SELECTED ARTICLES FROM THE RECENT LITERATURE 2003

11/25/03

IgE antibodies in wheezing infants: The risk for asthma in later childhood

Summary
Previous large population studies have indicated that increased total serum IgE levels in early childhood are associated with an increased risk for asthma development. But to what allergens are these IgE antibodies directed that are relevant to asthma development? Kotaniemi-Syrjanen et al of the Kuopio Univ Hospital in Finland carried out a follow-up study of 82 children who had been hospitalized for acute wheezing at age < 2 years, at which time a serum specimen had been obtained and place in frozen storage. When these children were later evaluated for asthma when they were school age, the presence of IgE antibodies to milk and wheat (but not other foods tested) in infancy was significantly associated with the subsequent presence of asthma at school age. IgE antibodies to inhalants were present in only 18% of the wheezing infants vs a 46% incidence of food-specific IgE in the same infants. However, the presence of such anti-inhalant IgE antibodies was significantly predictive of asthma being present later at school age. The authors concluded that the presence of certain IgE antibodies in wheezing infants is highly predictive of the later occurrence of childhood asthma.

Reference
Pediatrics 2003; 111:e255-61

Editor's Comments
These findings are of considerable interest and potential value in our understanding of the natural history of wheezing in childhood. It is of note that 40% of the wheezing infants in this study were considered to be asthmatic later at school age. These findings differ from that in the studies by the group in Tucson, AZ who find that the wheezing in infancy (generally with viral infections) was no longer present in the large majority of cases after age 3-4 years. However, this group in Tucson has found that increased serum levels of IgE, as well as the presence of atopic dermatitis and histories of parental asthma are strongly predictive of wheezing persisting into later childhood.

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